Biomedical subjects
Publications and source records attributed to J J Vitek.
An inexpensive digital subtraction angiography (DSA) apparatus that can perform live subtraction, processed subtraction, and road mapping is described. The apparatus can be used in any standard x-ray room with fluoroscopic capability, with a simple connection to the existing TV chain. It is especially useful in therapeutic neuroangiography.
Thirty-one patients with hyperprolactinemia were admitted for protocol study. Twenty-one of these patients had no findings of prolactinoma by computerized axial tomography (CAT) scanning; 10 had documented tumor by CAT scan. The patients were assigned to either Parlodel or Pergolide treatment on the basis of random numbers tables. They were treated for 6 months continuously and followed during this time with radiologic survey, hormonal evaluation, and blood chemistry determinations. Patients in both groups showed a decrease in prolactin levels, whether they were treated with Parlodel or Pergolide. The response was similar whether patients had hyperplasia or pituitary tumors. Patients with pituitary tumors tended to have a diminution in the size of their lesions regardless of the dopamine agonist used. The types of side effects experienced by various groups were similar regardless of the treatment. It is concluded that both Pergolide and Parlodel are useful in the treatment of hyperprolactinemic syndromes, although neither one appears to be superior to the other.
This patient had an aneurysm on the internal carotid artery that was responsible for episodes of severe hemorrhage through the nose. During occlusion of the aneurysm by a detachable balloon, the balloon became dislodged and migrated, obstructing the middle cerebral artery territory and causing a life-threatening situation. This was treated promptly and successfully by removal of the balloon and repair of the artery. Attention is drawn to the risk of such migration occurring, and the possible causes.
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Central nervous system (CNS) involvement by mycosis fungoides (MF) is rare. This is especially true of metastatic parenchymal involvement. Findings in two patients having the tumorous stage of MF are described. Multiple, well delineated, homogeneously and markedly enhancing nodules were seen in these two patients. The computed tomographic (CT) features of CNS involvement by MF are not specific. The differential diagnosis is discussed. By using CT in patients with MF, we will eventually be able to determine the incidence of CNS involvement in this condition.
Contrast enhancement provides valuable information in cranial computed tomography. We report the use of high-dose continuous contrast infusion as a means of consistently demonstrating major perisellar cerebral vasculature. This method was utilized in examining 73 patients, and three illustrative cases are presented. We propose that this technique be performed as the initial radiographic procedure in evaluating sellar and perisellar lesions. Results of clinical, laboratory, and CT examinations may necessitate additional studies including sellar complex motion polytomography, cerebral angiography, metrizamide CT cisternography, or pneumoencephalography. However, employing the CT techniques described, the role of invasive neuroradiographic procedures in the preoperative evaluation of the sellar and perisellar region requires reconsideration.
The capillary phase is discussed on the basis of primary serial magnification and subtraction. It is suggested that the term 'intermediate phase' better expresses the angiographic appearance in between the arterial and venous phases than the term 'capillary phase'. The intermediate phase is further divided into the precapillary, capillary and postcapillary subphases and anatomic correlations are discussed. Some physiologic and pathologic aspects of the intermediate phase are considered.
Sixty-five B-mode carotid sonograms were obtained at random on patients undergoing cerebral arteriography. A 5 mHz transducer was used. The results were correlated with magnified cervical carotid arteriograms obtained on these patients. B-mode sonography was accurate in evaluating the carotid arteries for surgical stenosis in 72 per cent of the cases. The feasibility of using B-mode sonography as a screening test in patients with asymptomatic carotid bruits is discussed.
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Carotid stenting is a percutaneous, minimally invasive treatment for carotid stenosis. It does not carry the surgical risks of carotid endarterectomy and therefore can be applied to the elderly and to patients with comorbidities. Complications and late events appear low.
Computed tomography (CT) is the procedure of choice for initial evaluation of patients suspected of having chiasmal or perichiasmal lesions. Over 1000 patients were examined with high resolution CT, using axial and coronal scans, contrast enhancement, multiplanar reformations, and, when indicated, metrizamide CT cisternography. The normal anatomic appearance of the chiasm and neighboring structures are: (1) symmetric or asymmetric enlargement of the chiasm; (2) areas of abnormal density, without or with contrast enhancement, in the chiasm or perichiasmal region; (3) alteration of the suprasellar cistern; and (4) distortion of the anterior-inferior third ventricle.
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In exploring new modalities to control or ameliorate unbearable intractable pain associated with invasive cancer, the authors studied the effectiveness and safety of a new method involving the destruction of the pituitary by injection of absolute alcohol into the gland. Of a series of 24 patients undergoing pituitary adenolysis for control of cancer pain, 13 patients experienced complete and lasting relief and 10 showed significant improvement. The authors hope that the encouraging results obtained in this preliminary study will stimulate other investigators also to employ the transnasal, transphenoidal approach to alcohol-induced hypophysectomy for the control of intractable pain due to advanced cancer.
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