Biomedical subjects
Publications and source records attributed to R R McClelland.
A young woman south medical care for headache, nausea, and evolving focal neurologic signs. The CSF was normal; cerebral angiography showed segmental narrowing and irregularity of intraparenchymal arterioles. Isolated cerebral vasculitis was the clinical diagnosis made by careful exclusion; the illness reponded well to steroids and there was later angiographic evidence of healing.
Congenital aneurysmal dilatation of the left auricle is a rare condition often associated with cardiac arrhythmias and systemic emboli. The diagnosis is made often by surgical exploration or presurgically by contrast angiography. A case is reported in which the dilated left auricle did not fill during contrast angiography but was demonstrated by sequential cardiac blood-pool scintiscanning.
The vertebral injuries sustained by 13 survivors of four light-plane crashes were reviewed. Eight patients sustained major nonvertebral injuries. Eleven patients sustained 18 lower thoracic and/or upper lumbar fractures. Eighty-five per cent of the fractures involved T12, L1, L2, or L3. Seven patients sustained vertebral burst fractures; ten sustained vertebral flexion fractures. In nine patients these vertebral fractures had associated fracture-dislocations of the posterior pedicles. Eight of these nine patients (89%) developed neurologic deficits of the conus medullaris and/or cauda equina. The severity and time of onset of these neurologic deficits were similar for the occupants of each aircraft. Downward vertical deceleration and rotational violence were the dominant forces which inflicted the vertebral column fractures which resulted in neurologic deficits.
Double diastematomyelia was diagnosed in a 23-year-old woman. The spurs occurred at T2 and L3. To the authors' knowledge, such a wide separation of double spurs has not been reported previously and the high position of the T2 spur is rare.
A case of right subdiaphragmatic extralobar pulmonary sequestration (PS) associated with a gastric duplication cyst is reported. To the authors' knowledge such a case has not been reported previously in the English literature. PS was first noted as a defect on a nuclear liver image. The duplication cyst was defined by ultrasonography. A review of the English literature is included.
Transverse cervical myelopathy, at C-6 level, followed injection of Renografin-60 into the right thyrocervical trunk during cerebral angiography. Review of the literature yielded only two cases in which attempted posterior fossa angiography resulted in cervical myelopathy. Two more cases were found. In one, cervical myelopathy occurred during aortography in a patient with coractation of the aorta, and in the other it followed mediastinal angiography. Summation of anoxia, hemorrhage, and cellular toxicity is responsible for spinal cord necrosis following arterial injection of contrast material.
A case of spontaneous posterior fossa subdural hematoma secondary to anticoagulation therapy with definitive diagnosis made by vertebral angiography is reported. Vertebral angiographic findings are illustrated and demonstrate primarily mass effect from posterior compartment of posterior fossa and avascular area. Carotid angiography did not show hydrocephalus. A review of the literature was made and this appears to be the first reported case in which a posterior fossa subdural hematoma has been diagnosed by vertebral angiography.
Two cases where focally increased activity was noted on scinticisternography are reported. One case involves a documented arteriovenous malformation, and the other, documented embolic vascular disease. After a review of the pertient literature, various other pathologic entities associated with similar scan findings are described. Possible causative mechanisms are discussed.
A total of 537 consecutive liver scintiscans were retrospectively reviewed and 80 of them revealed suspicious focal decreased activity in the region of the prota hepatis. Postmortem, surgical, or biopsy correlation was obtained in 40 of these cases: 14 were pathologically negative; 9, cirrhosis or fibrosis; 10, metastases; 3, dilated bile ducts; 1, viral hepatitis; 1, hepatic laceration; 1, falciform ligament cyst; and 1, ruptured gallbladder with abscessed head of the pancreas. Thus, only 42% represented significant disease. Sixty-eight percent of the defects were seen only on the anterior scintiscan. Appearance of the majority of defects was nonspecific. Subjective grading of defects according to size and comparative decrease in density was not beneficial. Elevations of serum alkaline phosphatase, total serum bilirubin, and serum glutamic-oxalacetic transaminase were nonspecific.