"There was this one guy ...": the uses of anecdotes in medicine.
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Biomedical subjects
Publications and source records attributed to K M Hunter.
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Patients who had given their informed consent took part in a study to compare the sedative properties of the new benzodiazepine, midazolam, with diazepam. The drugs were administered intravenously and the quality of sedation, profoundness of amnesia, and rate of recovery were examined. Both drugs provided good-quality sedation, with midazolam producing a significantly greater degree of amnesia. Psychomotor tests used to assess recovery showed that patient performance following exposure to either drug had returned to normal 2 hours postsedation. However, patients who had received diazepam were drowsier later in the day and during the night following sedation than those who received midazolam. The implications of these findings are discussed.
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In this series of intracerebral hematomas from aneurysmal rupture, gathered from several neurosurgical services, certain morphological features were studied in detail. Patients with very large hematomas tended to have poor neurological grades on admission to hospital and their immediate discharge outlook was correspondingly poor. Ruptured middle cerebral and pericallosal artery aneurysms were relatively common causes of intracerebral hematomas. Patients with temporal lobe hematoma did relatively well; those with parietal hematoma did poorly. The larger the hematoma the less chance there was of developing cerebral vasospasm but the more likely was pre-operative brain herniation. The survival was more closely linked to size and location of the hematoma than to the location of aneurysm or the degree of midline shift.
A clinical trial was designed to compare diazepam and lorazepam when administered intravenously immediately prior to third molar surgery. The two drugs were compared on three scores, patient behaviour during surgery, presence of amnesia and extent of psychomotor impairment. Within the confines of the investigation the principle difference between diazepam and lorazepam was the greater degree of psychomotor impairment induced by the latter drug two hours post-injection.
A double-blind clinical trial of the effects of the use of benzydamine hydrochloride for patients undergoing the surgical removal of impacted lower third molar teeth showed no significant effects on swelling and trismus between control and experimental groups, although a significant reduction in the post-operative consumption of analgesics was noted.
Isobutyl 2-cyanoacrylate monomer placed in an osseous defect excited an intense acute inflammatory response in the early stages of repair. Fibrous encapsulation of the adhesive followed, and chronic inflammation supervened for as long as the cyanoacrylate remaine. Damage to established bone, presumable due to toxic breakdown products, occurred even at a distance from the adhesive. Osteoblastic activity was retarded where cyanoacrylate was in close proximity, recovering as fibrous encapsulation and macrophage activity provided protection. Extensive marrow damage was seen, recovery similarly following fibrous protection. Repair progressed as cyanoacrylate was removed. The findings of this investigation, together with other reports of unfavourable bone reaction to isobutyl 2-cyanoacrylate (Kerr & Smyth, 1971; Corn et al., 1972) suggest that it should not be used in bone surgery. An ideal adhesive for use in bone repair should promote rather than retard osteoblastic activity, and should resorb apace with bone regeneration. Thus isobutyl 2-cyanoacrylate does not fulfil the criteria for the ideal adhesive. Hopefully, future development of the cyanoacrylates will circumvent their current disadvantages, resulting in an adhesive acceptable for clinical use in osseous repair.
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Cysts of the ligamentum flavum are uncommon causes of neurologic signs and symptoms and usually are seen in persons over 50 years of age. We report a case of an epidural cyst located in the ligamentum flavum, which contributed to spinal stenosis in a 30-year-old man. Radiologic features were similar to those of a synovial cyst, but synovium was not identified histologically. The imaging and pathologic features were unusual, including hemorrhage and a fibrohistiocytic reaction with giant cells.