Biomedical subjects
D Perlmutter
Publications and source records attributed to D Perlmutter.
Organochlorines, breast cancer, and GATT.
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Molecular genetics in pulmonary emphysema.
A vast array of new methods in molecular genetics are providing insights into problems at the cell and molecular level. Their applications in lung disease is unbounded. However, they are only methods. They are the right methods for certain kinds of questions and the wrong methods for other kinds of questions.
Spinal myoclonus associated with HTLV III/LAV infection.
We describe spinal myoclonus in a 35-year-old homosexual man with concurrent human T-cell lymphotropic virus type III/lymphadenopathy--associated virus (HTLV III/LAV) infection of the central nervous system as indicated by intra-blood-brain barrier synthesis of HTLV III/LAV-specific IgG. The spinal myoclonus was characterized by asymmetric, rhythmic contractions of the abdomen with a frequency ranging between 40 and 70 per minute. The myoclonus was self-limited, resolving over the course of two months. Human T-cell lymphotropic virus type III/lymphadenopathy--associated virus should be considered among the viral causes of spinal myoclonus.
"Hidden" disks and computerized tomography.
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Liver transplantation in pediatric patients.
Since the introduction of cyclosporine and a multidisciplinary surgical/medical approach, survival has improved in children undergoing orthotopic liver transplantation. In many areas, liver replacement is being considered a genuine treatment option for progressive liver disease. Before this procedure is routinely accepted, however, it will be important to follow long-term outcome and to compare results with those of conventional treatment when there are more patients in each disease category. In addition to continued experimentation with immunosuppressive regimens, methods for monitoring immunosuppression and detecting rejection at early stages are needed. Finally, the changes in bodily processes accompanying liver replacement should be used to learn more about the function of the liver, its role in immunity and its pathobiologic involvement by specific disorders.
Microsurgical anatomy of anterior communicating artery aneurysms.
The basic anatomy important to surgery of aneurysms of the anterior communicating region was defined in 50 brains. Significant findings were: (1) the recurrent artery of Heubner is frequently exposed before the A-1 segment in defining the neck of the aneurysm because it commonly courses anterior to the A-1 segment. The recurrent artery rose from the A-2 segment of the anterior cerebral artery in 78 percent of hemispheres. (2) The anterior communicating artery frequently gives rise to perforating arteries that terminate in the superior surface of the optic chiasm and anterior hypothalamus. (3) The proximal half of the A-1 segment was a richer source of perforating arteries than the distal half. (4) Aneurysms frequently occur in association with hypoplasia of the A-1 segment and their fundus points in a direction determined by the anatomic principles reviewed in this manuscript. These findings, as they apply to frontotemporal surgical approaches to these aneurysms, are illustrated.
Fungal infection of the brain: an increasing threat.
A 79-year-old, diabetic man with an ear infection had a temporal lobe abscess from which Aspergillus fumigatus was cultured. He died despite treatment with amphotericin and rifampin, removal of the abscesss, and left mastoidectomy. Because of the ever-increasing number of elderly debilitated patients, the frequency of mild diabetes in the aged, the prevalent use of steroids, antibiotics, cytotoxics and immunosuppressives, and the ubiquity of the organism, Aspergillus infections of the brain have and will become more frequent.
Microsurgical anatomy of common aneurysm sites.
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Microsurgical anatomy of the distal anterior cerebral artery.
The microsurgical anatomy of the distal anterior cerebral artery (ACA) has been defined in 50 cerebral hemispheres. The distal ACA, the portion beginning at the anterior communicating artery (ACoA), was divided into four segments (A2 through A5) according to Fischer. The distal ACA gave origin to central and cerebral branches. The central branches passed to the optic chiasm, suprachiasmatic area, and anterior forebrain below the corpus callosum. The cerebral branches were divided into cortical, subcortical, and callosal branches. The most frequent site of origin of the cortical branches was as follows: orbitofrontal and frontopolar arteries, A2; the anterior and middle internal frontal and callosomarginal arteries, A3; the paracentral artery, A4; and the superior and inferior parietal arteries, A5. The posterior internal frontal artery arose with approximately equal frequency from A3 and A4 and callosomarginal artery. All the cortical branches arose more frequently from the pericallosal than the callosomarginal artery. Of the major cortical branches, the internal frontal and paracentral arteries arose most frequently from the callosomarginal artery. The distal ACA of one hemisphere sent branches to the contralateral hemisphere in 64% of brains. The anterior portions of the hemisphere between the 5-cm and 15-cm points on the circumferential line showed the most promise of revealing a recipient artery of sufficient size for an extracranial-intracranial artery anastomosis. The distal ACA was the principal artery supplying the corpus callosum. The recurrent artery, which arose from the A2 segment in 78% of hemispheres, sent branches into the subcortical area around the anterior limb of the internal capsule.
Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex.
The microvascular relationships important to surgery of aneurysms in the anterior communicating region were defined in 50 cadaver brains. The recurrent artery of Heubner was frequently exposed before the A-1 segment in defining the neck on anterior cerebral aneurysms because it commonly courses anterior to A-1. It arose from the A-2 segment of the anterior cerebral artery (ACA) in 78% and most commonly terminated in the area of the anterior perforated substance, and lateral to it in the Sylvian fissure. The anterior communicating artery (ACoA) frequently gave rise to perforating arteries which terminated in the superior surface of the optic chiasm and above the chiasm in the anterior hypothalamus. This finding contrasts with previous reports that no perforating branches arise from the communicating artery. The proximal half of the A=1 segment was a richer source of perforating arteries than the distal half. The A-1 branches most commonly terminated in the anterior perforated substance, the optic chiasm, and the region of the optic tract. The ACoA increased in size as the difference in the diameter between the right and left A-1 segments increased. Frequent variants such as double or triple ACoA's, triple A-2 segments, and duplication of the A-1 segments were encountered. The clinical consequences of occlusion of the recurrent artery and of the perforators from the ACoA and medial and lateral segment of A-1 are reviewed.
Microsurgical anatomy of anterior cerebral anterior communicating recurrent artery complex.
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