Comments on proficiency testing.
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Biomedical subjects
Publications and source records attributed to R Rand.
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The reconstruction of mandibular defects pose problems because of the nature of the facial skeleton. The mandibular moves continuously. In contrast, nasal and orbital bone grafts have to be immobilized.
Unexpected complications may follow therapeutic embolization, even though no apparent technical errors have occurred. This report includes four cases of facial palsy following middle meningeal artery embolization, one case of aspiration pneumonia following glomus tumor embolization, and a case of pulmonary embolization following embolization of a spinal arteriovenous malformation.
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Of the approximately 160 acoustic neuroma patients treated with stereotactic radiosurgery in the world up to 1987, 8 patients at UCLA Medical Center have had two or more magnetic resonance scans at least one year apart available for study (all 8 patients were treated with stereotactic radiosurgery for acoustic neuromas by the Department of Neurosurgery at the Karolinska Hospital, Stockholm, Sweden). The followup time after radiosurgery ranged from 4 to 8 years. The volume doubling rate post-stereotactic radiosurgery was calculated to be slow (763 to 888 days) in two patients, virtually arrested in five patients (doubling times larger than 2500 days) and negative (-563 days) in one patient indicating a shrinking tumor. Due to the limited sample size no radiological finding or clinical data correlated with the volume doubling times. A control patient that had no treatment for her tumor had a doubling time of 217 days for comparison.
The magnetic resonance (MR) appearance of hemorrhagic acoustic neuromas has not previously been reported. Four patients with surgically proven acoustic neuromas containing spontaneous hemorrhage were preoperatively evaluated with MR imaging. All patients presented with new onset of symptoms and three had subarachnoid hemorrhage. Signal changes on T1- and T2-weighted spin echo sequences were characteristic for acute, subacute and chronic intraparenchymal hemorrhage. Recognition of hemorrhagic changes on MR is important since more rapid surgical intervention is required in this patient subgroup.