Biomedical subjects
Publications and source records attributed to A Burke.
Two patients with irreducible lateral dislocation of the subtalar joint are reported. In both patients the injury was closed and associated with a lateral calcaneal fracture. Open reduction confirmed the tendon of tibialis posterior was located around the lateral aspect of the neck of the talus and prevented reduction.
We measured mean cerebral blood flow (CBF) in 25 lupus patients using the xenon-133 method. The CBF was normal in lupus patients without cerebral disease and also in CNS lupus patients in remission. The CBF was lower than normal during bouts of cerebral lupus (p less than 0.001). Repeat studies showed a stereotyped pattern consisting of depressed CBF during exacerbation of CNS disease and normalization of CBF during remission (p less than 0.01). These results show that CBF is a sensitive indicator of activity of CNS disease and that the direction of change in CBF reflects the clinical course of CNS lupus.
We studied cerebral metabolism, anatomy, and clinical status in 36 patients with acute cerebral ischemia. Results from FDG-PET were compared with CT to find the relationships between the metabolic, anatomic, and clinical findings. Metabolic abnormalities seen on PET frequently were more extensive than the corresponding CT findings. The pattern of metabolic abnormality was significantly related to both the type of clinical syndrome and the degree of eventual recovery. No such relationships were found for the CT results. We conclude that studies of cerebral metabolism are of value in establishing prognosis after acute cerebral ischemia. Also, knowledge of the patterns of cerebral dysmetabolism provides a powerful means for the localization of clinical function.
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Analysis of the names of students from London medical schools taking their final examinations in June 1982, 1983 and 1984 has revealed that racial and sexual discrimination operate when students are selected for medical education. On the basis of name the ratios of European to African, Asian or Arabic students vary significantly between the two extreme schools (P less than 0.01), and for any school the proportion tends to be consistent from year to year. Differences also occur between the proportion of females at each school. Furthermore, the pattern of racial and sexual discrimination at each school shows a highly significant rank correlation (r = 0.77). The admission policies at the different London medical schools need to be reviewed.
In 44 patients, we studied the effects of superficial temporal-middle cerebral artery anastomosis on cerebral blood flow (CBF), neurologic examination, and cognitive functions. At 3 months, there was significant improvement in all variables. At 9 months, CBF was no longer significantly greater, but neurologic examination and cognitive functions had further improved. Patients with TIA had significant postoperative decreases in TIA frequency and did not progress to stroke, but had no significant changes in any variable. In stroke patients, we could not separate the effects of surgery from the natural evolution of changes in CBF and examination after stroke. None of the preoperative measurements predicted postoperative clinical improvement.
We used 18-F-fluoro-2-deoxyglucose positron emission tomography (PET) and computed tomography (CT) to study eight patients with homonymous hemianopias or quadrantanopias due to ischemic lesions of the visual pathways. Four patients with ischemic damage to all or part of the occipital lobe had decreased glucose metabolism in the affected region. Three patients with ischemic damage limited to the optic radiations had decreased glucose metabolism in the portion of striate cortex appropriate for the visual field defect. Changes in glucose metabolism frequently occurred in the undamaged ipsilateral thalamus and visual association areas.
Positron emission tomographic studies of 16 patients with cerebral ischemia and brain tumor showed asymmetries in cerebellar metabolism not encountered in 14 normal control subjects. An asymmetry was present in 62.5% of cases. The lower metabolic rate occurred in the cerebellar hemisphere contralateral to the cerebral lesion (p less than 0.001; sign test). In all cases computed tomography showed the supratentorial lesion to be unilateral and the posterior fossa contents to be unaffected. The presence of depressed cerebellar metabolism was highly associated with involvement of the contralateral parietal lobe (p less than 0.02; phi coefficient). The presence of a cerebellar abnormality was not related to the presence of any particular sign. Serial studies showed normalization of cerebellar metabolism over time. It is likely that this effect is a result of interruption of the functional interconnections between the cerebrum and the cerebellum.
Two patients with amyotrophic lateral sclerosis proved postmortem had nystagmus in addition to typical clinical signs of motor neuron disease. The first patient had gaze-evoked rotatory nystagmus that was followed by horizontal nystagmus in the primary position with supranuclear paresis of horizontal gaze and upgaze. The second patient had rotatory nystagmus that was evoked by lateral gaze, with normal range of eye movements. Nystagmus is so rare in motor neuron disease that these observations may imply another disease, but postmortem examination did not provide any other explanation. These two cases add to the increasing evidence that motor neuron disease comprises a heterogeneous group of disorders.
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A case of corneal graft operation using chondroitin sulphate (CDS-TM) to protect the endothelium, highlights the surgical difficulties encountered as a result of the severe dehydration effects on the donor corneal button produced by the CDS. In vitro experiments comparing Healonid and CDS on 8 mm excised donor corneal buttons from three pairs of human eyes, confirms this effect with CDS which was absent with Healonid.
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A right-handed woman developed left hemiparesis and a language disturbance. At autopsy, there was infarction in the territory of the right anterior cerebral artery, involving, among other structures, the supplementary motor area. This brain region has been considered to play a role in speech, but whether the language disorder that follows its destruction is truly aphasic is controversial. Our patient does not answer that question, but if her disturbed language is viewed as aphasic, she represents the fourth autopsy case of "crossed aphasia in a dextral" and the first, with or without autopsy, after right anterior cerebral artery occlusion.
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The use of stay sutures in tracheostomy is proposed. They can be of help during the performance of the operation and can be of even greater benefit after it. If the tube is displaced from the trachea in the early postoperative period traction on these sutures permits rapid reintubation.