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Biomedical subjects

J H Robertson

Publications and source records attributed to J H Robertson.

At least 37 records · Page 2Linked to original sources
PubMed1988

The effect of transportation between the recovery room and intensive care unit on postoperative acoustic tumor patients.

Cardiovascular changes have been noted to occur during movement from the operating room or recovery room (RR) to the intensive care unit (ICU). This study examined blood pressure changes and related variables during transport from the RR to the ICU in 135 postoperative acoustic tumor patients. Although there was no significant change in blood pressure values from the RR to the ICU, patients with pre-existing hypertension and elevated RR blood pressures were noted to have an increased frequency of postoperative complications. In addition, a relationship was noted between administration of halothane and frequency of postoperative complications. Results highlight the need for nurses not only to monitor, but also closely control postoperative blood pressure in this population.

Blood Pressure↗
PubMed1987

Risk of recurrence after treatment of severe intraepithelial neoplasia of the cervix. A follow-up of 896 patients.

Eight hundred and ninety-six patients were followed up cytologically for up to 21 years following treatment for a CIN III lesion of the cervix. The recurrence rate (8.8%) was lower after hysterectomy than after treatment which preserved the cervix (23%). Long-term yearly follow-up is not required as all recurrences were detected by annual smears for a seven-year period after treatment in both groups. It is important to keep patients under cytological review following hysterectomy because of the appreciable recurrence rate and also evidence that intraepithelial lesions of the vaginal vault behave in an aggressive fashion.

Carcinoma in Situ↗
PubMed1986

Enumeration of absolute numbers of T lymphocyte subsets in B-chronic lymphocytic leukaemia using an immunoperoxidase technique: relation to clinical stage.

An immunoperoxidase technique has been used to identify and enumerate helper and suppressor T-cell subsets, as defined by reactivity with Coulter T4 and OKT8 monoclonal antibodies in 54 patients with B chronic lymphocytic leukaemia (B-CLL) and in the same number of matched controls. The ratio of T4+ to T8+ cells was significantly reduced in the B-CLL group as a whole (P less than 0.001) and in each stage of the three clinical staging systems. There was an increase in the median absolute level of T8+ cells in the whole CLL group (P less than 0.001). However, subdivision of the CLL group by clinical staging systems revealed a large group (28 patients) in which median T8+ cell levels were not raised and median T4+ cell levels were low (P less than 0.01). There was no significant decrease in T4+:T8+ ratio, increase in T8+ cells or decrease in T4+ cells with progression of clinical stage. Absolute numbers of E+ cells were significantly raised in all staging systems as were E+ T4- T8- cells (P less than 0.001). A significant alteration in either of these populations with progression of clinical stage was not present.

Adult↗
PubMed1986

Hereditary monocyte esterase deficiency.

An inherited cytochemical staining abnormality of monocytes is described, affecting members of three generations of one family. alpha-Naphthyl acetate and alpha-naphthyl butyrate esterase staining reactions have been consistently negative in 95% of the monocytes of the propositus and her son and in 60-70% of the monocytes in two of four grandchildren.

Aged↗
PubMed1986

Successful remission induction with deoxycoformycin in elderly patients with T-helper prolymphocytic leukaemia.

Two elderly patients with prolymphocytic leukaemia (PLL) of T helper phenotype were treated with the adenosine deaminase inhibitor--deoxycoformycin--and achieved remission. The first patient has remained in an unmaintained remission for over a year. The second patient, treated with a regime which produced less side effects, subsequently relapsed in skin and lymph nodes and died. In view of the rarity of this condition a multi-centre assessment of the effectiveness of deoxycoformycin is indicated. T-lymphocyte colony formation in both cases was found to be reduced. Co-culture of the patients' lymphocytes with nonadherent mononuclear cells from normal individuals also showed inhibition of T-colony formation indicating that lack of nutrients or accessory cells was not responsible for low T-colony forming capacity.

Aged↗
PubMed1986

Nonsurgical management of small and intracanalicular acoustic tumors.

It is generally accepted that the proper treatment for acoustic tumors is surgical removal. In fact, there is little, if any, reference to nonsurgical treatment of these tumors in the recent medical literature. We would like to report on the nonsurgical management of six patients with cerebellopontine angle tumors based upon CT examination. The diagnostic findings, follow-up data, and the rationale upon which the decision was made to treat the patients nonsurgically will be presented, as will a review of the pertinent literature.

Aged↗
PubMed1986

Reformatted sagittal images in the differential diagnosis of meningiomas and pituitary adenomas with suprasellar extension.

Approximately 3 to 4 times a year, a tumor with suprasellar extension escapes classification on high resolution coronal and transaxial computed tomography. When arteriography failed to determine the diagnosis, the differential choices were usually meningioma or pituitary adenoma. The authors report the use of sagittal reformatted images in this differential diagnosis and conclude that these images may aid in the distinction between pituitary tumors with suprasellar extension and meningiomas located in this area.

Adenoma↗
PubMed1986

Mycobacterium tuberculosis meningitis: a report of twelve cases and a literature review.

Twelve recent cases of Mycobacterium tuberculosis meningitis were presented, and the literature was reviewed. There are no particularly new or unique therapies or approaches to the management of this most serious disease. The major obstacle to successful diagnosis and treatment of tuberculous meningitis continues to be a lack of clinical suspicion of its presence. As illustrated in the cases presented, it has been our experience that patients already moribund or nonresponsive do not respond, regardless of the intervention undertaken. The most sensitive and economical method of detecting M. tuberculosis in the CSF may be LPA. However, this has not yet been widely validated or accepted. Larger volumes of CSF should be sent to the laboratory for testing and centifuged to about 5x concentrations before both acid-fast bacilli staining and culture are attempted. If tuberculous meningitis is suspected, three-drug therapy can be started immediately without jeopardizing subsequent culture confirmation of the presence of the TB bacillus. In addition, these patients must be followed closely to detect hydrocephalus at the earliest possible moment. When patients fail to respond to appropriate antituberculosis and pressure-reducing therapy, hydrocephalus should be actively sought by either CT or radioisotope cisternography. Although the decision to proceed to ventricular drainage or shunting must be individually made in adult patients with infection-related hydrocephalus, we agree with others that surgical intervention should be considered early and should be performed if the level of consciousness deteriorates, intracranial pressure increases, or ventricular enlargement or enhancing basal exudates are identified on CT.

Adult↗
PubMed1985

Comparison of two-dimensional echocardiographic and angiographic findings in arrhythmogenic right ventricular dysplasia.

Comparison of 2-dimensional (2-D) echocardiographic and right ventricular (RV) angiographic findings was performed in 10 patients with arrhythmogenic RV dysplasia. Diagnosis was based on accepted electrocardiographic and angiographic criteria. Nine patients underwent invasive electrophysiologic study, which confirmed RV source of ventricular tachycardia (VT) in 7. Biopsy findings of RV dysplasia were available in 3 patients. Two-dimensional echocardiography and angiography corresponded closely when diffuse RV enlargement and hypokinesia were present. Such diffuse findings were not invariably present. Localized abnormalities consisting of bulging or sacculation of the RV wall were noted by both techniques, even in the absence of diffuse changes. Echocardiographic evidence of localized disease predicted the presence of similar lesions at angiography, but agreement as to specific location was poor. Subjectivity in interpreting subtle RV abnormalities by either technique and the inherent differences in information provided by the 2 methods probably account for the inconsistencies. In the patient with suspected arrhythmogenic RV dysplasia, 2-D echocardiographic evidence of diffuse RV enlargement, otherwise unexplained, strongly supports the diagnosis and angiography may be avoided. Isolated local changes seen by echocardiography should increase suspicion of RV dysplasia, but complementary angiographic study is warranted.

Adolescent↗
PubMed1985

A reconsideration of Doppler assessed gradients in suspected aortic stenosis.

To further define the clinical role of continuous wave Doppler echocardiography for determining aortic valve gradient, we studied 60 consecutive adult patients (age range 22 to 81 years, mean age 63) with suspected aortic stenosis within 24 hours of catheterization. Blind comparisons of Doppler peak and mean gradients by the simplified Bernoulli equation were made with catheterization peak-to-peak (r = 0.84), peak (r = 0.87) and mean (r = 0.84) gradients in a double-blind fashion. Despite these favorable correlations, Doppler peak gradient generally overestimated catheterization peak-to-peak gradient (1 to 53 mm Hg), making it impractical for clinical use. Doppler-catheterization correlations of peak and mean gradients were more favorable, with the least scatter noticed for mean gradient. The results of analysis of pooled data indicated that mean gradient may also be most specific for differentiating severe from less severe aortic stenosis. In this consecutive series where a full range of catheterization gradients was encountered, seven patients with predicted Doppler gradients were found to have none, which is best explained by the use of the simplified Bernoulli equation in patients with aortic insufficiency. These data indicate that prudence should be maintained when Doppler gradients alone are used for the assessment of aortic stenosis.

Adult↗
PubMed1985

Nonsurgical management of small and intracanalicular acoustic tumors.

Although surgical removal is generally regarded as the management strategy of choice for acoustic tumors, there remains a small group of patients usually with small or intracanalicular tumors in whom nonoperative management may be a desirable alternative to operation. The authors present a series of six such cases and discuss criteria that may aid in the selection of patients suitable for initial nonoperative management.

Aged↗
PubMed1985

Presentation of central nervous system sarcoidosis as intracranial tumors.

Five cases of sarcoid presenting as an intracranial tumor are reported. In one instance, the lesion presented as a tumor in the cerebellopontine angle, a site not previously reported for the initial presentation of sarcoid isolated to the central nervous system. The role of computerized tomography, surgery, and steroid therapy is discussed. In the absence of pulmonary involvement, serum angiotensin-converting enzyme levels do not appear to be helpful in predicting steroid response.

Adolescent↗
PubMed1985

Skull base surgery for glomus jugulare tumors.

Thirty-six patients with glomus jugulare tumors have been managed over a 13-year period using various combinations of skull base surgery and irradiation therapy. The data resulting from this study are presented; the techniques of diagnosis and treatment are reviewed. We conclude that irradiation therapy alone is a satisfactory form of treatment for elderly and poor-risk patients; preoperative x-ray therapy followed by skull base surgery is an effective treatment for younger patients.

Adult↗
PubMed1985

Facial nerve function in cerebellopontine angle tumor surgery.

This article evaluates previous reports of facial nerve function after acoustic tumor surgery, and reports the results of a series of 144 patients treated surgically for cerebellopontine angle tumors. Previous reports have been handicapped by lack of an adequate grading system, which makes it difficult to compare results of different series. Previous studies provide limited correlation of pertinent features of pathology and management. This study correlates both the anatomic status of the facial nerve postoperatively with the ultimate outcome, and whether or not additional facial nerve surgery was performed, as well as the level of facial nerve function with the duration of time elapsed since surgery. Findings indicate that, although the long-term likelihood for satisfactory recovery of facial function is high, there is also a high likelihood of severe facial paralysis at some point during the postoperative course. Emphasis is also placed on maximal use of available technology during the process of dissection of the nerve from the tumor.

Adult↗
PubMed1985

Transtemporal approaches to the cranial cavity.

A variety of surgical approaches through the temporal bone to the cranial cavity have been described in the past. We advocate creative modifications and combinations of these approaches in order to match the specific needs of particular tumors and other types of pathology. Two case examples demonstrating the need for such modifications are presented.

Adult↗