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R J Lane

Publications and source records attributed to R J Lane.

At least 91 records · Page 5Linked to original sources
PubMed1982

Operative ultrasonic features of insulinomas.

The technique of operative pancreaticosonography is described as a method of localizing occult insulinomas. The specific ultrasonic features of two small but palpable insulinomas are compared with those of other small lesions in the pancreas. Insulinomas are ultrasonically hypoechoeic and well-defined, with smooth borders, they deform but do not infiltrate surrounding structures, and they cause some dilatation of the secondary pancreatic ducts. Real-time, high resolution, intraoperative ultrasonic pancreatography is suggested as an adjunct to assist in the localization of insulinomas at surgery.

Adenoma, Islet Cell↗
PubMed1982

Neonatal myasthenia gravis in the infant of an asymptomatic thymectomized mother.

A case of neonatal myasthenia gravis is reported in the infant of an asymptomatic thymectomized mother with comparably elevated acetylcholine receptor (AChR) antibody titers. The mother remained asymptomatic despite elevated antibody titers while the infant became asymptomatic in association with the disappearance of the AChR antibody. It is suggested that the AChR antibody plays an essential role in the development of neonatal myasthenia gravis. It is also suggested that a thymic factor is necessary for the development of clinical symptomatology accounting for the lack of correlation between the clinical state of the mother and infant.

Adult↗
PubMed1982

Radiological diagnosis of carotid ulceration.

The standard radiological reports of 50 carotid angiograms were reviewed with regard to the presence of ulceration at the carotid bifurcation. The angiograms were then specifically re-examined retrospectively by a radiologist and the presence or absence of ulceration commented on. The macroscopic features of the carotid endarterectomy specimens of the same patients undergoing carotid endarterectomy were then examined by an independent observer. The results of these three examinations were then compared. There were 28 ulcers in 23 of the 50 specimens with 12 large ulcers (greater than three mm diameter) and 16 small ulcers (less than three mm). In the diagnosis of ulcers, the initial radiological report showed a sensitivity of 32% and a specificity of 97.2%, with an accuracy of 79%, whilst on the retrospective search for ulcers the sensitivity rose to 67.8% whilst the specificity fell to 55.5%, with an accuracy of 59%. The factors affecting the accuracy of the detection of carotid ulcers by angiography are discussed. Angiography in its present form has limitations in diagnosing carotid ulceration.

Carotid Arteries↗
PubMed1982

The limitations of B-mode imaging of the carotid bifurcation: a comparison with three flow-dependent non-invasive tests.

Three hundred and four carotid arteries in 152 patients presenting with cerebral symptoms or asymptomatic carotid bruits were scanned with a real time B-mode scanner. These patients were also submitted to three other non-invasive screening modalities of Oculoplethysmography (OPG), Periorbital Doppler (POD) and Carotid Phonoangiography (CPA). Contrast angiography was performed on 57 patients (114 arteries). Lesions greater than 50% luminal reduction were considered haemodynamically significant. B-mode identified these lesions with a sensitivity of 75.5% and a specificity of 80.3%. Combined with OPG the sensitivity reached 96.2% but with a reduction of the specificity to 73.8%. In defining the need for angiography, no individual with a potentially surgically correctable lesion was incorrectly refused angiography. The limitations of real time B-mode scanning of the carotid bifurcation are enumerated.

Carotid Artery Diseases↗
PubMed1982

Ultrasonic indications to explore the common bile duct.

A prospective comparison between operative cholangiography and operative choledochosonography has been made in 100 patients with cholelithiasis and potential choledocholithiasis. Thirty-one common bile ducts were explored, and 25 of them contained stones. Operative cholangiography was attempted in every case, but technical difficulties prevented examination of 12 common bile ducts, two of which contained stones. Both of these stones were detected by operative ultrasonography. Of the remaining 88 ducts, the sensitivity of the operative cholangiogram was 96% and the specificity 96%. Operative ultrasonography was performed for all 100 patients, with a sensitivity of 96% and a specificity of 93%. The ultrasonic findings of a sonically dense particle, shadowing, dilatation of the duct, and the persistence and meniscus signs are described with their relative incidence in the 100 patients. The time required for choledochosonography (3 to 5 minutes) compared favorably with the time needed for operative cholangiography (10 to 15 minutes). Operative bile duct scanning is a rapid, reliable technique for detecting the presence of choledocholithiasis at the time of routine cholecystectomy.

Cholangiography↗
PubMed1982

Real-time intraoperative angiosonography after carotid endarterectomy.

Real-time intraoperative angiosonography is a readily available and simple means of obtaining high-resolution imaging of the carotid vessels after endarterectomy. In an experience of 60 intraoperative scans, nine abnormalities (15%) were detected, or which 4 lesions were hemodynamically significant. Three of these abnormalities were in the external carotid artery, and one was in the common carotid artery. The detection of these defects, which usually were not obvious during palpation or inspection, enabled immediate reexploration and correction of the fault to be undertaken. The considerable advantages of the intraoperative method of scanning over the transcutaneous technique and operative angiography are discussed. Immediate intraoperative angiosonography is recommended for routine use after carotid endarterectomy.

Carotid Arteries↗
PubMed1982

A comparison of two techniques for the detection of the vasculogenic component of impotence.

Eighty-six patients have been evaluated in the vascular laboratory with regard to vasculogenic impotence. Doppler ultrasound and a new method, photoplethysmography, have been used alone and in combination, compared and correlated with the results of psychiatric therapy. Doppler ultrasound and the photoplethysmographic techniques give almost identical results apart from the zero reading on the Doppler recordings which correlates poorly with the results of psychotherapy and photoplethysmographic findings. The photoplethysmographic technique is quicker, more esthetically acceptable and is, therefore, the method of choice for the assessment of the vasculogenic component of impotence.

Blood Pressure↗
PubMed1981

Nonfunctional paraganglioma of the larynx: clinical and pathological considerations.

Paraganglioma of the larynx is a rare neoplasm. A review of the 16 previously reported cases in English medical literature is presented along with the details of an additional case. The tumor was analyzed by light and electron microscopy. The anatomy and embryology of the laryngeal paraganglia and controversies in nomenclature are discussed. Hoarseness, pain, dysphagia, and neck mass are the cardinal symptoms of this neoplasm; other clinical characteristics are reviewed. Partial laryngectomy and excision via lateral pharyngotomy and extralaryngeal approaches are the most commonly employed methods of treatment. More aggressive therapy including radical neck dissection, total laryngectomy, and radiation therapy have been used for malignancies.

Aged↗
PubMed1981

Variation of serum creatine kinase levels with age in normal females: implications for genetic counselling in Duchenne muscular dystrophy.

We have examined the variation of creatine kinase (CK) levels with age in 206 unrelated normal females. The subjects included 75 adult women aged 15-50, 11 post-menopausal women aged 50-70 and 120 girls under 15 years of age, comprising 84 girls with idiopathic epilepsy (65 pre-menarchal and 19 post-menarchal), well controlled on various anticonvulsant combinations, and 36 normal schoolgirl volunteers (28 pre-menarchal and 8 post-menarchal). Comparison of mean and variance values showed no significant difference between the CK levels in normal and epileptic girls and the data were subsequently combined. Creatine kinase levels were significantly higher in the pre-menarchal girls than in the post-menarchal girls and normal adult women. Levels were high in the first few months of life, fell during infancy and early childhood, rose rapidly in later childhood and then fell abruptly around the time of menarche. The levels then fell slowly throughout adult life but rose again after age 40. This phasic variation with age may be related to hormonal status. The use of age-specific CK ranges may have a significant effect on the carrier detection rate in Duchenne dystrophy.

Adolescent↗
PubMed1981

Carrier testing in families of isolated cases of duchenne muscular dystrophy. Creatine kinase activities in female relatives of mothers with normal CK activity.

A study of the serum creatine kinase (CK) activity in the female relatives of mothers of isolated cases of Duchenne muscular dystrophy (DMD) was undertaken.. It was restricted to the relatives of mothers with normal serum CK values. Ninety-eight females in 19 families were studied; none was found to have a serum CK activity more than 3 SD above the normal mean. This evidence, derived from a study in which the measurement of serum CK activity was used as the sole means of detecting carriers, suggests that very few distant female relatives in such families are carriers of the gene and provides some evidence against the hypothesis that mutation is a rare cause of isolated cases of Duchenne muscular dystrophy.

Adolescent↗
PubMed1981

No direct correlation between serum antiacetylcholine receptor antibody levels and clinical state of individual patients with myasthenia gravis.

Serum acetylcholine receptor antibodies were measured serially in myasthenia gravis patients before and after early extended thymectomy; they received no medication postoperatively. Clinical improvement occurred with little or no change in antibody level. After plasmapheresis without immunosuppressive drug therapy, we also found clinical improvement without decrease in serum antibody level.

Acetylcholine↗
PubMed1980

Intra-operative B-mode ultrasound scanning of the extra-hepatic biliary system and pancreas.

An evaluation of intra-operative B-mode ultrasound scanning of the extra-hepatic biliary tree and pancreas shows that it is a useful, noninvasive method of detecting bileduct calculi and assessing pancreatic disease. In 50 patients undergoing cholecystectomy for gallstones, ultrasound scanning was an accurate as per-operative cholangiography; the decision to explore the bileduct, made on ultrsound findings, was correct in 49/50 cases, and that made on X-ray findings was correct in 46/47 cases; there was 1 false-positive in each group. Scans of 5 patients with pancreatic disease were compared with 28 normal pancreatic scans. Infiltration of the portal vein by tumour was easily detected. Differentiation of carcinoma from chronic pancreatitis by ultrasound scanning might with more experience be possible, whilst identification of other pancreatic lesions, such as cysts, calculi, or endocrine tumours, will certainly be facilitated by this new technique.

Cholelithiasis↗
PubMed1980

Intraoperative B-mode scanning.

The applications of intraoperative scanning are described in the arterial and pancreatico-biliary trees. The findings in 85 patients and 10 postmortem specimens are reviewed. Specific scanning techniques are described, and the results are compared with conventional radiological methods and actual operative findings. A critical comparison of both techniques is presented with illustrations of the unique capacities of intraoperative ultrasound, particularly in the pancreas.

Carotid Arteries↗
PubMed1980

Carotid artery aneurysms: an otolaryngologic perspective.

Aneurysms of the carotid arteries are relatively rare and can present difficult diagnostic problems. They may occur anywhere along the course of the carotid artery in its cervical route, petrous portion, or intracranial extension. The associated clinical findings may range from a simple neck mass to a variety of neurologic deficits. Symptoms of headache, facial pain, tinnitus, vertigo, epistaxis, hoarseness, and dysphagia may require otolaryngologic evaluation. The high morbidity and mortality associated with the natural history of carotid aneurysms makes their early detection essential. Although these lesions have been a subject of great interest in the neurological and neurosurgical literature, surprisingly little has been written to bring them to the attention of otolaryngologists. A review of the literature and an assessment of 10 cases of extracranial carotid aneurysms treated at the University of Pennsylvania in the past 10 years form the basis of this report. Patients with aneurysms involving various portions of the carotid system are presented to illustrate the numerous head and neck manifestations these lesions produce. Differential diagnosis, etiology, natural history, and current management of carotid aneurysms are discussed.

Aged↗
PubMed1980

Electrocardiographic abnormalities in carriers of Duchenne muscular dystrophy.

Electrocardiographic (ECG) abnormalities characteristic of Duchenne muscular dystrophy (tall R waves in the right precordial leads and deep Q waves in the lateral chest leads) are rarely observed in carriers, but Emery (1969) found that the (R-S) amplitude sum in lead V1 was significantly greater in carriers than in age-matched controls. In a prospective single-blind study, we analyzed coded records from 11 carriers and 12 age-matched normal women for (R-S) amplitude sums and R/S ratios in leads V1 and V2. Values in carriers were significantly greater for all these characteristics, discrimination being most marked for R/S in V2 (p less than 0.01). This was confirmed in a further retrospective study, comparing records from 18 carriers with 100 normal ECGs from women of the same age range. Density functions for (R-S) in V1 and the R/S ratio in V2 derived from carrier and normal population can be incorporated into probability calculations to determine risk of carrier status.

Adult↗