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Biomedical subjects

W Hirsch

Publications and source records attributed to W Hirsch.

At least 19 recordsLinked to original sources
PubMed1995

Acute disseminated encephalomyelitis (ADEM) or ADEM-like inflammatory changes in a heart-lung transplant recipient: a case report.

Acute disseminated encephalomyelitis (ADEM) is a white matter inflammatory disease which usually follows a viral infection or pharmaceutical intervention. We describe a case of presumed ADEM in a heart/lung transplant patient, the etiology of which cannot be elucidated. The fascinating aspect is the mode of clinical presentation and the rapid resolution of radiologic abnormalities. Histologic examination of the brain is provided in an attempt to elucidate the radiographic abnormalities.

Adult↗
PubMed1995

Clinical significance of technetium-99m methylene diphosphonate myocardial uptake: association with carcinoma of the prostate.

Benign myocardial uptake of technetium-99m labelled phosphates, not related to cardiac or metabolic disorders, has been documented except in the case of 99mTc-methylene diphosphonate (MDP). The aim of this study was to assess the frequency of myocardial uptake and its possible association with malignant tumours in general and prostatic carcinoma in particular. We reviewed bone scintigrams performed with either 99mTc-hydroxydiphosphonate (HDP) or 99mTc-MDP over a period of more than 2 years for all patients with prostatic carcinoma and a matching group of patients suffering from other malignant and non-malignant disorders. A total of 965 scintigrams of 812 patients (males = 559, females = 253; age range 50-91 years, average age 69.2 years) were reviewed. Increased myocardial uptake was detected in 19 scintigrams (MDP = 13, HDP = 6) of 18 patients (17 males, one female). Most of the male patients with increased myocardial uptake had prostatic carcinoma (13/17) and were over 80 years of age (12/17). All patients were free of any cardiac or noncardiac disorder that might account for such uptake. When scintigraphy was repeated in the same patient, the uptake of 99mTc-HDP was more diffuse and of higher grade than that of 99mTc-MDP. "Benign" myocardial uptake of 99mTc-MDP is more common than previously thought. Although uptake of radiophosphates is attributed to asymptomatic atherosclerotic changes associated with old age, a strong association with prostatic carcinoma exists which may indicate variations in the bone: soft tissue affinity of different MDP complexes.

Aged↗
PubMed1992

Brain morphologic characteristics of cirrhotic alcoholics and cirrhotic nonalcoholics: an MRI study.

Cirrhotic alcoholics, cirrhotic nonalcoholics, and normal controls were compared on planimetric and subjective ratings of the MRI of the brain. The results indicated that the cirrhotic alcoholics exhibited more gross pathology than the nonalcoholic cirrhotics on ratings of frontal, parietal, and cerebellar atrophy; however, these groups were more similar to each other than they were different on planimetric measurements. The results are discussed in terms of the etiology and localization of the neuropathologic sequelae found commonly among alcoholics.

Adult↗
PubMed1991

Correlative angiographic and pathologic findings in the diagnosis of ulcerated plaques in the carotid artery.

We determined the accuracy of angiography in the diagnosis of internal carotid ulcers by comparing the angiographic reports with the pathologic findings in 36 endarterectomy specimens. Eighteen of these specimens had microscopic ulcerations, and the observer with the highest accuracy rate read 12, of which ten were ulcerated. These results revealed a sensitivity of 56%, a specificity of 89%, and an overall accuracy of 61% for angiography. The ulcers were classified into types A, B, and C to assess the interobserver agreement rate among three readers. This resulted in a 4% interobserver agreement among a total of 75 ulcers. Because of the high interobserver disagreement and the poor correlation between angiographic and pathologic findings in the surgical specimens, we conclude that the diagnosis of carotid artery ulceration by angiography is not reliable.

Angiography↗
PubMed1991

Postoperative computed tomographic evaluation of patients with large pituitary tumors treated with operative decompression and radiation therapy.

Thirty consecutive patients who underwent operative decompression and radiation therapy for large sellar and suprasellar pituitary tumors (greater than or equal to 2 cm) were studied in terms of the serial computed tomographic (CT) changes. There were 23 men and 7 women. The mean age was 49.6 +/- 2.5 years, and the mean follow-up was 45.3 +/- 3.9 months. Twenty-eight of the 30 patients had transsphenoidal surgery, and 27 had hormonally inactive tumors. Radiation therapy was begun within 1 month of surgery with a mean dose of 4855 +/- 70 cGy. Postoperative CT scans were obtained within 1 month of surgery and at 6- to 12-month intervals thereafter. Fourteen patients (45%) had no suprasellar tumor visualized in either the early postoperative CT scans or on subsequent scans. Eleven patients (35%) had a persistent suprasellar mass during the early postoperative period that resolved on serial CT evaluation. The mean time for resolution was 10.4 +/- 1.2 months. Six patients (20%) had a persistent suprasellar mass on serial CT evaluation. A persistent postoperative mass that subsequently resolved in many of the patients was thought to be caused by the gradual retraction of the postoperative packing and hematoma, as well as the effect of radiation on any residual tumor.

Combined Modality Therapy↗
PubMed1991

Herniated L4-L5 disc after placement of Harrington instrumentation for a fracture of the thoracolumbar spine.

The authors report a case in which L5 radiculopathy developed acutely after surgery for placement of Harrington rod instrumentation for an L1 body fracture. Computed tomographic myelography demonstrated a large L4-L5 herniated disc that had not been present in preoperative studies. An emergency laminectomy was performed, and a large, free, subligamentous disc fragment was removed. The patient subsequently regained L5 sensorimotor function. The postoperative development of lumbar radiculopathy is an uncommon complication of Harrington rod instrumentation that may result from several biomechanical features of the instrumentation. These injuries may not be detected by intraoperative monitoring of somatosensory evoked potentials, and therefore, the postoperative neurological examination assumes a crucial role in the early diagnosis of these lesions. As our case demonstrates, these radicular deficits may be reversible if their cause is promptly recognized and treated.

Aged↗
PubMed1990

[Minimal cerebral hemorrhage in premature infants].

Under the term minimal cerebral haemorrhage we understand subependymal haemorrhages which occur as a consequence of ruptures in the capillaries in the stratum germinativum. They occur exclusively in newborn babies after the 36th week of pregnancy. In premature babies born up to or after 32 weeks we found these haemorrhages to a degree of 45% in cases where there was also more haemorrhage. We did not discover any neurological abnormalities in the development after birth as a result of isolated subependymal haemorrhage. This makes the question of how and in how much detail the parents should be informed about the findings more acute. On questioning the relatives it was found that they had undergone some uncertainty and psychological strain after being informed about the findings.

Capillaries↗
PubMed1990

Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogenesis.

Thirty-seven patients with 44 intracavernous carotid artery aneurysms (ICCAAns) were seen at one institution from 1976 through 1988. Fifteen patients had multiple intracranial aneurysms and 7 had bilateral ICCAAns. Age at diagnosis ranged from 15 to 80 (median 61). Thirty patients were women. Sixteen had a history of hypertension. In 34% of patients the ICCAAns were asymptomatic at diagnosis, 36% were associated with headache, and 57% had associated signs or symptoms of mass effect including sixth nerve paresis (43%), trigeminal pain or sensory loss (32%), third nerve paresis (20%), decreased vision or visual field cut (18%), fourth nerve paresis (16%), and Horner's syndrome (7%). In 4 patients the ICCAAns ruptured, leading to subarachnoid hemorrhage in 3 and epistaxis in 1. Two patients with ICCAAns were seen with spontaneous thrombosis of the ipsilateral internal carotid artery leading to distal ischemic symptoms in 1. More than 90% of the ICCAAns were saccular. Thirty-four percent were small (less than 1 cm), 48% were large (1 to 2.5 cm), and 16% were giant (greater than 2.5 cm). The majority arose from the anterior genu of the intracavernous internal carotid artery, followed in frequency by the horizontal segment, and then the posterior genu. Magnetic resonance imaging is superior to computed tomography for diagnosing ICCAAns and is the screening procedure of choice. Angiography remains the "gold standard" for diagnosis and determining specific anatomic details necessary to plan therapy. Analyzing the radiographic anatomy of 44 ICCAAns. we conclude that theories attributing the origin of aneurysms to arterial bifurcations may be inadequate to explain the point of origin and direction of take off of up to one-fourth of ICCAAns.

Adolescent↗
PubMed1989

[C-reactive protein in the maternal serum and risk of maternal infection in premature rupture of the fetal membranes and threatened premature labor].

For diagnosis of ascending intra-uterine infections, regular controls of the serum CRP levels were carried out in 129 patients with premature rupture of membranes and impending premature labour. The height of the maternal CRP level and the simultaneously determined leucocyte counts and band counts were compared with the peripartal fever morbidity (intrapartal fever, puerperal fever). It was established that patients who had a prepartal CRP level of 10 mg/l or more suffered febrile complications more frequently (fever morbidity 18.2%) than females in whom such high CRP values did not occur (fever morbidity 3.4%). Similar correlations existed between the other parameters tested and the fever morbidity, and subclinical intrauterine infections were recognized with higher reliability if CRP, leucocyte count and band count had been determined in combination.

C-Reactive Protein↗
PubMed1989

[C-reactive protein in the maternal serum and risk of fetal infection in premature rupture of the fetal membranes and threatened premature labor].

In order to find out whether, in the framework of our obstetrical management, determinations of the C-creative protein (CRP) in maternal serum enables recognition of incipient intra-uterine infections, regular controls of the CRP level were performed in 129 patients with premature rupture of membranes and impending premature labour. The maternal CRP levels and the simultaneously determined total leukocyte counts and band counts were compared with the frequency of neonatal infectious diseases up to the 3rd day of life. None of the infants were affected whose mothers never had values above 10.0 mg/l. If he maternal CRP values exceeded the 10.0 mg/l limit, then 6.3%-57.1% of the newborns were affected depending on their birth weight. Therefore, the prepartal CRP diagnosis can, especially in infants with low birth weight, help to determine the risk of infection.

C-Reactive Protein↗
PubMed1985

Effect of cyclodextrins on sparingly soluble salts.

On addition of various cyclodextrins, the increase in solubility of some salts of biological interest has been monitored using electrochemical concentration cells. A mathematical model has been developed to calculate the equilibrium constants for the formation of inclusion complexes composed of the large, organic anions inside the cyclodextrin cavities. One stability constant determined by this method has been verified by visible spectrophotometry.

Cyclodextrins↗
PubMed1985

CT findings following diphenylhydantoin intoxication.

CT findings in three female epileptic patients are presented. The patients were treated with toxic doses of the anticonvulsant diphenylhydantoin, leading to irreversible ataxia of varying severity. CT shows cerebellar atrophy, including discernible sulci, a dilated 4th ventricle, basal cisterns, and subarachnoid space. These effects of severe DPH toxicity are relevant in the differential diagnosis of 'idiopathic' and other toxic and systemic atrophies, as well as dysontogenetic lesions of the cerebellum.

Adult↗
PubMed1985

Trypanosoma brucei: analysis of relapsing populations in sensitive and resistant breeds of cattle.

The clone DiTat 1.1 of Trypanosoma brucei brucei was injected into four bovids, and clones obtained from successive waves of parasitemia were used to study the expressed variant-specific surface glycoprotein repertoire. Twenty-four clones were obtained which could be classified into 12 different variable antigen types, in addition to the clone injected, using agglutination or immunofluorescence with monospecific antisera. The variable surface glycoproteins of the 25 clones were extracted using the detergent octyl-beta-D-glucopyranoside in the presence of the protease inhibitor, N-cbz-L-phenylalaninechloromethylketone. The molecular weights varied from 52,000 to 69,000 and the pI from 5.0 to 8.8. The virulence of 14 clones representing 13 variable antigen types was ascertained in mice. The mean survival time ranged from 20.5 to 43.0 days. Clones isolated from early peaks of parasitemia in the bovid were the most virulent while clones derived from later peaks were less virulent. It seems that organisms of diminishing virulence appear in bovids, leading to self-cure of the disease. All clones were sensitive to human serum in a blood infectivity inhibition test. Antibody against all virulent clones appeared in 20 cattle (10 Zebus, 10 Baoulés) which had been injected with T. brucei DiTat 1.1. There was no evidence for parasites of high or low virulence being preferentially expressed in resistant or sensitive hosts.

Agglutination Tests↗
PubMed1985

[A method for the noninvasive measurement and recording of intracranial pressure via the open fontanelle of infants].

Measurement and checking of the behaviour of the intracranial pressure (ICP) are of considerable clinical interest for the appraisal and treatment of primary or concomitant cerebral diseases. A non-invasive method of the measurement of the cerebral pressure is presented, which permits measurements and graphic recording according to the aplanation principle of the ICP via the open fontanelle. The pressure uptake of the instrument transformer is effected by a resistance strain gauge, measurement and recording by means of an equipment combination of VEB Messgerätewerk Zwönitz (GDR). Methodological and theoretical foundations are described and normal values of the fontanelle pressure of 80 newborns and babies are submitted.

Cranial Sutures↗
PubMed1984

Cerebellar atrophy following diphenylhydantoin intoxication.

Seven epileptic patients with permanent ataxic dysfunction following DPH treatment are described. The ataxia correlates with cerebellar atrophy, though the extents of clinical and structural lesions are not necessarily proportional. Cerebellar atrophy is demonstrated by CT scans, the vermal region seems to be predominantly affected.--The tentatively increased susceptibility of female patients and of patients with pre-existing brain lesions, as well as the possible consequences pertaining to the course of the epilepsy are discussed.

Adolescent↗
PubMed1984

Anti-trypanosome specific immune responses in bovids of differing susceptibility to African trypanosomiasis.

A clone of Trypanosoma brucei brucei (DiTat 1.1) was injected into 32 bovids of various breeds, 11 animals being kept as controls. Five animals, Simmental-Ndama F1 crosses, were extremely sensitive. They showed overt symptoms and one died on day 18 of infection despite treatment with a trypanocidal drug. Seven other animals became ill but recovered progressively and cleared the infection. Twenty animals, of breeds generally considered to be trypanosensitive as well as ones from trypanotolerant breeds, did not show symptoms apart from anaemia and cleared the infection. Putative protective antibody, i.e. directed against exposed determinants on the coat variant-specific glycoprotein, was detected by agglutination, complement-mediated lysis and inhibition of infectivity. All animals showed a primary immune response consisting of IgM whose kinetics and amplitude were indistinguishable between animals of differing sensitivity. The response was long-lasting, whether the animals had been treated or not with a trypanocidal drug 3 weeks after infection, and antibody of IgG1 and IgG2 types were detected in certain sensitive as well as resistant animals after 2 months. Some animals were rechallenged with DiTat 1.1 either 1 year after the primary infection or 6 months after inoculation of irradiated trypanosomes. Peak titres of antibody were lower than was the case following primary infection but higher levels of mercaptoenthanol-resistant antibodies were seen. In no case was there any difference in the response of sensitive or tolerant animals. Our results do not support the idea that resistance of certain bovids to African trypanosomiasis is due to a better protective antibody response.

Animals↗
PubMed1983

Gasoline sniffing and lead toxicity in Navajo adolescents.

During a 6-year period, 23 Navajo adolescents were hospitalized 47 times for presumed lead intoxication secondary to gasoline sniffing. Most patients were male (87%) and sniffed gasoline as a social activity, more frequently in spring and summer. Sixty-five percent of the patients first presented with toxic encephalopathy. Of total episodes, 31% involved asymptomatic lead overload; 31% involved tremor, ataxia, and other neurologic signs; and 38% involved encephalopathy with disorientation and hallucinations. Free erythrocyte protoporphyrin levels were not consistently high, although blood lead levels were all elevated. One death occurred. Approximately 11% of 537 Navajo adolescents said they inhaled gasoline for enjoyment at least occasionally. Among 147 junior high school students, blood lead levels averaged 18 +/- 6 micrograms/dL with no values greater than 40 micrograms/dL. Three of these students had elevated zinc protoporphyrin levels and all three were anemic. No correlation was found between levels of blood lead or zinc protoporphyrin and whether or not the youth reported sniffing gasoline. However, sniffing gasoline was associated with poor school performance and delinquent behavior. Although apparently many Navajo adolescents experiment with gasoline inhalation, only a few engage in this activity frequently enough to develop either asymptomatic or symptomatic lead overload.

Adolescent↗