Search PubMed⌕ Search

Biomedical subjects

C M Fisher

Publications and source records attributed to C M Fisher.

At least 37 records · Page 2Linked to original sources
PubMed1997

Difficulty recalling people's names.

BACKGROUND: Difficulty recalling people's names is common in the adult population, especially in the elderly. The subject is scarcely mentioned in the literature. An 82-year-old patient gave the history that for 33 years he had made prospective observations on his own difficulty with people's names. METHOD: Documentation and analysis of the patient's personal observations in which his ability to recall the names of friends, acquaintances, colleagues, public figures, movie stars and athletes is compared with that of his spouse. A suitable test-battery for the names of famous North American persons was not available. RESULTS: The patient's capability in recalling people's names was clearly inferior to that of his spouse. The patient's intellect was otherwise intact and the impairment seemed to be isolated to the category of proper-naming. Doubts were raised about the patient's own conclusion that the deficit was progressive. CONCLUSIONS: A parallel may be drawn between benign difficulty recalling people's names and the acquired categorical deficit for proper naming reported in the literature in recent years. Based on Damasio's concept of anatomically compartmentalized sensory subsystems, it is hypothesized that our patient's symptom represents an innate limited capacity for proper naming.

Aged↗
PubMed1996

The incidence of deep venous thrombosis after laparoscopic cholecystectomy.

OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT) after laparoscopic cholecystectomy. DESIGN: Prospective cross-sectional analysis, with a one-month follow-up, conducted in 1994. SETTING: University teaching hospital. SUBJECTS: 20 patients undergoing elective or urgent laparoscopic cholecystectomy, consecutively recruited. INTERVENTIONS: Patients received thromboprophylaxis according to the normal practice of the attending surgeon and underwent laparoscopic cholecystectomy. A venous duplex scan was performed before the operation and on Day 1, 7 and 30 after the operation. MAIN OUTCOME MEASURE: The presence of postoperative DVT. RESULTS: All patients were given graduated compression stockings to wear and 16 received electrical stimulation of the calf during the operation. Only 16 patients received pharmacological thromboprophylaxis before the operation, but all patients received this after the operation. The median duration of pneumoperitoneum was 80 minutes (40-160 minutes). Eleven of 19 patients completing all the required scans developed venous thrombosis (incidence, 55%); in three the thromboses involved major axial veins. In one patient the Day 7 and Day 30 scans were not performed, but the Day 1 scan was negative. Seven of the 11 thromboses were detected on the Day 1 scan. None of the DVTs were suspected clinically. CONCLUSIONS: This extremely high incidence of venous thrombosis correlates with the haemodynamic changes which occur in the venous system during pneumoperitoneum. Laparoscopic cholecystectomy should not be considered a procedure with a low risk of DVT, and further studies are needed to determine optimal DVT prophylaxis for laparoscopic surgery.

Adult↗
PubMed1996

Ruptured abdominal aortic aneurysms: who should be offered surgery?

PURPOSE: Operation for ruptured abdominal aortic aneurysm is generally still associated with a high mortality rate. A review of our experience over a 9-year period was undertaken to identify factors present on admission associated with 30-day operative mortality. METHODS: A retrospective analysis of 154 patients with ruptured abdominal aortic aneurysm submitted for operation in a university teaching hospital between January 1985 and December 1993 was undertaken. RESULTS: The hospital mortality rate was 39%. Logistic regression identified a set of five independent preoperative factors associated with mortality: age (> 76 years), creatinine level (> 0.19 mmol/L), loss of consciousness after arrival, Hb (< 9 g%), and electrocardiographic ischemia. In the 52 patients with a single risk factor present, the mortality rate was 37%, with two factors (32 patients) it was 72%, with three or more factors (8 patients), it was 100%, and no patient had all five risk factors. A 16% mortality rate was found in the 62 patients with no risk factors. CONCLUSION: These risk factors can be easily determined on admission and may be used to help improve patient selection for surgical intervention. The current operative mortality rate for ruptured abdominal aortic aneurysm remains high, and in some cases health care resources are used in a nonproductive fashion. Restricted patient selection and allocation of scarce resources will bring advantages to both the patient and the community.

Aged↗
PubMed1996

Variation in measurement of ankle-brachial pressure index in routine clinical practice.

PURPOSE: The purpose of this study was to determine the variation in ankle-brachial pressure index (ABPI) measurements in routine clinical practice. METHODS: Analysis was done of preoperative and postoperative ABPIs in 130 limbs contralateral to those undergoing femoral bypass grafting in 123 patients over a 15-month period. RESULTS: The mean initial ABPI was 0.72 (range 0.22 to 1.10). The range of observed differences between the preoperative and postoperative ABPIs was from -0.33 to +0.25. The mean (+/-SD) difference between the first and second ABPIs was 0.00 (+/-0.11). The 95% confidence limits of the difference were -0.21 to 0.21. There was no trend for the size or direction of the difference in ABPI to vary according to the mean ABPI, brachial blood pressure, or time between tests. CONCLUSIONS: ABPI is routinely used as an objective measure of peripheral vascular disease. The variation observed in this study is comparable with values obtained in reproducibility studies and is greater than that accepted in clinical practice. The difference between an ABPI measurement and the actual ABPI and the difference between repeat single measurements are not the same and should be distinguished. Vascular laboratories should determine the accuracy of ABPI measurement on a local basis to guarantee and maintain quality assurance.

Aged↗
PubMed1996

No additional benefit from laser in balloon angioplasty of the superficial femoral artery.

OBJECTIVES: To evaluate the efficacy of the addition of plaque ablation by hot-tip laser to balloon angioplasty. DESIGN: Prospective randomised clinical trial. MATERIALS AND METHODS: Patients with either occlusion orf > 50% diameter stenosis less than 3 cm in length in the superficial femoral artery, and with two or three calf vessel run-off were eligible and randomised to receive either balloon angioplasty alone or with laser assistance. Treatment failure in follow-up was defined as reocclusion or recurrence of greater that 50% stenosis at the site of angioplasty. RESULTS: Ninety limbs (82 patients) were entered into the study. Forty-four patients had mild claudication, 32 more severe symptoms and 6 rest pain or ulceration. More patients with diabetes (5 of 5, p = 0.04, Fisher's exact test) and occlusions (16 of 22, p < 0.05, chi(2)) were randomised to the laser group. Initial technical success was obtained in all lesions. The median duration of follow-up was 1 year. Failure occurred in 40 limbs during follow-up. Three segments, all with initial occlusions and undergoing laser angioplasty re-occluded within 2 days, one requiring immediate thrombectomy. Another 20 limbs underwent further intervention. Overall success (+/- S.D.) (Kaplan-Meier) at 1 year was 67% (+/- 5%) and at 2 years 43% (+/- 7%). Only increased age, initial occlusion, female sex, and not smoking were significantly (p < 0.05, Cox's proportional hazards) associated with failure; on multivariate analysis, age and occlusion were the best independent predictors. There was no significant difference (p > 0.05) in outcome between limbs undergoing laser assisted balloon angioplasty and balloon alone either overall of within the stenosis or occlusion subgroups. CONCLUSIONS: This study found no significant benefit was gained by the addition of laser to balloon angioplasty and that the long term success was modest for lesions considered to be suitable for angioplasty.

Aged↗
PubMed1996

Hypomanic symptoms caused by herpes simplex encephalitis.

This is a case report of a brief episode of rather typical hypomanic symptoms in the acute phase of presumed herpes simplex encephalitis in a young woman. I infer that the hypomanic episode was triggered from the anterior inferomedial temporal lobe or limbic system, the presumed cerebral substrate of the emotions in general, and review the literature relating to the occurrence of hypomania associated with structural disease of the nervous system.

Adult↗
PubMed1995

Brain herniation: a revision of classical concepts.

This paper is an update on evolving ideas about brain herniations. Following observations on cerebellar pressure coning that raised doubts about its reputed lethal connotations, herniation at the tentorium was re-examined for its role in critically damaging the brain stem. Combining clinical, pathologic, computed tomography and magnetic resonance imaging data, it is concluded that temporal lobe herniation is not the means by which the midbrain sustains irreversible damage in acute cases, but rather lateral displacement of the brain at the tentorium is the prime mover and herniation a harmless accompaniment. Transtentorial herniation has been investigated with computed tomography using the three calcification relationship and descent through the tentorial opening could not be documented. Bilateral brain stem compression in acute bilateral cases must be distinguished from herniation. Upward cerebellar herniation is only the sign of an overfull posterior fossa. Subfalcial herniation is tolerated unless lateral displacement is excessive.

Brain↗
PubMed1995

The economic cost of elective carotid endarterectomy.

Cost awareness and accountability for the use of health care resources have become major issues for clinicians. In order to identify the economic costs associated with carotid endarterectomy (CEA), a retrospective review of 50 elective CEA between May 1993 and April 1994 was undertaken. Despite our belief [based on the Australian National Diagnostic Related Groupings (ANDRG)], that our resource utilization had been refined to produce a median length of stay significantly below the New South Wales (NSW) State average, this study has identified several areas of non-productive expenditure. The mean cost of CEA per patient was $7053. This figure includes non-productive expenditure of $793 per patient in the pre-operative period and $395 per patient in the postoperative period. If these costs, which did not contribute to patient care, were removed the mean cost of CEA would be $5865. The major causes of non-productive resource utilization included prolonged pre-operative stay, duplicated or omitted investigations, as well as the use of the Intensive Care Unit for patient monitoring in the postoperative period.

Aged↗
PubMed1994

Bilateral decompressive craniectomy for worsening coma in acute subarachnoid hemorrhage. Observations in support of the procedure.

Bilateral craniectomy in a woman comatose and decerebrate after a subarachnoid hemorrhage, resulted in normal mentation in 3 days. The dramatic recovery is unmatched in our experience. The rationale rested on clinicopathologic studies showing that in such cases brain swelling was the cause of death, the brain being otherwise intact. Emergency surgery to relieve the tamponade seemed reasonable. The question is whether the procedure has a role in those patients who fail to respond to current therapeutic measures. The arguments in favor, presented herein, are illustrated by three pathologic studies selected from our longtime experience.

Acute Disease↗
PubMed1994

Gait disorders.

Explore the source record for details and available documents.

Aged↗
PubMed1994

Hunger and the temporal lobe.

A boy experienced two episodes of intracerebral hemorrhage in the region of the right anterior temporal lobe. On both occasions, the bleeding was ushered in by an exclamation of intense hunger. The patient provides further evidence for the temporal lobe localization of the sensation of hunger. We describe a model of the neural system subserving feeding that incorporates the cortical locus of hunger.

Cerebral Hemorrhage↗
PubMed1994

Alterations in brainstem and cortical organization of rats sustaining prenatal vibrissa follicle lesions.

Vibrissa follicles were cauterized in late fetal or newborn rats to determine whether the relationships between brainstem and cortical changes observed after neonatal peripheral damage would also be obtained when vibrissa follicles were cauterized earlier in development. Vibrissa follicles were cauterized between embryonic day 15 (E-15) and the day of birth (P-0). The vibrissa-related representation in the brainstem was examined with cytochrome oxidase histochemistry, and that in the cortex was evaluated with either serotonin immunocytochemistry or anterograde labeling with Di-I when animals reached 6-8 days of age. There was a significant relationship between the ages at which lesions were carried out and the extent to which the representations of undamaged vibrissa follicles were altered in the brainstem and cortex. Peripheral lesions carried out between E-15 and E-18 resulted in significant increases in the cross-sectional areas of the patches corresponding to the undamaged vibrissa follicles in both the brainstem and cortex. Lesions at later ages resulted in significant increases only in the cortex. In some animals that sustained peripheral damage on E-20 and all of those that received lesions on P-0, there were aggregates of labeling in cortex that had no counterpart in the brainstem. Prenatal, but not postnatal, vibrissa follicle damage also reduced the overall dimensions of the cortical region devoted to the representation of these receptor organelles. Finally, there was a strong negative correlation between the magnitude of peripheral lesions (i.e., the number of vibrissa follicles ablated) and the extent of the reorganization in the brainstem and cortex.

Afferent Pathways↗
PubMed1993

Concerning mind.

The nature of the human mind is addressed from a neurological viewpoint. First from reported observations on subjects born blind with congenital cataract, who acquired vision after surgery, the concept of the primacy of somatosensation is developed. Therefrom some principles of the organization of higher sensory functions in the dominant parietal, occipital and temporal lobes are deduced. Sentience is traced to somatosensation. Some characteristics of the mind and of thinking are described. The non-existence of the unconscious is inferred. The question of free will is approached. Using neurological experience it is demonstrated that a good case for operation of a free will is difficult to establish. Positing the absence of a free will may be beneficial in the analysis and management of behavior. Finally the opportunity to study the nature and mechanism of the emotions in clinical neurology is outlined.

Blindness↗
PubMed1993

Measurement of the ultrasonic intima-media complex thickness in normal subjects.

PURPOSE: The evolution of atherosclerosis can be studied before development of symptomatic plaque by evaluating morphologic changes of the intima-media (I-M) complex, seen on high-resolution ultrasonography of the arterial wall. These qualitative changes require large alterations in vessel wall appearance to recognize progression of atherosclerosis. It has been suggested that measurement of the thickness of the I-M complex may be a quantitative and more sensitive method of assessing these early atherosclerotic changes. METHODS: High-resolution ultrasonography has been used to measure the thickness of the I-M complex in 140 symptom-free subjects. RESULTS: The mean thickness of the I-M complex of the common carotid arteries was linearly related to the age (r = 0.77; p < 0.001), pack-years of smoking (r = 0.39; p < 0.05), the systolic blood pressure (r = 0.51, p < 0.01), and to the arterial ultrasound score (r = 0.85). The arterial ultrasound score has previously been shown to correlate with the presence of asymptomatic myocardial ischemia and with the development of cardiovascular symptoms. The mean thickness of the I-M complex in subjects without plaque (in the common carotid or common femoral artery bifurcations) was significantly thinner than in subjects with plaque (p < 0.001). CONCLUSION: The thickness of the I-M complex of the common carotid arteries is a measure of the risk for the development of cardiovascular symptoms in symptom-free individuals.

Adolescent↗