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Biomedical subjects

D Uttley

Publications and source records attributed to D Uttley.

At least 55 records · Page 3Linked to original sources
PubMed1989

Surgical management of midline skull-base tumors: a new approach.

Many surgical approaches to the clivus and upper cervical spine have been used in the treatment of skull-base tumors over the past 50 years. However, the outcome of surgery has been complicated by difficulties of access to the whole clivus, together with pharyngeal wound breakdown with subsequent development of cerebrospinal fluid (CSF) fistula and meningitis. A technique described recently utilized Le Fort I osteotomy to improve exposure of the clivus in the approach to vertebrobasilar aneurysms, facilitating control of the aneurysm and reducing the risk of posttraumatic CSF fistula. The same approach, via maxillotomy, has permitted partial or total tumor resection in 13 consecutive procedures carried out at Atkinson Morley's Hospital on 10 patients presenting with tumors of the skull base. Neurological status was either improved or unchanged in all patients postoperatively, and pain relief was obtained in five of eight cases in which this was a presenting symptom. No patient developed a CSF fistula following surgery. Cosmetic results were good, and no problems related to malocclusion were reported. This approach may be used to advantage in the surgical treatment of skull-base tumors, at initial presentation, and can be repeated without undue difficulty should there be tumor recurrence.

Adult↗
PubMed1989

Neurosurgery for cervical spondylosis.

The pathogenesis of radiculopathy and myelopathy secondary to cervical spondylosis is described, together with the clinical features of these conditions and the factors that influence their natural history. After discussing the differential diagnosis the medical management and the indications for surgery are considered. Details of the operative approaches are presented in association with the results of treatment.

Humans↗
PubMed1988

Application of radioimmunoassay to monitor treatment of human cerebral gliomas with bleomycin entrapped within liposomes.

A radioimmunoassay was assessed for its suitability for monitoring the blood and urinary concentrations of bleomycin entrapped within large unilamellar liposomes in patients receiving therapeutic doses of the drug. Bleomycin entrapped within liposomes was administered by direct intracerebral injection to three patients with grade III to IV cerebral gliomas, twice weekly for up to six weeks. No clinically important toxic effects were observed which could have been attributed to these preparations, although all three patients showed progressive deterioration in their clinical condition. This type of treatment may be more beneficial to patients at an earlier stage of their disease.

Adolescent↗
PubMed1988

CT scanning in the management of intracranial abscess: a review of 100 cases.

One hundred cases of brain abscess presenting between 1974 and 1984 are reviewed. The overall mortality was 20%, 98 cases were actively treated with a peroperative mortality of 14%. The results are compared to Garfield's 1969 series, drawn from similar clinical material. Changes in presentation and outcome are described. A significant improvement in survival (p less than 0.001) has occurred following the introduction of computerised tomography (CT Scan) which permits the rapid diagnosis and accurate localisation of intracranial sepsis. As the basic therapeutic regime remains unchanged (burr hole aspiration and appropriate antibiotic treatment), other aspects of management have been examined, leading to the suggestion that CT Scanning has made a major contribution to the reduction in mortality.

Adolescent↗
PubMed1987

Management of subdural empyema: a series of 24 cases.

Twenty four cases of subdural empyema are reviewed. The overall mortality was 17%, 18 patients were managed by burr hole and five by craniotomy or craniectomy. Antibiotic therapy was commenced once pus had been evacuated. Infection of the paranasal and mastoid sinuses was the commonest aetiological factor. Aspiration of pus through burr holes is the recommended surgical procedure with low mortality and morbidity, when combined with early diagnosis and aggressive chemotherapy.

Adult↗
PubMed1987

Basilar aneurysms: a new transclival approach via maxillotomy.

A transoral transclival approach to vertebrobasilar aneurysms, using a Le Fort I maxillary osteotomy rather than splitting the soft and hard palates, was employed successfully in three patients. This technique gave much improved access to the clivus, and eased exposure of the aneurysms without the need for traction on the brain stem or cranial nerves. There were no postoperative cerebrospinal fluid fistulae and no neurological complications. In one patient, a human-derived fibrin adhesive was used for dural repair. The postoperative cosmetic results were excellent and no problems relating to malocclusion were reported. This approach may have advantages when dealing with other diseases in or around the clivus.

Adult↗
PubMed1986

Spontaneous subarachnoid hemorrhage and negative cerebral panangiography. Review of 140 cases.

One hundred and forty consecutive patients who sustained proven spontaneous subarachnoid hemorrhage (SAH) with negative cerebral panangiography were studied retrospectively. Attention was directed to the presence, amount, and distribution of subarachnoid blood on computerized tomography (CT) scans. It was determined that the finding of blood on CT had a significant association with clinical grade, loss of consciousness, ventricular ratio, fixed ischemic deficit, and total of all complications, but not with epilepsy, hypertension (previously known or detected on admission), treated hydrocephalus, rebleeding, angiographic spasm, and eventual outcome (which was generally excellent on follow-up examination). The distribution of blood, predominantly around the basal cisterns, suggests leakage from ventriculostriate and thalamoperforating vessels as the cause of SAH, and closer study of these vessels is suggested.

Adolescent↗
PubMed1986

Hydatid disease of the cervical spine.

Hydatid disease affecting the cervical spine occurred in a 31-year-old man. Because bone grafting is associated with a high failure rate, treatment included filling the excised defect with a high-density polyethylene implant and fusing the cervical spine to stabilize it.

Adult↗
PubMed1985

A potential application for the intracerebral injection of drugs entrapped within liposomes in the treatment of human cerebral gliomas.

After intravenous injection of therapeutic doses of bleomycin only small amounts could be measured in glioma tissue obtained at operation in patients with malignant gliomas and the drug was rapidly cleared from the blood (T1/2 = 2 hrs). Negatively charged liposomes injected through Ommaya reservoirs into the glioma tumour bed were tolerated without observable side effect. The appearance of bleomycin in the blood and urinary clearance after intracerebral injection of bleomycin entrapped within negatively charged liposomes through an Ommaya reservoir in patients with malignant gliomas was decreased as compared with levels when free bleomycin was injected. These preliminary observations suggest a role of drugs entrapped within liposomes as a depot preparation in the treatment of human cerebral gliomas.

Bleomycin↗
PubMed1981

Chronic cerebellar stimulation in cerebral palsy.

This report summarizes the experience with chronic cerebellar stimulation in cerebral palsy patients at the Children's Hospital of Eastern Ontario. From July, 1977, to September, 1978, 12 patients suffering from cerebral palsy underwent cerebellar implant for chronic cerebellar stimulation. Postoperative evaluation was made approximately 1 week, 3 months, 6 months, and 12 months after surgery by a group of specialists using speech, respiration, muscle tone, involuntary movements, salivation, and activities of daily living as parameters, and these findings were compared with the findings prior to surgery. Chronic cerebellar stimulation did not noticeably alleviate symptoms and signs of cerebral palsy nor did it improve activities of daily living in a significant number of patients.

Activities of Daily Living↗
PubMed1981

Acute myelopathy in association with heroin addiction.

The occurrence of spinal cord lesions in association with self-administration of heroin is a recognised entity in the United States of America which has not up to now been reported in British literature. Three cases are described, the literature reviewed and possible aetiological factors discussed.

Adolescent↗
PubMed1979

Benign intracranial hypertension: clinical features and diagnosis using computed tomography and treatment.

A series of 28 patients presenting with benign intracranial hypertension is reported. The diagnosis was based on normal CT scanning appearances, including ventricular size, and it is stressed that no further neuroradiological investigations were required. Conservative treatment is shown to be effective in the majority of patients. It is, however, suggested that surgical intervention in the form of a shunting procedure (lumboperitoneal in our cases) might prove necessary, if vision remains in jeopardy.

Acetazolamide↗