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Biomedical subjects

S R Freidberg

Publications and source records attributed to S R Freidberg.

At least 19 recordsLinked to original sources
PubMed1989

Glucocorticoid dependency as a prognostic factor in radiotherapy for cerebral gliomas.

Records of 76 consecutive patients treated with radiotherapy for cerebral gliomas were reviewed. Eleven patients had no tissue diagnosis, and their outcome was comparable to that of patients with glioblastoma. Patients with other histologic diagnoses had much better results. Among the entire study population, the most important prognostic factors included age and histologic grade. Even with stratification by histologic grade and age, glucocorticoid (steroid) dependency was a reliable prognostic indicator in terms of survival. Fifteen of the 47 patients (32%) who were less steroid dependant are still alive with a median survival time of 29 months. Among the 29 patients who were heavily dependant on steroids during the course of radiotherapy, the median survival time was 5 months with only 2 patients (7%) still alive.

Astrocytoma↗
PubMed1989

Transsphenoidal pituitary surgery in the treatment of patients with Cushing's disease.

Transsphenoidal adenomectomy is the treatment of choice for patients with Cushing's disease. The combination of high serum and urinary cortisol and high plasma ACTH point to a nonadrenal source for Cushing's syndrome. It is important to rule out an ectopic source of ACTH production. Imaging of the sella with MRI and CT and sampling petrosal sinus blood for ACTH measurement should allow differentiation between the two conditions. For younger patients, every effort should be made to preserve the normal gland. If in the younger patient the adenoma cannot be clearly demonstrated, it is appropriate to remove the central portion of the gland, as advocated by Hardy. Should hypercortisolism persist, radiation therapy to the sella should be considered before attempting total hypophysectomy. In the woman past childbearing age, a total hypophysectomy can readily be considered if a sharply demarcated adenoma is not found. In fact, we counsel our older patients before operation that a total hypophysectomy is a possibility. For the patient with an aggressive tumor that is not cured by pituitary operation, radiation therapy must be considered. If it is not possible to wait for the therapeutic effect of radiation, adrenal suppression with aminoglutethimide, metyrapone, or ketoconazole is indicated. Adrenalectomy may be considered.

Adenoma↗
PubMed1987

Lymphocytic hypophysitis in a man.

Fewer than 20 patients with lymphocytic adenohypophysitis have been reported, all of them women, and it usually occurs during pregnancy or the postpartum period. We report the recognition of lymphocytic adenohypophysitis in a man. The patient presented with anterior hypopituitarism and an intrasellar mass on computed tomography. Antipituitary antibodies, found in only one of the previous patients, were not present in this man, although low titer antinuclear antibodies were found. The implications of this latter finding are unclear. The patient's histocompatibility antigen (HLA) types were A2, B8, Bw58, DR1, and DR5. The degree of pituitary failure seemed out of proportion to the size of the mass seen on computed tomographic scan.

Antibodies, Antinuclear↗
PubMed1986

Brain necrosis after radiotherapy for primary intracerebral tumor.

Radiotherapy is a standard postoperative treatment for cerebral glioma. We have observed the onset of symptoms related to brain necrosis, as opposed to recurrent tumor, in surviving patients. This has been manifest as dementia with a computed tomographic pattern of low density in the frontal lobe uninvolved with tumor, but within the field of radiotherapy. Two patients presented with mass lesions also unrelated to recurrent tumor. We question the necessity of full brain irradiation and suggest that radiotherapy techniques be altered to target the tumor and not encompass the entire brain.

Adult↗
PubMed1985

Ataxic Creutzfeldt-Jakob disease: diagnostic techniques and neuropathologic observations in early disease.

We studied two cases of ataxic Creutzfeldt-Jakob disease. EEG, CT, evoked responses, and CSF were normal in one purely ataxic patient. Diagnosis was established by cerebellar biopsy. Autopsy demonstrated devastating spongiform changes in the cerebellum, basal ganglia, and thalamus with rare focal changes in cerebral cortex. In the second patient, late generalized changes developed with dementia. Diagnostic studies included abnormal visual evoked responses, CSF with abnormal oligoclonal bands and IgG, and subacute spongiform encephalopathy in frontal lobe biopsy. Early diagnosis is best established by biopsy of brain areas most likely to be involved on the basis of clinical neurologic findings.

Ataxia↗
PubMed1982

Concurrent production of adrenocorticotropin and prolactin from two distinct cell lines in a single pituitary adenoma: a detailed immunohistochemical analysis.

A pituitary tumor from a patient with severe Cushing's disease and marked hyperprolactinemia was extensively studied by immunohistochemical techniques. Tissues from two separate areas of the adenoma were found to contain similar cell proportions of PRL as well as ACTH and related peptides (beta-lipotropin, beta-endorphin, and alpha MSH). The tumor was composed of approximately 70% immunoreactive PRL cells and 5% ACTH-containing cells. Double immunostaining revealed that PRL or ACTH and related peptides were found in two distinct populations of tumor cells. These results document for the first time inappropriate synthesis and secretion of an unusual combination of pituitary hormones from a mixed pituitary adenoma.

Adenoma↗
PubMed1980

Combined otolarygologic and neurosurgical approaches to tumors of the temporal bone and skull base.

Craniofacial resections are extensive procedures with serious potential complications and may not lead to cure but appear to offer an appreciable palliative benefit. This is acceptable for situations normally considered inevitably fatal. Most neoplasms of the head and neck are relatively slow growing and metastasize to distant sites late in their course. This can lead to months or years of suffering. Eliminating a bulky, unsightly, painful neoplasm can make remaining life more tolerable. Further, if cure is to be at all possible, an attempt must be made at total excision. In the recent experience of the Lahey Clinic with five patients utilizing a combined approach, results have been gratifying for both patients and surgeons.

Ear Neoplasms↗
PubMed1979

Treatment of intracranial hemorrhage.

The acute cerebellar hematoma and the subdural hematoma resent urgent surgical problems and treatment early in the clinical course should result in an excellent outcome. The subdural hematoma may be especially difficult to diagnose early, but may be suspected in patients on anticoagulant therapy or with shunze, and surgery, especially in the acute stage, should be avoided if possible. The CT scan supplemented when necessary by angiography is the diagnostic procedure of choice and will clearly demonstrate the lesions.

Anticoagulants↗
PubMed1979

Intranasal approach to the sella turcica.

A transseptal approach to the sella turcica is described which is entirely intranasal and avoids the sublabial incision. The first incision is unilateral along the caudal edge of the septum, and the second incision is made across the base of the nasal columella. This allows the speculum to open the width of both nasal chambers, giving adequate exposure. The septal cartilage is either preserved or resected except for a caudal strut. The difficult dissection of mucosa from the nasal floor and maxillary crest is avoided. This technique is rapid and straightforward and results in a cosmetically acceptable scar.

Humans↗
PubMed1976

Amyloidoma of the gasserian ganglion.

A case report, the third in the literature, is presented of a patient whose progressive numbness in the second and third divisions of the trigeminal nerve led to the discovery of an isolated amyloidoma of the gasserian ganglion. The clinical impression of tumor was confirmed by surgical and pathologic findings.

Amyloidosis↗