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Biomedical subjects

P V Marks

Publications and source records attributed to P V Marks.

At least 37 records · Page 2Linked to original sources
PubMed1991

A trial of the effect of nimodipine on outcome after head injury.

We performed a randomised prospective double blind trial to study the effect of the calcium antagonist nimodipine on the outcome of head injured patients. The subjects were not obeying commands at the time of entry to the study, within 24 hours of injury. One hundred and seventy-five patients received nimodipine IV, 2 mg per hour for up to 7 days and 176 received placebo. The two groups were well matched for important prognostic features. Six months after injury 93 (53%) of the nimodipine group and 86 (49%) of the control group had a favourable outcome (moderate/good recovery). The relative increase in favourable outcomes (8%) was not significant but is compatible (95% C.I.) with an increase in favourable outcomes in treated patients by 33% or a decrease by 12%. Nimodipine was well tolerated and there were few adverse reactions; means of systolic and diastolic blood pressures and the intracranial pressure did not differ between the groups. It is unlikely that nimodipine has a marked effect on outcome (ie an increase in favourable outcome of greater than 15%) after head injury of this severity but the study does not exclude a modest but clinically useful benefit.

Adult↗
PubMed1991

Symptomatic intraventricular xanthogranulomata. A report of 2 cases.

Intraventricular xanthogranulomata may occasionally be seen as incidental findings at post-mortem. It is however, exceptionally rare for them to become symptomatic, but if they do, it is usually attributable to obstruction of the CSF pathways. Two further symptomatic cases are presented and the literature is reviewed. Treatment is surgical excision, but stereotactic biopsy should be avoided due to the often impenetrable nature of the capsule.

Adult↗
PubMed1991

Long-term abolition of parkinsonian tremor following attempted ventriculography.

Three patients are described who were selected for stereotactic thalamotomy to alleviate the tremor and rigidity of Parkinson's disease but in whom these symptoms were abolished whilst attempting ventriculography. Discrete deep brain lesions were seen on post-operative CT scan and the basis for their relieving the patients' symptoms is discussed. Although the tremor and rigidity was abolished in these cases and a favourable result ensued, ventriculography is an invasive and potentially dangerous procedure and it is therefore recommended that CT-derived thalamic targets should be employed for functional stereotaxy.

Aged↗
PubMed1990

Breast sarcoma. A clinicopathologic review of 25 cases.

Sarcoma of the breast represents less than 1% of primary mammary malignancies; this study reports 25 such cases. The largest group had malignant fibrous histiocytoma (44%), followed by liposarcoma (24%) and fibrosarcoma (16%). Also represented were clear cell sarcoma, neurogenic sarcoma, leiomyosarcoma, and alveolar soft part sarcoma (4% each). Of 19 patients treated by wide local excision or simple mastectomy with or without adjuvant radiotherapy, 11 had local recurrence develop, of which one patient died and nine of the remaining ten had metastases develop. Of the remaining eight patients in this group with no local recurrence, only two had metastases develop. Of the six patients treated by radical or Patey mastectomy, none had local recurrence develop, but two died of metastases. No patient had metastases develop more than 5 years after diagnosis. Regional lymph node involvement with tumor was observed in only one patient (with malignant fibrous histiocytoma) despite regional lymphadenopathy in seven. The overall mortality at 5 years is 64% but does not increase thereafter. The authors' findings suggest that failure to establish local control is associated with a poor prognosis and that wide local excision or simple mastectomy does not provide sufficient clearance to be used as first-line treatment. Excision of the axillary lymphatics and adjuvant radiotherapy are unlikely to be beneficial.

Adult↗
PubMed1990

The effect of nimodipine on outcome after head injury: a prospective randomised control trial. The British/Finnish Co-operative Head Injury Trial Group.

To study the effect of nimodipine on the outcome of head injury, three hundred and fifty-two patients who were not obeying commands were randomised to placebo or nimodipine (2 mg per hour intravenously for 7 days). The 2 groups were well matched for important prognostic features. Six months after injury, more of the patients who were given nimodipine had a favourable outcome (moderate/good recovery) than in the control group, but the increase in favourable outcome (8%) was not significant statistically.

Craniocerebral Trauma↗
PubMed1990

The 'Cambridge' stereotactic biopsy instrument.

The recent expansion in CT guided stereotactic biopsy has revealed deficiencies in biopsy instrumentation. In view of this, the authors have developed a versatile side-cutting cannula which has been used successfully in over eighty stereotactic biopsies as well as for the drainage of deep seated abscesses.

Biopsy↗
PubMed1990

Computerized tomographic stereotaxy in the management of 200 consecutive intracranial mass lesions. Analysis of indications, benefits and outcome.

Two hundred consecutive stereotactic procedures were performed. These were 153 biopsies and 43 therapeutic procedures. The latter included aspiration of craniopharyngiomata, arachnoid cysts, deep-seated abscesses, and the destruction of colloid cysts. Cryogenesis was used to treat an arteriovenious malformation (AVM) in one case. In four cases, the system was used to locate lesions during open surgery. Leksell stereotactic systems were used throughout. The ages of the patients ranged between 12 months and 83 years. Overall, in 35% of biopsies the preoperative diagnosis was not confirmed. When the provisional diagnosis was glioma 70% were confirmed; 21% of them were benign, with 9% some other form of malignancy. Biopsy provided tissue on which a histological diagnosis could be made in 140 procedures. In eight cases the biopsy was repeated and in seven cases a positive diagnosis was subsequently made. Mortality was 1%; there was transient deterioration postoperatively in 5% and prolonged deterioration in 1%. These observations suggest that stereotactic surgery is far superior to freehand burr hole biopsy in the management of these lesions. No radiation treatment should be considered without histological confirmation.

Adolescent↗
PubMed1989

Multiple brain abscesses secondary to bronchiectasis. A case of 34 discrete abscesses in one brain.

Multiple brain abscesses are a rare complication which may occur in a number of conditions including intra-thoracic sepsis. Computerized tomography has had an advantageous impact on the management of this condition by facilitating earlier diagnosis. However, the treatment modalities are inadequate and mortality remains high. A case of multiple brain abscesses in a patient with bronchiectasis is reported which exemplifies this often fatal condition. The management of multiple brain abscesses is discussed.

Adult↗
PubMed1989

Primary melanoma of the dura mater.

A case of primary malignant melanoma of the dura mater occuring in a 10-year-old girl is reported. Surgical excision was complicated by the location of the lesion in the region of the torcular Herophili. The aetiology and treatment of melanoma in the central nervous system is discussed.

Brain Neoplasms↗
PubMed1989

Tumours of the pineal region.

Tumours arising in the region of the pineal gland provide a considerable challenge in treatment because of their diversity and location. In this article the anatomy and physiology of the pineal gland are considered, together with the pathology of its tumours, their presentation and management.

Antineoplastic Agents↗
PubMed1988

Multiple brain abscesses secondary to dental caries and severe periodontal disease.

A case is reported in which an intra-oral focus of sepsis is thought to have resulted in the patient developing multiple brain abscesses without the presence of lung infection or cardiac valvular disease. The link between the two sites of infection is supported by the isolation of two Streptococcus viridans species normally associated with dental caries and periodontal disease. The management of multiple brain abscesses is discussed.

Adult↗
PubMed1987

Angiographically occult arteriovenous malformations of the brainstem.

Two cases of infratentorial arteriovenous malformations that were occult to angiography but detected by computed tomography are discussed. In both cases a preoperative diagnosis of low-grade glioma was considered. Attention is drawn to the relative paucity of such lesions below the tentorium.

Adolescent↗