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Biomedical subjects

R Goodkin

Publications and source records attributed to R Goodkin.

11 recordsLinked to original sources

Resolution of petrous internal carotid artery stenosis after transluminal angioplasty. Case report.

Percutaneous transluminal angioplasty is commonly used for treatment of peripheral vascular disease, but only recently has it been applied to craniocervical lesions. The successful use of percutaneous transluminal angioplasty for treatment of an isolated high-grade stenosis of the petrous internal carotid artery is described in a patient with progressive ischemic symptoms despite maximum medical management. At his 2-year follow-up examination, the patient remained asymptomatic with angiographic evidence of progressive resolution of the stenotic lesion and indirect evidence of improved hemispheric blood flow ipsilateral to the lesion. Percutaneous transluminal angioplasty may provide an effective means of treatment for selective intracranial artherosclerotic stenosis.

Aged

Translumbar amputation.

Six patients underwent translumbar amputation (TLA), a life-saving procedure, after standard modalities of therapy failed to control the progression of the disease. The primary diagnoses were as follows: pelvic arterial-venous (A-V) malformation, 1; sacral chordoma, 3; giant cell tumor of the sacrum, 1; and paraplegia with squamous cell cancer arising in intractable decubitus, 1. There were no operative deaths. The following postoperative complications developed in five patients: urinary fistulae, 2; small bowel obstruction, 1; intraabdominal bleeding, 1; hypertension, 2; small bowel fistula, 1; and dehiscence of skin closure, 1. Two patients died with distant metastases (24 months) and distant metastases with local recurrence (6 months). The remaining four patients were alive and well 72, 56, 48, and 18 months after the surgical procedure. All of these patients have reached the rehabilitation goals.

Adolescent

Arteriovenous malformation and glioma: coexistent or sequential? Case report.

A 9-year-old girl was evaluated for behavioral changes and seizures. Initial computerized tomography and cerebral angiography revealed a left cerebral vascular mass, diagnosed as an arteriovenous malformation. An embolization procedure was attempted but was terminated before completion because the patient developed a right hemiparesis. Her right-sided neurological deficit subsequently increased with enlargement of the mass lesion. On follow-up cerebral angiography approximately 2 years later the vascular malformation was no longer demonstrated. Biopsy of the mass lesion revealed it to be an anaplastic astrocytoma. This case is reported with a review of the literature on the coexistence of a brain tumor and a vascular malformation, the difficulties in diagnosis, and possible etiologies.

Astrocytoma

Herniated lumbar disc disease in patients with malignancy.

Six patients with cancer presented with signs and symptoms of a lumbar herniated disc syndrome due to a herniated lumbar disc. The differential diagnosis and literature are reviewed. In four of the six, the patients' complaints were attributed to the malignancy, with delay in diagnosis and institution of appropriate therapy. In two of the patients, treatment was administered for presumed spinal metastasis with radiation therapy and/or chemotherapy with castration before the correct diagnosis was made. Surgery was performed on all six patients confirming the diagnosis of a herniated lumbar disc at the involved level and relieving the patients' pain.

Adult

Breast cancer with osseous metastasis and herniated lumbar disc. A cautionary tale.

A 39-year-old white woman with breast cancer, metastatic to her skeleton, developed low back and left lower extremity pain and lower extremity weakness. A bone scan evidenced increased radioisotope activity in her lumbar spine and a computed tomography (CT) scan showed a lesion of the L4 vertebra. Because of myelographic findings of a extradural defect at the L4-5 disc space and the possibility of a herniated disc causing the patient's pain and neurologic deficit in her lower extremities, the patient underwent surgery and a large herniated L4-5 disc was removed. As a consequence, the patient experienced relief of the lower extremity pain and return of strength in her lower extremities. She died a considerable time later from refractory hypercalcemia.

Adult

Translabyrinthine removal of cerebellopontine angle meningiomas.

The authors report two cases of the microscopic total removal of meningiomas in the region of the cerebellopontine angle using the translabyrinthine approach. Although both tumors were larger than 4 cm, the only resulting neurological deficit was ipsilateral hearing loss. The translabyrinthine approach may be an alternative measure in dealing with these difficult lesions.

Adult