Biomedical subjects
Publications and source records attributed to B Mickey.
A series of cases are presented to illustrate various facets of the clinical management of pineal tumors. Emphasis is placed on markers of normal and neoplastic pineal function, and in particular melatonin. Although variable before therapy, after therapy four of five patients had little evidence of melatonin production, suggesting that pinealectomy had been complete.
Seventy measurements of CBF were performed in 12 stroke patients by 133Xe inhalation and a rapidly rotating single photon emission computerized tomograph. CBF was measured every other day during the acute phase and at 2- and 6-month follow-up visits. A persistent contralateral cerebellar blood flow depression was evident in five patients with severe hemispheric low flow areas, which correlated with large, hypodense lesions on the computerized tomographic scan. In a sixth patient with a small, deep infarct, a transient crossed cerebellar low flow was observed, while the clinical symptoms persisted. It is concluded from this serial study that crossed cerebellar diaschisis is a common finding in completed stroke. It is probably caused by disconnection of the corticopontine pathways, a disconnection that tends to persist. The phenomenon is in fact less variable than the stroke-related CBF changes in the infarcted hemisphere, in which a period of relative hyperemia is frequently seen.
A noninvasive three-dimensional method for measuring cerebral blood flow (CBF), xenon-133 inhalation and emission computerized tomography, was used to investigate the CBF changes accompanying delayed neurological deterioration following subarachnoid hemorrhage (SAH). A total of 67 measurements were performed on 20 patients in Hunt and Hess' clinical Grades I to III in the first 21 days post SAH. Five patients with normal CBF tomograms on admission developed delayed neurological deficits in the 2nd week after hemorrhage, at which time repeat CBF tomograms in four patients revealed large areas of well defined regional flow decrease in the vascular territories of the anterior or middle cerebral arteries. Severe vasospasm was noted in three of these patients in whom arteriography was performed in the 2nd week post SAH. Diffuse bihemispheric CBF decreases were noted later in the course of delayed neurological deficits; however, measurements obtained soon after the onset of focal symptoms suggest that the only CBF decreases directly produced by vasospasm in Grade III patients are regional changes.
We dissected 30 human temporal bones in order to establish a reliable method for avoidance of the membranous labyrinth in acoustic neuroma surgery. We believe that the variability of the surgical landmarks is sufficient to make complete reliance on anatomic measurements quite treacherous. Fine-cut computed tomograms were evaluated, and it was determined that measurements taken from such scans can define the anatomy of individual temporal bones. We conclude that hearing conservation surgery for acoustic neuroma is a relatively difficult surgical exercise and that complete familiarity with the anatomy and use of all available landmarks is required for successful tumor removal and hearing conservation. Success can be improved further by using measurements taken from the individual patient's preoperative CT scan.
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