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Biomedical subjects

R V Jeffreys

Publications and source records attributed to R V Jeffreys.

34 records · Page 2Linked to original sources
PubMed1986

The surgical treatment of cervical myelopathy due to spondylosis and disc degeneration.

A personal prospective study of the surgical treatment of cervical myelopathy due to spondylosis and disc protrusion is presented. One hundred and thirty-seven patients with severe disability have undergone surgery according to a protocol involving both the anterior approach of Cloward and decompressive laminectomy. Fifty-two percent of patients have returned to full employment, 39% to light employment and 9% remained disabled though improved from their pre-operative status. The pathenogenesis, natural history and treatment are discussed and reasons advanced to suggest that the disability resulting from severe forms of the condition may be alleviated in the majority of cases.

Adult↗
PubMed1986

An intrasellar pituitary tumour producing metastases in liver, bone and lymph glands and demonstration of ACTH in the metastatic deposits.

We report the history, laboratory and histological findings in a man who presented with Cushing's disease. Despite removal of the primary pituitary tumour, his disease progressed and after bilateral adrenalectomy, he became pigmented and plasma ACTH levels remained elevated. He had further pituitary surgery and radiotherapy, to relieve compression of the optic chiasma. Plasma ACTH levels remained elevated. He developed liver, bone and lymph gland metastases and after an acute paraparesis due to spinal metastases he died. Immunoperoxidase staining techniques demonstrated ACTH in the pituitary recurrence and metastases. The combination of bone, liver and lymph node metastases has not previously been reported, nor has ACTH been reported before in metastases from a primary intrasellar tumour.

Adrenocorticotropic Hormone↗
PubMed1983

Head injury patients admitted to general hospitals in Merseyside.

During 1975 and 1976, 11837 patients with head injury were admitted to 16 general hospitals serving 2.1 million people. Eight hundred and seventy-five had fractures of the skull, 178 died and 103 were transferred to the regional department of neurosciences. A fall was the cause of injury in 49 per cent, a traffic accident in 24 per cent and assault in 17 per cent. Seventeen per cent of adult patients had taken alcohol and 16 per cent had major extracranial injuries (including fractures of the bones of the face). Sixty-seven per cent stayed in hospital for 0-48 hours and 8 per cent for 8 days or more. The mortality rate and the number of deaths associated with avoidable factors both increased with the patient's ages. After standardization for age and sex, neither of these measures of the effectiveness of the management of head injury in hospital was found to differ significantly amongst the sixteen hospitals; nor were they related to differences in the way in which head injury patients were managed (for example, duration of stay in hospital) or to admission policy, work load (number of patients admitted with head injury per year) or the distance by road to the regional neurosciences department.

Adolescent↗
PubMed1982

The use of the CAT scanner in the management of patients with head injury transferred to the regional neurosurgical unit.

The use of computerized tomography (CAT scanning) in the management of 204 severely head-injured patients transferred to a regional neurosurgical unit has been evaluated. The experiences gained with CAT scan have been contrasted with those of a period immediately before when the CAT scan was not available. The CAT scan has resulted in a major reduction in burr-holes without worsening the long-term result.

Adolescent↗
PubMed1982

Erythropoietin levels in posterior fossa haemangioblastoma.

Using an in vitro bioassay, erythropoiesis stimulating activity has been measured in serum, cyst fluids and tumour homogenates from fourteen patients with cerebellar haemangioblastoma. Only two patients had elevated peripheral blood red cell counts and haemoglobin concentrations. Significantly elevated serum erythropoiesis stimulating activity was found in only one patient. High level, however, were detected in seven out of the fourteen cyst fluids and in the two homogenates tested. The dose response lines from these paralleled those of normal human erythropoietin. It was possible to neutralise the erythropoiesis stimulating activity in the cyst fluids with anti-human erythropoietin serum, indicating its similarity to erythropoietin, the normal erythropoietic regulating hormone. Significant release of the erythropoietic stimulating factor from the cyst fluids into the blood seemed to be an uncommon occurrence.

Adult↗
PubMed1982

Intramedullary enterogenous cyst of the spinal cord. Case report.

The authors describe a case of intramedullary enterogenous cyst of the spinal cord, and review the clinical aspects f this entity together with the histological classification. Discussions on the embryogenesis and pathogenesis of this rare lesion are reviewed and summarized.

Cysts↗
PubMed1981

Relative risk of alternative admission policies for patients with head injuries.

During 1975 and 1976, 10 200 patients with head injuries were admitted for observation to sixteen general hospitals serving 2.1 million people. The neurological condition of 60 (0.59%) patients subsequently deteriorated, including 27 (0.26%) who died. The effect of alternative admission policies on outcome and bed occupancy was calculated. If no patients were admitted solely for observation, 35 beds would be released for elective surgery but 30 patients with severe intracranial injuries would be sent home each year. Alternatively, if only patients with a history of loss of consciousness were admitted, 18 beds would be released but 11 patients with severe injuries, including 7 with unrecognised skull fractures, would be sent home. The effect of introducing a standard policy for routine skull radiography has also been determined. If, in England and Wales, post-traumatic skull radiography was restricted to patients with alteration in level of consciousness when examined, with neurological signs, with physical signs (e.g., a palpable fracture), or with a history of loss of consciousness, each year 163 patients with unrecognised skull fractures and potentially lethal intracranial injuries would be sent home and not be admitted for observation. Can the expected annual saving of 3 million pounds on routine skull radiography justify the risk to these patients?

Adolescent↗
PubMed1981

Avoidable factors contributing to the death of head injury patients in general hospitals in Mersey Region.

In 1975 and 1976 190 head injury patients died after admission to 19 general hospitals in Mersey Region or after transfer to the regional department of neurosciences. Their hospital case-notes were examined. Avoidable factors definitely contributing to death were identified in 58 (30%), and those possibly contributing to death in another 45 (24%). Of the avoidable factors 38% occurred in patients who "talked and died" and 77% in patients with intracranial haematomas. The most common avoidable factors were failure to recognise the development of a haematoma, respiratory difficulty leading to hypoxia, hypotension, and convulsions. The following recommendations are made: hospital case-notes of all head injury deaths should be assessed by a panel of senior consultants; all patients unconscious for 4 h in primary surgical wards in general hospitals should be transferred to the regional department of neurosciences; and fewer patients with minor head injuries should be admitted for observation.

Adolescent↗
PubMed1981

Early complications and results of surgery for ruptured intracranial aneurysms.

A personal prospective study has been carried out on 91 consecutive patients undergoing direct surgery for aneurysms of the anterior Circle of Willis. The protocol particularly involved maintaining normotension for each patient during surgery, and operating on all patients in Grades I, II, and III and on those patients in Grades IV and V suffering from coincidental hydrocephalus or intra-cranial haematoma. The results are discussed with particular regard to earlier complications following surgery.

Adolescent↗
PubMed1979

Experiences with head injuries in a regional neurosurgical unit.

A review of all patients with major head injuries transferred to a regional neurosurgical unit for the years 1975 and 1976 has been carried out for comparison with the total number of patients with head injury admitted to district general hospitals of the region. Fifty-four per cent of patients admitted to the neurosurgical unit have resumed their old occupation and 20 per cent died. The significance of these figures is discussed, particularly in the light of the need for a more comprehensive policy for treating head injuries within the United Kingdom.

Adolescent↗