Biomedical subjects
Publications and source records attributed to M Fine.
A case of optochiasmatic arachnoiditis mimicking Foster-Kennedy syndrome is reported. The difficulties in establishing diagnosis are considered, and the literature of optochiasmatic arachnoiditis presenting in this unusual manner is reviewed.
One hundred clear corneal grafts with a minimum follow-up of 10 years and average follow-up of 17.4 years were studied with specular microscopy. Central and peripheral graft endothelial cell counts as well as central corneal thickness measurements were done and these were correlated with the following parameters: diagnostic subgroups; donor age; graft age (follow-up time); and the postoperative clinical course. The average central endothelial cell counts for the entire series was 684 cells/mm2. Peripheral cell counts were performed in 78 eyes and averaged 749 cells/mm2. Central corneal thickness was measured in 80 eyes and averaged 0.49 mm. There were no statistically significant differences in central or peripheral cell counts when analyzing donor age, graft age, or postoperative course. When cell counts were examined among the diagnostic subgroups, those in the hereditary stromal dystrophy subgroup had a significantly lower cell density when compared to those in the keratoconus subgroup.
One of the main purposes of an Infant Stimulation Program is to assist parents in finding ways of adjusting to and developing the potential of the handicapped child. The Peel Infant Stimulation program at the Mississauga Hospital in Mississauga, Ontario, while aptly fulfilling this purpose, noted that in some instances the stress of having a handicapped child added tension to the marital relationship. In addition, some parents appeared to have difficulty recovering from the news of their child's condition. In response to these observations a consultant with expertise in groups, couples, and family therapy was hired to help form groups for parents who appeared to be having difficulties. An Occupational Therapist from the Infant Stimulation Program was trained in group leadership while co-leading the groups with the consultant. The article explores the rationale for the groups, describes the sessions, and discusses a number of issues that are pertinent to the running of the groups. The intent of the article is to encourage staff working in similar programs to investigate the use of parent groups.
The long-term results in 326 eyes grafted for phakic keratoconus by the same surgeon were reviewed. All consecutive grafts performed for this disease with a minimum of five-year follow-up were included in the study. The mean follow-up was 11.3 years, with a range of 5 to 34 years. Ninety percent of grafts remained clear, 3% were nebulous but retained 20/40 vision, and 7% failed. Donor age was available for 188 of the 326 grafts. No relationship was found between donor age and long-term graft clarity even when older (more than 70 years) donor tissue was used. The visual acuity was measured with the patient's preferred optical device worn daily. Seventy-three percent of eyes achieved 20/40 or better vision after their initial graft.
The radiological findings in 22 patients with malignant lymphoma of the nervous system are reviewed in relation to the clinical and histological features. The radiological findings were grouped into four major categories: intracranial, orbital, nasopharyngeal, and spinal. A fifth category, complications, was considered separately. The common neuroradiological manifestations of nervous system lymphoma are reviewed and compared with the recent literature.
Eleven children admitted to hospital with H. influenzae meningitis had computerized tomographic head scans during the acute stage of the illness. 10 of the 11 had at least one other scan between two weeks and 30 months later. This study evaluated the changes seen in the scans in relation to the evolution of the illness, especially with reference to subdural effusions and communicating hydrocephalus. The early scans were found to have no significance in predicting clinical outcome. However, a temporary developmental lag occurred in those children with subdural effusions, transient communicating hydrocephalus, and without permanent neurological deficit.
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A 62-year-old man with progressive cerebellar degeneration, corticospinal tract dysfunction, and mild dementia was found to have Hodgkin's disease. Serial computed tomographic studies revealed progressive cerebellar atrophy. The clinical features and neuroradiologic studies in nine previous cases are reviewed. A thorough search for lymphadenopathy should be made in patients with unexplained cerebellar degeneration.
One to 2 weeks after severe brain ischemia, four infants developed an unusual vascular lesion with a characteristic appearance on computed tomography that has not been reported previously. Restricted areas (most frequently the basal ganglia and thalamus) displayed increased attenuation, which enhanced further upon infusion of contrast medium. Autopsy of one infant revealed that the CT abnormality corresponded to an extremely dense neovascular network which had almost completely replaced the parenchyma in that region. We postulate that this pathological change is a stage in the organization of ischemic brain damage reflecting the infant's vascular plasticity. Thus, hypoxia induces marked capillary proliferation in regions of normally high metabolism and capillary density. The CT pattern may prove useful in predicting the location and extent of sequelae to perinatal asphyxia.
We evaluated, in 128 patients with recurrent nephrolithiasis, the efficacy of special treatment programs for some of the common causes of nephrolithiasis, chosen on the basis of their ability to correct underlying physicochemical and physiologic derangements. Therapy included sodium cellulose phosphate for 18 patients with absorptive hypercalciuria, thiazide diuretics for 27 patients with absorptive hypercalciuria and for 10 with renal hypercalciuria, orthophosphate for eight patients with hypophosphatemic absorptive hypercalciuria, allopurinol for 21 patients with hyperuricosuric calcium oxalate nephrolithiasis, thiazide and allopurinol for 26 patients with absorptive hypercalciuria with hyperuricosuria, and high fluid intake and/or low calcium diet for 22 patients with normocalciuric nephrolithiasis. Patients in all seven groups had a significant reduction in stone formation during 1.70 to 3.37 years of treatment, as compared with the pretreatment period of three years. Remission was found in 70 to 91 percent of patients and reduced stone formation rate was encountered in 88 to 100 percent. Each treatment program produced a significant decline in stone formation rate from 1.90 to 2.28 stones per year to 0.09 to 0.55 stones per year. The actual number of stones formed during treatment was significantly lower than the number predicted from the pretreatment frequency of stone formation (less than 26 percent). The results provide evidence supporting a selective approach to therapy of nephrolithiasis.
A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.
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A review of the computed tomography and clinical characteristics of a series of sphenoid wing meningiomas revealed a high incidence of edema involving the ipsilateral cerebral hemisphere. This edema frequently accounted for the clinical presentation indicating the non-localizing insidious nature of these tumors. The etiology of the edema appears to be related in parts to the location of tumor in the middle cranial fossa and its proximity to the major venous pathways of this area.
Four cases of nasopharyngeal tumors are presented. The neurological complications of these lesions are discussed. The importance of the neuroradiological examination in different stages of these processes, particularly computed tomography, is emphasized.
This report details the clinical course and angiographic findings of a patient with intermittent vertebrobasilar insufficiency. Recanalization of the basilar artery was demonstrated during anticoagulant therapy. A review of the literature failed to disclose a previous report of this occurrence.
Calvarial and extracranial metastases by hematogenous spread of primary intracranial neoplasms have been considered a rare occurrence. This report deals with the clinicopathological and radiological findings of a child with metastatic medulloblastoma. Correlation of serial postoperative computed tomography (CT) scans and the autopsy examination indicated hematogenous calvarial and intracranial spread of the primary lesion.
The course of 200 patients who recently underwent appendectomy at UCLA for acute appendicitis has been reviewed to determine the efficacy of preoperative systemic antibiotic prophylaxis in reducing septic morbidity after surgery. Among those with nonperforated appendicitis who were given gentamycin and clindamycin preoperatively, a reduction of infection rate from 10.2 to 5.3 per cent was found when compared with patients who received no antibiotics.