Biomedical subjects
G D Perkin
Publications and source records attributed to G D Perkin.
Vasovagal attacks.
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Conversion hysteria/malingering.
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Urgent carotid surgery for high risk patients.
Carotid surgery was performed urgently on 22 occasions out of 300 (7%). Of 15 patients with progressing stroke, in all, progression of stroke was arrested. Six patients recovered virtually completely and eight had improving neurological deficit after surgery, i.e. 14 of 15 (93%) benefitted. The other patient had arrest of stroke for a week and then suffered ipsilateral stroke. Of the seven patients operated upon for crescendo transient ischaemic attacks, five had no deficit after surgery or further attacks. The sixth patient had no further attacks but was found to have a tiny, neurological deficit. In these six patients (87%), surgery was greatly beneficial. The remaining patient had a fatal stroke following operation.
99Tcm HMPAO SPECT in progressive multifocal leucoencephalopathy.
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An analysis of 7836 successive new outpatient referrals.
An analysis has been performed of 7836 successive new outpatient referrals seen by one consultant neurologist. In approximately a quarter of the patients, a specific diagnosis was not possible. A further 30% of the total was accounted for by epilepsy, tension headache, cerebrovascular disease and migraine.
The association of hemifacial spasm and facial pain.
The recognition of an association between trigeminal neuralgia and ipsilateral hemifacial spasm has been delayed by confusion over the nomenclature of the two conditions. Three patients are presented who had facial pain associated with hemifacial spasm. The findings on investigation of these patients, and an analysis of the literature, suggests that the combination is almost inevitably associated with pathological processes in the posterior fossa, particularly anomalous, ectatic or aneurysmal blood vessels.
Delayed somatosensory evoked potentials in pernicious anaemia with intact peripheral nerves.
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Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS.
To compare the efficacy of high-dose intravenous methylprednisolone with intramuscular ACTH in the treatment of acute relapse in multiple sclerosis, we undertook a double-blind, randomized, controlled study involving 61 patients. There was a marked improvement in both groups in the course of the study, but no difference between them in either the rate of recovery or the final outcome. High-dose IV methylprednisolone is a safe alternative to ACTH in the management of acute relapse in MS.
[Study of the expression of the interleukin 2 receptor on the lymphocytes of patients with multiple sclerosis using anti-Tac monoclonal antibodies].
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Palatal myoclonus influenced by neck posture.
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T lymphocyte-derived demyelinating activity in multiple sclerosis patients in relapse.
Supernatants of cultured T lymphocytes of multiple sclerosis patients were tested for a demyelinating activity in rat cerebellum explant cultures. Supernatants of unstimulated T lymphocytes in seven out of 10 multiple sclerosis patients in relapse produced demyelination when checked by phase contrast microscopy. Supernatants of unstimulated T lymphocytes from healthy subjects did not produce demyelination, but when T cells were stimulated by phytohaemagglutinin (PHA), 50% of tested supernatants produced demyelination, which was, however, never as advanced as in multiple sclerosis supernatant treated cerebellum cultures. The demyelinating activity proved to be heat labile. Gel filtration study revealed two fractions of the demyelinating activity 12.5-29.0 kD and 43.0-66.0 kD. The results suggest that lymphokines can be directly involved in the pathogenesis of demyelination in multiple sclerosis.
A critique of steroid trials in multiple sclerosis.
A review has been performed of the trials of steroids in MS published between 1958 and 1970. None of the trials concerned with the long-term treatment of the disease, whether with ACTH or oral steroids, revealed any benefit. Some advantage of steroids over placebo in accelerating the recovery of acute exacerbations can be claimed, though in no study has the gain been substantial.
Neurological morbidity of arch and carotid arteriography in cerebrovascular disease. The influence of contrast medium and radiologist.
A prospective study of 230 arch and carotid arteriograms in 229 patients with symptomatic cerebrovascular disease revealed that neurological morbidity was not significantly affected by patient age, nature of neurological symptoms, duration of procedure, volume of contrast medium or degree of arterial stenosis. The total neurological morbidity of 132 examinations carried out with non-ionic contrast medium (iohexol) was slightly lower than that of 98 examinations carried out with ionic contrast medium (meglumine and sodium iothalamate) but the difference was not statistically significant. However, the morbidity of 185 examinations performed by an experienced vascular radiologist was significantly lower (p less than 0.025) than the morbidity of 45 examinations performed by a series of radiologists in training and the mean time required for the procedure was 18 min longer in the latter group (p less than 0.001). These findings suggest that the neurological morbidity of arch and carotid arteriography in patients with cerebrovascular disease depends largely upon catheter technique and will not be significantly reduced by the use of non-ionic contrast medium.