Biomedical subjects
Publications and source records attributed to M A Weinstein.
Lateral subcutaneous internal anal sphincterotomy in the management of chronic anal fissures is well established. Its role in the management of the acute severely painful fissure is reported and the technic described.
A case of dural arteriovenous malformation involving the cavernous sinus is reported. The patient was successfully treated with selective embolisation of the fistula. These patients constitute a distinct neuro-ophthalmological syndrome which may be very difficult to diagnose clinically because of the subtle signs and symptoms they present with. Angiography is necessary to make diagnosis and to differentiate these patients from those with the more common carotidcavernous fistulae.
Computed tomography (CT) accurately localized juvenile angiofibromata in 3 patients. The expanded pterygopalatine fossa and canal were visualized by CT in all three cases. Because of the hemorrhagic tendency of these tumors, a noninvasive modality such as CT is especially valuable in planning therapy.
Computed tomography demonstrated areas of abnormal attenuation in the white matter in 14 patients with multiple sclerosis (MS). Nine were studied two or more times. Acute MS lesions exhibit decreased or normal attenuation without contrast enhancement and increased attenuation with it. On later scans these lesions show decreased attenuation with or without contrast material. Some lesions remain decreased in attenuation and some become normal both with and without contrast material.
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The use of the pulsating water jet lavage (Water Pik) in the care of the perineal wound is discussed. The relative case with which debridement of a difficult-to-locate perineal wound can be efficiently debrided and cared for by a patient on an ambulatory basis is stressed. This facilitates early patient hospital discharge and offers effective self-care to the patient.
Eleven patients with injuries of the rectum and sigmoid colon secondary to the insertion of the clenched fist are presented. Six patients sustained mucosal lacerations of the rectum and four patients had rectosigmoid perforations requiring laparotomy. One patient sustained a severe sphincter laceration producing complete anal incontinence. The management of these conditions is discussed.
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The white and gray matter of the brain can be clearly differentiated by computed tomography (CT). The differentiation is enhanced by the administration of contrast material. Without contrast material, the mean attenuation number of the white matter was 29 units, of the gray matter, 35 units. The effective low contrast resolving power of CT scanners can be clinically evaluated by comparing their ability to differentiate the white and gray matter of the brain.
Basilar artery eclasia was demonstrated by computed tomography (CT) in 4 cases. The course and diameter of the basilar artery as seen by CT closely approximated those aspects of the artery visualized by angiography. The clinical manifestations of basilar ectasia correlated with what brain stem structures were impinged upon by the ectatic artery.
Computed tomography has revolutionized the diagnosis of ophthalmologic and neuro-ophthalmologic disease. High resolution CT with thin-section techniques has made available the depiction of finer anatomic orbital detail and permits radiologic detection of more subtle lesions than was previously available. The display of normal-sized superior ophthalmic veins by CT is further evidence of the resolving power of the currently available machines. A segment of the superior ophthalmic vein was identified in 18 of 64 orbits examined by CT. Virtually the entire superior ophthalmic vein was identified in three orbits.
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Branches of the anterior and middle cerebral arteries and thalamostriate, septal, and internal cerebral veins can be clearly defined with computed tomography during contrast enhancement with the Ohio Nuclear Delta 25 scanner. Pathologic vessels can also be recognized. Visualization of vessels smaller than 1.5 mm belongs in the province of angiography.
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One thousand consecutive computed tomograms were reviewed to determine the accuracy of the procedure in the detection of juxtasellar lesions. The detection rate was compared to those of plain skull films, radionuclide studies, angiography, and pneumoencephalography. Computed tomography was slightly superior to angiography and was surpassed only by pneumoencephalography, both of which are invasive procedures which carry a definite risk. The data indicate that computed tomography is the screening method of choice in the detection of juxtasellar masses.
The orbit is an ideal structure to examine by CT because of large differences between absorption values of retroorbital fat and other structures such as muscle, optic nerve, and ophthalmic artery. Spatial resolution in CT is dependent upon the volume of each pixel (individual picture element). Whereas the pixel volume of the original EMI scanner was 117 mm, that of the Ohio Nuclear Delta head scanner employed in this paper is only 5 mm. Ovver 200 patients have been examined using this scanning instrument, including 32 patients in whom the orbits were specifically examined with a scan plane parallel to Reid's baseline. Representative abnormalities are discussed and illustrated. Orbital tumors such as hemangiomas, lymphomas, meningiomas, and inflammatory pseudotumors can be accurately localized while still very small.