Biomedical subjects
M Lubow
Publications and source records attributed to M Lubow.
'Pseudo' pseudotumor cerebri in aplastic anemia.
Explore the source record for details and available documents.
Prevention of stroke by carotid endarterectomy.
Cerebral stroke can occur in patients having visual symptoms only. Fundoscopy is valuable in identifying those patients with visual symptoms who are likely to have carotid disease; and carotid endarterectomy can prevent a stroke in a significant percentage of patients at risk. Meticulous operative technique is essential. In a series of 187 carotid endarterectomies performed on 154 patients over a 7-year period, the operative mortality rate was zero. Operative morbidity was 1.3% in 139 patients who had no prior permanent neurological deficits, and 13% in 15 patients who had suffered previous strokes. Data compiled on follow-up for an average of 20 months indicated that six patients (4.7%) suffered postoperative strokes, nine patients (7%) experienced persistence of symptoms, and 113 patients (88.3%) remained neurologically well.
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.
Surgical management of the totally occluded carotid artery.
Surgical revascularization of the completely occluded carotid artery was evaluated in 19 symptomatic patients who had recurrent episodes of amaurosis fugax or transient hemiparesis. Nine had complete internal carotid occlusion on arteriography and 10 had severe stenosis which had progressed to total occlusion by the time of surgical exploration. At operation irreparable fibrotic changes were observed in four patients, but in 15 a pattern of proximal focal obstruction with relatively healthy distal internal carotid vessels was observed. Thromboendarterectomy produced good back-bleeding in most of these and resulted in improved carotid flow after operation. Seventeen of 19 patients were relieved of symptoms. Two patients continued to have symptoms, but less frequently. There were no deaths after operation. Follow-up from 3 to 36 months showed no change from immediate postoperative results. This study suggests that carotid artery exploration and thromboendarterectomy should be considered when transient ischemic episodes are present despite complete internal carotid artery occlusion.
Visual loss and perioptic vascular malformations in the eye and orbit.
Three patients with monocular visual symptoms had intraocular vascular malformations, presumably congenital, in the affected eye. Special radiographic techniques (magnification of the orbit with subtraction of overlying bone during carotid arteriography) were necessary to demonstrate the orbital perioptic vascular malformations that were responsible for the visual symptoms.
Chromophobe adenoma and chiasmal syndrome without enlargement of the bony sella.
Four cases of chiasmal syndrome resulting from chromophobe adenoma with normal-sized sella turcica are reported. The predominantly suprasellar growth of these tumors was probably the result of a well-pneumatized sphenoid sinus and/or a congenitally deficient diaphragma sellae. In patients with chiasmal syndrome, a high suspicion of a surgically treatable lesion must be maintained in spite of radiographs showing a normal-sized sella. In spite of the difficulties presented by normal variations, subtle findings should be searched for on the plain films and given additional weight in the patient with a chiasmal syndrome. An aggressive diagnostic work-up, including pneumoencephalography with thin-section tomography, should be pursued in all such patients before accepting some alternate explanation, such as demyelinating disease, for visual impairment.
Polytomoencephalography of the optic chiasm and adjacent structures.
The addition of polytomography considerably increases the sensitivity of pneumoencephalography. The chiasmatic area lends itself particularly well to investigation by polytomoencephalography. In a series of 28 patients, the transverse dimension of the optic chiasm ranged from 4 to 20 mm, with a mean of 18 mm. The posterior portion of the chiasm tended to be U-shaped; its anterior portion's shape was that of a dumbbell. Intrachiasmatic tumors distort and enlarge the chiasm. The diaphragma sella is also particularly well evaluated by this technique. The study is safe, reliable, and can be repeated as needed.
Effect of argon laser on proteolytic enzymes within the bovine vitreous.
Explore the source record for details and available documents.