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R H Patterson

Publications and source records attributed to R H Patterson.

At least 37 records · Page 2Linked to original sources
PubMed1988

Usefulness of preoperative inferior petrosal vein sampling in Cushing's disease.

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.

Adenoma↗
PubMed1988

Morbidity and mortality of craniotomy for excision of supratentorial gliomas.

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)

Adult↗
PubMed1986

Craniotomy versus transsphenoidal excision of large pituitary tumors: the usefulness of magnetic resonance imaging in guiding the operative approach.

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.

Adult↗
PubMed1986

A code of ethics. The 1986 AANS presidential address.

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.

Ethics, Medical↗
PubMed1985

Focus of epithelial dysplasia arising in hereditary gingival fibromatosis.

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.

Adult↗
PubMed1983

Subchoroidal trans-velum interpositum approach to mid-third ventricular tumors.

Our experience with the subchoroidal, trans-velum interpositum approach to mid-3rd ventricular tumors is reviewed, and our operative technique is described. Excellent exposure of the mid-3rd ventricle is gained by opening the foramen of Monro posteriorly after dividing the septal vein and/or the thalamostriate vein from the ipsilateral internal cerebral vein. There has been no morbidity or mortality in eight successive cases. The principal advantage of this technique is that the fornix is preserved and memory function is not at risk.

Adolescent↗
PubMed1983

Intraoperative localization of subcortical brain tumors: further experience with B-mode real-time sector scanning.

Intraoperative ultrasonography is a potentially useful tool for the neurosurgeon faced with the task of finding and removing small subcortical brain tumors. With the B-mode real-time sector scan equipment now available, satisfactory images of the intracranial contents can be obtained. Others have reported obtaining images by applying the transducer directly to the dura mater or cortex. This carries the risk of pressure damage to the brain. Furthermore, the presence of acoustical noise in the region close to the transducer results in poor image resolution in the superficial region of the cortex. To circumvent these two problems, we have used a saline-filled cylinder placed over the craniotomy site to achieve acoustical coupling. This technique also increases the area of cortex visualized by the pie-shaped beam of the sector scan by separating the transducer from the brain surface.

Adenocarcinoma, Papillary↗
PubMed1983

Echocardiographic features of traumatic disruption of the aortic valve.

The echocardiographic findings are presented of a patient who had evidence of aortic regurgitation one year after blunt trauma to the chest. Combined M-mode and 2-D imaging showed features suggestive of disruption of the posterior aortic leaflet, subsequently confirmed at operation, in the absence of infective endocarditis. Diagnosis of this uncommon cause of aortic regurgitation, heretofore confirmed only by direct visualization, may be made preoperatively by echocardiography.

Adult↗
PubMed1981

Management of trigeminal neuralgia (tic douloureux).

The initial treatment of trigeminal neuralgia is accomplished with drugs, primarily carbamazepine and occasionally phenytoin sodium. However, many patients become refractory to treatment or side effects develop such as drowsiness or ataxia. In these circumstances, surgical therapy is appropriate. At our institution, microsurgical decompression has yielded good to excellent results in 29 of 32 patients and is currently recommended for persons in good general health who are younger than 70 years. Because of the notable incidence of unpleasant dysesthesias in the face, percutaneous radiofrequency rhizotomy is reserved for persons whose age or general medical condition precludes craniotomy.

Carbamazepine↗