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Biomedical subjects

W A Friedman

Publications and source records attributed to W A Friedman.

At least 127 records · Page 7Linked to original sources
PubMed1983

Percutaneous discectomy: an alternative to chemonucleolysis?

At the University of Florida, a new technique for lumbar disc removal, called percutaneous discectomy, has been explored. This procedure may be performed under general or local anesthesia, frequently takes less than 15 minutes, and is generally bloodless. The patient selection process and the surgical technique are presented in detail. A total of nine patients have undergone percutaneous discectomy. Seven had clear radiculopathies with appropriate radiographic findings, and they all have had excellent relief of symptoms. Two patients presented with intractable low back pain, bilateral mechanical findings, and central disc herniations on radiographic examination. One experienced good relief and one did not. Three patients had several days of paraspinous spasm after the procedure, and one complained of a lower extremity dysesthetic sensation that persisted for several weeks after operation. Our early experience with percutaneous discectomy suggests that it is a technically easy procedure that may prove, in carefully selected cases, to be a viable alternative to other discectomy techniques.

Anesthesia, General↗
PubMed1983

Head injuries.

Explore the source record for details and available documents.

Brain Injuries↗
PubMed1982

Successful treatment of the normal perfusion pressure breakthrough syndrome.

Massive, multifocal bleeding after the technically successful removal of a cerebral arteriovenous malformation (AVM) represents a frightening and usually catastrophic complication. This phenomenon, termed normal perfusion pressure breakthrough by Spetzler et al., is caused by the diversion of blood flow from the AVM into adjacent, maximally dilated, and nonautoregulating small vessels. We recently encountered three cases of cerebral AVM that exhibited breakthrough bleeding immediately after an apparently successful operation. In all cases, the surgeon was unable to control the resultant hemorrhage by standard microsurgical techniques. High dose barbiturate anesthesia, combined with blood pressure reduction to the lower levels of the normal cerebral perfusion curve, was then initiated in each case. Controlled hyperventilation, steroids, and osmotic dehydrating agents were also used to control intracranial pressure elevation. After maintenance of this regimen for several days, the patients were returned to the operating room for hematoma evacuation. At this time, bleeding was controlled easily and breakthrough did not occur. Although this regimen requires intensive anesthetic, pulmonary, and cerebral monitoring, it successfully salvaged all three patients. Two made immediate, remarkable recoveries, and the third patient is slowly improving. This protocol therefore seems promising for the management of the massive, uncontrollable cerebral swelling or bleeding that may occur as a consequence of AVM removal.

Adult↗
PubMed1981

Encysted fourth ventricle.

A case of an encysted fourth ventricle subsequent to meningitis is described. This clinical entity may cause a progressive neurological deficit secondary to mass effect and recurrent central nervous system infections. Direct drainage, as opposed to lateral ventricular shunting alone, is indicated.

Cerebral Ventricles↗
PubMed1980

Postoperative evaluation of third ventriculostomy patients using 111in-DTPA.

A radioisotope scanning and clearance procedure has been developed for the postoperative assessment of third ventriculostomy patients. The patency of third ventriculostomy sites can be verified by this procedure, and the bulk flow clearance of CSF can be quantitated. 4 postoperstive third ventriculostomy patients have been evaluated by this procedure to date. In each case the third ventriculostomy site was shown to be patent. The bulk flow clearance of CSF ranged from 170 to 342 cm3/24 h. Comparison of these figures with estimates of CSF production suggests that the majority of CSF reabsorption in these patients occurs through the arachnoid villi.

Arnold-Chiari Malformation↗
PubMed1980

Hydrocephalus in achondroplasia: a possible mechanism.

The relationship of achondroplasia and hydrocephalus has long been the subject of debate. The authors present two patients with these conditions who responded dramatically to shunting procedures. Diagnostic studies implicated venous outflow obstruction in the pathogenesis of their disease.

Achondroplasia↗
PubMed1980

Cervical carotid dissecting aneurysms.

Thirteen cases of cervical carotid dissecting aneurysm have been seen at the University of Florida during the past 3 years. In our experience, two groups of patients with this disease can be distinguished clearly by either clinical or angiographic criteria. One group of cervical carotid dissecting aneurysms is characterized by spontaneous onset, unilaterality, and the absence of pseudoaneurysm formation. These lesions have a strong tendency to resolve with appropriate medical therapy. The other group is characterized by an association with obvious predisposing factors, such as fibromuscular dysplasia, angiography, or trauma. These lesions are often associated with pseudoaneurysms and rarely resolve spontaneously. These two groups of lesions probably represent a spectrum of the same basic disease process. The natural history of patients who survive a cervical carotid dissection is usually one of stability or improvement. A trial of medical therapy (to prevent embolic symptoms) and repeat arteriography are indicated before the consideration of surgical therapy.

Adult↗
PubMed1980

Percutaneous tunnel ventriculostomy. Summary of 100 procedures.

External ventricular drainage is an important therapeutic adjunct in neurosurgical practice. Unfortunately, this procedure has been associated with a significant incidence of ventriculitis. A major source for many of these infections has been bacterial contamination of the tract of the ventricular catheter, at the site where it enters the scalp. To prevent this problem, the authors have devised a new ventriculostomy technique that involves tunneling the ventricular catheter through the scalp, between the dermis and the galea. One hundred consecutive procedures in 66 patients are analyzed in this paper. The average duration of drainage was 6.2 days. There were no infections subsequent to the insertion of the ventricular catheter in this group of patients.

Cerebral Ventricles↗
PubMed1980

A quantitative assessment of CSF reabsorption in infants with meningomyelocele.

The production of cerebrospinal fluid and bulk flow reabsorption were determined in four children with meningomyelocele who developed hydrocephalus. By subtracting bulk flow reabsorption from CSF production, the amount of CSF reabsorbed by alternative pathways was determined. The results of the study indicate that the majority of CSF reabsorption in these patients takes place by bulk flow. CSF reabsorption by alternative pathways, however, is significant.

Absorption↗
PubMed1979

Cushing's disease with cyclic hormonogenesis and diabetes insipidus.

A cyclic excess of cortisol secretion was detected in a patient with diabetes insipidus and diabetes mellitus. The cycles of hypercortisolism were of 7 days' duration, but during the nadir of these cycles urinary excretion of corticosteroids and 17-ketosteroids was within the normal range. The radiological appearance of the sella turcica was normal; however, computerized axial tomography of the head revealed a small tumor immediately superior to the sella turcica. At operation a small chromophobe adenoma superior to the diaphragma sellae and involving the hypophysial stalk was partially resected. Postoperatively, the patient continued to have 7-day cycles of increased corticosteroid excretion, but the amounts excreted were less than they had been preoperatively. Other patients have been described in whom Cushing's disease has been due to cyclic hypercortisolism. These cycles have been remarkably regular in individual patients, but of variable duration in different patients. Furthermore, cyclic hormonogenesis probably occurs in a variety of endocrinopathies. (Neurosurgery, 5: 598--603, 1979).

17-Hydroxycorticosteroids↗
PubMed1979

Ganglioglioma of the medulla oblongata.

A patient with signs and symptoms suggestive of symptomatic Arnold-Chiari malformation was encountered. Neuroradiologic investigation revealed the presence of a medullary tumor, which later proved to be a ganglioglioma. A review of the literature suggests that this presentation is typical of medullary gangliogliomas. It is proposed that the pathophysiology of this lesion renders it amenable to decompressive therapy via suboccipital craniotomy.

Arnold-Chiari Malformation↗
PubMedDate not supplied

Linac radiosurgery for locally recurrent nasopharyngeal carcinoma: rationale and technique.

BACKGROUND: Patients with locally recurrent nasopharyngeal carcinoma benefit from reirradiation. A main barrier to successful palliation or cure is dose limitation secondary to normal tissue tolerance. There are many strategies to increase the tolerated dose to the recurrent lesions. Stereotactic radiosurgery for the treatment of these lesions has rarely been reported. METHODS: Three patients with recurrent nasopharyngeal carcinoma were treated with linac-based stereotactic radiosurgery. RESULTS: One patient remained disease-free 1 year after radiosurgery; the second patient had neurologic deterioration of uncertain etiology (complication vs recurrence) 6 months after radiosurgery; and the third patient had local recurrence 6 months after radiosurgery. CONCLUSION: Stereotactic radiosurgery can be used to deliver a boost dose of radiation to recurrent nasopharyngeal carcinomas. The technique is increasingly available and may offer some advantages compared with other techniques. Treatment recommendations are presented.

Aged↗