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Biomedical subjects

D H Wilson

Publications and source records attributed to D H Wilson.

At least 73 records · Page 4Linked to original sources
PubMed1983

Forebrain commissurotomy for epilepsy. Review of 20 consecutive cases.

During the past 10 years, 20 patients with intractable generalized, generalized and partial, and partial seizures have been treated here by surgical division of one or more of the forebrain commissures. Modifications in the operative technique and extent of operation have resulted in continued good results in seizure control with decreased morbidity. The present operation, a two-stage division of the corpus callosum and underlying hippocampal commissure, is demonstrated to be effective in controlling intractable seizures. Good or excellent results account for more than 80 per cent of the series. Historical background, indications for operation, criteria for patient selection, operative technique, results, complications, and the value of forebrain commissurotomy as a research tool are presented.

Adolescent↗
PubMed1982

Teaching in casualty.

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Education, Medical, Undergraduate↗
PubMed1982

1086 consecutive injuries caused by glass.

A prospective study of 1086 consecutive injuries caused by glass showed that the mean age of the patients was 15 years and there was a 7 : 3 male to female ratio. The home (35 per cent), public places (31.3 per cent) and places of work (21.1 per cent) were the main locations where these accidents occurred. Although most of the injuries were mild, 3 case histories illustrate that some of them were extremely serious. 4.6 per cent of patients requiring immediate admission to hospital. Extrapolation of the figures indicates that approximately 210,000 people attend hospital each year in England and Wales for treatment of an injury caused by glass. The annual cost to the National Health Service is about 7,500,000 pounds but the full financial implications of these injuries in terms of compensation and insurance payments must be much greater. Suggestions are made of ways to reduce the incidence of these injuries from road traffic accidents and accidents with plate glass and glass containers.

Accident Prevention↗
PubMed1982

Cortical mechanisms involved in praxis: observations following partial and complete section of the corpus callosum in man.

In patients who have undergone complete section of the corpus callosum for intractable epilepsy, lateralized presentation of visual nonverbal stimulation showed that the coordination of motor acts by either hand is controlled exclusively by the contralateral hemisphere. When two patients had serial operations consisting of an initial division of the splenium and posterior 3 cm, followed by complete callosal division, an opportunity arose to test the explicit cortical pathways involved in ipsilateral control. Between operations, these patients could not coordinate movements of the hand ipsilateral to the hemisphere receiving the command. This suggested that for visual nonverbal stimulation, the posterior 3 cm of corpus callosum is necessary for control of the ipsilateral hand; the rostral callosum cannot transfer sensorimotor commands. Also, contrary to current views, each hemisphere can carry out sequentially dependent motor activity.

Corpus Callosum↗
PubMed1982

"Central" commissurotomy for intractable generalized epilepsy: series two.

A second consecutive series of 12 patients underwent microsurgical "central" commissurotomy (division of the entire corpus callosum and hippocampal commissure) for the relief of previously intractable generalized seizures. This modified operation was found to be safer than the multiple commissurotomies performed in the first series of eight patients and was equally effective. Central commissurotomy was modified further by being performed in two stages, which reduced the length and severity of the "acute disconnection syndrome," a common cause of morbidity in the early postoperative phase. Best results were obtained in patients who were not severely retarded, had signs of unilateral cerebral damage, and included akinetic spells as a prominent form of their generalized seizures. EEG showed that bilateral symmetric discharge became either unilateral or asymmetric after surgery, which emphasized the important role played by the corpus callosum in conducting seizure discharges from one hemisphere to the other.

Adolescent↗
PubMed1982

Telencephalic theory of generalized epilepsy: observations in split-brain patients.

The anatomical structures involved in the origin and spread of generalized seizures in humans have not been fully elucidated. Cortical, centrencephalic, and corticoreticular theories have been proposed to explain the clinical and electroencephalographic findings in patients with primary, generalized epilepsy or secondarily generalized seizures. Our observations in patients undergoing forebrain commissurotomy for intractable, generalized seizures lead us to propose a telencephalic theory of generalized epilepsy. This theory stresses the importance of the cerebral cortex as the site of origin of seizure discharge and the function of the forebrain commissures in the rapid propagation and bilateral synchronization of such discharge. These observations plus a review of the data generated from animal models of epilepsy are presented as evidence for such a theory. Although none of our patients had classical petit mal epilepsy, our findings suggest a secondary role of the brain stem reticular formation in generalized seizures and may be cogent to the discussion of primary, generalized epilepsy.

Adolescent↗
PubMed1981

Cognitive interaction after staged callosal section: evidence for transfer of semantic activation.

Sensory and cognitive functions were assessed in a right-handed male before and after partial and complete callosal commissurotomy. After the initial posterior section was made, there was no evidence of interhemispheric sensory transfer, although the left hemisphere did have access to stimulus-related semantic and episodic information from the right hemisphere. After the callosum was completely sectioned, this exchange was no longer observed.

Adult↗
PubMed1981

Death of my baby.

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Emergency Medicine↗
PubMed1981

Staged commissurotomy and central auditory function.

Two young right-handed men with normal peripheral hearing underwent a "staged" commissurotomy procedure. At the first surgical setting, approximately the posterior half of the corpus callosum was sectioned. Approximately two months after the first operation, the remaining portion was surgically disconnected. Extensive central auditory assessment indicated little deficit after each surgery, which was not the case in previous data on patients with commissurotomy at one setting. We discuss possible mechanisms for these differing results, along with the advantages of the staged surgical procedure.

Adult↗
PubMed1981

Aerobic and anaerobic bacteriology of subcutaneous abscesses.

Pus from 84 patients with subcutaneous abscesses was examined for aerobic and anaerobic bacteria: organisms were recovered from 70 (83.3 per cent). In 13 no organisms were seen in the Gram-stained smears and the cultures showed no bacterial growth. Staphylococcus aureus was the most prevalent organism (n = 44), isolated in 43 in pure culture, in marked contrast to the anaerobic organisms which almost invariably were associated with mixed cultures. All patients were treated by the primary suture method. Half of them were not given preoperative antibiotics and 3 developed bacteraemia and 1 septicaemia. Blood isolates were of S. aureus of the same phage type as pus isolates. The other patients received one infection of 300 mg of clindamycin phosphate 30 min to 1 h before surgery. From this group only one patient, with a perianal abscess, developed Escherichia coli bacteraemia. The levels of clindamycin in the abscess aspirate were inhibitory for S. aureus, bacteroides, streptococci and other Gram-positive bacteria but not for E. coli.

Abscess↗
PubMed1981

Microsurgical and standard removal of the protruded lumbar disc: a comparative study.

The operation of lumbar discectomy has been improved steadily since its introduction by Mixter and Barr in 1934. The present standard operation represents an accumulation of techniques that became available to succeeding generations of neurosurgeons. The addition of microsurgical technique may be the most recent means to refine the process of lumbar discectomy. One hundred cases of microsurgical discectomy were compared to the same number of standard operations, all performed by one surgeon and analyzed by another. The patient profiles were the same; the operative results showed that the standard discectomy was of good quality and that microsurgical discectomy could equal it; in comparing postoperative results, however, microsurgical discectomy was superior to the standard operation: patients returned to their usual activities in half the time. The advantage of the microsurgical technique is its capacity to preserve better the integrity of normal tissue and to impose less trauma on the body. From this analysis, we conclude that microsurgical discectomy represents a small but significant refinement of standard discectomy.

Humans↗
PubMed1981

Variability in right hemisphere language function after callosal section: evidence for a continuum of generative capacity.

Two recent patients in our behavioral series investigating the psychological effects of callosal section exhibit right hemisphere language. Using lateralized visual and auditory stimulation, semantic, phonetic, and expressive linguistic functions were examined. While the right hemisphere language systems in both patients were shown to be capable of semantic information processing, they differed in their abilities to process phonetic information, follow verbal commands, and produce linguistic responses. It is argued that the differences between left and right hemisphere language systems are quantitative and are best characterized along a continuum of generative capacity. It is the variability in such capacity that appears to be responsible for the variability in right hemisphere language function within the split-brain population.

Adult↗
PubMed1980

Antibiotics in surgical treatment of acute abscesses.

A four-way, double-blind, prospective trial of treatment of abscesses by incision, curettage, and primary closure with and without antibiotic cover (clindamycin injection before operation or capsules after operation, or both) was conducted. There was no appreciable difference in mean healing time between the patients given both the antibiotic injection and the antibiotic capsules and those given the injection and placebo capsules, whereas healing times in those given the placebo injection and antibiotic capsules or placebo only were appreciably longer. Four of the patients who were not given the antibiotic injection developed bacteraemia; one patient who was given the antibiotic injection also developed a bacteraemia, but this was caused by clindamycin-resistant bacteria. These results show that a single injection of an effective antibiotic before operation is sufficient to protect the patient against bacteraemia and permit optimum healing.

Abscess↗