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Biomedical subjects

S M Wolpert

Publications and source records attributed to S M Wolpert.

At least 19 recordsLinked to original sources
PubMed1992

Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke.

An open angiography-based, dose rate escalation study on the effect of intravenous infusion of recombinant tissue plasminogen activator (rt-PA) on cerebral arterial recanalization in patients with acute focal cerebral ischemia was performed at 16 centers. Arterial occlusions consistent with acute ischemia in the carotid or vertebrobasilar territory in the absence of detectable intracerebral hemorrhage were prerequisites for treatment. After the 60-minute rt-PA infusion, arterial perfusion was assessed by repeat angiography and computed tomography scans were performed at 24 hours to assess hemorrhagic transformation. Of 139 patients with symptoms of focal ischemia, 80.6% (112) had complete occlusion of the primary vessel at a mean of 5.4 +/- 1.7 hours after symptom onset. No dose rate response of cerebral arterial recanalization was observed in 93 patients who completed the rt-PA infusion. Middle cerebral artery division (M2) and branch (M3) occlusions were more likely to undergo recanalization by 60 minutes than were internal carotid artery occlusions. Hemorrhagic infarction occurred in 20.2% and parenchymatous hematoma in 10.6% of patients over all dose rates, while neurological worsening accompanied hemorrhagic transformation (hemorrhagic infarction and parenchymatous hematoma) in 9.6% of patients. All findings were within prospective safety guidelines. No dose rate correlation with hemorrhagic infarction, parenchymatous hematoma, or both was seen. Hemorrhagic transformation occurred significantly more frequently in patients receiving treatment at least 6 hours after symptom onset. No relationship between hemorrhagic transformation and recanalization was observed. This study indicates that site of occlusion, time to recanalization, and time to treatment are important variables in acute stroke intervention with this agent.

Acute Disease↗
PubMed1992

Current role of cerebral angiography in the diagnosis of cerebrovascular diseases.

The role of cerebral angiography in the diagnosis of cerebrovascular disease is currently being questioned because of the increasing availability of MR angiography. The purpose of this essay is to place the use of cerebral angiography in perspective in light of these new developments. In patients with atherosclerotic cerebrovascular disease, MR angiography can almost entirely supplant cerebral angiography as a screening procedure in the evaluation of the carotid bifurcation. However, detection of "pseudoocclusion" still requires cerebral angiography for accurate diagnosis. Atherosclerotic stenosis or occlusion of the major intracranial vessels at the base of the brain can be detected with MR angiography, but not as accurately as with cerebral angiography. Furthermore, for detection of more distal occlusions, cerebral angiography is still needed. A number of erroneous concepts about the risks and value of cerebral angiography have prevented its optimal use for patients with cerebrovascular disease. These myths can be countered by applying several rules to optimize the use of cerebral angiography. Subarachnoid hemorrhage is best evaluated with CT followed by detailed cerebral angiography, although MR angiography can be used as a screening test for aneurysms 3 mm or larger. Cerebral angiography is still necessary to confirm the diagnosis of cerebrovascular malformations, although MR angiography is a useful screening test. Cerebral angiography is required for the definitive diagnosis of arteritis, arterial dissection, or fibromuscular dysplasia.

Cerebral Angiography↗
PubMed1979

Selective transsphenoidal adenomectomy in women with galactorrhea-amenorrhea.

Thirty women with prolactin (PRL)-secreting adenomas underwent selective adenomectomy via a transsphenoidal route. All had abnormal sella polytomes or visual fields, amenorrhea with low basal serum gonadotropin levels despite decreased serum estradiol concentrations, and elevated basal serum PRL levels with blunted PRL response to neuroendocrine stimulation tests )thyrotropin-releasing hormone, levodopa, chlorpromazine, and hypoglycemia). Of 17 patients with microadenomas, 14 (82.4%) were cured and three (17.6%) improved. None were unchanged or worse. Three (60%) of five patients with larger, but still intrasellar tumors, had normalization of PRL levels, return of menses, and resolution of galactorrhea. The patients with tumors extending out of the sella did not fare as well. Overall, 21 (70%) were cured, six (20%) improved, two (6.7%) were unchanged, and the condition of one (3.3%) became worse. All preoperative neurologic deficits resolved. Postoperative complications were minimal with no neurologic morbidity. When tumors are small, surgical results are excellent with minimal risk.

Adenoma↗
PubMed1979

Computed tomography of spinal fractures.

Computed tomography (CT) has aided significantly in the diagnosis and management of spinal fractures. The examination is easy, relatively quick, and avoids potentially harmful manipulation. The diagnostic advantages of CT include precise anatomic delineation and indication of extent of fractures, assessment of spinal stenosis, and demonstration of associated peraspinal lesions.

Adult↗
PubMed1979

The value of computed tomography in evaluating patients with prolactinomas.

The use of computed tomography (CT) in 28 patients with surgically proved prolactinomas is described. The authors' experience suggests that in evaluating patients with galactorrhea-amenorrhea syndrome, CT in combination with pluridirectional tomography usually provides sufficient information to make further invasive studies unnecessary. In selected cases with low-density areas within the sella as seen on CT, pneumoencephalography is still advisable to distinguish between the empty sella and the necrotic tumor. Angiography is still necessary to exclude vascular causes for suprasellar and parasellar masses such as aneurysms and meningiomas.

Empty Sella Syndrome↗
PubMed1979

Factors governing the course of emboli in the therapeutic embolization of cerebral arteriovenous malformations.

Many factors are involved in the therapeutic intra-arterial management of cerebral arteriovenous malformations (AVMs) by embolization. If these factors could be better defined, the suitability of patients for embolization could be more accurately predicted. In 59 embolization procedures, the diameters of feeding arteries of AVMs were analyzed, and a critical diameter found below which emboli are likely to stray into normal vessels and above which embolization can be carried out with a greater chance of success. Neurologic complications occurred on 20 occasions, but most were temporary; in only 1 of 34 patients did a permanent incapacitating complication occur.

Adult↗
PubMed1978

Computed tomography of the skull base in the coronal plane.

Coronal plane computed tomography (CT) is a valuable adjunct to standard transverse plane computed tomography in determining size and extension of intracerebral lesions. Extracerebral lesions at the skull base can also be evaluated by coronal plane CT. The appearances and diagnostic evaluations of these lesions, when used in conjunction with techniques to demonstrate bone detail, form the basis of this report.

Brain Neoplasms↗
PubMed1977

Extra-axial growth of fourth ventricle tumors - angiographic changes.

Tumors of the fourth ventricle, particularly ependymomas, may grow out of the ventricular cavity into the cerebellopontine angle cistern and the subarachnoid cisterns. The angiographic changes will then suggest both the intra- and extraventricular location of the tumors. The ependymoma is the most prone of the fourth ventricle tumors to demonstrate this pattern of growth.

Cerebellopontine Angle↗
PubMed1977

Computed tomography of the skull base.

By applying a wide window to computed tomography (CT) images, excellent detail of the skull base has been obtained. This technique has been apllied to lesions involving the sellar, parasellar, sphenoid wing, petrous bone, clival, and foramen magnum regions. Thus, CT has proved to have an additional dimension in the delineation of pathology.

Humans↗
PubMed1977

The ventricular size on computed tomography.

Deriving a ventriculocranial index for the evaluation of ventricular size from a standard transverse plane image can lead to an erroneously small estimate of ventricular size due to partial volume averaging. Coronal plane imaging largely eliminates this problem. The index can then be derived either from the video image or the digital printout. There appears to be less error in measurements derived from the image than in measurements derived from the 64 X 64 printout, provided the image is photographed at large window widths of 2,000 Delta units or more.

Brain↗