Echoencephalography & hyperostosis. Frontalis interna.
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Biomedical subjects
Publications and source records attributed to F W Saunders.
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The current understanding of the intracavernous changes that cause or accompany penile erections has encouraged the use of vasodilators as therapy for erectile dysfunction. An established vasodilator, glyceryltrinitrate, was selected for in vivo study because of its rapid transdermal absorption. Color coded duplex ultrasound was used to assess penile vascular response. In a large group of men with erectile dysfunction significant dilation was noted in response to a small amount of nitroglycerine paste applied to the penis. There is a measurable vasodilatory response that can be induced by synthetic nitrates in penile tissue in impotent men.
We report our experience monitoring head-injured patients by means of transcranial Doppler sonography. Cerebral velocity measurements and waveforms change in a consistent pattern with the existence of intracranial pressure, and it is possible to discriminate low versus high flow states. The technique, in contrast to cerebral blood flow measurement, is reliable, atraumatic, and repeatable so that diagnostic assessments can be made and the patient can be followed for therapeutic efficacy.
A case of a spinal artery aneurysm is presented and the relevant literature is reviewed. The pathology of this aneurysm differed from that of standard intracranial aneurysms. The coexistence of a spinal aneurysm and fibromuscular hyperplasia has not been previously reported.
Calcium blockers are being investigated for a potential role in the prevention and treatment of cerebral vasospasm. They have been found to inhibit platelet function both with in vivo and with in vitro experiments. Clinical evidence of abnormal platelet function is sparse, however. We are presenting three patients who developed increased bleeding times that reverted to normal when the diltiazem was discontinued. This may lead to serious consequences in the presence of an unsecured aneurysm and for patients facing major intracranial surgery.
Calcium antagonists are being investigated for their role in preventing or ameliorating the vasospasm associated with subarachnoid hemorrhage. We have done a phase I and phase II type trial of diltiazem. No effect on spasm was documented. A tendency to increase the bleeding time was noted, but no detrimental clinical effect occurred. The rebleed rate was not changed. It appears that further study of diltiazem through a proper randomized study would not be cost- or time-effective.
The role of the carotid siphon as a source of embolic material has had limited morphological or clinical study. The morphologic data available suggests that the siphon plays only a small role in embolic cerebrovascular disease. Clinical studies, however, suggest that it has a significant ischemic potential. To clarify this apparent discrepancy, we have designed a scanning electron microscope study of the carotid siphon. Eighty percent of the specimens from the carotid bifurcation and 30% of the siphon specimens showed evidence of damaged endothelium with attached red cell and platelet debris. The embolic potential of the siphon is estimated to be between 1/3 to 1/2 that of the carotid bifurcation. This supports the most recent clinical studies.
Herpes simplex encephalitis in a 21-year-old man presented as a flu-like illness, followed by inappropriate behaviour, drowsiness and focal neurologic signs. Investigations indicated a lesion in the right temporal lobe. The diagnosis was confirmed by isolation of the virus from a cerebral biopsy. Pronounced clinical improvement was noted when cytosine arabinoside therapy was started in the postoperative period. This report supports the observation by some authors that cytosine arabinoside may be of value in the treatment of herpes simplex encephalitis.