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Biomedical subjects

J L Keltner

Publications and source records attributed to J L Keltner.

At least 91 records · Page 5Linked to original sources
PubMed1977

Optic nerve decompression. A clinical pathologic study.

Decompression of the perioptic meninges for intractable chronic papilledema was done in a patient with a right parietal temporal glioblastoma multiforme. The patient died 39 days postoperatively. Histologic study of the optic nerves indicated fistulas in the dura compatible with cerebrospinal fluid (CSF) egress and maintenance of a normal subarachnoid space around the nerve. Two additional patients with unilateral optic nerve decompression producing bilateral resolution of papilledema were studied. We contend that egress of CSF was the principle mode of action in these three cases. How long the dural fistula remains patent is unknown. Reports in the literature show considerable variation in the effects of optic nerve decompression. Anatomic variation of the intracanalicular subarachnoid space together with differences in underlying pathologic condition, surgical technique, and patient response may explain discrepancies among the results reported.

Adolescent↗
PubMed1977

Mycosis fungoides. Intraocular and central nervous system involvement.

A 58-year-old man with mycosis fungoides was treated with chemotherapeutic agents and radiation for the recurrent cutaneous form of this disease. Five years after the onset, he developed blurring of vision, neurologic signs, and then lapsed into coma. Chemotherapy and radiation treatment resulted in improvement of the ocular and systemic picture. Within three months, however, the patient's vision deteriorated and swelling of both optic discs, along with retinal and vitreous infiltrates, was noted. Local radiation of the eyes was followed by improvement of the ocular changes. Five months later the patient died. Results of a histologic examination of the eyes showed extensive involvement of the retina and vitreous by tumor cells. The CNS was remarkably free of tumor cells and it was assumed that the radiation and chemotherapy were responsible for this.

Central Nervous System Diseases↗
PubMed1977

Experimental internuclear ophthalmoplegia.

A midline experimental lesion separating the medial longitudinal fasciculi at and below the level of the abducens nuclei without damaging either fasciculus at the level of the nuclei has produced defects of ocular motility resembling those of clinical internuclear ophthalmoplegia. Electromyographic recordings during lateral gaze demonstrate: (1) lack of inhibition of the lateral rectus muscle in the adducting eye, (2) delayed inhibition of the medial rectus muscle in the abducting eye, and (3) occasional evidence of excitation of the medial rectus muscle of the abducting eye probably associated with pupillary constriction. The presumed physiologic mechanisms involved in conjugate gaze movements are discussed in the light of the experimental findings.

Animals↗
PubMed1977

Neuro-ophthalmology, for the pediatrician.

The pediatrician needs to develop some skills in evaluating afferent visual functions and ocular motor abnormalities. He must know some fundamental neuro-ophthalmologic facts to prevent his patients from undergoing unnecessary diagnostic and surgical procedures. In addition, he needs to understand the fundamentals of strabismus and amblyopia, which are briefly considered in this article but are explored thoroughly elsewhere in this issue of PEDIATRIC ANNALS. First, the most common type of nystagmus in children is congenital nystagmus. These children often have a head turn or tilt. Also, it should be remembered that numerous drugs may cause nystagmus. Second, any child with a head turn or tilt must be considered to have some ocular motor abnormality until a complete ophthalmologic evaluation has eliminated this possibility. In addition, before a child is considered to have an isolated sixth-nerve palsy, Duane's retraction syndrome should be looked for. Also, before an inferior oblique palsy is diagnosed, a Brown's tendon sheath syndrome should be considered. Thus, any ocular muscle abnormality deserves an ophthalmologic evaluation. Third, when bilateral swollen optic nerves are noted as an incidental finding, drusen of the optic nerve head should be suspected. A unilateral swollen disk with decreased visual acuity and a Marcus Gunn pupil should bring to mind a papillitis, which is a local inflammatory condition of the optic nerve head. Remember, papilledema is a bilateral condition secondary to increased intracranial pressure with normal vision. Children with papilledema usually have other signs of increased intracranial pressure. If the article has convinced you of only two facts -- that head tilts and turns are usually ocular in origin, and that bilaterally swollen optic nerves in an otherwise asymptomatic child may be optic nerve drusen -- it has accomplished its purpose.

Child↗
PubMed1976

Active giant cell arteritis with cerebral involvement. Findings following four years of corticosteroid therapy.

A patient had continued active giant cell arteritis proved on biopsy four years after the initial diagnosis of temporal arteritis. The patient had had erythrocyte sedimentation rates within the normal range and had been receiving corticosteroids without interruption for four years. Central nervous system symptoms occurred three and four years after the initial diagnosis.

Aged↗
PubMed1976

Skip areas in temporal arteritis.

Segments of temporal arteries removed from patients with the characteristic systemic findings of temporal arteritis were studied to determine whether they showed "skip areas" lacking evidence of granulomatous inflammation, as has been frequently described in this disease, or showed diagnostic evidence of inflammation throughout the entire length of the artery. Eleven temporal artery specimens from ten patients were included in this study. Sections from areas of each specimen had previously been found to contain typical granulomatous inflammation. Nine of these biopsy specimens contained granulomatous inflammation throughout their entire length. Two specimens each had two discrete areas of granulomatous inflammation adjoining segments that lacked evidence of epithelioid or giant cells. These "skip areas" showed diffuse round-cell infiltration of the adventia or lacked evidence of inflammation entirely. This series suggests that "skip areas" in temporal arteritis do occur.

Aged↗
PubMed1975

Myotonic pupils in Charcot-Marie-Tooth disease. Successful relief of symptoms with 0.025% pilocarpine.

Twenty-seven members of a family with dominantly inherited Charcot-Marie-Tooth disease (CMTD) were examined. Fifteen members had CMTD and 13 of these had varying amounts of myotonic pupillary abnormalities similar in some ways to Adie tonic pupil syndrome. Those with graver neurologic disease showed greater pupillary abnormalities. Ten of the 15 patients had pupillary constriction with methacholine chloride (Mecholyl) and some of these had extensive iris atrophy. Several affected patients received symptomatic relief from 0.025% pilocarpine. Seven other patients with CMTD who were not related to our initial family were checked for myotonic pupils; two had findings similar to our initial family. Pupillary abnormalities in certain patients with CMTD appear secondary to a parasympathetic denervation of the iris sphincter and ciliary muscle, as shown by a positive methacholine test, and probably represent part of the autonomic nervous system dysfunction associated with the polyneuropathy in CMTD.

Adult↗
PubMedDate not supplied

Neuro-ophthalmologic dilemma: chronic optic neuritis?

A patient with an 8-month history of chronic progressive visual loss was referred to the Neuro-ophthalmology Consult Office of Washington University with a diagnosis of chronic optic neuritis. Previous diagnostic studies, including CAT scan, had been negative. Because chronic progressive visual loss is considered a hallmark of mass lesion, more vigorous investigation, including repeat CAT scans, was undertaken, leading to the diagnosis and removal of a 2 cm meningioma.

Adult↗