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Biomedical subjects

A J Fox

Publications and source records attributed to A J Fox.

At least 217 records · Page 12Linked to original sources
PubMed1985

Social class mortality differentials: artefact, selection or life circumstances?

Data from 10 years follow up of mortality in the OPCS Longitudinal Study are used to relate deaths of men in 1976-81 to their social class as recorded by the 1971 census. Explanations of social class mortality differentials are critically reviewed in the light of these new data. The similarity between the class differentials observed for men aged 15-64 years in this study and those reported in the 1970-2 Decennial Supplement on Occupational Mortality indicate that the published gradients were not in fact grossly distorted by numerator denominator biases. Distortions to gradients observed in the early years of the longitudinal study and ascribed to selective health related mobility out of employment from the principal social classes to the permanently sick had largely worn off after five years of follow up. Sharp gradients at ages over 75 years, similar to those at younger ages, suggest that, for men aged over 50 years, selective health related mobility between social classes does not contribute to differentials in mortality.

Adolescent↗
PubMed1985

CT of multiple sclerosis: reassessment of delayed scanning with high doses of contrast material.

A prospective study involving 87 patients was carried out to evaluate the necessity for a high dose of contrast material in addition to delayed computed tomographic (CT) scanning for optimal detection of the lesions of multiple sclerosis in the brain. In patients with either clinically definite multiple sclerosis or laboratory-supported definite multiple sclerosis, CT scans were obtained with a uniform protocol. Lesions consistent with multiple sclerosis were demonstrated on the second scan in 54 patients. In 36 of these 54 patients, the high-dose delayed scan added information. These results are quite similar to those of a previous study from this institution using different patients, in whom the second scan was obtained immediately after the bolus injection of contrast material containing 40 g of organically bound iodine. The lack of real difference in the results of the two studies indicates that the increased dose, not just the delay in scanning, is necessary for a proper study.

Brain Diseases↗
PubMed1985

Stenotic and occlusive disease of the venous drainage system of deep brain AVM's.

Angiograms obtained prior to treatment in 53 cases of deep-seated cerebral arteriovenous malformations (AVM's) were retrospectively analyzed with particular attention to the topography of the AVM nidus and the venous drainage. The location of the lesion was determined by a combination of angiography and computerized tomography. Twenty-seven AVM's involved the basal ganglia and thalamus, 12 were located in the corpus callosum, six were intraventricular, and eight involved the mesencephalon and brain stem. Forty-one patients (77.3%) presented with intracranial hemorrhage. Vessel wall irregularities and/or stenosis of the system of the vein of Galen were observed in 14 cases, and occlusion of the deep venous system was present in seven cases. These AVM's showed numerous collateral venous pathways through enlarged medullary and cortical regional veins. There was dominant participation of the basal vein of Rosenthal in all cases. Unique local hemodynamic factors produced by the convergence of the draining veins of the AVM's into the vein of Galen and straight sinus may lead to a higher incidence of stenosis and/or occlusion of the venous drainage. The relatively high incidence of intracranial hemorrhage in these deep-seated AVM's may suggest a relationship between an increased incidence of intracranial bleeding and impaired venous outlets.

Adolescent↗
PubMed1985

Subependymal metastases of an extracranial malignancy.

We report a patient in whom subependymal metastases from a primary lung cancer were demonstrated by computed tomography of the head and in whom tissue correlation became available. To our knowledge, no such patient has previously been reported.

Aged↗
PubMed1985

Oblique positioning for intravenous digital subtraction angiography images of the neck and head.

Oblique intravenous digital subtraction arteriography (IV-DSA) images of the neck were centered high to include the carotid bifurcations and siphons on one view in 80 consecutive patients being investigated for cerebral vascular atherosclerosis. Using a 27 cm image intensifier, these two important areas for atherosclerotic involvement were seen together on 68.1% of the images. In 25.6% of the images, the centering was too low to include the siphons on the film due to incorrect interpretation of facial anatomy on the oblique scout view. Careful attention to anatomic detail will allow correct centering in most patients. This will allow the bifurcations and siphons to be seen in profile together, thereby decreasing the number of film runs needed and the contrast volume given.

Arteriosclerosis↗
PubMed1984

Unemployment and mortality in the OPCS Longitudinal Study.

The mortality of men aged 15-64 who were seeking work in the week before the 1971 census was investigated by means of the OPCS Longitudinal Study, which follows up a 1% sample of the population of England and Wales. In contrast to the current position, only 4% of men of working age in 1971 fell into this category. The mortality of these unemployed men in the period 1971-81 was higher (standardised mortality ratio 136) than would be expected from death rates in all men in the Longitudinal Study. The socioeconomic distribution of the unemployed accounts for some of the raised mortality, but, after allowance for this, a 20-30% excess remains; this excess was apparent both in 1971-75 and in 1976-81. The data offer only limited support for the suggestion that some of this excess resulted from men becoming unemployed because of their ill-health; the trend in overall mortality over time and the pattern by cause of death were not those usually associated with ill-health selection. Previous studies have suggested that stress accompanying unemployment could be associated with raised suicide rates, as were again found here. Moreover, the mortality of women whose husbands were unemployed was higher than that of all married women (standardised mortality ratio 120), and this excess also persisted after allowance for their socioeconomic distribution. The results support findings by others that unemployment is associated with adverse effects on health.

Adolescent↗
PubMed1984

Computed tomography in temporal lobe epilepsy.

Forty patients who had intractable temporal lobe epilepsy had surgery for treatment of their seizures following study by computed tomography (CT). Fifteen of 19 patients with tumors had good correlation between CT and pathological findings. Another group of patients had macroscopic changes that were demonstrated on CT and verified at surgery. Sixteen patients had microscopic pathological diagnoses including cytoarchitectural abnormalities, Chaslin gliosis, and ectopic neurons. Six of these had enlarged temporal horns on the ipsilateral and five on the contralateral side to the electroencephalographic-pathological abnormality. In the investigation of temporal lobe epilepsy we believe that CT, especially with the newer generation scanners, records tumors and other larger macroscopic changes but that temporal horn size is unreliable in predicting the abnormal side if only microscopic changes are present.

Adolescent↗
PubMed1984

Revisited old and new CT findings in unruptured larger arteriovenous malformations of the brain.

Several papers have already described the computed tomographic (CT) findings in arteriovenous malformations (AVMs) of the brain. In a population of larger and unruptured AVMs, however, improved resolution CT has made it possible to demonstrate findings not previously appreciated: (a) major and minor mass effects in the absence of rupture of an AVM (33 of 60 cases); (b) cisternal enlargement secondary to vessel ectasia and tortuosity; (c) extensive edema of white matter; (d) the detailed features of finer and coarser calcifications of the malformation; (e) gray matter changes, disturbances in the gray-white matter interface, and intrinsic hypodense regions within the AVM; and (f) visualization of small vessels on intravenous enhancement.

Brain↗
PubMed1984

A new bacterial flagellar structure found in campylobacters.

A previously unrecognized bacterial flagellar structure present in Campylobacter jejuni and Campylobacter fetus is described. The structure is located just below the insertion of the flagellar apparatus through the bacterial wall. It is disc shaped, approximately 100 nm in diameter and has eleven spokes radiating from a central hole. The function of this new structure and its possible importance in the taxonomy of campylobacters and other spiral micro-organisms are discussed.

Campylobacter fetus↗
PubMed1984

Isobutyl-2-cyanoacrylate pulmonary emboli associated with occlusive embolotherapy of cerebral arteriovenous malformations.

Three patients had cerebral arteriovenous malformations (AVM) treated by occlusive embolotherapy using isobutyl-2-cyanoacrylate (IBC). At necropsy two had asymptomatic IBC pulmonary emboli. The numbers of emboli and the size of pulmonary vessels occluded correlated roughly with an increasing frequency and volume of injectate made in the cerebral tissue. The extent of pulmonary vascular occlusion in one case suggests that pulmonary vascular hypertension could develop as a complication of this form of treatment.

Adult↗
PubMed1984

Vertebrobasilar occlusion therapy of giant aneurysms. Significance of angiographic morphology of the posterior communicating arteries.

The clinical and angiographic records were reviewed for 71 patients with giant aneurysms of the posterior circulation, who underwent therapeutic occlusion of the basilar artery or both vertebral arteries. This treatment is used when the aneurysm neck cannot be surgically clipped, and occlusion of the parent artery is performed to initiate thrombosis within the lumen. In these cases, collateral blood flow to the brain stem is supplied mainly by the posterior communicating arteries. Consequently, their angiographic morphology (patency, size, and number) is demonstrated as a preoperative indicator of whether the patient will be able to tolerate vertebrobasilar occlusion. Vertebral angiograms with carotid artery compression (the Allcock test) will often be needed to provide this information. The data relating posterior communicating artery morphology to clinical outcome in 71 cases of attempted vertebrobasilar occlusion are presented. The use and accuracy of carotid artery compression studies are also discussed. It is essential for the radiologist to supply the neurosurgeon with this valuable information in every case of giant posterior circulation aneurysm.

Basilar Artery↗
PubMed1984

Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases.

Sixty-five carotid-cavernous fistulas were studied at University Hospital, London, Canada, from 1978 to 1982, 20 of which fulfilled the clinical and angiographic criteria of a spontaneous carotid-cavernous fistula. Of these 20 fistulas, 17 were unilateral, and three were bilateral. In 18 cases the angiographic findings were typical of an arteriovenous malformation (AVM), and in two a ruptured giant intracavernous aneurysm was found. These patients were treated according to whether they had a nonresolving or progressive cavernous sinus syndrome or deterioration of vision. The cavernous dural AVM's were treated with polyvinyl-alcohol and/or isobutyl-2-cyanoacrylate (IBCA) embolization of the external carotid artery blood supply. Two patients underwent postembolization surgical procedures. The detachable balloon technique was used to occlude the fistulas associated with the two giant ruptured intracavernous aneurysms and a small dural intracavernous AVM. Eight patients received no therapy; in two, spontaneous obliteration of the fistula occurred. Of the nine cavernous AVM's embolized with particles and/or IBCA, successful transvascular embolization was achieved in seven cases, and partial embolization followed by surgery in two cases. Successful balloon obliteration of the giant intracavernous ruptured aneurysm was obtained in two cases. In one patient, right hemiplegia with aphasia resulted from reflux of IBCA emboli through the artery of the foramen rotundum into the left middle cerebral artery.

Adolescent↗
PubMed1984

Double blind study of the toxicity of intrathecal iopamidol and metrizamide in lumbar myelography.

Water-soluble contrast agents (metrizamide) provide a finer myelographic assessment of the spinal neuroanatomical structures but at the expense of some occasional toxic side effects. Iopamidol, a new non-ionic water-soluble agent, has been submitted to clinical trial by the authors in their respective institutions. The combined results indicate better tolerance to this new agent with fewer side effects and those of lesser severity.

Dizziness↗
PubMed1984

CT demonstration of hemiatrophy and fatty replacement of the tongue.

We report a patient in whom computed tomography was used to demonstrate denervation, hemiatrophy and fatty replacement of the tongue, secondary to lower motor neuron involvement of the hypoglossal nerve by a meningioma. This unusual finding has only been described once before.

Adipose Tissue↗
PubMed1983

Intraoperative embolization of cerebral arteriovenous malformations in the awake patient.

Fourteen cases of relatively large AVMs within important functional cortical areas, the majority in the dominant hemisphere, are discussed; these AVMs have undergone varying degrees of obliteration by intravascular embolization with IBC in the operating room, under neuroleptanalgesia and local anesthesia. Our belief is that while there have been complications these can hopefully be avoided in the future and that with the evolution of the present technology there will be further refinements in the technique which will eventually allow predictable and definitive treatment of such AVMs.

Adolescent↗