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Biomedical subjects

R C Holgate

Publications and source records attributed to R C Holgate.

At least 19 recordsLinked to original sources
PubMed1994

Interventional techniques in the management of disorders of the brain: current status.

The role, techniques and tools of interventional neuroradiology are growing rapidly because of the number of active investigators. Training programs are being certified by the American Society of Neuroradiology. Recommendations are that Interventional Neuroradiologists be fully qualified in neuroradiology (two years) and have a one or two-year additional fellowship in interventional. The ideal interventionalist would also have some clinical neuroscience training. While these training requirements seem excessive on the surface one must recognize that with the overall drop in routine angiography that a longer exposure is necessary to acquire the prerequisite knowledge, skill and experience easily obtained in one year ten years ago. In fact there has been some pressure to place all of diagnostic neuroangiography in the hands of interventionalists. Endovascular approaches are the treatment of choice for: (1) cerebral vasospasm, (2) carotid cavernous fistulae, (3) vertebral artery origin stenosis, (4) subclavian artery stenosis, (5) innominate and left carotid origin stenosis, and (6) giant intracranial aneurysms. Endovascular treatment is developmental and should be restricted to centers performing formal trials in the treatment of: (1) cerebral arteriovenous malformations and (2) internal carotid artery and intracranial stenosis.

Cerebrovascular Disorders↗
PubMed1991

Brain MRI in obsessive-compulsive disorder.

Magnetic resonance imaging (MRI) brain scans were performed on 12 patients with obsessive-compulsive disorder and 12 healthy controls. Measurements of the area of the head of the caudate nucleus, cingulate gyrus thickness, intracaudate/frontal horn ratio, and area of the corpus callosum did not differ between the two groups. These limited data do not support the presence of a consistent gross brain structural abnormality in obsessive-compulsive disorder. Further studies using other anatomic measurements and other brain structural imaging techniques are warranted.

Adult↗
PubMed1990

Acute-onset Brown's syndrome associated with pansinusitis.

We treated a 5-year-old girl and a 6-year-old boy with acquired Brown's syndrome associated with pansinusitis. In both patients, the diagnosis was established roentgenographically, and the patients were treated with oral antibiotics. Systemic corticosteroids were used in one case, although their clinical value was uncertain. Patients presenting with acute-onset Brown's syndrome of undetermined cause should undergo computed imaging of the orbits and paranasal sinuses.

Amoxicillin↗
PubMed1990

Persistent stapedial artery supplying a glomus tympanicum tumor.

Vascular anomalies of the middle ear are extremely rare. The most common anomaly is a persistent stapedial artery. This artery is important clinically because of the risk of profuse bleeding during middle ear surgery. We describe a 26-year-old woman with a glomus tympanicum tumor. The blood supply to the tumor was from a persistent stapedial artery. A preoperative angiogram supported this finding by demonstrating a small vessel originating from the anterior branch of the middle meningeal artery as the major vascular supply to the tumor. To our knowledge, this is the first case report of a glomus tympanicum tumor vascularized by a persistent stapedial artery that was suggested by angiography and confirmed intraoperatively. To better understand this anomaly, we review the embryological development of the stapedial artery and discuss its clinical significance.

Adult↗
PubMed1988

Rectus muscle position in V-pattern strabismus. A study with coronal computed tomography scanning.

Coronal computerized tomographic (CT) scans were obtained on ten children with previously unoperated V-pattern strabismus and ten control patients to determine the relationship of rectus muscles to the globe. All patients with V-pattern had sufficient overaction of the inferior oblique muscles to warrant bilateral surgical weakening. Control patients had no strabismus or isolated horizontal deviations without A- or V-patterns. Using a horizontal reference line constructed along the anterior cranial fossa, the mean horizontal rectus-muscle axes were found to approximate the expected value of 180 degrees closely. The vertical rectus muscle axes were excyclotorted in both groups. However, there was no significant difference in the mean superior temporal quadrant angles formed by the intersection of the horizontal and vertical rectus muscle axes. Analysis of covariance with age as the covariant demonstrated a significant relationship (P less than 0.01) between age and the superior temporal quadrant angle measured in each eye. Our data suggest that apparent rectus muscle malposition identified by CT scanning is a function of age and cannot be implicated as an important cause of V-pattern strabismus.

Age Factors↗
PubMed1988

Penetrating intracranial wood wounds: clinical limitations of computerized tomography.

The case history of a patient with a periorbital penetrating wooden foreign body is presented. The computerized tomography (CT) densities of several different sources of wood were compared using an experimental model. The clinical usefulness and practical limitations of CT in the evaluation of intracranial foreign bodies is discussed, and the management of this type of injury is reviewed.

Brain Injuries↗
PubMed1987

Midline central nervous lipomas in children.

We review the clinical, radiologic, surgical, and pathologic features of 15 children with central nervous system lipomas. Three were situated in the corpus callosum and 12 at the conus medullaris. The intracranial and the intraspinal disorders share several features suggesting that they are related. Both are midline developmental abnormalities associated with dysraphism and both may have extrinsic as well as intrinsic components. Both can occur as occult asymptomatic lesions, particularly early in life, or can be part of extensive dysraphic malformations. Computed tomography is the best way to demonstrate the nature and extent of these lesions prior to treatment.

Adolescent↗
PubMed1983

Lesions simulating glomus tumors of the middle ear.

Several non-glomus middle ear masses may mimic glomus tumors. Clinical features alone may not be sufficient to differentiate these lesions. Radiography, particularly angiography is valuable in establishing the diagnosis in most cases. In some, however, diagnosis can only be made on tympanotomy. Four case reports are included in which the diagnosis turned out to be hemangioma, meningioma, high jugular bulb, and cholesterol granuloma. Careful assessment of the clinical, radiological, and operative findings is essential in order to avoid serious complications.

Cholesterol Esters↗
PubMed1982

Sophisticated CT in complex maxillofacial trauma.

Conventional radiology and selective complex-motion tomography suffice for the diagnosis of isolated facial fractures. Complex facial fractures, however, require a more directed diagnostic approach, utilizing the imaging potential of computed tomography (CT). In the acutely injured but stable patient, unenhanced axial CT (preview-monitored under clinical orientation) provides the most effective, safe, reasonably rapid diagnostic examination. Direct coronal CT can also be utilized. The brain is studied by contiguous 10 mm slices; the facial skeleton is studied with contiguous 5 mm slices, which permits coronal and sagittal reformations. In suspected cervical spine injury (where direct coronal CT is contraindicated), the axial CT format above will provide essential diagnostic information and allow image reconstruction. The late complications of brain abscess and CSF leak are well imaged by CT; the latter is best assessed (during activity) by preview-controlled CT after intrathecal injection of metrizamide.

Brain Injuries↗
PubMed1982

Clinically-directed CT in occult disease of the skull base involving foramen ovale.

Occult disease of the skull base may present as an isolated neurogenic symptom in the absence of physical signs or radiologic findings. It therefore often remains undiagnosed until advanced. Computed tomography (CT) provides the potential for diagnostic imaging far beyond conventional radiology. Not only do current generation scanners provide exquisite bone detail, they also provide the capability of soft tissue imaging. In the past year, we have matched the diagnostic problem of occult disease of the middle fossa skull base and its foramina with the potential diagnostic imaging solution of CT. Five patients were referred with possible occult middle fossa skull base disease--all had persistent unilateral facial paraesthesia in the distribution of one of the lower two trigeminal nerve divisions (V2 V3) as their only complaint; all had previously been extensively investigated (including axial CT); all remained undiagnosed. Utilizing clinically-directed CT (based on acoustic neuroma diagnostic index of suspicion and imaging experience), 2 of the 5 patients were found to have small mass lesions involving foramen ovale. This presentation will demonstrate our experience based on image-manipulated CT, actively monitored by both radiologist and otolaryngologist.

Adult↗
PubMed1982

CT and intracranial manifestations of otorhinologic disease.

Most inflammatory and neoplastic diseases of the ear, nose, nasopharynx, and paranasal sinuses have the capability of intracranial extension. CT is extremely important in defining such lesions, and surpasses complex motion tomography in delineating the extracranial soft tissue involvement and intracranial spread. Trauma can simultaneously affect both intracranial and extracranial compartments but because of its scope, is not dealt with in this submission.

Adenocarcinoma↗
PubMed1982

CT in occult disease of the skull base and basilar foramina.

Current generation CT with its high resolution technology, its capability for soft tissue and bone imaging through an expanded gray scale, its feature of thin section imaging (1.5 mm cuts), and its capacity for multiplanar imaging (axial, direct coronal, coronal, and sagittal reformations, etc.) bring a truly unique element to radiologic evaluation of the skull base and basilar foramina. CT modifications continue to develop, such as dynamic scanning. Thus CT provides the possibility of improved radiologic diagnosis in a clinically problematic area--the recognition of occult disease, invariably tumor, involving the skull base, the neurovascular foramina that penetrate it, and portions of the subjacent visceral cranium and the suprajacent brain. The purpose of this manuscript is to demonstrate and define a role for CT in the possible solution of this problem. Equally, a role for the selective and continued use of conventional radiology and other imaging modalities to both guide and complement CT is considered.

Brain Neoplasms↗