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Biomedical subjects

W E Stern

Publications and source records attributed to W E Stern.

At least 19 recordsLinked to original sources
PubMed1988

A view from the center. A former division chief's perspective on being a megadepartmental chairman.

Upon completing his sixth year as chairman of a large department of surgery in a major United States medical school, the author, a neurosurgical chief for 32 years, reflects upon the goals of departmental stewardship. The charges and challenges to any chairman of a multispecialty department are sampled from the perspective of personal experience. The general message could be interpreted as a call to service and a job description.

Neurosurgery↗
PubMed1988

Dural ectasia and the Marfan syndrome.

The not-uncommon spinal abnormalities associated with Marfan's syndrome rarely undergird clinical problems, and neurological features accompanying such bone abnormalities are rare. In such unusual circumstances it is a widened vertebral canal that attracts attention: the substrate of such widening is dural ectasia with bone erosion, presumably due to hydraulic forces operating via the cerebrospinal fluid (CSF). When neural symptoms or findings do occur they may be related to stretching and traction mechanisms. This study of a symptomatic patient defined with reasonable clarity the abnormal anatomy, and some neurological symptom relief was achieved by attempting to alter the CSF dynamics. The relevant literature has been sampled to elucidate the condition.

Adolescent↗
PubMed1979

Effect of proximal occlusion on anastomosis patency in dogs.

This study compared the superficial temporal-middle cerebral artery (STA-MCA) anastomosis patency in animals with and without proximal embolic middle cerebral artery (MCA) occlusion. Sixteen dogs underwent STA-MCA bypass in association with silicone embolization of the MCA via an internal carotid injection. Animals re-explored 3 to 5 days postoperatively with evaluation of anastomosis patency by Evans blue injection and direct cutting of the STA demonstrated that 10 of 10 dogs with proximal MCA emboli had a patent STA-MCA anastomosis, whereas only 2 of 6 animals without an embolus lodged in the proximal middle cerebral artery had a patent connection. The likelihood of the anastomosis remaining open seems to be greatly influenced by the potential flow gradient between the extracranial and intracranial circulations (Neurosurgery, 5: 596--597, 1979).

Animals↗
PubMed1979

Hemangioma calcificans. Case report of an intraparenchymatous calcified vascular hematoma with epileptogenic potential.

A middle-aged woman, with a previous history of medically suppressed absence attacks, presented with mild changes in mental status and a skull film demonstrating several areas of mottled, granular, intracranial calcifications. These lesions, although readily visible on computerized tomography, appeared avascular during the course of cerebral angiography. At the time of surgery the masses, which were densely calcified and generally circular, demonstrated numerous areas of superficial, white, verrucous excrescences. Microscopic, pathological evaluation confirmed the diagnosis of hemangioma calcificans. The literature describing this rare entity is briefly reviewed.

Blood Vessels↗
PubMed1978

Spectrum of complications in the use of intrathecal fluorescein.

The authors describe a case in which 0.5 cc of 5% fluorescein diluted in 10 cc of cerebrospinal fluid (CSF) was injected at the L4-5 level for evaluation of nasal CSF leakage. Within minutes, tone increased in lower extremities accompanied by knee and ankle clonus and subjective numbness up to the waist. Non-preserved saline irrigation of the lumbar CSF was administered until it became clear, and the patient's head was elevated to retard the developing symptomatology. Although a transient temperature elevation was observed with negative CSF cultures, all signs and symptoms cleared within 48 hours. In a survey of the members of the Americal Association of Neurological Surgeons regarding frequency of use and complications stemming from intrathecal fluorescein, the response rate was 58.3% (1111) of the 1907 members, of which 6.8% (76) had used intrathecal fluorescein, and among those, 25% (19 of the 76) had observed complications involving lower extremity weakness, numbness, generalized seizure activity, opisthotonos, and cranial nerve deficit. No complications were permanent. The authors recommend caution if intrathecal fluorescein must be used. Means should be available to clear the CSF of the agent and elevate the head if complications arise.

Adolescent↗
PubMed1977

Traumatic intracerebral hematoma with stable neurological deficit.

The possibility of an intracerebral hematoma may be overlooked in the presence of a "fixed" neurologic deficit. The clinical complex that is emphasized is composed of (a) ipsilateral cranial trauma, (b) early development of focal neurological deficit, (c) a plateau in the subsequent course of the disease, (d) the delayed appearance of a positive radioactive isotope scan, and (e) a focal area of distorted vessels in angiographic studies. The availability of the computer tomographic scan has made the diagnosis of intracerebral hematomas more certain but it is important that the possibility of a hematoma be considered and pertinent investigations be performed. Even after diagnosis, an operative procedure may be delayed in patients who are neurologically stable. In the five cases presented, the diagnosis of cerebral contusion led to a delay in operative evacuation which was associated with improvement in the previously stable neurological deficit.

Adolescent↗
PubMed1976

Effects of collagenase upon the intervertebral disc in monkeys.

The authors studied 5 rhesus monkeys for the effects of annulotomy, with or without the addition of a bacterially-derived collagenase into the nuclear-evacuated centrum of lumbar intervertebral discs. The animals were sacrificed from 3 weeks to 21 months after the single or staged double procedures. The earliest radiographic changes were loss of height of the interspace at 7 days, erosion of the vertebral body margins at 3 weeks, malalignment at 6 weeks, osteophytic formation at 3 1/2 months, sclerosis of vertebral body surfaces at 9 1/2 months, and fusion of adjacent vertebral bodies at 13 1/2 months. Pathological changes included early loss of disc convexity, focal new home formation, osteophytic new growth, through-and-through bone formation, irregular cystification, and disc replacement by hyaline fibrous tissue. Changes were reminiscent of those seen in humans with naturally acquired disc disease or aging of the disc. Injuries were produced in a tissue that probably has a limited scope of variation in reaction to insult.

Animals↗
PubMed1976

Pathologenesis of hematogenous bacterial meningitis in rabbits.

The authors present data obtained from a series of 27 rabbits studied following intracarotid injection of saline, brain-heart infusion broth, aerobic, or anaerobic bacteria. These data support the hypothesis that injections of cultures of both aerobic and anaerobic organisms by way of the carotid artery disrupts the blood-brain barrier over the cerebral convexities within 15 minutes; however, the inflammatory response and bacterial proliferation occur much more rapidly in the ventricular system. Within 3 hours,the barrier over the convexities is intact, but leukocytes and organisms may be seen in the long cilia of the aqeuductal region. A relative failure of leucotaxis over the convexities of the brain is the most likely explanation of these preliminary findings in this experimental model.

Animals↗
PubMed1975

Loss and recovery of vision with suprasellar meningiomas.

Central visual acuity losses were documented in a group of 23 patients with surgically and histologically verified suprasellar meningiomas. The pattern demonstrated was that of acute, gradual or fluctuating loss in one eye, followed by later loss of central acuity in the other eye. Both optic nerves and chiasm were invariably involved either by stretching or compression. Neither preoperative field abnormalities nor central acuity deficits could be correlated with the anatomical location of the tumor, nor could postoperative changes in vision be correlated with tumor size. Lengthy duration of acuity loss and severe visual deficit did not preclude postoperative recovery of vision. Improvement in sight most frequently occurred within the first several weeks after operation, and further return of vision was not noted after 1 year.

Blindness↗
PubMed1975

Brain stem abscess treated surgically. Wtih special note upon the employment of thorium dioxide.

A 10-year-old girl, with congenital heart disease, harboring a brain stem abscess, was recently treated at the UCLA Hospital. Needle aspirations of the abscess was performed through a posterior occipital craniectomy, and thorium dioxide (Thorotrast) was placed within the abscess cavity as a marker. Postoperatively, the patient improved temporarily but died 18 days later. Autopsy examination included radioactive analysis of brain and liver tissue. Radioautographs were superimposed on H&E preparations of the abscess wall to localize the extent of activity of the thorium dioxide. The unusual occurrence of this abscess in a young patient, clinically diagnosed and treated by operation, provided a rare opportunity to assess the problem of the surgical accessibility of brain stem abscess as well as to reevaluate a role for thorium dioxide as a marker for intracranial purulent collections.

Autoradiography↗