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Biomedical subjects

J P Weaver

Publications and source records attributed to J P Weaver.

At least 19 recordsLinked to original sources

Predictive value of the intracarotid amobarbital test in bihemispheric seizure onset.

The intracarotid amobarbital test (IAT) is used to lateralize language function and assess hemispheric memory. In this study 23 non-lesional epileptic patients were evaluated. The magnitude of the difference in IAT scores between the two hemispheres was significantly greater in the patients whose seizures lateralized on scalp or intracranial EEG than in patients with bihemispheric seizure onset. This suggests that the IAT is useful not only in predicting lateralized seizure focus, but bihemispheric onset as well.

Adult

Bone SPECT of the spine: a comparison of attenuation correction techniques.

UNLABELLED: Image artifacts from variable self-attenuation are recognized as major sources of diagnostic uncertainty in SPECT. For myocardial perfusion studies, an attenuation map is often obtained from a separate transmission study. However, for many applications such as bone SPECT, it has been believed to be unnecessary to obtain a transmission study to correct for the effects of attenuation. We have had significant success in clinical management of lower spine pain using bone SPECT. This success has led us to consider SPECT for the management of cervical spine pain. Cervical spine reconstructions without attenuation correction are difficult to interpret, because the high attenuation in the mandible and skull tends to decrease estimates of activity of the upper cervical spine, and the lower cervical/upper thoracic vertebrae are obscured by the shoulders. We present a technique that uses downscatter to provide attenuation correction for these acquisitions and compare it with other recognized attenuation correction techniques. METHODS: An emission study is acquired using two windows: one for obtaining the photopeak data and another for obtaining the downscattered photons. A body outline is estimated from these datasets using a projection data thresholding method. From this outline, a uniform attenuation map is created using attenuation coefficients appropriate for 99mTc in water (0.154 cm(-1)). These maps are used in SPECT reconstruction using ordered-subset expectation maximization (OSEM). This method is compared with (a) no attenuation correction (NC), (b) conventional Chang attenuation correction based on the interactive determination of the body outline from the 99mTc emission photopeak data (ChangAC) and (c) OSEM correction using attenuation maps estimated with a line source and fanbeam collimators (transAC). RESULTS: Patient studies using scatterAC demonstrated a significant improvement in the uniformity of estimated cervical spine uptake in normal patients, compared with either NC or ChangAC. Results using scatterAC were similar to those of transAC. We also observed significant improvement in uniformity using scatterAC in SPECT of the lower back in obese patients, as well as the relative limitations of scatterAC versus nonuniform, transmission-based attenuation correction. CONCLUSION: Comparisons with reconstructions using transmission data for estimating attenuation demonstrate that reasonable quantitative accuracy can be obtained in SPECT of the cervical spine using this simple attenuation estimate. Both scatterAC and transAC appear to provide consistent and expected uniform spine uptake in the cervical spines of normal patients.

Algorithms

Middle fossa cyst presenting as a delayed complication of temporal lobectomy: case report.

Symptomatic middle fossa cysts have not previously been described as complications of temporal lobectomy that has been performed to control complex partial seizures. A patient is described who developed a middle fossa cyst causing mass effect, intracranial hypertension, and neurological deterioration > 2 years after temporal lobectomy for complex partial seizures. An enlarging cyst with cerebrospinal fluid imaging characteristics was detected on neuroimages 1 year before neurological deterioration. The patient was treated by the insertion of a cystoperitoneal shunt for cerebrospinal fluid diversion. The potential causes of an acquired arachnoid cyst and hydrocephalus are discussed.

Adult

The brachioaxillary interposition graft as a successful tertiary vascular access procedure for hemodialysis.

There is a steady increase in the number of patients with chronic renal insufficiency undergoing long-term hemodialysis, and an increasing number of these patients have exhausted veins due to multiple vascular access and salvage procedures. These patients may be candidates for an alternative vascular access procedure, the brachioaxillary interposition arteriovenous graft. This graft was used in 13 patients with a 100% patency rate and no significant complications at 81 patient months. The results indicate that the large axillary vein, which provides an adequate runoff, and a narrow graft-to-vein inflow angle may lessen the turbulence inherent in the more conventional grafts and may contribute to an improved long-term patency. If these assumptions prove correct, this graft may find more frequent application in the future.

Adult

Subarachnoid hemorrhage: an update of pathogenesis, diagnosis and management.

Subarachnoid hemorrhage (SAH) remains a devastating neurological disorder, which most commonly develops after rupture of an intracranial aneurysm. Advances have occurred in the areas of epidemiology, diagnostic imaging, medical management and surgical intervention, related to aneurysmal SAH. Interested physicians must become aware of these and other advances to diagnose and manage this potentially lethal disorder more effectively. This review provides information about the pathogenesis and complications of aneurysmal SAH and an update of new and evolving treatment modalities to provide an in-depth overview for the clinician and researcher involved in this rapidly evolving field.

Arrhythmias, Cardiac

Differential responses to angiotensin-(1-7) in the feline mesenteric and hindquarters vascular beds.

Regional vascular responses to angiotensin (Ang)-(1-7), a heptapeptide derivative of Ang II were investigated in the feline hindquarters and mesenteric vascular beds under conditions of controlled flow. In the mesenteric vascular bed, injections of Ang-(1-7) in doses of 1, 3 and 10 micrograms produced dose-dependent decreases in mesenteric perfusion pressure whereas at doses of 30 and 100 micrograms, increases were observed. In contrast, in the hindquarters circulation, low doses produced increases while high doses produced decreases in perfusion pressure. In both vascular beds the degree of vasoconstriction was weak, being less than 1% of that elicited by Ang II. The vasoconstrictor effect of Ang-(1-7) in both the mesenteric and hindquarters vascular bed was blocked by DuP 753 (1 mg/kg i.v.), an Ang receptor subtype 1 (AT1) antagonist. The vasodilator responses in both vascular beds were partially blocked by the nitric oxide synthase inhibitor, NG-nitro-L-arginine methyl ester (100 mg/kg i.v.) but were unaffected by the cyclooxygenase inhibitor, meclofenamate (2.5 mg/kg i.v.). The present results show that in the peripheral vascular bed of the cat, Ang-(1-7) causes vasodilation or modest vasoconstriction, depending on the dose and the regional vascular bed studied. The present data also suggest that the vasodilator effect of the peptide may be mediated in part by the release of endothelium-derived relaxing factor and the vasoconstrictor effect by activation of the AT1 receptor subtype.

Amino Acid Oxidoreductases

Evaluation of the benefits of gastric tube feeding in an elderly population.

OBJECTIVE: To assess the benefits of gastric tube feeding in an elderly community hospital population. SUBJECTS: One hundred consecutive patients who required feeding gastrostomies from July 1984 through June 1987. SETTING: Durham (NC) Regional Hospital, a 380-bed community hospital. METHODS: Patients were evaluated using a quality of life scale (QL scale) adapted from Spitzer's QL Index. The evaluation was based on hospital records at the time of tube placement and interviews with patients or family members at follow-up between June 1991 and March 1992. Subjective evaluation of the benefits of gastric tube feeding were obtained in interviews with patients or their families at follow-up. RESULTS: Overall there was no significant change in the objective evaluation of quality of life at follow-up. Men, patients over 76 years of age, and patients with chronic illnesses such as multiple strokes or dementia showed the poorest response on the QL scale. Subjective evaluation by patients or their family members was positively correlated with objective evaluation on the QL scale. Family members of patients who showed the poorest response on the QL scale were more likely than other family members to respond no to the question, "Would you want this done to you if you were in his/her situation?" CONCLUSIONS: Our QL scale provides a good indication of patients' and family members' subjective evaluation of the benefits of gastrostomy tube feeding after 4 to 8 years. Thus, the scale should be helpful to physicians who must consult with patients and their families and make decisions about the use of this procedure. The significant discrepancy between family members' evaluations of the benefit of the procedure to the patient and their refusal of the procedure for themselves if they were in the patient's situation confirms the need for advance directives and the importance of conscientious implementation of the Patient Self Determination Act of 1990.

Adult