Biomedical subjects
Publications and source records attributed to P Macpherson.
A series of cervical myelograms performed by direct puncture resulted in almost identical incidence of side effects, more contrast within the skull, more frequent EEG abnormalities and only slightly better radiographic quality than in a comparable series of patients in whom the contrast was run up from the lumbar region.
The correlation between angiographic vasospasm, hematoma, and ischemic brain damage was studied in 29 patients who died as a result of subarachnoid hemorrhage following rupture of a saccular aneurysm. None of these patients was treated surgically. A comprehensive neuropathological examination was undertaken in each case. A significant relationship between the presence and degree of vasospasm and ischemic brain damage was found. Furthermore, even though intracerebral hematoma probably increased the risk of infarction associated with vasospasm, hematoma per se did not increase the incidence of ischemic brain damage.
Fourteen male patients with chronic bronchitis and hypoxia had a lateral radiograph of the pituitary fossa. Nine of the 14 had definite or probable abnormalities, a significantly higher frequency (p less than or equal to 0.01) than is represented by the two out of 14 age-matched men from a control group with head injuries. The most common change was thinning or erosion of the lamina dura. Patients with hypercapnia were no more prone to such abnormalities than were those with normocapnia, a finding that conflicts with a previous paper. We confirm that radiological pituitary fossa changes do occur in chronic bronchitis, that they are unrelated to steroid treatment, and that they are probably not solely due to the chronically raised intracranial pressure associated with hypercapnia. Other possible mechanisms are discussed--in particular hypoxia, which might produce changes on account of the increased cerebral blood flow and engorged intracranial blood vessels.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The changes produced by aneurysms which project into the pituitary fossa as seen on plain films and radiological investigations have been reviewed and then compared with those caused by pituitary tumours. Erosion of the lateral wall of the sphenoid sinus and a filling defect within the cavernous sinus were features seen only in the aneurysm cases. A widened superior orbital fissure, non-filling of cavernous sinus (especially with a normal contralateral sinus), and, on Ct, unilateral sellar erosion, calcification and eccentric (in relation to sella) circular attenuation on enhanced scan, were more commonly associated with aneurysms. A completely eroded area of bone, a completely eroded fossa, a soft tissue opacity in the sphenoid sinus, bilateral displacement of the cavernous sinuses and, on CT, general enlargement of the fossa were seen only with cases of pituitary tumour. Abnormalities pointing to the presence of an aneurysm were seen in every case in which one was present. Our view suggests that innocuous techniques will demonstrate the presence of a vascular anomaly in the pituitary fossa and validates the policy in this Institute of relying on these measures and of dispensing with routine angiography as a preliminary to transsphenoidal hypophysectomy or microadenomectomy.
A technique of orbital venography/cavernous sinography has been developed during a personal series of 500 examinations. By bare finger palpation anterior to the hair line a frontal vein was located and cannulated in all but one of the last 270 cases. Rubber bands and swab compression were used to dilate the frontal veins and subsequently to direct contrast to the ophthalmic veins without requiring help from the patient or an assistant. The popularity of the examination in this Institute is a reflection not only of the contribution it has made to diagnosis and management, but also of the success rate achieved and of its acceptability to patients.
Basal ganglia calcification was found as an incidental finding in 42 out of 7000 patients who underwent computed tomography. The calcification showed on plain skull radiography when the maximum density on computed tomography exceeded 100 Hounsfield units. The 26 patients with basal ganglia calcification detected on computed tomography who were available for follow-up, were investigated with matched controls. No clinical features of basal ganglia calcification were noted. Twenty-four patients had no significant metabolic abnormality and two patients had parathyroid disorder identified.
Radiological findings in 30 patients with proven prolactin-secreting pituitary adenomas, originally diagnosed exclusively by endocrine criteria, have been reviewed. Conventional tomography was the examination most often abnormal (50%), and changes or lack of changes corresponded to the state of the pituitary fossa as noted at operation in 93%. Tomographic abnormalities indicated the site of the tumour in 86%. Plain films were less sensitive (27% abnormal) although the changes reported were all confirmed during the surgical procedures. Although cavernous sinography and CT rarely yielded positive information unless either plain films or tomograms were abnormal, each may have a place in the assessment of a patient before operation: sinography to ensure that there is no significant anomaly of the carotid artery at the level of the pituitary fossa; CT scan to exclude a hypothalamic lesion or to detect an associated suprasellar tumour extension or intrasellar cisternal herniation. Strategies for the radiological investigation of patients suspected of having a prolactin-secreting pituitary tumour are proposed.
Explore the source record for details and available documents.
Four cases of anterior sacral meningocele (ASM) are described, with comparisons between radiological and sonographic findings. On plain films, 2 cases showed the classic scimitar sign, and 1 case showed a defect in the anterior sacrum. The other lesion appeared radiologically to be a purely intrasacral meningocele. Myelography outlined part of the ASM in two cases. Sonography demonstrated the anterior sacral cysts in all cases. Sonography is a noninvasive method of monitoring progress or contraction of a lesion, and it can be used to demonstrate any associated pathology. The combination of plain-film appearances and sonographic findings should be sufficient for diagnostic purposes. If an operative procedure is contemplated, then myelography may be performed in an attempt to outline the stalk.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Prolactin-secreting tumours of the pituitary were identified and treated by transsphenoidal microsurgery in fourteen infertile females with hyperprolactinaemia. Resting prolactin levels were 590--9000 mU/1 (mean 3400). In seven patients, tomography of the pituitary fossa was normal and resting prolactin levels were 590-6000 mU/1 (mean 3400). In these patients the pre-operative diagnosis prolactinoma in these patients was made by demonstrating loss of the normal circadian prolactin profile and impaired prolactin response to intravenous thyrotrophin-releasing hormone (T.R.H.) and metoclopramide stimulation. Prolactin response to the acute oral administration of L-dopa and bromocriptine was of less diagnostic value. Preoperative assessment of anterior pituitary function identified abnormalities other than hyperprolactinaemia in four patients (28%). Post-operative assessment indicated that microsurgery was curative in twelve patients (86%), selective in all, and without significant side-effect. It is concluded that dynamic tests such as T.R.H. and metoclopramide stimulation have considerable value in identifying hyperprolactinaemic patients with prolactin-secreting adenomas, particularly those which are radiologically occult.
Explore the source record for details and available documents.
A case of aneurysm of the vein of Galen is presented to demonstrate the value of computed tomography, not only as a diagnostic procedure, but also in the overall management of the condition.