Alzheimer's Disease: A Decreased Cerebral Blood Flow to Critical Intraneuronal Elements Is the Cause.

Normally, an adequate cerebral blood flow arrives at individual cerebral neurons in which the blood flow augments activity of intraneuronal mitochondria, which is the source of intraneuronal ATP, the energy source of cerebral neurons. With a decrease in cerebral blood flow that can occur as a function of normal aging phenomena, less blood results in decreased mitochondria, decreased ATP, and a decrease in neuronal activity, which can eventually lead to Alzheimer's disease. It has been found that placement of the omentum directly on an Alzheimer's disease brain can lead to improved cognitive function.

Potential improvement of survival statistics for glioblastoma multiforme (WHO IV).

The present-day treatment of a glioblastoma multiforme IV (glioblast) is by surgery, radiation, and chemotherapy. Unfortunately, the current treatment has not significantly improved the survival statistics of this tumor. There are now two relatively new surgical procedures that may improve the survival statistics of this malignancy. One of these procedures is the intraoperative use of the drug 5-aminovolumic acid (ALA), which fluoresces a red color in malignant brain tissue that is not observed in normal brain tissue. This allows a neurosurgeon to distinguish brain tissue infiltrated by malignant cells, thus allowing a more complete resection of the tumor. Another procedure that has the potential to improve the survival statistics of glioblasts is the use of the omentum. Direct placement of the omentum on a brain infiltrated by malignant cells would allow omental blood vessels, known to be completely clear of endothelial cells, to penetrate directly into the underlying brain. The blood flow through omental blood vessels could be expected to carry chemotherapeutic agents throughout the involved brain, thereby totally bypassing the blood-brain barrier. Combining a tumor resection using 5-ALA and placing the omentum on the brain may prove instrumental in improving the survival statistics of patients suffering from a glioblast.

Benefit of omental blood flow in Alzheimer's disease: effect on deteriorating neurons.

It has been commonly believed that a decrease in cerebral blood flow (CBF), which routinely occurs in Alzheimer's disease (AD), results from the death of critical intracerebral neurons that no longer require the maintenance of an adequate blood supply. This belief is presently being challenged by the idea that it is not neuronal death that causes a decrease in CBF, but actually a decrease in the CBF which leads to the death of neurons seen in AD. In association with dead neurons located within the AD brain are varying numbers of deteriorating neurons. Increasing the CBF to still viable but deteriorating neurons in AD is believed to delay and even improve the clinical manifestations of AD. This increase in CBF has proven effective in treating a group of patients with AD. The increase in CBF was accomplished surgically by placing an intact pedicled omentum directly on the AD brain. While surgery is not a long-term answer in the treatment of AD, the surgical procedure should be evaluated by a carefully controlled study while awaiting the future development of a pharmaceutical method to control the disease.

Pyloric valve transposition as substitute for a colostomy in humans: a preliminary report.

BACKGROUND: The purpose of this article was to show that a transposed pyloric valve (PV) can be mobilized to the perianal region and can function as a replacement for an excised rectal sphincter. Surgical research on animals has shown that a vascularized PV can be taken out of gastroduodenal continuity, transposed to the pelvic region with maintenance of fecal control when positioned in the anal area. METHODS: The surgical procedure has recently proved successful in humans in which the distal end of the left colon was anastomosed to the proximal end of the transposed PV with the distal end of the PV sutured to the skin in the perianal area as the replacement for an excised rectal sphincter. Fecal control was established after the operation. RESULTS: The PV healed in an anal position in humans with no apparent anatomic or physiological reasons to suggest that the operation might not be successful in the future as a substitute for a surgically excised or a severely damaged rectal sphincter. CONCLUSIONS: A vascularized PV supplied by the gastroepiploic artery within an omental pedicle can serve as a replacement for an excised rectal sphincter, thus eliminating the need for a permanent colostomy.

A new approach to the treatment of Alzheimer's disease: the need for a controlled study.

It has been widely believed that decreased cerebral blood flow (CBF), known to occur in Alzheimer's disease (AD), is the result of neuronal degeneration that causes a decrease in the need for adequate CBF. There is new interest in the idea, however, that it is not neuronal degeneration that leads to decreased CBF to critical neurons, but it is the decrease in CBF which is the cause of the neuronal deterioration seen in AD patients. In order to increase CBF to the AD brain, an operation called omental transposition has been developed in which an intact elongated omental pedicle, when placed directly on the brain, provides additional CBF and other biological nutrients to the brain. It is understandable that AD patients are awaiting a method to control their disease, but this may take years to become available. Placing the omentum on the AD brain has demonstrated increased CBF which may be the reason that several studies have shown that omental transposition to the brain can improve the cognitive ability of AD patients who have undergone the operation. What is needed is a prospective controlled study that could scientifically establish the benefit of the procedure.

Treatment of communicating hydrocephalus by a lumbo-omental shunt: case report.

Based on preliminary experiences from the early 1970s, a patient with chronic and severe communicating hydrocephalus has been successfully treated with transposition of an omental pedicle to the lumbar subarachnoidal space. This patient, who suffered from congenital toxoplasmosis, at the age of 29 years had undergone no fewer than 82 shunt revisions. In the 5-year follow-up after treatment, she has had no further surgery or other treatment. She is in excellent condition and has demonstrated definite signs of improved CSF circulation. This case report confirms that a pedicle of the omentum may serve as an effective CSF absorber in patients presenting with persistent failures with conventional treatments of communicating hydrocephalus, avoiding the use of any implanted foreign material.

Can the standard treatment of acute spinal cord injury be improved? Perhaps the time has come.

OBJECTIVES: To present additional surgical maneuvers that might lead to improved results in the treatment of acute spinal cord injuries (SCI). METHODS: Techniques are presented that allow the dura mater to be widely opened over a traumatized spinal cord, thus limiting the opportunity for extrusion of edematous spinal cord material. Additionally, placement of an intact omental pedicle over a traumatized SCI allows absorption of spinal cord edematous fluid. RESULTS: Widely opening the dura mater and placing an intact omental pedicle over an SCI site results in a dynamic equilibrium between the production of spinal cord injury edema fluid and its absorption by the omentum. This absorption of edema fluid allows for the associated absorption of fibrinogen. A decreased fibrinogen level lessens its activation to fibrin, thus resulting in the decreased production of scar tissue which is readily observed in patients with a chronic SCI. CONCLUSION: A proposal is presented that may have the potential to improve the neurological results following the surgical treatment of an acute SCI.

Spinal cord separation: MRI evidence of healing after omentum-collagen reconstruction.

INTRODUCTION: Animal experimentation has demonstrated that omental-collagen bridge reconstruction of a transected spinal cord in cats can result in the growth of axons crossing the transection site which resulted in the return of motor and sensory activity. This paper raises the possibility that a comparable spinal cord reconstruction model could be possible for human application. METHODS: Cats had their spinal cord transected at the T-9 level. This led to a gap at the transection site that was filled with semi-liquid collagen, followed by omental transposition onto the underlying collagen bridge, which had subsequently hardened. A comparable technique was used on a patient who had, as reported by magnetic resonance imaging (MRI), a complete spinal cord transection at the T-6 level. RESULTS: Reconstruction of a transected spinal cord in cats using an omental-collagen bridge resulted in axons that grew across the transection site at the rate of 1 mm/day. Several animals developed forelimb and hindlimb locomotion. The patient in this paper had omental-collagen reconstruction of her cord and has clinically progressed to the point where she can ambulate with the use of a walker. The patient had a spinal cord defect of 4 cm, which, with multiple MRI studies, has shown the longitudinal development of a spinal cord connection in the area of the omental-collagen bridge that connects the proximal and distal ends of the transected spinal cord. CONCLUSION: This report suggests that a transected spinal cord has the ability to heal when the spinal cord separation is reconstructed using an omental-collagen bridge. This technique has led to neurological improvement.