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Biomedical subjects

P Macpherson

Publications and source records attributed to P Macpherson.

At least 55 records · Page 3Linked to original sources
PubMed1987

Syringomyelia: cyst measurement by magnetic resonance imaging and comparison with symptoms, signs and disability.

The severity and distribution of symptoms and signs in patients with syringomyelia is considered to be dependent on the longitudinal and transverse dimensions of the syrinx and it is thought that clinical examination can identify the extent of the cyst. Magnetic resonance imaging has made the anatomical localisation of intramedullary spinal lesions more exact and probably more specific than previous methods of investigation. Syrinx length, diameters, cyst:cord and cord:canal ratios have been studied in 12 patients with syringomyelia to assess whether the dimensions of the syrinx relate to the clinical findings. The length of syrinx appeared to be related to cyst diameter, cyst:cord and cord:canal ratios. Patients with a small syrinx tended to have a small cyst diameter, and small cyst:cord and cord:canal ratios. No significant relationship was found between muscle wasting or weakness, distribution of sensory loss, degree of disability or distress and the dimensions of the syrinx. These findings should be borne in mind when surgical management is being considered.

Adult↗
PubMed1987

Do cerebral arteriovenous malformations increase in size?

Six patients are reported with cerebral arteriovenous malformations which have enlarged over follow up periods of from 4 to 20 years. The frequency of spontaneous enlargement is estimated to range from 0.2% to 2.8% per annum. This rate of enlargement should be considered when treatment options are reviewed in individual patients, and should be added to the risk of haemorrhage.

Adolescent↗
PubMed1987

Rhino-orbital-cerebral mucormycosis--a clinico-pathological report of two cases.

Rhino-orbital-cerebral mucormycosis is an acute fungal infection of the oropharynx, paranasal sinuses, orbit and intracranial structures. It is rare, occurring mainly in diabetics in ketoacidosis. The clinical presentation is highly suggestive of the diagnosis. Current treatment has resulted in a greatly improved prognosis for survival and clinical awareness of this disease is important for early initiation of treatment with optimal effect. A clinico-pathological report of two cases is presented.

Adult↗
PubMed1986

Brain lesions detected by magnetic resonance imaging in mild and severe head injuries.

50 patients were studied by magnetic resonance imaging (MRI) within one week of a head injury. Abnormalities indicating primary brain damage were found in 46 patients, almost twice as many as with computed tomography. Cortical contusions were the most common finding, irrespective of the effect of injury on the level of consciousness. Intracerebral lesions were seen only in patients who had lost consciousness and were present in 29 of 42 patients whose consciousness was still impaired on arrival at hospital. Lesions in the deep white-matter of the cerebral hemispheres were seen in 15 patients; they were significantly more frequent in patients in coma but were also seen in patients who had lost consciousness for no more than 5 min. The findings indicate that lesions in the cerebral hemispheres may be the primary factor in traumatic unconsciousness. MRI studies may also clarify the sequelae of head injuries.

Acute Disease↗
PubMed1986

The prophylactic use of phenytoin during iopamidol contrast studies of the subarachnoid space.

Contrast examinations of the subarachnoid space are associated with side effects including convulsions. Attention has been given to the prophylactic use of anticonvulsants. We describe a simple oral regimen using the established anticonvulsant phenytoin that can be administered to short-stay patients and that achieves effective serum and CSF concentrations. A preliminary account of this work was presented to the British Pharmacological Society in January 1984 in London.

Contrast Media↗
PubMed1986

High-resolution computed tomography in pituitary microadenoma: is seeing believing?

Controversy surrounds the reliability of high-resolution computed tomography (CT) in the identification of functioning microadenomas, especially in patients with hyperprolactinaemia and hypercortisolaemia. We studied 34 such patients: each underwent a high-resolution CT examination of the pituitary gland and each had a trans-sphenoidal exploration. Computed tomography showed 28 focal abnormalities but only 20 of these were confirmed to be due to a tumour at operation. In the other eight the tissue at the site of the radiological abnormality was normal histologically. In a total of 29 patients a tumour was found at operation and confirmed histologically; 20 were at the site of an abnormality shown by CT but in nine a tumour was found in a part of the gland judged to be normal radiologically. In general, good correlation between CT and the surgical findings was found only with tumours more than 6 mm in size. Of the indirect signs of a tumour, such as stalk deviation and a convex upper surface of the gland, only the former showed any correlation with the presence of a tumour. The results show that cautious, even sceptical interpretation of pituitary CT scans is essential and suggest that this investigation is not sufficiently reliable to be used as a routine in the assessment of hyperprolactinaemia or Cushing's syndrome. Computed tomography should be reserved for patients undergoing pituitary surgery, those with an enlarged fossa on plain radiography and those with extreme hormone hypersecretion.

Adenoma↗
PubMed1986

The significance of traumatic haematoma in the region of the basal ganglia.

Computed tomography demonstrated a haematoma in the region of the basal ganglia in 61 of 2000 head injured patients. In 41 the haematoma occurred as an isolated lesion while in 20 there was another associated intracranial haematoma. Clinical and radiological differences within these groups are discussed. The patients with basal ganglia haematoma were more severely injured than those in a group who had an intracranial haematoma evacuated by craniotomy and the findings closely resembled those of a group of patients who had sustained diffuse brain damage. They share many features with those of patients with diffuse white matter injury and have a worse prognosis than other traumatic intracranial haematomas.

Adolescent↗
PubMed1986

CT appearances of craniopharyngiomas before and after therapy.

Different means of therapy are available for the treatment of craniopharyngiomas (surgery, radiation therapy, radioactive implants) but their respective impact is still a matter of controversy. Computed tomographic examinations of 26 patients before and after various forms of therapy were used to monitor the efficacy of treatment. 118 scans were retrospectively studied for characteristic features. 16 patients were treated by surgery and additional radiotherapy, 10 had surgery alone. The total size of the tumour was found to be decreased in 69% of patients treated by incomplete surgery and irradiation up to 9 years after treatment, while tumor progression occurred in three patients. Where the surgeon considered that there had been excision of the lesion, evidence of residual tumour was seen in 4/8 (50%) of cases, but no regrowth occurred in these whose postoperative scans had indicate complete resection. The increase or development of calcification after radiotherapy is compatible with a silent tumour.

Adolescent↗
PubMed1985

Routine bed rest is unnecessary after cervical myelography.

After undergoing myelography with iopamidol by either direct puncture (n = 120) or lumbar puncture and run up of the contrast medium (n = 232), the patients were randomly allocated into one of two groups, one group being confined to bed for 24h and the other allowed to be fully ambulant. Questionnaires recording the occurrence and severity of side effects were completed at specific intervals after the myelogram. Adverse reactions experienced were significantly fewer than in our previous direct puncture study using metrizamide. Neither in the direct puncture nor in the run up group were side effects adversely affected by allowing the patients to remain ambulant after the examination. There is, therefore, no necessity to confine patients to bed following cervical myelography.

Bed Rest↗
PubMed1985

Iohexol versus iopamidol for cervical myelography: a randomised double blind study.

A randomised double blind trial of iohexol and iopamidol in cervical myelography by both lumbar puncture and direct puncture techniques is reported in one hundred consecutive patients. All patients had EEG examination before and 6-8 h after the myelogram and for each a questionnaire regarding adverse reactions was completed at set intervals. The side effects, radiographic quality of the examination and production of sharp wave activity on EEG were equivalent in the iohexol and iopamidol series. Contrary to previous reports, we consider that iohexol and iopamidol are equally acceptable for all forms of myelography.

Clinical Trials as Topic↗
PubMed1985

Oligodendroglioma and cerebral cavernous angioma. Case report.

The authors report a case of frontal lobe oligodendroglioma associated with a cavernous angioma. The patient presented with signs and symptoms of raised intracranial pressure. Computerized tomography with contrast enhancement failed to detect the vascular component. The clinical and pathological significance of the presence of this vascular malformation in an oligodendroglioma is discussed.

Adult↗
PubMed1984

Radiculography with non-ionic contrast medium: routine bed rest is unnecessary.

In a prospective study into the occurrence of side-effects, 200 patients who had undergone iopamidol radiculography were randomly allocated into two groups, one being confined to bed for 24 h and the other allowed to be fully ambulant. We found that the incidence of side-effects was not increased by allowing the patients to remain ambulant and that headache and dizziness were significantly less frequent than in a comparable study in which we had used metrizamide.

Bed Rest↗
PubMed1984

Guidelines for cervical myelography: lumbar versus cervical puncture technique.

Cervical myelography may be performed with non-ionic contrast media either by direct cervical puncture or by lumbar puncture with run-up of the contrast medium. In this prospective study of 300 cervical myelograms using iopamidol (130 by direct puncture and 170 by lumbar puncture), we have shown that the run-up technique causes no more side effects than direct puncture technique and films of equivalent diagnostic quality are obtained. A sub-group of 80 patients had EEG examinations before and after myelography, plus a lateral skull film taken at the end of the myelogram to assess the amount of contrast medium that had entered the skull. More EEG abnormalities were found in those patients examined by direct puncture and significantly more contrast medium had entered the skull in this group. Run-up myelography therefore results in less intracranial spill and so less potential for cortical irritation. In view of the EEG abnormalities, anticonvulsant premedication is discussed, and we now give phenytoin to all patients having cervical myelography with iopamidol. We consider that cervical myelography can be adequately and more safely performed by lumbar puncture technique but, to optimise patient safety, should be performed by a radiologist experienced in neuroradiology.

Anticonvulsants↗
PubMed1984

Subselective preoperative embolization for meningiomas. A radiological and pathological assessment.

Over a 2-year period the authors have studied the effects of preoperative subselective embolization of meningiomas. Thirty-six consecutive patients shown by computerized tomography (CT) to have a meningioma underwent selective internal and external carotid artery angiography, and any significant external carotid artery feeders were embolized (27 cases). It was found that CT and dynamic radioisotope scan findings were unable to predict the degree of vascularity of the tumor or its suitability for embolization. Furthermore, these tests, repeated after embolization, were unreliable in detecting either the extent of necrosis or reduction in blood flow. The effects of embolization upon surgery were recorded, and the excised tumor specimen examined for evidence of thrombosis and infarction. Subselective embolization was determined to be a simple, safe, and effective method of producing tumor necrosis and intraoperative hemostasis in selected patients.

Adult↗
PubMed1983

Incidence of side effects following direct puncture cervical myelography. Bed rest versus normal mobility.

After cervical myelography by direct puncture at C 1/2 level, 120 patients were randomly allocated to one of two groups, in one the patients were allowed to be fully ambulant and in the other the regimen was bed rest for 24 h. Questionnaires recording the frequency and severity of side effects were completed at intervals after the examination. Headache, nausea and vomiting were common; fits and mental changes occurred also but were uncommon. The incidence and severity of these side effects did not differ significantly between the two groups.

Bed Rest↗
PubMed1983

Radiculography: is routine bed rest really necessary?

After undergoing metrizamide radiculography, 119 patients were randomly allocated to two groups, one group remaining ambulant and the other being kept in bed for 24 h. A member of staff who did not know the category allocation questioned each patient regarding the occurrence of side-effects 24 and 48 h after the procedure. It was found that the incidence and severity of complications was neither increased nor decreased by allowing the patient to remain ambulant.

Bed Rest↗