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Biomedical subjects

A J Fox

Publications and source records attributed to A J Fox.

At least 199 records · Page 11Linked to original sources
PubMed1986

Clinical predictors of cardiac and arterial lesions in carotid transient ischemic attacks.

In 205 patients with carotid transient ischemic attacks (TIAs) who underwent full angiographic and cardiac investigations, we found that ipsilateral carotid bruit and triggering of TIA by exertion or standing up suggested a carotid lesion. Angina pectoris or palpitations at onset of TIA suggested a cardiac source of emboli. Patients with only one TIA, multiple identical attacks, progression of symptoms over minutes, and appropriate infarct on computed tomograms (28%) were likely to show a potential arterial or cardiac cause for the TIAs in subsequent investigations. Transient monocular blindness correlated with carotid occlusion, but the severity of the carotid lesion did not influence the duration and repetition of attacks. Transient ischemic attacks in multiple territories, identical attacks, and multiple or silent infarcts on computed tomograms occurred equally in the patients with arterial lesions and those with cardiac lesions. These findings suggest that only a few, albeit important, conclusions regarding etiology can be drawn from the clinical characteristics of TIAs.

Adult↗
PubMed1986

Correlates of brain-stem oculomotor disorders in multiple sclerosis. Magnetic resonance imaging.

Three patients with focal brain-stem oculomotor disturbances (nuclear sixth nerve syndrome, sixth nerve palsy, bilateral internuclear ophthalmoplegia) as a consequence of multiple sclerosis have been studied with high-volume delayed computed tomography and high-field magnetic resonance imaging. In all of them, high-volume delayed computed tomography was inconclusive in the brain stem, but magnetic resonance imaging showed an area of prolonged T1 and/or T2 in the region appropriate to the oculomotor findings. Magnetic resonance imaging is the imaging technique of choice of small plaques in the brain stem. It can considerably aid clinicotopographic correlation in multiple sclerosis.

Adult↗
PubMed1986

Magnetic resonance imaging in Down's syndrome.

100% of brains of Down's adults over age 40 will show Alzheimer-type neuropathologic changes in the frontal and temporal lobes. In an attempt to image these lesions, magnetic resonance imaging (MRI) was performed in seven patients with Down's syndrome, ranging in age from 17 to 45 years, using a resistive unit operating at 0.15 Tesla. All scans were within normal limits except for one 45 year-old patient with severe left temporal lobe atrophy. No areas of abnormal signal were seen in the frontal or temporal lobes and the white matter lesions commonly seen in elderly demented subjects were not visualized in this group. We conclude that these white matter lesions are likely coincidental and not causally related to Alzheimer's changes. The pathologic process leading to the formation and development of Alzheimer's changes in the brains of Down's adults may not be visible on magnetic resonance images.

Adolescent↗
PubMed1986

Antibody to the gastric campylobacter-like organism ("Campylobacter pyloridis")--clinical correlations and distribution in the normal population.

Different cellular proteins of the gastric campylobacter-like organism (GCLO) were shown to be immunogenic for man. Antibodies to GCLO were detected in sera by both complement fixation and enzyme-linked immunoabsorbent assay. Antibody was found in 133 (52%) of 254 patients attending for gastroscopy. There was a high correlation between presence of antibody and a positive GCLO culture from the gastric mucus. Patients with normal endoscopic appearances, duodenal ulcer, duodenitis and oesophagitis had similar prevalences (c. 50%) of antibody. Only patients with endoscopically visible gastritis or gastric ulcer had a higher frequency (c. 80%) of antibody. In a normal population, antibody was uncommon in individuals less than 20 years old, but the prevalence of antibody increased (to c. 50%) with age. There was little evidence to support an important pathological role for GCLO in disorders of the upper gastrointestinal tract, although the possibility that it may be a co-factor in the pathogenesis of gastric ulcer cannot be excluded.

Adolescent↗
PubMed1986

Stress and heart disease: evidence of associations between unemployment and heart disease from the OPCS Longitudinal Study.

The OPCS Longitudinal Study has been used to study both overall and cause-specific mortality patterns in 1971-1981 among men and women directly or indirectly affected by unemployment in April 1971. Groups studied included men seeking work in 1971, the wives of men seeking work in 1971 and other women in the same households as a man seeking work in 1971. The findings of this project are summarized here and attention is focused on mortality from circulatory diseases, in particular ischaemic heart disease. The study provides evidence which could be seen as supporting hypotheses about relationships between stress and overall mortality, with a marked excess for suicides. The evidence with respect to ischaemic heart disease is positive but less convincing with excess mortality from this cause principally occurring among younger unemployed men and among the wives of men who were seeking work in 1971. Given the sharp contrasts in the pattern and levels of unemployment between 1971 and 1981 it is difficult to extrapolate from these findings to the present day.

Adolescent↗
PubMed1986

Intraluminal thrombus of the internal carotid arteries: angiographic demonstration of resolution with anticoagulant therapy alone.

Fourteen patients with angiographically demonstrated thrombus in the cerebral vessels were treated immediately with anticoagulant or antiplatelet medication. Follow-up angiograms, obtained in eight cases, showed resolution of the thrombus in seven. In no patient did the thrombus progress to occlude the vessel completely, and no new distal emboli were identified on the follow-up angiograms. There were no new permanent neurologic events in these 14 patients while they were undergoing medical therapy. Six patients subsequently underwent delayed endarterectomy to treat underlying stenoses. Our experience indicates that the presence of intraluminal thrombus may not be a surgical emergency.

Adult↗
PubMed1986

Dextran microsphere embolization: experimental and clinical experience with radiologic-pathologic correlation. Work in progress.

The radiologic and pathologic effects of canine renal embolization with dextran microspheres of two size ranges (40-150 micron and 100-300 micron) were studied 30 minutes and 1, 2, 4, and 6 weeks after embolization. Dramatic occlusions occurred with very small quantities of these particles, which reached more distally and were suspended and embolized more easily than other solid embolic agents. Because of these qualities, however, they should be used with more caution. They can be injected through 2-F catheters, calibrated-leak balloons, and open-ended guide wires. Embolization with dextran microspheres was also used for epistaxis, meningioma, dural arteriovenous malformation, renal tumors, bone metastasis, multiple myeloma, or peripheral angioma in ten patients. The technique was safe and effective, but special attention should be directed to proper dilution and gentle embolization with careful monitoring to avoid excessive embolization or reflux.

Animals↗
PubMed1986

Bilateral occlusion of vertebral artery: clinical patterns and long-term prognosis.

We studied 17 patients with atherosclerotic bilateral occlusion of vertebral arteries (VA) identified by angiography. Seven had vertebrobasilar TIAs, eight a brainstem stroke (severe in two), and two had only carotid symptoms. Brainstem strokes were more frequent with bilateral intracranial occlusion (60%) than with at least one extracranial occlusion (28.6%), but long-term prognosis did not differ in these two groups. In follow-up, the mortality rate was 4.5% per year, and the stroke rate was 1.8% per year. Major functional disability was seen in 16.7% of the survivors. Bilateral distal VA occlusion may sometimes have a better prognosis than previously assumed. These findings raise doubts about the value of extra-intracranial surgical bypass procedures in patients with these lesions.

Adult↗
PubMed1986

CT metrizamide myelography in syringomyelia: sensitivity and specificity.

In a retrospective study of 32 patients with "proven" syringomyelia and 15 patients with an alternate proven diagnosis, a change in the caliber of the spinal cord with different positions ("collapsing cord sign or cord collapse") had a sensitivity of 38% and a specificity of 87%. Central cord enhancement ("bull's-eye") on delayed CT had a sensitivity and specificity of 91% and 87%, respectively. The positive predictive value of cord collapse was 87%, while the positive predictive value of central cord enhancement was 94%.

Humans↗
PubMed1986

Unusual clinical manifestations of dural arteriovenous malformations.

Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.

Adult↗
PubMed1986

Increased density of tentorium and falx: a false positive CT sign of subarachnoid hemorrhage.

Noncontrast computed tomographic (CT) findings in 10 patients with profound brain swelling or a mass effect revealed a high density of the falx and tentorium and thus suggested subarachnoid hemorrhage. Postmortem examinations performed shortly after the CT scans demonstrated no subarachnoid blood. A review of 100 CT scans drawn at random was carried out to assess the frequency of a hyperdense, noncalcified falx in the same population and failed to demonstrate this finding. Therefore, in the presence of profound brain swelling or a mass effect, factors other than subarachnoid hemorrhage may be responsible for increased density of the falx and tentorium on cranial CT head scans.

Adult↗
PubMed1986

Clinical events following neuroangiography. A prospective study.

The authors prospectively evaluated the clinical event rate over a 72 hour period following femorocerebral angiography in 1002 procedures. The neurologic event rate was 1.3 per cent in the first 24 hours (0.1% permanent) and 1.8 per cent between 24 and 72 hours (0.3% permanent). The non-neurologic event rate (mostly hematomas) was 7.2 per cent. There were no deaths. One hundred and nine pieces of data per procedure were analysed statistically. Delayed cerebral ischemia does occur and could be secondary to the procedure. The low risk of judiciously performed cerebral angiography was confirmed. Carefully cataloguing all events for up to 72 hours neither verifies nor excludes angiography as the cause of deterioration.

Adult↗
PubMed1986

Diagnosis and endovascular therapy of vascular lesions in the cavernous sinus.

One hundred and twenty-eight lesions of the cavernous sinus were diagnosed and treated by endovascular embolization alone or combined with postembolization surgery. All patients presented with acute or subacute cavernous sinus syndrome. A complete angiographic evaluation included bilateral internal and external carotid and vertebral angiography. A total of 88 carotid-cavernous (c-c) fistulae (68 traumatic and 20 spontaneous) and 40 giant aneurysms were demonstrated. A complete anatomic cure or satisfactory clinical improvement was seen in 67 of 68 traumatic fistulae, in 14 of 20 spontaneous c-c fistulae and in 38 of 40 giant intracavernous aneurysms. An overall 15 per cent immediate and 2.7 per cent long-term morbidity with one death was observed. The technical and clinical complications involving endovascular therapy of each specific intracavernous vascular lesion are analyzed.

Adult↗
PubMed1986

Results of the international extracranial/intracranial bypass study. Implications for neuroradiologists.

A randomized trial to determine whether bypass surgery would benefit patients with appropriate atherosclerotic lesions followed 1377 patients for almost five years, and found no benefit from surgery. This negative result has a number of potential implications for neuroradiologists including the expectation for other randomized trials to be carried out, such as for carotid endarterectomy, and the need for neuroradiologists to carry out trials for embolization of cerebral arteriovenous malformations and angioplasty of stenotic cervical or cranial vessels. We are reminded that, ultimately, the clinical outcome is the real measure of procedures, not pretty pictures.

Cerebral Revascularization↗
PubMed1985

Migration during early married life.

"A one percent sample drawn from the 1971 Census (the OPCS Longitudinal Study) [of England and Wales] was used to study the migration patterns of women in the early years of first marriage. Information from the retrospective fertility and migration history contained in the 1971 Census record was analyzed and the results show migration at, or soon after, marriage to be almost universal." The focus is on internal migration. Factors considered include marriage duration, age, husband's occupation, and timing of births. The value of the OPCS Longitudinal Study as a source of migration data is noted. (summary in FRE)

Age Factors↗
PubMed1985

Correlative studies in Alzheimer's disease.

An approach is described for establishing and maintaining a correlative study of Alzheimer's Disease. A sample of the findings by the University of Western Ontario (U.W.O.) Dementia Study Group is provided.

Aged↗