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Biomedical subjects

J E Adams

Publications and source records attributed to J E Adams.

At least 109 records · Page 6Linked to original sources
PubMed1988

Long-term treatment of Nelson's syndrome with sodium valproate.

Eleven patients with Nelson's syndrome were given sodium valproate (Epilim, Sanofi). Plasma ACTH and cortisol levels were measured under carefully controlled conditions which were designed to eliminate spontaneous fluctuations in ACTH. At 6 weeks all 11 patients were reassessed while taking sodium valproate 600 mg/day; there was then a small but significant (P less than 0.05) reduction in plasma ACTH concentration. Six patients continued to take sodium valproate, and were reassessed at 1 year when five were taking 1200 mg/day and one patient was taking 600 mg/day. At 1 year for these six patients there had been an increase in mean plasma ACTH which was then not significantly different from basal values. The five patients who discontinued sodium valproate were also reassessed at 1 year, when there were no significant differences compared to basal or 6-week values. During therapy with sodium valproate, there were no significant changes in the half-life of plasma cortisol, plasma sodium and potassium concentrations, or serum liver enzymes. Weight gain on sodium valproate was the main reason for patients asking to discontinue therapy. Sodium valproate is not an effective long-term therapy for reducing plasma ACTH for patients with Nelson's syndrome.

Adolescent↗
PubMed1988

Jugular vein thrombosis associated with distant malignancy.

We describe two patients who developed internal jugular vein thrombosis associated with primary malignant disease arising outside the neck, and in one patient it was the presenting feature. Computed tomography was performed and the findings characteristic of internal jugular vein thrombosis are illustrated. We conclude that malignant disease should be considered in patients presenting with spontaneous internal jugular vein thrombosis with no other predisposing factors and that computed tomography is of value in confirming the diagnosis.

Carcinoid Tumor↗
PubMed1988

A critical appraisal of "out-of-hours" radiography in a major teaching hospital.

The use of plain radiography performed outside normal working hours was studied at the Manchester Royal Infirmary to determine the costs of the service and where possible financial savings could be made. The annual cost of "out-of-hours" radiography was estimated to be in order of 250,000 pounds. During a selected 2-week period, 84% and 76% of all examinations performed on Accident and Emergency patients and inpatients, respectively, were found to be normal. Previous reports suggest that the number of radiographs requested in the Accident and Emergency department can be reduced without detriment to patients by the implementation of appropriate clinical guidelines. We consider that if similar guidelines were developed and applied to the use of out-of-hours radiography, substantial savings could be made. We estimate that in our hospital these savings could amount to 18% of the current expenditure on this service.

Appointments and Schedules↗
PubMed1987

Three-dimensional computed tomographic reformations of sellar and para-sellar lesions.

The purpose of this study was to determine whether diagnostically useful three-dimensional (3D) reformations could be obtained from unmodified high resolution pituitary CT scans. Twelve CT examinations in 9 patients in whom an enhancing tumour or extensive bone destruction was identified around the sella, were studied using 3D images obtained on soft tissue and bone thresholds. 3D images were considered superior to conventional CT sections and reformations for the assessment of the vascular relations of tumours with large supra-sellar components, and in cases of extensive bone erosion. In selected cases, 3D CT imaging may facilitate a faster and more comprehensive appraisal of high resolution CT studies by clarifying otherwise complex spatial relationships.

Adult↗
PubMed1987

Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature.

Since the senior author's (J.E.A.) first report in 1972 of the use of deep brain stimulation (DBS) to control chronic pain, electrodes for DBS have been implanted in 141 patients. Of reported series, this one has the largest number of patients and the longest period of follow-up. The mean age of patients in this study was 51.2 years. The mean length of follow-up was 80 months. Patients had experienced pain for a mean period of 65 months before DBS was attempted; all patients had exhausted other medical and surgical therapies. For the purposes of this study, pain states were characterized as being either nociceptive or deafferentation in nature. Nociceptive pain was treated primarily by stimulation of the periaqueductal or periventricular gray, and deafferentation pain was treated primarily by stimulation of the sensory thalamus. Eighty-four patients were treated for deafferentation pain, which included the thalamic pain syndrome (25 cases), peripheral neuropathic pain (16 cases), anesthesia dolorosa (12 cases), paraplegia pain (11 cases), postcordotomy dyesthesia (5 cases), phantom limb pain (5 cases), thoracic neuralgia (4 cases), and miscellaneous pain states (6 cases). We treated 57 patients with nociceptive pain states, 51 for low back and skeletal pain and 6 for pain from the invasion of cancer. Initial relief of pain was obtained by 83 patients (59%). After the mean follow-up period of 80 months, 42 patients (31%) continued to obtain significant pain relief with DBS. Some pain states, particularly anesthesia dolorosa and paraplegia pain, did not seem to respond to DBS. Major complications of therapy included wound infection (12%) and intracranial hemorrhage (3.5%); there was one death in the series (0.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗
PubMed1986

Autopsy analysis of the safety, efficacy and cartography of electrical stimulation of the central gray in humans.

Electrical brain stimulation is effective in controlling certain intractable chronic pain syndromes in humans, but the specific target site(s) for stimulation producing a maximal analgesic effect is (are) not well defined. This prospective study correlates the clinical results of chronic stimulation of the periaqueductal gray (PAG) and periventricular gray (PVG) matter in humans with the anatomic site of electrode placement as determined at autopsy, and documents the histologic reactions to electrode implantation and electrical stimulation of the area. Seven patients underwent electrode implantation to control their chronic pain; two had electrodes implanted bilaterally. All patients obtained complete analgesia with stimulation, although 3 subsequently found the stimulation to have diminished efficacy. The opiate antagonist naloxone reversed the analgesia in the 4 patients so tested. All 7 patients later died of causes unrelated to electrode implantation or stimulation. Postmortem analysis showed that, for 6 of the 9 electrodes implanted, the electrode tip was located in the ventrolateral PAG at the level of the posterior commissure; the other 3 electrodes were found in the white matter adjacent to the PAG. No evidence of gliosis or parenchymal reaction was observed along the tracts and tips of the electrodes. The results indicate that the ventrolateral PAG and PVG matter at the level of the posterior commissure is the optimal site for therapeutic electrical brain stimulation for opiate-responsive pain in humans.

Adult↗
PubMed1986

Supplemental mandibular condyle.

A case of supplemental mandibular condyle is presented and possible aetiological factors are discussed. The value of computed tomography and of scintigraphy in the diagnosis of such cases is illustrated and surgical and histological details of an excised supplemental condyle are presented for the first time.

Adolescent↗
PubMed1986

Intra-spinal new bone formation and spinal cord compression in familial hypophosphataemic vitamin D resistant osteomalacia.

Four patients with familial hypophosphataemic vitamin D resistant osteomalacia and spinal cord compression are reported. Three of these patients were treated by decompressive laminectomy and each made a good recovery. At surgery new bone formation in the ligamentum flavum and thickening of laminae were found to be responsible for the canal stenosis and cord compression. Two of these four patients, and 10 others were examined by computed tomography to determine the incidence, site and extent of any intra-spinal new bone formation. Facet joint hypertrophy and thickened laminae were observed at some level in all the patients, but much the most important cause of spinal canal stenosis was new bone formation in the ligamentum flavum, in the mid and lower thoracic spine, occurring at several, but mainly contiguous vertebral levels. Severe spinal canal stenosis was found in eight of the 12 patients scanned. No obvious relation was found between the presence of intra-spinal new bone formation and the clinical severity of the disease or the presence of extra-skeletal ossification in para-spinal and other sites. Computed tomography offers a simple, non-invasive technique for identifying those patients at risk of cord compression from new bone formation.

Female↗
PubMed1985

Reduced anesthetic requirement after electrical stimulation of periaqueductal gray matter.

To determine whether electrical stimulation of the periaqueductal gray region decreases anesthetic requirement, the authors studied the effect of such stimulation on the MAC of halothane and 60% nitrous oxide in 33 patients. These patients, who were undergoing implantation of a radio-frequency-coupled receiver and connection of that receiver to electrodes previously implanted in the periaqueductal gray area, were assigned randomly to receive (n = 16) or not receive (n = 17) electrical stimulation 1 h before surgery. The mean value (+/- SEM) for the minimum alveolar concentration of halothane combined with 60% nitrous oxide was significantly less (P less than 0.001) for patients who were stimulated preoperatively (0.15 +/- 0.05%) than for those who were not (0.51 +/- 0.02%). The authors conclude that stimulation of the periaqueductal gray region decreases anesthetic requirements and believe that at least three mechanisms are possible: a nonspecific narcotic-like effect, a specific effect on a pain pathway, or an effect on specific neural pathways that affect anesthetic requirements secondary to changes in regional concentrations of neurotransmitters.

Anesthesia, Inhalation↗
PubMed1985

Isolated adrenocorticotrophin deficiency and empty sella associated with hypothyroidism.

A case of isolated ACTH deficiency is described. The patient had an empty sella and longstanding radio-iodine induced hypothyroidism. The association between isolated ACTH deficiency, empty sella and hypothyroidism is reviewed. It has not previously been recognized that the commonest endocrine association of isolated ACTH deficiency is primary thyroid failure. ACTH secretion does not recover following thyroxine replacement treatment.

Adrenocorticotropic Hormone↗
PubMed1984

Use of the argon surgical laser in neurosurgery.

The argon surgical laser has been used in 68 neurosurgical procedures that included the removal of intracranial and intraspinal tumors, spinal cord fenestration for syringomyelia, and the production of dorsal root entry zone lesions. Characteristics that make the argon surgical laser a useful microneurosurgical instrument include the availability of a fiberoptic delivery system, a laser spot size that can be varied continuously between 0.15 and 1.5 mm, a single laser-aiming and treatment beam, the transmission of argon laser light through aqueous media such as irrigating or cerebrospinal fluids, and improved hemostasis compared to conventional techniques. The argon laser is limited primarily by its relatively low power output (less than 16 W), which makes the excision of large tumors difficult. However, even with these limitations, which can be used to advantage in the proper setting, the authors' laboratory and clinical experience suggests that the argon surgical laser may be useful in certain microneurosurgical operations.

Adolescent↗
PubMed1984

Pain relief from dorsal root entry zone lesions made with argon and carbon dioxide microsurgical lasers.

Argon and carbon dioxide microsurgical lasers were used to produce lesions in the dorsal root entry zone (DREZ) experimentally in six cats and surgically in 21 patients who had denervation pain syndromes. The technique of producing lesions, the histological and physiological changes seen in the cat spinal cord, and the results of treatment in the clinical series are discussed. Lesions were produced within the DREZ without new involvement of the dorsal column system or corticospinal tract in all but one patient. Based on their subjective evaluation, two-thirds of the patients were relieved of more than 50% of their preoperative pain. These experimental results and clinical experience suggest that the argon and carbon dioxide lasers effectively produce localized microsurgical lesions in the DREZ. The concept that an abnormality involving either neurons in the substantia gelatinosa or internuncial fibers in Lissauer's tract is responsible for pain in patients with primary sensory nerve deafferentation is discussed.

Adult↗
PubMed1983

Computed tomography in adrenal disease.

Ninety-eight patients with suspected adrenal disease were examined by computed tomography (CT). In 73 patients adrenal disease was confirmed on biochemical and other grounds (Cushing's syndrome (38), primary aldosteronism (8), phaeochromocytoma (12), androgen excess (7), Addison's disease (1) and non-functioning adrenal masses (7)). The CT appearances of hyperplasia and benign and malignant adrenal tumours are described in detail. Ninety-six per cent of the adrenal glands were identified, and all but one of the 39 adrenal mass lesions were correctly identified and localised by CT. The failure to identify some adrenal glands and one adrenal tumour was related to a paucity of intra-abdominal fat. Two abdominal ectopic phaeochromocytoma were not identified (in one patient because the appropriate area was not scanned). The 25 patients examined with unproven adrenal disease had normal glands on CT. That some hyperplastic glands appear normal on CT precludes its use as a screening procedure for biochemically unproven adrenal disease. Computed tomography allows the differentiation of adrenal hyperplasia from functioning adrenal tumours, and the differentiation of benign from malignant lesions with a high degree of certainty; it is the method of choice for the identification and localisation of adrenal tumours.

Addison Disease↗
PubMed1982

Lumbar intrathecal naloxone blocks analgesia produced by microstimulation of the ventromedial medulla in the rat.

In lightly barbiturate-anesthetized rats. low threshold (less than 10 micro A) electrical stimulation within the rostral ventromedial medulla inhibited the tail-flick response to noxious heat. Naloxone applied intrathecally at the lumbar level reversed this inhibition, but the same dose of naloxone applied to the cervical intrathecal space had no effect. Doses of naloxone 1- to 4-fold greater than the intrathecal dose did not antagonize tail-flick suppression when given systemically. Because neither systemic nor intrathecal naloxone had any effect on base-line tail-flick latencies, we conclude that the inhibition of the tail-flick response resulting from microstimulation in the ventromedial medulla is mediated by a spinal opioid synapse.

Animals↗