PET: its clinical role in neurology.
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Biomedical subjects
Publications and source records attributed to D Brooks.
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Facial nerve anatomy was compared in the rat, rabbit, cat, and pig in an effort to develop a model for facial nerve trauma within the temporal bone. The porcine model was found to have the most suitable anatomy. Landmarks for the nerve were excellent. The pig had a definite facial nerve mastoid segment that was vertical, as in the human, and long enough to allow for performance of sequential procedures on the nerve. It was also large enough for grafting and electrical testing. A detailed description of the advantages of the pig model and the anatomy of the surgical approach to the facial nerve in the porcine model is presented.
The accepted approach to patients with intermittent calf claudication is nonoperative unless the symptoms are truly incapacitating, in which case arteriography and either percutaneous angioplasty or operation is indicated. Arteriography is considered a preoperative procedure. However, with improvements in percutaneous angioplasty, we have altered our approach to those patients with limiting, but not incapacitating, claudication. These patients are given the choice of conservative treatment or percutaneous angioplasty, but not operation. In an attempt to limit arteriography to only those patients who would benefit from angioplasty, we have employed color Doppler imaging as a screening technique. Over a 2-year period, 62 patients with limiting claudication were evaluated with color Doppler imaging. Thirty-six patients had long occlusions and did not undergo arteriography since they were not believed to be candidates for percutaneous angioplasty. Three short (less than 5 cm) occlusions and 23 localized stenoses were identified in the superficial femoral and popliteal arteries. Angiography confirmed the Doppler findings in all 26 cases. In 24 patients, dilatation was successful, whereas 2 patients' arteries could not be dilated. Two stenoses recurred early and were redilated. There were no complications from the angioplasties. We conclude that in the subset of patients with limiting, but not incapacitating, claudication, color Doppler imaging can accurately select those patients who will benefit from angioplasty. In this way, patients can be spared unnecessary angiograms.
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Most patients with cystitis can be managed without investigation. There is no evidence that recurrent infection in women leads to a rise in blood pressure, serum urea concentration or kidney scarring. However, children require an entirely different approach because of the risk of renal scarring.
Several investigators have recently described the isolation of slow growing mycobacteria from the tissues of patients with Crohn's disease (CD). The primary purpose of this study was to culture and identify mycobacteria from the intestines of patients with CD and other intestinal diseases (control tissues). The culture methods were designed to eliminate most rapid-growing mycobacteria and to enhance the isolation of slow growing mycobacteria. Eighty-two surgically resected intestinal tissue samples were cultured over a four-year period: 27 tissues were from CD patients and 55 from patients with other intestinal diseases. After 4-12 months of culture, five mycobacteria were isolated, but only two have been identified thus far. Both of these organisms appeared to have initially grown as spheroplasts, but revertant bacteria were cultivated after transfer into fresh media. Four of the mycobacteria were from CD tissues, and one isolate was from a control tissue. Two of the isolates have been identified as M. chelonei subsp. abscessus, strain 390 and M. paratuberculosis strain 410. This M. paratuberculosis is similar to the previously identified M. paratuberculosis strains isolated from other human intestinal tissues from patients with CD. Both strains 390 and 410 were inoculated into neonatal goats, but they failed to reproduce a CD-like disease. The isolation of four mycobacteria from 27 CD tissues and only one from 55 control tissues strengthens the findings of previous investigators and supports the hypothesis that mycobacteria may be etiologically associated with some cases of Crohn's disease.
The iridocorneal angle of the horse was anteriorly lined by a pectinate ligament, consisting of several layers of vertically oriented collagenous beams, that were interrupted by a network of extracellular spaces. The anterior chamber angle consisted mostly of a large uveal trabecular meshwork that was composed of widely-spaced, thick trabeculae. These trabeculae were attached in part posteriorly to extensions of the ciliary body musculature and anteriorly inserted into the prominent pectinate ligament. The corneoscleral trabecular meshwork was shaped hemiobovately and formed the external boundary of the iridocorneal angle. The extracellular spaces were smaller and more evenly spaced than those in the uveal trabecular meshwork. Uveal and corneoscleral trabecular meshwork beams were mostly composed of cores of collagen and elastin surrounded by several layers of basement membrane-like material and, in turn, were entirely enveloped by trabecular cells. An anterior narrow zone of broad corneoscleral trabeculae was composed of elastin-collagen cores surrounded by circular bundles of long-spacing collagen. The angular aqueous plexus was extensive, forming much of the external border of the outer corneoscleral trabecular meshwork. A dense zone was associated with the angular aqueous plexus, completely encompassing these aqueous outflow vessels. Posteriorly, the iridocorneal angle was confluent with a well-defined band of trabeculae that was situated between the ciliary body musculature and subjacent sclera and extended posteriorly to the anterior-most region of the choroid where these trabeculae tapered and ended. This region is referred to as the supraciliary trabecular meshwork and indicates a potentially extensive route for outflow of aqueous humor in the equine eye.
The anterior vasculature of the pony eye was examined by the corrosion cast method. The anterior segment of the pony eye has a vascular pattern which is similar but distinct from that of other mammalian species. Large iridal veins collateralized directly with the anterior vortex venous system. The intrascleral plexus was present but formed a fine, radially oriented, extensive network. This contrasted to the circumferential larger-diameter intrascleral plexus noted in dogs and the canal of Schlemm present in primates. The intrascleral plexus only drained posteriorly in the pony as compared to that in other species where anterior collateralizations have been described. The pattern of aqueous outflow was found to have relevance clinically in veterinary medicine and could provide insight into the frequent occurrence and treatment of equine recurrent uveitis as well as diseases of the posterior segment.
In a placebo controlled double-blind cross-over study, the cardiovascular and antidepressant effects of three weeks' treatment with mianserin (30-80 mg daily) and trazodone (150-400 mg daily) were studied in depressed patients who had co-existant cardiac disease. In 14 of the 16 patients, no haemodynamic deterioration occurred with either drug. Two patients withdrew from the study. One with coronary artery disease, whose concomitant medication included a calcium-antagonist and a beta-adrenoceptor blocker and who developed severe postural hypotension after his first dose of trazodone while the other had an increased frequency of transient cerebral ischaemic attacks with both mianserin and trazodone, but not with placebo. Mianserin and trazodone are comparable for both antidepressant efficacy and paucity of cardiovascular effects. Although unwanted effects were generally mild, the incidence of dizziness was greater in those patients receiving trazodone. Caution is advised, however, when prescribing either drug to patients with transient cerebral ischaemic attacks or those with coronary artery disease receiving medication.
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The authors studied the relative contribution of cerebrospinal fluid (CSF) and vascular parameters to the level of intracranial pressure (ICP) in 34 severely head-injured patients with a Glasgow Coma Scale score of less than 8. This was accomplished by first characterizing the temporal course of CSF formation and outflow resistance during the 5-day period postinjury. The CSF formation and outflow resistance were obtained from pressure responses to bolus addition and removal of fluid from an indwelling ventricular catheter. The vascular contribution to the level of ICP was assessed by withdrawing fluid at its rate of formation and observing the resultant change in equilibrium ICP level. It was found that, with the exception of patients with subarachnoid hemorrhage, CSF parameters accounted for approximately one-third of the ICP rise after severe head injury, and that a vascular mechanism may be the predominant factor in elevation of ICP.
The authors studied intracranial pressure (ICP) and intracranial compliance as defined by the pressure-volume index (PVI) in 34 severely head-injured patients with a Glasgow Coma Scale score of 8 or less. The objective of the research was to determine if there was a correlation between the pressure-volume status and subsequent increase in ICP. The PVI and ICP measurements were obtained serially, and the temporal course of the pressure-volume status and ICP was determined during the 5-day period following injury. Aggressiveness of ICP was quantified by a therapy intensity level scale. A clear relationship between the PVI measured soon after injury and subsequent development of ICP emerged. Following mechanical trauma the PVI is reduced, and the degree of reduction and extent of biomechanical recovery are closely related to outcome and development of raised ICP.
A patient developed progressive right hemidystonia in childhood. Subsequently, left-sided blepharospasm, slurred and stuttering speech, and right-sided rigidity and bradykinesia, responsive to dopamine agonists, appeared. Investigation with computed tomography and magnetic resonance imaging (MRI) at age 43 years revealed a left-sided calcified rostral brainstem-thalamic lesion of uncertain aetiology. Although no structural lesion was seen in the striatal regions, L-[18F]-fluorodopa uptake was severely diminished in the left striatum but normal on the right. Dopamine receptor binding identified by [11C]-methylspiperone was in the normal range on both sides.
We formed vesicles from mixtures of egg phosphatidylcholine (PC) and the gangliosides GM1, GD1a, or GT1 to model the electrokinetic properties of biological membranes. The electrophoretic mobilities of the vesicles are similar in NaCl, CsCl, and TMACl solutions, suggesting that monovalent cations do not bind significantly to these gangliosides. If we assume the sialic acid groups on the gangliosides are located some distance from the surface of the vesicle and the sugar moieties exert hydrodynamic drag, we can describe the mobility data in 1, 10, and 100 mM monovalent salt solutions with a combination of the Navier-Stokes and nonlinear Poisson-Boltzmann equations. The values we assume for the thickness of the ganglioside head group and the location of the charge affect the theoretical predictions markedly, but the Stokes radius of each sugar and the location of the hydrodynamic shear plane do not. We obtain a reasonable fit to the mobility data by assuming that all ganglioside head groups project 2.5 nm from the bilayer and all fixed charges are in a plane 1 nm from the bilayer surface. We tested the latter assumption by estimating the surface potentials of PC/ganglioside bilayers using four techniques: we made 31P nuclear magnetic resonance, fluorescence, electron spin resonance, and conductance measurements. The results are qualitatively consistent with our assumption.
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An enzyme-linked immunosorbent assay (ELISA) was developed to monitor antibodies against Coxiella burnetii among animal populations used in research and teaching facilities. Various antigenic components of C burnetii prepared from phase I and phase II whole cells and commercially available antigens were evaluated. A trichloroacetic acid extract was selected for routine use. There was a linear relationship between the transformed absorbance readings of the ELISA results and microagglutination (MA) titers. Comparison between positive or negative results of the MA test and ELISA gave 98.6% concordance. Using the MA test as the standard, ELISA results were 97.8% sensitive and 100% specific. The efficacy of ELISA was evaluated by testing ruminants with known histories of C burnetii infection. Antibody prevalence was 0 in 117 sheep with no history of C burnetii infection, 22% in 145 naturally infected sheep used for research, and 53% in 115 sheep used for vaccine field trials. Forty-eight percent of 120 dairy cows and 52% of 79 goats from endemically infected herds were seropositive. These results indicate that ELISA should be the test of choice for mass screening and surveillance of animals when Q fever is a suspected biohazard.