Search PubMed⌕ Search

Biomedical subjects

D M Forster

Publications and source records attributed to D M Forster.

At least 37 records · Page 2Linked to original sources
PubMed1994

Posterior decompression and fusion in rheumatoid disease of the cervical spine: redressing the balance.

Forty-seven patients with rheumatoid disease of the cervical spine were followed over an 8-year period. Twenty-one patients with isolated atlantoaxial subluxation and four with combined atlantoaxial and subaxial disease had their atlantoaxial instability treated by posterior decompression and fusion. The incidence of surgical mortality was 8%, and clinical improvement was noted in 75%. There was no neurological deterioration in those patients who survived long term. We have found posterior decompression and fusion to be a satisfactory procedure for the treatment of atlantooccipital subluxation. In our experience, anterior decompression has not been found necessary for successful treatment of atlantoaxial subluxation in patients with rheumatoid cervical spine disease.

Adult↗
PubMed1993

Risk of cerebral bleeding from arteriovenous malformations in pregnancy: the Sheffield experience.

Data were obtained from 191 women with cerebral arteriovenous malformations (AVMs) referred for stereotactic radiosurgery with the Leksell Gamma Unit in Sheffield. The risk of cerebral bleeding from arteriovenous malformations during pregnancy was examined and related to the different trimesters of pregnancy in these women. Some tentative guidelines are suggested for advising women with AVMs, who become pregnant.

Adolescent↗
PubMed1992

Untoward clinical effects after stereotactic radiosurgery for intracranial arteriovenous malformations.

Stereotactic radiosurgery has become one of the most acceptable means of treating deep-seated intracranial arteriovenous malformations, as well as being a useful adjunct in a number of other pathologies. One hundred and sixty patients are discussed, having follow-up of at least 2 years. Radionecrosis occurred in six patients and haemorrhage in the latent period prior to thrombo-obliteration in a further six. Successful thrombo-obliteration was ultimately achieved in 76% of patients. As a bonus, epilepsy was improved in 29 of 48 patients presenting with seizures and worsened transiently in only three of these.

Adolescent↗
PubMed1990

Urinary continence in spinal injury patients following complete sacral posterior rhizotomy.

Complete sacral posterior rhizotomy was carried out in 15 spinal injury patients in conjunction with implantation of sacral anterior root stimulators. All patients were incontinent pre-operatively and had video-pressure cystometry before and at regular intervals after surgery. Detrusor hyper-reflexia was totally abolished in all but 1 patient following rhizotomy and 87% no longer require any form of incontinence appliance. Deafferentation produced adverse changes in vesicourethral function and even when rhizotomy was complete, continence could not be guaranteed. The pre-operative state of the bladder neck and distal sphincter mechanism had an important bearing on future continence and those patients with a closed bladder neck and no previous sphincterotomy had the greatest chance of becoming continent after deafferentation. The majority of patients in this series are now fully continent, representing a transformation in their quality of life; it is recommended, however, that to optimise the success of rhizotomy precise pre-operative evaluation and selection of patients are essential.

Adult↗
PubMed1990

Cerebral radiation necrosis complicating stereotactic radiosurgery for arteriovenous malformation.

A patient presented with symptoms and signs of raised intracranial pressure and increasing focal deficit 13 months after stereotactic radiosurgical treatment of an arteriovenous malformation (AVM). Computed Tomography (CT) showed a mass lesion at the site of the previous abnormality typical of radiation necrosis, but with features identical to those of a malignant neoplasm. Biopsy confirmed cerebral radiation necrosis. The radiation dose was 25 Gray to the periphery of two overlapping 14 mm collimator fields, delivered in a single dose. Treatment with steroids led to improvement in the symptoms and signs of raised intracranial pressure, but not the focal deficit. Radiation necrosis is a consequence of the large doses required to obliterate AVMs and is a limiting factor in their treatment. It is important for clinicians referring patients for stereotactic radiosurgery to be aware of this complication, and to be able to recognise and treat it.

Adult↗
PubMed1989

Results of stereotactic radiosurgery of arteriovenous malformations: an analysis of 52 cases.

The stereotactic radiosurgery unit in Sheffield became operational in September 1985 and over 180 patients harbouring AVMs have been treated. The first 52 patients underwent one year follow up angiography and comprise the material for this study. At one year 26 patients (50%) already had a favourable outcome (16 complete and 10 almost complete obliteration). The results were the same in the two sexes. There was a better response in younger patients: under 20 years 75% favourable, between 20 and 40 years 45% favourable and above 40 years about 25% favourable. Malformations in a lateral position appeared to respond better than those in the midline. Lesions fed by vessels from more than one large vessel territory had less chance of complete obliteration at one year than those gaining blood from only one main supply. There was no difference in outcome between small malformations (less than 2 cm3) medium (2-3 cm3) or large (greater than 3 cm3). No immediate morbidity or late side effects were encountered in these patients. Stereotactic radiosurgery is a safe and effective method in the treatment of arteriovenous malformations but there is a relatively long latency. The number of malformations obliterated is expected to be much higher when two years have elapsed after treatment.

Adolescent↗
PubMed1989

Management of cerebrovascular malformations.

More and more cerebrovascular malformations are being recognized during life as a result of improved imaging techniques. The nature of the different varieties of malformation and their clinical significance are discussed and a brief account given of the relative merits of surgical excision, thrombo-obliteration by stereotactic radiosurgery, and occlusion by endovascular embolization as compared with conservative management.

Embolization, Therapeutic↗
PubMed1988

Long-term follow-up of selective sacral neurectomy.

Between 1976 and 1981, 22 patients underwent selective, complete sacral root section as a treatment for severe detrusor overactivity. Eighteen were followed up for more than 4 years (mean 6.2). Thirteen of the 22 patients had significant symptomatic improvement lasting for more than 4 years post-operatively (59%), 8 of whom had stable bladders. It was concluded that this operation still has a place in the treatment of detrusor overactivity.

Adolescent↗
PubMed1988

Cerebral medullary venous malformations. Report of four cases and review of the literature.

Each type of cerebral vascular malformation has its own unique clinical, radiological and pathological features, and a different pattern of natural evolution. With greater awareness and advances in neuroimaging, there is increasing recognition of Cerebral Medullary Venous Malformations (MVM), angiographically characterised by an 'Umbrella' or 'Caput Medusae' appearance. The clinical and radiological features of four patients with angiographically demonstrable features of cerebral medullary venous malformations, seen in our departments are presented to illustrate the features of cerebral MVMs. Three patients have been managed conservatively and one has been treated with stereotactic radiosurgery. The literature on cerebral MVMs has been reviewed and presented in this paper. It appears that most are benign and even in those cases where there has been a haemorrhage the outcome seems to be much better than with arteriovenous malformations. The rationale behind radiosurgical treatment is discussed. Before embarking upon any form of interventional therapy the natural course of these lesions should be considered.

Adolescent↗
PubMed1979

Selective sacral neurectomy in the management of urinary incontinence due to detrusor instability.

Since Torrens (1974) reported on the use of selective sacral neurectomy in the management of bladder instability, the procedure has been used increasingly in specialised centres. We report the clinical and urodynamic findings in 9 patients in whom this procedure has been performed. The results suggest that selective sacral neurectomy is a valuable procedure in a highly selected group of patients with neurogenic bladder dysfunction. Patient selection, contraindications and the choice of which sacral nerves to divide are discussed.

Adolescent↗
PubMed1979

Relationship between presence of vasoconstrictor activity in cerebrospinal fluid and time after subarachnoid haemorrhage from rupture of cerebral arterial aneurysms.

The relationship between clinical condition and vasoconstrictor factors in cerebrospinal fluid was studied in 19 patients for up to six weeks after subarachnoid haemorrhage. Vasoconstrictor activity was assayed biologically. Sixteen of 19 patients improved as vasoconstrictor activity declined; this pattern was not significantly influenced by surgery. Serial angiography was performed on three patients and a qualitative relationship was shown between arterial dilatation, clinical improvement, and reduced pharmacological activity.

Adult↗
PubMed1978

The broken clip.

Explore the source record for details and available documents.

Female↗
PubMed1978

The value of repeat pan-angiography in cases of unexplained subarachnoid hemorrhage.

Four-vessel angiography was repeated in 56 patients with confirmed subarachnoid hemorrhage in whom the initial investigation was negative. Only one aneurysm was demonstrated. The results suggested that, with good technique, careful observation, and a complete four-vessel cerebral angiography, a false negative rate of less than 2% can be achieved. It is suggested that to repeat pan-angiography is seldom justified unless further bleeding episodes occur.

Adult↗