Biomedical subjects
Publications and source records attributed to M A Mangan.
Breast cancer is the leading malignancy in women in the United States. Breast reconstruction is an important aspect in the treatment regime for breast cancer. Reconstruction now is a daily occurrence, providing women with a life-enhancing opportunity. Women contemplating reconstruction may choose from a broad menu of options allowing for tailored care.
A large personal experience with breast reconstruction using tissue expanders (149 patients with Radovans, and more than 150 patients with Beckers), with many suboptimal results especially in the early learning stages, has brought about changes in approach offering a much higher probability of acceptable breasts. This report attempts to combine multiple factors useful in yielding such results. Areas addressed include immediate versus delayed reconstruction, selection of candidates, selection of expander type, appropriate placement of expander at a site minimizing the requirement for pocket modification, choosing the optimal size expander, importance of maximal overexpansion to yield a good submammary fold, and means of determining adequate overexpansion to match an unmodified contralateral breast and the risks inherent in overexpansion. Timing, interval, and length of maintenance of hyperexpansion are described along with deflation and timing of port removal. Both the skate and star techniques of nipple and areolar reconstruction in the hyperexpanded patient yield very acceptable results despite thinned skin and minimal subcutaneous tissue. Good, satisfactory, and suboptimal clinical results will be presented. In our experience, tissue expansion reconstruction offers distinct advantages in a large majority of patients with the proviso that patients are willing to accept the time required for hyperexpansion and the waiting period for deflation.
Two patients with congenital anomaly of the craniovertebral junction causing disabling hemifacial spasm (HFS) are presented. In one patient, complete cessation of the HFS occurred for a period of two years following simple bony decompression of the craniovertebral junction raising unanswered questions as to the exact pathogenesis of HFS. Eventually both patients required microvascular decompression at the root entry zone of the facial nerve.
The problem of intracranial aneurysm causing subarachnoid hemorrhage in several members of three different families is illustrated and discussed in this report.
The pedigree of two interrelated families with 10 affected members suffering from malignant supratentorial gliomas is reported. In addition, three other unrelated families with two members each who were treated for different types of brain tumors are described. Genetic implications are discussed.
Provocative tests of hypothalamic-pituitary function were performed in 20 healthy subjects to learn whether the simultaneous testing by three agents--insulin, thyrotropin-releasing hormone, and luteinizing hormone-releasing hormone--was feasible. The responses to simultaneous testing on one day did not differ significantly from those to testing on three separate days. The time and expense of pituitary-hypothalamic testing can thus be much reduced with no impairment of reliability and with no increased risk to the patient.
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It is rare for patients with diastematomyelia to manifest initial symptoms in adult life. Clinical, radiological, and surgical features of a patient with symptomatic adult diastematomyelia are presented. Pathogenetic mechanisms are considered to include a variety of congenital spinal anomalies, distinct from the spur, as well as mechanical factors.
The authors report a case of acute spinal cord compression caused by a subarachnoid and subdural hematoma. This occurred following traumatic brachial plexus avulsion. It is believed to be the first such case recorded.
The surgical treatment of carotid cavernous fistula gradually evolved into a "trapping" technique. This technique includes ligation of the cervical internal carotid artery, clipping of the intracranial portion distal to the fistula and often embolization of the isolated segment. The development of embolization techniques using intravascular balloon catheters greatly simplified this treatment. The authors report a case of spontaneous carotid cavernous fistula in which obliteration was achieved by an intracarotid balloon catheter. This was inserted by direct puncture of the carotid artery, which had been exposed by a simple neck incision. The patient's visual acuity was preserved. The efficacy, ease and safety of this method are emphasized.
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