Biomedical subjects
Publications and source records attributed to R H Patterson.
A case is presented in which a 14-mm Russell-Taylor intramedullary nail, placed to secure a right femoral shaft fracture, was deformed 22 months postoperatively by subsequent trauma. The nail was straightened in situ, removed, and replaced with a larger nail. The femur subsequently healed without complication.
Histologic examination of an excisionally biopsied botryoid odontogenic cyst (BOC) documented that it was composed of at least 2 separate cysts, the location of which suggested that both originated within the alveolar bone rather than from within the periodontal ligament. These observations provide evidence for a multicentric origin of this example of BOC, and are consistent with a previous suggestion that lateral periodontal cysts of non-inflammatory origin arise from remnants of the dental lamina.
Forty-two patients with large pituitary tumors were studied with magnetic resonance imaging scans. Based on the operative findings, the tumors were divided into two groups. Tumors in Group 1 (n = 35) were soft or partially necrotic and were easily removed by suction and curettage. Tumors in Group 2 (n = 7) were firm and required sharp dissection or use of the laser for removal. Tumors were divided into two groups based on the long TR signal: a) isointense in comparison with white matter, or b) hyperintense in comparison with white matter. All 7 firm tumors (Group 2) had an isointense signal on long TR sequences. Thirty-two of 35 soft tumors showed a hyperintense signal on long TR sequences, and 3 an isointense signal. Based on these results, we recommend a transsphenoidal approach for the initial operation in patients with large pituitary tumors. If the tumor is largely isointense on the magnetic resonance imaging scan, we discuss with the patient preoperatively the possibility (70% in this series) that the tumor may be too firm to remove in a single transsphenoidal procedure. In these circumstances, a second, transcranial, procedure may be required to decompress the suprasellar structures adequately.
The potassium titanyl phosphate (KTP) laser recently has been introduced for use in surgery, but as yet, no data have been published concerning the safety or efficacy of use of the KTP laser in neurosurgery. A series of patients treated with the KTP laser that revealed some practical advantages of this instrument over other lasers presently available is reported. The KTP laser has been designed with user safety in mind. In general, the KTP laser, with its angled, low-profile, lightweight hand pieces, was especially useful in anatomically confined locations, where a laser beam directed from an attachment operated with a joy stick mounted on the operating microscope would prove awkward. The KTP laser provided very good hemostasis. Certain large fibrous tumors were found to be more easily removed using a combination of the KTP laser and ultrasonic aspiration rather than with either instrument alone.
Eosinophils have been associated with endomyocardial fibrosis. However, their effect on the myocardium and the reactions they elicit have not been emphasized. We describe four patients with extensive myocardial eosinophilic infiltration with and without endomyocardial fibrosis. Patients with a short duration of disease had eosinophilic infiltrates, myocardial eosinophilic abscesses containing granular eosinophilic material, and/or Charcot-Leyden crystals with and without profuse histiocytic and giant cell reaction with granuloma formation. In the early phase, the granular eosinophilic material can be visualized by the Luna stain and/or by electron microscopic examination. In patients with a long duration of symptoms, well-developed granulomas and profuse fibrosis are seen and eosinophilic material may not be visualized. Toxic eosinophil granular protein may be involved in the development of these lesions.
Acute cerebrovascular changes which occur following traumatic brain injury represent a highly complex, multifactorial pathophysiologic process which is poorly understood. It is now recognized that, under normal conditions, the brain is a source of a variety of arachidonic acid metabolites which are synthesized by both cyclooxygenase and lipoxygenase. The specific cellular source of these highly vasoactive substances remains controversial. Recent work has demonstrated that lipoxygenase products were detected by immunosensitive assay in whole brain samples from a gerbil concussive injury model, yet the production of leukotrienes could not be accounted for by cerebral vessels and their contents alone. It has been theorized that the probable source for these metabolites is the cortical neuron. We sought to elucidate whether cultured human glial cells, obtained from specimens removed at the time of surgery, are a significant source of lipoxygenase products as measured by high performance liquid chromatography (HPLC). We observed that these cells consistently produced 5, 12, and 15-HETE class eicosanoids despite failure to produce significant cyclooxygenase products. These preliminary findings are of considerable interest because these lipoxygenase products are known to be highly vasoactive as well as potent mediators of increased vascular permeability. Since it is known that mechanical perturbation of cell membranes stimulates the release of arachidonic acid from membrane phospholipids, it is conceivable that the production of these eicosanoids following traumatic brain injury could account for local cerebrovascular changes including both vasospasm and interstitial edema formation.
Adrenocorticotropic hormone (ACTH) levels from the inferior petrosal sinuses and peripheral veins were measured in 10 patients with Cushing's disease. All patients had normal or indeterminate computed tomography scans. In 9 of the 10 patients the petrosal vein sampling showed a gradient between pituitary ACTH and peripheral ACTH verifying the supposition of pituitary dependent hypercortisolism. In seven cases preoperative ACTH levels lateralized tumor to one side of the gland. In six of these cases tumor was found at that location at surgery. In the seventh case, no tumor was identified at surgery and that half of the gland was resected. Nine patients were cured following transsphenoidal excision of tumor.
Extensive surgical resection of supratentorial gliomas increases survival. However, some reports suggest that the perioperative morbidity and mortality outweigh the potential benefit of the procedure. We examined prospectively morbidity and mortality in 104 consecutive patients who underwent surgery for supratentorial glioma, as well as other factors that might affect the short-term outcome. To determine if our experience was unusual, we compared these results with those obtained from another academic neurosurgical center by a review of the records of 109 patients also treated surgically for supratentorial glioma. Mortality was 3.3% and the medical plus neurologic morbidity was 31.7%. Functionally significant neurologic worsening occurred in 42 (19.7%) patients. Complications were more frequent in patients with moderate or severe preoperative disabilities than those with mild or no preoperative disability. Patients with complete resection had fewer acute neurologic complications, and no greater risk of being neurologically impaired at 1 week, than patients with biopsy or less extensive procedures. Morbidity and mortality correlated with location: deep-midline lesions had a higher overall rate of perioperative complications (p = 0.032) and mortality (p = 0.019) and bilateral lesions a higher rate of hemorrhage (p = 0.017) and hydrocephalus (p = 0.010). Older patients (greater than 55 years) and those receiving high daily dose of preoperative dexamethasone (greater than or equal to 24 mg) had a significantly higher risk of surgical mortality. Reoperation for recurrent tumor carried no greater risk of mortality, neurologic deterioration, and infection than a first operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Fifteen patients with large pituitary tumors were studied with computed tomography (CT) and magnetic resonance imaging (MRI). CT was performed using General Electric 8800 and 9800 scanners (General Electric Co., Medical Systems Division, Milwaukee, Wisconsin). MRI was performed utilizing a Technicare superconducting scanner (Technicare, Cleveland, Ohio) at 0.5 tesla. Based on the operative findings, the tumors were divided into two groups. Tumors in Group 1 (n = 12) were described by the surgeon as soft or partially necrotic and easily removed by suction and curettage. Tumors in Group 2 (n = 3) were firm and required sharp dissection or the laser for removal. The tumors were divided into four categories based on MRI signal: (a) isointense with surrounding brain on spin echo (SE) 30 and SE 90, (b) increased signal intensity on SE 30 and SE 90, (c) decreased signal intensity on SE 30 and increased signal intensity on SE 90, and (d) isointense signal on SE 30 and increased signal intensity on SE 90. All three of the firm tumors were isointense with brain on MRI appearance. The tumor consistency (firm vs. soft) was not differentiable on CT scan. The transsphenoidal approach is less satisfactory than craniotomy in cases of firm, fibrous pituitary tumors. Based on our preliminary data, if the MRI signal in the tumor is isointense, then the surgeon should be prepared to deal with a fibrous tumor and might elect a transcranial rather than a transsphenoidal approach.
More than 50 years after the founding of the American Association of Neurological Surgeons as the Harvey Cushing Society, the delineation of a Code of Ethics constitutes a milestone for neurosurgeons. The reasons for developing the Code, its historical basis, and the continuing need to reinterpret any code in view of continuing changes in neurosurgical practice and delivery of health care are discussed.
The gingiva of a 32-year-old black male was biopsied for evidence of vasculitis, but instead an area of epithelial dysplasia was found. Further investigation revealed that the patient and several members of his family had hereditary gingival fibromatosis. Treatment included four quadrants of gingivectomy plus inverse bevel incisions for trimming those areas which were too thick for simple gingivectomy. Histopathologic examination of the excised tissues supported the diagnosis of gingival fibromatosis, but no other areas of epithelial dysplasia were seen. To our knowledge, this is the only reported instance of a premalignancy or malignancy arising in gingival fibromatosis, and thus there is no reason to regard the gingival disorder as predisposing to carcinoma. However, the pedigree reported here supports a previous suggestion that hereditary gingival fibromatosis is not as rare among blacks as the literature has indicated.
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Explore the source record for details and available documents.