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Biomedical subjects

I Robertson

Publications and source records attributed to I Robertson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit's experience with 63 cases.

BACKGROUND: Neuroendoscopic third ventriculostomy (NTV) is becoming a first line treatment for hydrocephalus in this center. Its use in a consecutive series of adults is reported. METHOD: Initially a retrospective data collection after 7 months becoming prospective studying all patients who underwent NTV in this center. The adults (17 years or older) have been studied. RESULTS: Sixty-three patients met the criteria for inclusion: 38 male, 25 female. Mean age at first NTV 37.5 years. There was an 80% success rate (i.e., no further therapy for the hydrocephalus required). Follow-up was for a mean of 3.1 years. The largest subgroup were patients with third ventricular tumours (35%), of whom 86% were successfully treated. Mean time to failure for the whole series was 8.5 months (range immediate--30 months). Complications occurred in 17.5%; those deemed serious in 11%. There were three deaths (4.7%) within 30 days of the procedure. There were six other deaths during follow-up, five because of tumour progression and one because of pneumonia. CONCLUSIONS: This procedure lends itself to the treatment of hydrocephalus in adults and appears to be more successful than in young children. It is efficacious in both previously shunted and non shunted patients. It is now the first-line treatment for noncommunicating hydrocephalus in this center and also for patients with shunt failure who are anatomically suitable, having cerebrospinal fluid spaces large enough to admit the endoscope. The complication and mortality rates compare favorably with those for shunts.

Adolescent↗
PubMed2001

Endovascular repair of an inflammatory abdominal aortic aneurysm complicated by aortoduodenal fistulation with an unusual presentation.

Aortoenteric fistulation (AEF) is a well-documented late complication of open abdominal aortic aneurysm (AAA) repair, occurring in between 0.4% and 4% of cases. In the absence of an anastomosis, AEF is likely to be rare after endovascular aneurysm repair (EVAR) and has only recently been described in the literature as a result of mechanical stent failure or migration. We present the case of a 61-year-old man who underwent EVAR for an AAA with a "nonspecific" periaortic inflammatory mass. Six months postoperatively, an AEF developed, presenting with metastatic sepsis followed by septic infective thromboembolization to his right leg, and amputation was necessary. His stent was well positioned and mechanically intact. We emphasize the need for vigilance about the risk of AEF when adopting an endovascular approach to repair the AAA with a nonspecific periaortic inflammatory mass and highlight the need for awareness about the unusual septic manifestations of AEF.

Aortic Aneurysm, Abdominal↗
PubMed2001

Lymphocytic and granulocytic hypophysitis: a single centre experience.

Lymphocytic and granulocytic hypophysitis are rare pituitary masses. A series of five dealt with at a single centre is presented and discussed. Retrospective analysis of pathology records revealed the cases. Of pituitary mass lesions dealt with in this centre, 0.8% have the diagnosis. Five females presented, one pregnant at the time of presentation, three presenting with signs and symptoms of panhypopituitarism, and two with visual problems. All were treated by surgical means. All had good postoperative visual function, but all were panhypopituitary. Follow-up was for a mean of 4 years and 1 month. This rare condition should be treated by surgical means to obtain a diagnosis. Further treatment of residual tumour can be with corticosteroids. Good visual function should be expected, but so should permanent loss of pituitary function.

Adult↗
PubMed2001

Cyclist's iliac syndrome: temporary relief by balloon angioplasty.

External iliac stenosis due to endofibrosis is a rare condition that predominantly affects top level cyclists. Short term symptomatic relief is reported in an Olympian after percutaneous transluminal angioplasty, which was performed to allow the patient to return to training without delay.

Adult↗
PubMed2000

Surgery versus thrombolysis for acute limb ischaemia: initial management.

BACKGROUND: Peripheral arterial thrombolysis has become established as a useful adjunct in the management of peripheral arterial ischaemia. Much has been learnt about indications, risks and benefits using this technique, although data from randomised controlled studies is not extensive. The optimal initial management of the acutely ischaemic leg needs to be determined. OBJECTIVES: To determine if surgery or thrombolysis is the preferred option in the initial treatment of acute limb ischaemia. SEARCH STRATEGY: The search strategy was that adopted by the Cochrane Review Group on Peripheral Vascular Diseases. Additionally, reference lists of papers resulting from this search were reviewed. SELECTION CRITERIA: All randomised studies comparing thrombolysis and surgery in the management of acute limb ischaemia. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by all three reviewers. MAIN RESULTS: Patients with acute lesions of less than seven days duration had a significantly increased survival at one year for patients having thrombolysis, compared to those undergoing initial surgery [84% v 58%, p=0.01; Odds ratio (95% CI) 0.28 (0.13,0.63)] largely associated with a reduced level of in-hospital cardio-pulmonary complications (Ouriel 1994). Lesions less than 14 days duration fared better with initial lysis with a reduced amputation and reduced death rate at six months [15.3% v 37.5%; p=0.001; Odds ratio (95%CI) 0.29 (0.12,0.72)] (STILE 1994), compared to initial surgery. Analysis of the same trial at one year however revealed that native vessel thromboses had a more favourable outcome with initial surgery, largely due to continuing ischaemia in the lytic group [64% v 35%; p<0.0001; Odds ratio (95%CI) 3.26(1.96,5.52)] (Weaver 1996). Bypass graft thromboses less than 14 days old treated with initial thrombolysis were shown to have a reduced amputation rate (15% v 47%; p=0.05). However, overall, one year results revealed that thrombolysis of thrombosed grafts was associated with a higher level of continued ischaemia [73% v 50%; P=0.010; Odds ratio (95%CI) 2.72(1.27,5.80)] (Comerota 1996). REVIEWER'S CONCLUSIONS: A universal initial treatment with either surgery or thrombolysis cannot be advocated on the available evidence. There is no overall difference in limb salvage or death at one year between initial surgery and initial thrombolysis. Thrombolysis may however be associated with a higher risk of ongoing limb ischaemia, and a higher overall risk of haemorrhagic complications including stroke. The higher risk of complications needs to be balanced against the risks of surgery in the individual patient.

Humans↗
PubMed2000

Stent implantation for mesenteric bypass graft stenosis.

PURPOSE: To present a case of symptomatic mesenteric bypass graft stenosis treated with Palmaz stent implantation. METHODS AND RESULTS: A 65-year-old man with a history of mesenteric ischemia and superior mesenteric artery (SMA) occlusion presented with recurrent symptoms 3 years after Dacron graft revision surgery for occlusion of a venous aorto-SMA bypass graft. Graft thrombectomy revealed a tortuous segment of narrowed graft proximally, and a Palmaz stent was deployed across the defect. Adequate flow was restored through the conduit, and the patient has remained asymptomatic for 2 years. CONCLUSIONS: Mesenteric ischemia is a rare and potentially fatal condition requiring major vascular intervention. Revision surgery may be avoided by angioplasty and stent insertion across flow-limiting stenoses, even in prosthetic grafts.

Aged↗
PubMed1999

Endovascular stent-grafts for superficial femoral artery disease: results of 1-year follow-up.

PURPOSE: To document a preliminary study to assess the deployment and outcomes of endoluminal stent grafting in the superficial femoral artery (SFA) with use of a prototype device. MATERIALS AND METHODS: Twenty patients with lifestyle-limiting intermittent claudication were selected for treatment with a balloon-mounted expansive polytetrafluoroethylene graft. All patients had angiographically proven SFA disease (median length, 17 cm) with normal arterial inflow and at least two calf vessels patent to the ankle. Follow-up was by means of ankle brachial pressure index (ABPI), duplex ultrasound, and angiography. RESULTS: Fourteen patients were successfully treated. Six patients were excluded: five by the study protocol and one because the procedure was a technical failure. ABPI rose from 0.6 before treatment to 1.0. The treated limbs became asymptomatic. Twelve-month primary, primary assisted, and secondary patency rates of treated patients were 29%, 50%, and 64%. CONCLUSION: Endovascular stent grafting of SFA lesions is technically feasible, but the patency rates obtained with this design are inferior to those obtained with conventional surgical bypass.

Aged↗
PubMed1999

Meningiomas involving the internal auditory canal: a diagnostic and surgical challenge.

Meningiomas are the second most common lesion encountered within the cerebello-pontine angle (CPA) and rarely project into or originate from the internal auditory meatus (IAM). It is important to distinguish between meningiomas and acoustic neuromas preoperatively as the choice of surgical approach may differ depending on the tumour type. Fortunately, most lesions can be accurately diagnosed with gadolinium-enhanced magnetic resonunce imaging (MRI). We report six cases of meningioma involving the IAM, often leading to an incorrect preoperative MRI diagnosis. We highlight the challenges these tumors present to radiologists and surgeons.

Journal Article↗
PubMed1999

Clinical features and outcomes in patients with non-acoustic cerebellopontine angle tumours.

OBJECTIVES: Non-acoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. These features were studied in patients presenting to the regional neuro-otological unit. METHODS: A retrospective analysis of clinical notes identified 42 patients with non-acoustic tumours of the cerebellopontine angle. Data were extracted regarding presenting clinical features, histopathological data after surgical resection, surgical morbidity and mortality, and clinical outcome (mean 32 months follow up). RESULTS: The study group comprised 25 meningiomas (60%), 12 epidermoid cysts/cholesteatomata (28%), and five other tumours. In patients with meningiomas, symptoms differed considerably from patients presenting with vestibular schwannomas. Cerebellar signs were present in 52% and hearing loss in only 68%. Twenty per cent of patients had hydrocephalus at the time of diagnosis. After surgical resection, normal facial nerve function was preserved in 75% of cases. In the epidermoid group, fifth, seventh, and eighth nerve deficits were present in 42%, 33%, and 66% respectively. There were no new postoperative facial palsies. There were two recurrences (17%) requiring reoperation. Overall, there were two perioperative deaths from pneumonia and meningitis. CONCLUSIONS: Patients with non-acoustic lesions of the cerebellopontine angle often present with different symptoms and signs from those found in patients with schwannomas. Hearing loss is less prevalent and cerebellar signs and facial paresis are more common as presenting features. Hydrocephalus is often present in patients presenting with cerebellopontine angle meningiomas. Non-acoustic tumours can usually be resected with facial nerve preservation.

Cerebellar Neoplasms↗
PubMed1999

Stepping-table gadolinium-enhanced digital subtraction MR angiography of the aorta and lower extremity arteries: preliminary experience.

PURPOSE: To compare stepping-table digital subtraction gadolinium-enhanced magnetic resonance (MR) angiography of the distal aorta and lower extremity arteries with conventional catheter digital subtraction x-ray angiography in patients with arterio-occlusive disease. MATERIALS AND METHODS: Twenty patients underwent both conventional catheter angiography and fast three-dimensional gadolinium-enhanced MR angiography of the aorta and outflow vessels at 1.5 T; the images were acquired in three consecutive imaging locations during a single infusion of a gadolinium chelate. RESULTS: Compared with catheter angiography, according to the findings of two blinded independent reviewers, MR angiography had sensitivities of 81% and 89% and specificities of 91% and 95%, respectively, for demonstration of insignificant (< or = 50%) stenosis versus significant (51%-100%) stenosis. For demonstration of occlusion, the sensitivity and specificity were 94% and 97%, respectively, by consensus. There was good interobserver correlation between the two readers overall (kappa = 0.65 for reporting the degree of narrowing in all lesions; 0.86, for reporting of insignificant versus significant stenoses; and 0.928, for reporting of occluded versus patient segments). CONCLUSION: Stepping-table digital subtraction contrast material-enhanced MR angiography has high accuracy compared with catheter angiography in patients with arterio-occlusive disease of the aorta and outflow vessels. These preliminary study results suggest that this technique may ultimately provide a safe, noninvasive, and cost-effective alternative to catheter angiography.

Aged↗
PubMed1999

Subclavian stents and stent-grafts: cause for concern?

PURPOSE: To report cases of stent and stent-graft fracture in the subclavian vessels. METHODS AND RESULTS: Three patients with self-expanding stents of 3 different types in 1 subclavian artery and 2 subclavian veins presented with recurrent symptoms 6 months to 2 years after stenting. All devices showed signs of compression with stent fracture. The covered stent in the subclavian artery was excised. Of the 2 venous patients, 1 was treated with first rib resection and the other refused further treatment. CONCLUSIONS: The subclavian vessels are prone to flexion during movement, and the vessels may be compressed by external structures, including the clavicle and first rib. Stents that have not been designed to withstand these forces may be damaged.

Adult↗
PubMed1998

Body site specific incidence of basal and squamous cell carcinoma in an exposed population, Townsville, Australia.

Most data on body site distribution of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) do not take into account the surface proportion occupied by body sites experiencing differing amounts of ultraviolet radiation. The recording of BCC and SCC is heterogenous and body sites are not standardized. This study was undertaken to assess the magnitude of the incidence rates of skin cancers at different body sites in a population which experiences high ultraviolet exposure and involved all primary care services in Townsville over 6 weeks in June 1993. The annual site-specific age-standardized (World Population) incidence rates of histologically diagnosed lesions, determined from data where lesions were recorded on a body map, were adjusted for surface area and expressed per 100,000 body units (BU). Relative site densities of lesions were also calculated. Annual incidence rates for BCC per 100,000 BU on the most exposed face (ears, nose and cheeks) were 25,893 (95% confidence interval (c.i.) 18,837-32,950), 13,222 (95% c.i., 8273-18,171) on the less exposed face (forehead,eyebrow, chin and jaw) and 27,837 (95% c.i., 12,560-43,115) on the least exposed face (area within the orbit and nasolabial fold). Incidence rates for SCC rates were highest on the less exposed face, 5843 (95% c.i., 2627-9058) most exposed face, 4200 (95% c.i., 1274-7126) and the exposed upper limb, 3786 (95% c.i., 2783-4789). The relative site density of histologically confirmed BCC was 14 on the most exposed face in males compared with 5 in females and 11 around the eyes (least exposed) in males and 9 in females compared with the body as a whole. Adjustment for body surface proportion demonstrates that highly exposed body sites are at very high risk. The magnitude of the incidence rates on these sites is attributed to the combination of a susceptible population and high ambient ultraviolet radiation (UVR).

Australia↗