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Biomedical subjects

P J Teddy

Publications and source records attributed to P J Teddy.

At least 19 recordsLinked to original sources
PubMed1995

Implants for spasticity.

In carefully selected groups of patients, intrathecal baclofen therapy offers well-proven benefits in reducing spasticity, notably in cases of spinal injury and multiple sclerosis. The initial costs of implantation are high, and there must be a long-term commitment by both patient and medical personnel to careful and proper management. Nevertheless, in suitable cases, the techniques should generally be properly considered before proceeding to any irreversible destructive neurosurgical procedure.

Baclofen↗
PubMed1992

Cerebrospinal fluid kinetics of epidural clonidine in man.

Ten patients with deafferentation pain after spinal cord injury were given 150 micrograms clonidine epidurally. CSF and plasma samples were collected over the following 24 h, and drug concentrations were measured by radio-immunoassay. The results of only 6 patients are included in the pharmacokinetic analysis because the catheters were not in the epidural space in the remaining 4 patients. These analyses revealed a mean maximum CSF concentration of 228 ng/ml whereas the mean plasma concentration at all time points was less than 0.7 ng/ml. The elimination half-life of epidural clonidine was 66 +/- 2 min, while the absorption half-life was 31 +/- 7 min, Tmax was 60 +/- 7 min and Cmax was 228 +/- 56 ng/ml. The ratio of the area under the curve (AUC) for CSF and plasma was 52. One patient's catheter was intrathecal and 3 were not in the epidural space. The measured plasma concentrations were similar after all injections. As 4 of 6 patients with epidural catheters obtained pain relief and all 3 patients with spasms obtained relief from epidural clonidine, these data suggest that clonidine has a place in the treatment of patients with spinal cord injury.

Adult↗
PubMed1991

Supratentorial masses: stereotactic or freehand biopsy?

CT-guided stereotactic biopsy is now an accepted method of tissue sampling in intracranial mass lesions but many surgeons still practise freehand burrhole biopsy. This study compares two groups of patients who had either stereotactically guided (n = 153) or freehand (n = 217) biopsy. Stereotactic biopsy has a lower incidence of both mortality (2.6%) and morbidity (1.3%) than freehand (7.8 and 7.8%) while diagnostic accuracy is 92.1 and 64.9%, respectively. The success rate for stereotactic biopsy is independent of the size and depth of the lesion while freehand biopsy is most successful for large, superficial lesions but its success never exceeds 88%. The stereotactic technique is superior to the freehand for all intracranial biopsies regardless of size or site.

Adult↗
PubMed1990

Effect of a new computed tomographic image transfer system on management of referrals to a regional neurosurgical service.

A computed tomographic image transfer system ('Image Link') was used to link scanners within the Oxford region, UK, to the regional neurosurgical service. 100 consecutive neurosurgical referrals were examined by this system; 43% of the emergency referrals did not require transfer, 31% were transferred electively, and 26% urgently. Most of the patients defined as potentially hazardous for transfer (10/11) did not require neurosurgical intervention. The delay by the use of the system was negligible and early detection of intracranial haematoma contributed to good outcome in some head injured patients. Overall, 3,170 miles of ambulance journey were avoided. Use of image link has led to substantial improvements in management of neurosurgical emergency referrals, cost-effectiveness of neurosurgical and ambulance facilities, and interhospital communication between doctors.

Adolescent↗
PubMed1990

A double blind placebo controlled trial of the calcium entry blocking drug, nicardipine, in the treatment of vasospasm following severe head injury.

A double blind, placebo controlled trial of nicardipine in the treatment of high Doppler Flow Velocity (DFV) following severe head injury (Glasgow Coma Score (GSC) less than or equal to 8) was performed. Thirty patients with high DFV (greater than or equal to 100 cm/s for 6 h duration) on transcranial Doppler ultrasound, were treated with nicardipine or placebo for 24 h (2.5 mg/h, increasing in steps of 2.5 mg/h at 2 h intervals (maximum rate 7.5 mg/h) depending on response of DFV). DFV was measured hourly for 24 h and then every 12 h for 2 days. Nicardipine significantly reduced DFV below the threshold of 100 cm/s (16/19 cf placebo 3/11, chi-square p less than 0.001). In the nicardipine treated group maximum DFV was significantly reduced (p less than 0.001) and time with DFV below 100 was significantly longer. Rises in DFV were significantly reduced by the drug if the DFV was normal at the time of entry. High DFV returned on cessation of the infusion. No unexpected or adverse side effects were seen. No clinical benefit was demonstrable.

Adolescent↗
PubMed1990

Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients.

The clinical features, perioperative course, and postoperative outcomes of 144 patients who underwent microsurgical resection of craniopharyngioma were reviewed. Overall, 90% of the tumors were completely resected and 7% recurred. Evaluation of those patients who underwent primary resection revealed much better results. The operative techniques and approaches are reviewed in detail. The results of this series suggest that primary total removal of craniopharyngiomas yields the best long-term outcome for the patient. Experience has shown that the larger the tumor the greater will be the damage, both preoperatively and intraoperatively, to vital intracranial structures. Consequently, early diagnosis, at a stage when the tumor is still small, improves the chances of accomplishing complete removal and of achieving good operative results. The early diagnosis of craniopharyngioma, before it can produce devastating neurological defects, continues to be the principal goal of our medical and pediatric colleagues.

Adolescent↗
PubMed1987

Cerebral arterial vasospasm following severe head injury: a transcranial Doppler study.

Transcranial Doppler ultrasound was used to determine the natural history of cerebral arterial vascular spasm following severe head injury. Doppler Flow Velocity (DFV) was measured in the anterior cerebral, middle cerebral and terminal carotid arteries. High DFVs consistent with vasospasm were identified in 68% of the 25 patients studied. They came on from between 12 h and 4 days and lasted from 12 h to 14 days. No relationship could be determined between presumed vasospasm and blood pressure, intracranial pressure or outcome. Rises in the maximum DFV value (to above 100 cm s-1) were associated with neurological deterioration in 12 instances (in 11 of these the DFV remained elevated for more than 12 h). Deterioration occurred in three instances without change in DFV. DFV rose to above 100 cm s-1 on 10 occasions without neurological change (but remained elevated for more than 12 h in only four of these). Vasospasm has been found to be more common following head injury and may be a more significant cause of deterioration than previously thought.

Adolescent↗
PubMed1987

Lymphomatoid granulomatosis apparently confined to one temporal lobe. Case report.

Lymphomatoid granulomatosis is of uncertain etiology and poses problems with diagnosis and treatment. A case with involvement of the right temporal lobe, but associated with cystoid macular edema of the retina, is described. The unusual mode of presentation, the radiographic, operative, and pathological findings, the response to surgery and radiotherapy, and the possible etiology are discussed.

Adult↗
PubMed1986

Role of spinal noradrenergic system in transmission of pain in patients with spinal cord injury.

15 patients with deafferentation pain due to spinal cord injury were investigated for a spinal mechanism of pain transmission. Epidural morphine 5 mg in 5 ml of water had an analgesic effect in 5 patients, 3 of whom also had pain relief with epidural clonidine. Epidural clonidine 150 micrograms in 5 ml of saline had an analgesic effect in 7 patients who did not respond to epidural morphine. Neither epidural morphine nor clonidine was effective in the other 3 patients, 2 of whom obtained relief with epidural buprenorphine 0.3 mg in 5 ml of saline. 1 patient did not find relief with any of the injections. These data suggest that a spinal noradrenergic system may be as important as the opioid system in the transmission of pain in patients with spinal cord injury.

Adult↗
PubMed1986

Epinephrine reduces systemic absorption of extradural diacetylmorphine.

The effect of epinephrine on the vascular absorption of morphine from the extradural space is uncertain; this study examined the effect of epinephrine on the related but more lipophilic opiate diacetylmorphine (diamorphine, heroin) because any effects of vasoconstriction on diacetylmorphine absorption should be maximally apparent. With this experiment, we hoped to resolve whether epinephrine does or does not alter vascular absorption of extradurally injected opiates. Thirty patients undergoing lumbar laminectomy were given either extradural diacetylmorphine, 5 mg, extradural diacetylmorphine, 5 mg with 1:200,000 epinephrine, or 1:200,000 epinephrine followed 5 min later by 5 mg extradural diacetylmorphine. Plasma morphine concentrations were measured by radioimmunoassay because of the rapid conversion of diacetylmorphine to morphine in plasma; repeated blood samples were obtained the first 30 min after injection into the epidural space. Significantly lower plasma morphine levels occurred between 3 and 20 min when epinephrine was added to diacetylmorphine. Peak plasma morphine levels (mean +/- SEM) were 179 +/- 37 nmol/L with diacetylmorphine alone, 87 +/- 16 nmol/L with diacetylmorphine and epinephrine given together and 44 +/- 11 nmol/L with epinephrine pretreatment, all significantly different from one another. The mean peak plasma morphine concentration was 8.7 +/- 1.1 min for diacetylmorphine alone, but addition of epinephrine (together or sequentially) meant that 15 of 20 patients had no peak level before 120 min. Epinephrine reduced absorption of diacetylmorphine from the extradural site by at least 55% over the first 30 min. The incidence of patients with more than 9 hr analgesic duration was significantly (P = 0.033) greater in patients who had diacetylmorphine and epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed1984

Arteriovenous malformations of the spinal cord.

The operative experience in Zürich of forty-one cases of spinal AVM with major intramedullary components showed that it was possible, with the aid of precise microsurgical techniques, to remove completely 60% of these lesions with improvement, or, at least, without deterioration in neurological condition. A further 12% could be apparently effectively palliated by subtotal removal. Radical surgery may be justified in patients with irreversible neurological deficits to treat pain and to prevent fatal SAH. The best results have generally been obtained in patients with less severe neurological deficits and with lesions in the cervical region rather than the thoracolumbar region. The natural history of intramedullary spinal AVMs--that of deterioration after recurrent haemorrhage--is analogous to that of intracranial aneurysms--and the need for earlier diagnosis and for early preventive surgery is the same for both. It would, perhaps, be preferable to treat all cases of spinal AVM by transvascular occlusion to obviate the risk of open surgery and of spinal deformity, but some AVMs will remain impossible to treat by this means and the long term results of embolization still require full analysis before it can be accepted as definitive treatment. Comprehensive and exact superselective spinal angiography is a mandatory prerequisite to surgery and preoperative partial embolization may facilitate operation considerably in the future. However, even the most careful angiographic studies do not always totally define the lesion and the surgeon must be prepared to find unexpected vascular relationships at operation. A simple classification of intramedullary and mixed extra/intramedullary lesions is described. The experiences with dural arteriovenous malformations in Queen Square again show that the best results are obtained in patients who have mild or moderate neurological deficit preoperatively. There is no doubt that progressive neurological deficits finally become irreversible and it is therefore clear that once the diagnosis is suspected, it should be definitively established and operation should follow immediately. The prime, indeed the only, necessary investigation is selective spinal angiography, which demands a high degree of radiological skill and experience, but given these prerequisites, may be performed with little hazard. While embolization of these lesions is possible, the simple surgical disconnection of the nidus of the shunt from the coronal venous plexus is effective in most cases, apparently permanently, and is substantially without risk.

Adolescent↗
PubMed1984

Traumatic cerebral flaccid paraplegia.

Two cases of paraplegia caused by head injuries sustained in recent military conflicts are presented. The underlying pathological disturbances could be related to the CT scan appearances and are discussed in the light of previously reported series. Both cases were remarkable for an early and prolonged paraplegia which was flaccid, rather than spastic, and for the sensory impairment produced.

Adult↗
PubMed1984

CSF smooth-muscle constrictor activity associated with cerebral vasospasm and mortality in SAH patients.

Cerebrospinal fluid (CSF) was collected preoperatively (by lumbar puncture) or perioperatively (by lumbar or ventricular drain) from 32 patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms. Samples were also obtained from six control patients without evidence of subarachnoid blood. Smooth-muscle constrictor activity in the CSF was measured by bioassay using the isolated rat stomach fundus preparation. Concentrations of unidentified smooth-muscle constrictor substances were considerably greater in CSF from a group of seven patients with evidence of severe angiographic vasospasm and/or delayed ischemic deficits who died (73.8 +/- 39.7 nmol/liter prostaglandin E2 (PGE2) equivalents), as compared to 25 other SAH patients who survived (6.5 +/- 1.4 nmol/liter PGE2 equivalents), and six control patients (1.17 +/- 0.34 nmol/liter PGE2 equivalents). The data suggest that there is a relationship between smooth-muscle constrictor substances in the CSF after SAH and both the degree of angiographic vasospasm and the outcome. It is possible that this relationship might be exploited clinically.

Humans↗