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Biomedical subjects

M J Gleeson

Publications and source records attributed to M J Gleeson.

At least 55 records · Page 3Linked to original sources
PubMed1991

Prediction of facial nerve function after surgery for cerebellopontine angle tumors: use of a facial nerve stimulator and monitor.

A series of 18 patients undergoing surgery for cerebellopontine angle tumors is reported. Patients were grouped according to size of tumor (0 to 2.5 cm, 11 cases; more than 2.5 cm, 7 cases). In all, the facial nerve was identified and conductance assessed by monitoring the facial electromyographic response to facial nerve stimulation. Postoperative facial nerve function was graded clinically after 3 months according to the House scale. Tumor removal was complete in all cases. In patients with tumors up to 2.5 cm the facial nerve was intact to visual inspection at the end of the procedure in all but one, where partial division was evident. In this group intraoperative facial nerve stimulation indicated electrical integrity in 8 of the 11 cases, all of which regained good facial nerve function postoperatively (House grades I and II). Nerve conduction was lost during the operation in the remaining three patients with small tumors; two subsequently developed a moderately severe (grade IV) dysfunction and the third, a total paralysis (grade VI). In the large (more than 2.5 cm) tumor group the facial nerve was anatomically intact in five of the seven cases, partially divided in one, and completely sectioned in the remaining case. Facial nerve stimulation indicated functional integrity in three patients, two of whom developed moderate (grade III) and the third a severe (grade V) dysfunction. In the other four cases nerve function could not be detected at operation; three of these developed a moderate facial nerve dysfunction (grade III/IV) and the final case a complete paralysis (grade VI). Intraoperative facial nerve monitoring appeared to predict eventual facial function accurately in the small tumor group, but did not predict facial nerve recovery reliably following surgery for larger tumors.

Journal Article↗
PubMed1991

Randomized, double-blind trial of Lithostat (acetohydroxamic acid) in the palliative treatment of infection-induced urinary calculi.

In a prospective, double-blind, placebo-controlled study, the efficacy and safety of acetohydroxamic acid (AHA) in preventing urinary calculogenesis was evaluated in 94 patients with chronic urinary infection. Stone growth occurred in 17% of the AHA group and in 46% of the placebo group (p less than 0.005). Completely reversible side effects consisting predominantly of psychoneurologic and musculo-integumentary symptoms were more prevalent in the AHA group (p less than 0.01). Side effects which were judged 'intolerable' were experienced by 10 (22.2%) of patients in the AHA group and 2 (4.1%) in the placebo group. It is concluded that AHA treatment is effective, relatively safe, and clinically useful in preventing infection-induced urinary calculogenesis.

Adult↗
PubMed1991

Registration of MR and CT images for skull base surgery using point-like anatomical features.

We have developed a registration technique for combining magnetic resonance imaging (MRI) and computed tomography (CT) images of the skull base for use in surgical planning. The technique is based on user identification of point-like landmarks visible in both modalities. The combination of images involves a small amount of expert interaction, is relatively quick and preliminary evaluation indicates that it is accurate to within 1.5 mm. Registered or fused images can be viewed either on an image processing workstation, or fused images can be printed onto conventional film for convenience in clinical use. We present one patient in order to demonstrate the technique's indications and advantages.

Humans↗
PubMed1990

Percutaneous cholecystolithotomy. A minimally invasive alternative to cholecystectomy and to shock wave lithotripsy.

Recently introduced treatment alternatives for gallstones include peroral pharmacological chemolysis plus shock wave lithotripsy and percutaneous cholecystolithotomy. Herein we report on the treatment preferences of 23 patients with symptomatic gallstones and our initial experience with percutaneous cholecystolithotomy in 6 of these patients. All patients were rendered stone free after one procedure. Percutaneous cholecystolithotomy, which is applicable to all types of gallstones, is a safe, practical, low-morbidity alternative to cholecystectomy in selected patients.

Adult↗
PubMed1990

Percutaneous endoscopic treatment of cholelithiasis.

Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

Chenodeoxycholic Acid↗
PubMed1990

Effect of unprocessed wheat bran on calciuria and oxaluria in patients with urolithiasis.

Seventeen hypercalciuria patients (8 control, 9 treatment) with a history of urolithiasis were randomly selected to receive low-calcium, low-oxalate diets with or without the addition of 30 g of dietary fiber as unprocessed wheat bran. Diet alone resulted in a 5.6 percent decrease in calciuria compared with a 23.5 percent decrease with the addition of the fiber. The addition of hydrochlorothiazide and potassium citrate further reduced calciuria by 40.4 percent and 34.5 percent, respectively. Oxaluria was decreased 21.4 percent by diet alone compared with 3.9 percent in the diet and fiber treatment group. Patient compliance to diets was good, and no complications resulted from fiber intake.

Adult↗
PubMed1990

Comparison of oscillation with three other methods for measuring nasal airways resistance.

In this study we have compared the sensitivity and reproducibility of nasal airways resistance measurements made using an oscillometer, with those made by passive anterior, active anterior and active posterior rhinomanometry. Nasal airways resistance values were compared in 12 patients with rhinitis and 15 normal subjects, of whom ten had additional measurements after a vasoconstrictor spray, oxymetazoline. The coefficients of variation of 6-8 technically satisfactory measurements were 9-19%. The decongestant effect of oxymetazoline was detected by all methods, with no decrease in reproducibility. Post vasoconstrictor nasal airways resistance fell by 28% (passive anterior), 35% (active anterior), 36% (active posterior) and 58% (oscillometry). In conclusion, the oscillation method for deriving nasal airways resistance is a useful, new, simple and noninvasive way of assessing nasal airways patency. Results compare favourably with other, more established techniques.

Adult↗
PubMed1990

Oncocytic adenomas and oncocytic hyperplasia of salivary glands: a clinicopathological study of 26 cases.

Twenty-six benign oncocytic lesions of the salivary glands, excluding Warthin's tumours, have been reviewed and criteria for their classification as oncocytoma, multifocal nodular oncocytic hyperplasia, diffuse oncocytosis, pleomorphic adenoma with oncocytic change or oncocytic monomorphic adenoma have been proposed. The histological and clinical features of this heterogeneous group of lesions are discussed. This analysis suggests that the majority of lesions initially categorized as oncocytomas were, in fact, either non-neoplastic or, alternatively, oncocytic change in other types of adenoma.

Adenoma↗
PubMed1990

Urinary diversion.

Although the ileal conduit must be regarded as the "gold standard" technique of urinary diversion, many long-term complications result and patients must wear urinary collection devices with their associated psychological and social limitations. The recent interest in continent diversions was primarily an attempt to improve the quality of life rather than improve survival or reduce renal and metabolic complications. Although continent stomas can be achieved with low pressure reservoirs fashioned from detubularised or augmented bowel, many operations may be required to perfect the continent stoma. Long-term results using continent reservoirs are awaited. It seems that a bladder substitute using reconfigurated bowel is preferable to a continent reservoir but continence remains a problem and all of the techniques lack long-term follow-up. The use of bladder substitutes in females is limited by the need to use a prosthetic sphincter to achieve continence.

Humans↗
PubMed1990

Ultrastructural aspects of the human peripheral vestibular system.

The sensory epithelia from the membranous labyrinths of 4 patients were examined by transmission electron microscopy. The distribution ratio of type 1 to type 2 cells was recorded, compared for each sensory area and correlated with age. An ultrastructural assessment confirmed generalized patterns consistent with autolytic and preparation artefact, viz. calyceal dilatation, cytoplasmic protrusions and some sensory hair loss. More specific features, i.e. lipofuscin accumulation, membrane-bound inclusions and neural degeneration were consistent with pre-mortem pathological change. In 2 patients, total nerve fibre counts of 15,766 and 19,741 were obtained. Total fibre counts correlated with the sensory cell density of the innervated areas. Differential counts of the superior and inferior vestibular nerves suggested that there was a reduced number of fibres in the superior division of both patients, in comparison with established normative data. Morphometric analysis of the constituent fibre diameters revealed a skewed distribution with a modal value of 6 microns for both patients.

Aged↗
PubMed1990

Gallstones: advantages and disadvantages of five treatment alternatives.

Cholecystectomy is the gold standard treatment for symptomatic gallstones. However, within the last decade peroral drug chemolysis, methyl-tert-butyl ether lavage, shock wave lithotripsy, and percutaneous cholecystolithotomy have been introduced. This article compares and contrasts the presently available therapeutic modalities for gallstones and highlights the limitations of each treatment option.

Bile Acids and Salts↗
PubMed1989

Effectiveness of radiation control program for Dornier HM3 lithotriptor.

Radiation exposure during extracorporeal shock-wave lithotripsy (ESWL) was calculated using a "worst-case method" in 135 randomly selected patients. The patients were divided into four groups according to body weight: small (less than 140 pounds), medium (141-180 pounds), large (181-220 pounds), and very large (greater than 220 pounds). Average skin exposure was found to be 15.2 R (from 1.2 to 95.6 R). After implementation of a "radiation awareness program" radiation exposure was calculated in 128 cases (matched for body weight and stone burden) and average exposure was 9.5 R (from 0.9 to 33.4 R) with a reduction of 20, 37, 33, and 62 percent for each group, respectively. Radiation exposure reduction was primarily due to a reduction in the number of radiographic "snapshots" taken as a result of preferential use of special-mode fluoroscopic "stills."

Body Weight↗
PubMed1989

Infection stones.

The pathogenesis and epidemiology of infection stones are well understood. While percutaneous lithotripsy and extracorporeal shock wave lithotripsy have emerged as the mainstay of extirpative therapy, surgical lithotomy is the standard to which other therapies must be compared. Adjunctive therapy with pharmacological agents that inhibit urease with few side effects and effective urinary acidifiers favor chemolysis. Diet and chemotherapy offer the hope of slowing stone growth and/or recurrence in patients with chronic urease-producing bacteriuria.

Humans↗