Biomedical subjects
J B Miles
Publications and source records attributed to J B Miles.
Electrical stimulation of the spinal cord in peripheral vascular disease.
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Intracranial extension of a naso-ethmoid schwannoma.
A rare case of intracranial extension of a naso-ethmoid schwannoma is presented. Its subsequent removal with few sequelae confirmed the benign nature and good prognosis of the disease.
Pain clinics and pain clinic treatments.
Chronic pain is multi-factorial, and consequently a multidisciplinary approach is essential for its proper management. Pain Clinics may treat acute pain, chronic pain and cancer pain, and need to differentiate between these different conditions. Careful diagnosis and assessment is essential, including history, examination, questionnaires and relevant investigations. A variety of treatments exist to manage chronic pain, some of which have already been discussed in this issue. Treatments may be summarized as drugs, surgical (including nerve blocks), stimulation techniques, psychological techniques and general or physical measures. If a Pain Relief Unit has the ability to provide all of these types of treatment, then it can manage any type of pain, with the ability to relieve pain and improve quality of life greatly in a significant number of sufferers.
Stroke due to carotid artery dissection.
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Subcutaneous erythropoietin therapy: comparison of three different sites of injection.
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Pituitary enlargement and hyperprolactinaemia due to primary hypothyroidism: errors and delays in diagnosis.
Two young women with pituitary gland enlargement and hyperprolactinaemia were referred for pituitary surgery. Both had received bromocriptine (one patient for 13 years) for presumed prolactinoma. Mild clinical signs of hypothyroidism were present and endocrine tests revealed primary autoimmune thyroid failure. Following thyroxine replacement treatment, the pituitary enlargement and hyperprolactinaemia completely resolved. In both patients the hyperprolactinaemia was relatively mild and menorrhagia had been present for many years. A third patient, a 61-year-old man presenting with bitemporal hemianopia due to pituitary enlargement underwent transphenoidal pituitary surgery. The results of thyroid function tests on admission were not available until after surgery. Although the patient was clinically euthyroid, these revealed primary hypothyroidism and his considerable pituitary enlargement may also have been secondary to thyroid failure. Urgent thyroid function tests should be performed in all patients with pituitary enlargement prior to surgery to exclude hypothyroid induced pituitary swelling.
Meningiomas presenting with paranasal sinus involvement.
Extracranial paranasal spread of meningiomas is uncommon. We describe the management of four cases, all of which first presented to an oto-rhino-laryngologist for an opinion. We suggest that greater use of modern imaging techniques could lead to earlier diagnosis. The natural history of extracranial spread is relatively benign but the management of regrowth of residual disease is difficult. We therefore suggest radical surgery in the first instance provided that the patients general health and configuration of the tumour allow.
Stimulation of dopamine output from adrenal medullary cells by beta-endorphin and its C-terminal tetrapeptide (MPF).
The output of dopamine from cultures of rat adrenal medullary strips was increased by 71-120% when Lys-Lys-Gly-Glu (MPF), the C-terminal tetrapeptide sequence of human beta-endorphin, was added to the culture medium at 100 micrograms/ml concentration. Human beta-endorphin caused a 44% increase, but an N-terminal fragment of its molecule and somatotrophin caused no increase. Results with analogs of MPF show that small structural change of the C-terminal Glu residue causes complete loss of activity.
Acute isodense extradural haematoma.
A case of acute isodense extradural Haematoma in a 30-year-old woman is reported. This uncommon computed tomography finding is discussed and the pathophysiology is reviewed.
Consensus on HIV testing.
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Transphenoidal meningohydroencephalocoele.
A case of transsphenoidal meningohydroencephalocoele is presented. The clinical features and pathogenic factors are discussed briefly. An awareness of this condition should prevent attempted biopsy--which might otherwise prove disasterous. Air or contrast cisternography, with plain or computerised tomographic radiology, would seem to be the investigation of choice.
The place of 'salvage' petrosectomy.
Thirty-three of 58 patients with carcinoma of the external auditory meatus and middle ear were treated by radiotherapy. Nineteen patients suffered a recurrence. This proved to be unsuitable for petrosectomy in all patients with a tumour of the middle ear. A few patients with tumours of the external auditory meatus, usually of non-squamous variety, have survived for a reasonable period after 'salvage' petrosectomy.
Idiopathic spinal extradural lipomas: three cases and review of the literature.
Three cases of extradural spinal lipomas in adults are described in which there was no association with steroids. In all three cases the tumors were situated in the lumbar region and the patients were muscular, nonobese males. Two of the three cases had long histories contrary to those previously reported. Preceding transient neurological symptoms were noted in two of the three cases. The etiology of this phenomenon is discussed. It is possible that these lipomas, which are not associated with steroids, may represent a different spectrum of disease.