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Biomedical subjects

E R Laws

Publications and source records attributed to E R Laws.

At least 253 records · Page 14Linked to original sources
PubMed1980

Seizures after head trauma: a population study.

A cohort of 2747 patients with head injuries was followed for 28,176 person-years to determine the magnitude and duration of the risk of posttraumatic seizures. Injuries were classified as severe (brain contusion, intracerebral or intracranial hematoma, or 24 hours of eight unconsciousness of amnesia), moderate (skull fracture or 30 minutes to 24 hours of unconsciousness or amnesia), and mild (briefer unconsciousness or amnesia). The risk of posttraumatic seizures after severe injury was 7.1% within 1 year and 11.5% in 5 years, after moderate injury the risk was 0.7 and 1.6%, and after mild injury the risk was 0.1 and 0.6%. The incidence of seizures after mild head injuries was not significantly greater than in the general population.

Adolescent↗
PubMed1980

The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935-1974.

Records in the Mayo Clinic linkage system were reviewed to determine the incidence of head trauma in Olmsted County, Minnesota, from 1935-1974. Minimum criteria for inclusion--loss of consciousness, posttraumatic amnesia, or skull fracture--were met by 3587 cases. During the decade from 1965-1974, the age-adjusted incidence rates per 100,000 population were 270 in males and 116 in females. The rate was highest--658--in males aged 15 to 24, but it was at least 50 in all age and sex groups. Major causes of head injury were automobile accidents (37%) and falls (29%). The incidence of head injuries related to automobiles and recreation has been increasing, whereas most other categories have remained stable or have declined. Of all cases, 446 were fatal, the average annual incidence being 32 per 100,000 in males and 9 per 100,000 in females. Among the groups at high risk of head trauma are those who have had head trauma previously.

Adolescent↗
PubMed1980

Perioperative management of patients with pituitary microadenoma.

A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The goals in this joint neurosurgical, endocrinological, and otorhinolaryngological team effort are to eliminate errors in patient management, to assure the safety of the patient in the perioperative period, and to make the therapy as efficient and as cost-effective as possible.

Adenoma↗
PubMed1980

Nasal and paranasal presentations of chordomas.

Eight patients with chordomas whose initial manifestations were caused by nasal and paranasal extension of the tumor are presented. Their ages ranged from 24 to 51 years. Disturbances of vision developed subsequently in all eight patients, and headache was present in each patient. Roentgenograms showed bony erosion of the sphenoid sinus or a nasopharyngeal mass. Because chordomas can be confused with chondrosarcomas histopathologically, differentiation is important. Treatment consists of surgical debulking or radiotherapy (or both). Despite such treatment, six patients died from their disease. The average survival was five years. This emphasizes the well-known poor prognosis for patients with clival chordomas.

Adult↗
PubMed1980

Radiology of cerebrospinal fluid rhinorrhea.

Fifty-one patients with cerebrospinal fluid rhinorrhea were evaluated at the Mayo Clinic from 1974 to 1977. The causes of the leak were fairly even distributed among postoperative, traumatic unrelated to previous surgery, and nontraumatic. The slightly fewer patients with a traumatic cause compared with those reported in most series reflects the referral patterns and surgical nature of the practice at the institution. Three-fourths of the patients had plain films of the skull, although the site of the leak was identified in only 21% of them. Two-thirds of the patients had tomography, which was helpful in 53%, especially in 10 of the 13 patients with traumatic nonpostoperative cerebrospinal fluid rhinorrhea. Posteroanterior tomography generally was more helpful than lateral tomography, except in leaks around the frontal sinuses. Radioisotope cisternography with intranasal pledgets helped localize the site of leak in 50% of patients and suggested the site of the leak in 25%. Radioisotope cisternography with pledgets often gave helpful positive results when the plain films and tomography were not helpful.

Adolescent↗
PubMed1980

Transsphenoidal microsurgery in the management of craniopharyngioma.

The rationale for the transsphenoidal approach in the surgical management of craniopharyngioma is presented, based on experience with 26 cases. In 14 patients without prior therapy, nine had "total" removal of the lesion, and only two had permanent postoperative diabetes insipidus. One operative death occurred in this group, and two patients had cerebrospinal fluid leaks. In 12 patients who had undergone prior craniotomy, successful palliation was accomplished, at least temporarily, in every case. Vision was improved postoperatively in 15 of the 16 patients who presented with visual loss. Enlargement of the sella by the tumor is the critical feature allowing for successful transsphenoidal management.

Adolescent↗
PubMed1979

Dianhydrogalactitol and radiation therapy. Treatment of supratentorial glioma.

Dianhydrogalactitol was the most active of 177 agents tested against a mouse ependymoblastoma tumor. We conducted a prospectively randomized trial comparing whole-brain irradiation alone vs identical irradiation plus dianhydrogalactitol in 42 patients with grade 3 and 4 supratentorial astrocytomas. Patients receiving dianhydrogalactitol in addition to irradiation had a significantly longer median survival time (67 vs 35 weeks) than did patients receiving only irradiation. The major toxic effect of dianhydrogalactitol is hematologic suppression of a cumulative nature. Dianhydrogalactitol may play an important role (in conjunction with radiation therapy) in the initial treatment of patients with supratentorial glioma. Our data may indicate that the mouse ependymoblastoma system is a useful screen for agents to be used in the treatment of human glioma.

Adult↗
PubMed1979

Pituitary adenoma and oral contraceptives: a case-control study.

A search of the centralized data resource available at the Mayo Clinic for all cases of pituitary adenoma diagnosed in the population of Olmstead County, Minnesota, disclosed an increasing incidence of this tumor in women of childbearing age. The sex, age, and temporal relationships suggest that, if this increase is real, oral contraceptives should be considered as one of the possible etiologic factors. A case-control study, however, did not reveal an association of prior use of oral contraceptives with pituitary tumor--relative risk, 0.5; 95% confidence interval, 0.1 to 2.2. No association was found with other possible risk factors, i.e., prior head injury, radiation therapy, seizures, and smoking. Thus, unless other etiologic agents can be identified, it appears that the increasing incidence is due to advances in diagnostic and surgical technology rather than to a specific etiologic factor.

Adenoma↗
PubMed1979

Successful management of bilateral carotid-cavernous fistulae with a trans-sphenoidal approach.

A patient with traumatic bilateral carotid-cavernous fistulae was successfully treated by an entirely extracranial approach. The larger fistula on the left was exposed via a transethmoidal, trans-sphenoidal route and was directly opened and packed while the cavernous carotid artery was stented open by an intraluminal balloon catheter. The balloon catheter provided temporary hemostasis and was removed after the fistula had been packed. The left carotid artery remained patent, and the smaller fistula on the right was subsequently obliterated by a balloon catheter. The fistulae have remained cured, and the left internal carotid artery supplies the cerebral circulation.

Adult↗
PubMed1979

Head trauma and subsequent brain tumors.

A long term study of 2,953 persons with 29,859 person-years of follow-up after head injury provided an opportunity to investigate the long-debated association between head trauma and subsequent intracranial tumor. In this series the observed number of cases of subsequent brain tumor did not differ from the number we expected. Because brain tumors are relatively rare, the results of this large series cannot absolutely refute the possibility that head trauma predisposes to brain tumor, but the individual risk is very small, and the weight of evidence does not support an etiological association. The occurrence of subsequent brain tumors in this series was not associated with the severity or location of the head injury. Head trauma does not seem to be a significant etiological factor in meningioma; that tumor has a higher incidence in females, whereas males have 2- to 3-fold greater incidence of head trauma. If any association between head trauma and subsequent brain tumor does exist, it is extremely small or occurs only in the presence of other factors, which themselves must be rare.

Adult↗
PubMed1979

The transseptal approach to lesions of the pituitary and parasellar regions.

In a series of 505 consecutive procedures, the transseptal-transsphenoidal pituitary operation has proved safe and effective. The overall mortality in this series is 1.39%. A wide variety of sphenoid and sellar lesions and nearly every pituitary adenoma have been found suitable for the exposure provided through the sublabial-transseptal approach. This statement rests on the premise that both the rhinologist's and the neurosurgeon's skills are optimally applied to each case. The role of the otorhinolaryngologist is defined in this paper, and the benefits of the team approach are explored. An interpretive history of the transsphenoidal approach is presented, and the evolution of the transseptal technique developed at the Mayo Clinic from 1972 to 1978 is reviewed. Emphasizing the rhinologic aspects, all details of the surgical technique are described and illustrated. Our experience with the special endocrine syndromes is also reviewed to spotlight clinical features that require individual consideration by the rhinologic surgeon.

Anesthesia↗
PubMed1979

Neurosurgical management of acromegaly. Results in 82 patients treated between 1972 and 1977.

A consecutive series of 82 acromegalic patients who underwent transsphenoidal surgery during a 5-year period is presented. Preoperative and postoperative values for human growth hormone (HGH) were available in 80 cases. Microadenomas were present in 18 patients with a mean preoperative HGH value of 25.2 ng/ml, diffuse adenomas in 39 patients with mean of 53.8 ng/ml, and invasive adenomas in 25 with mean of 68.0 ng/ml. There was no operative mortality. The results reflected the classification of the tumors, with apparent cures accomplished in 87.5% of previously untreated patients with microadenoma, all of whom had anterior pituitary function preserved. The percentages of apparent cures in cases of diffuse adenoma (68%) and invasive adenoma (54%) were much less satisfactory. Transsphenoidal microsurgery is capable of achieving good results, particularly in patients with microadenoma.

Acromegaly↗