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Biomedical subjects

R Worth

Publications and source records attributed to R Worth.

At least 19 recordsLinked to original sources
PubMed2002

Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients.

PURPOSE: We studied the surgical outcome, complications, and the late mortality rate in a large group of patients with medically refractory temporal lobe epilepsy (TLE). METHODS: Two-hundred fifteen patients with TLE were treated surgically between 1984 and 1999 after a comprehensive presurgical evaluation. Patients were followed up at 6 weeks, 3-6 months, and yearly thereafter. In addition, questionnaires were sent on the anniversary of their surgery. Surgical outcome (Engel's classification), complication rate, and factors contributing to late mortality were analyzed. Standardized mortality ratios (SMRs) were calculated. RESULTS: There was no surgical mortality. Two (0.9%) had mild hemiparesis, one (0.4%) had a hemianopia, seven (3.2%) had transient cranial nerve palsies, and eight (3.7%) had transient postoperative language difficulties. One hundred forty-eight (69%) became seizure free, 43 (20%) had rare seizures, 14 (6.5%) had worthwhile seizure reduction, and 10 (4.6%) had no improvement (follow-up, 1-15 years). Three (2%) of 148 seizure-free patients died during follow-up, compared with eight (11.9%) of 67 not seizure-free patients. The mean duration of epilepsy before surgery for the surviving patients was 17.8 years, and for those patients who died, 25.9 years (p < 0.05). Six (5.7%) of 104 patients with right-sided resections died during follow-up, compared with five (4.5%) of 111 with left-sided resections. CONCLUSIONS: Eighty-nine percent of patients became seizure free or had rare seizures, with low morbidity, and no surgical mortality. The late mortality occurred predominantly in patients with persistent seizures (SMR, 7.4). Those patients who died had a longer duration of epilepsy before surgery. In contrast, among those patients who became seizure free, the mortality rate was much lower, and similar to the general population of Indiana (SMR, 1.7).

Adolescent↗
PubMed2001

Focal functional deficits in temporal lobe epilepsy on PET scans and the intracarotid amobarbital procedure: comparison of patients with unitemporal epilepsy with those requiring intracranial recordings.

PURPOSE: To analyze the relationship between the intracarotid amobarbital procedure (IAP) and positron emission tomography (PET) and study the lateralizing value of these tests in patients with unitemporal epilepsy and those requiring intracranial recordings. METHODS: We compared 51 patients with unitemporal epilepsy (group1) with 26 patients in whom surface recordings failed to reveal a distinct unitemporal focus, necessitating invasive recordings (group 2). RESULTS: The brain magnetic resonance imaging (MRI) scans for group 1 showed mesial temporal sclerosis in 70.5% of the patients. PET showed unilateral temporal hypometabolism in 88%. In addition, 74.5% of the patients in group 1 had impaired memory on the epileptogenic side on the IAP, and 89.4% of those patients also had ipsilateral temporal hypometabolism on PET scans. All the group 1 patients underwent temporal resections. The pathologic examination showed hippocampal sclerosis in 72% of the patients. Eighty percent of group 1 patients became seizure free, and 16% had rare seizures (follow-up, 2-7 years). MRIs for group 2 showed mesial temporal sclerosis in 31% of the patients; PET scans showed temporal hypometabolism in 39%. The IAP was lateralized in 47.8%. Sixty-nine percent had temporal lobe resections. The pathologic examination showed hippocampal sclerosis in 44% of the patients. Forty-four percent of group 2 patients became seizure free, and 27.7% had rare seizures (follow-up, 2-8 years). CONCLUSIONS: Ninety-six percent of the patients with unitemporal foci had focal functional deficits on the epileptogenic side on 18-fluorodeoxyglucose-(FDG) PET scans, the IAP, or both. The results of the FDG-PET were predictive of impaired memory on the IAP. Memory impairment contralateral to the temporal hypometabolism found on the PET scans was never seen. These patients had an excellent outcome. In contrast, <50% of the patients requiring intracranial recordings had focal functional deficits, suggesting that more a diffuse pathology may account for their less favorable outcome.

Adolescent↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMed1999

Presurgical evaluation and surgical outcome of temporal lobe epilepsy.

The authors analyzed 22 patients younger than 18 years of age with temporal lobe epilepsy (TLE) treated surgically. Patients underwent a comprehensive presurgical evaluation, including video-electroencephalogram. Fifty-five percent had a history of febrile seizures. Eighty-two percent had auraes and most exhibited oroalimentary and gestural automatisms. Contralateral dystonic posturing was present in 36% and postictal dysphasia in 54% of patients with left-sided resections. Cranial magnetic resonance imaging (MRI) was abnormal in 59% of patients. MRI revealed changes consistent with mesial temporal sclerosis in 8 (47%) of 17 patients without lesions. Fluorodeoxyglucose-positron emission tomography (PET) scans revealed ipsilateral temporal hypometabolism (PET-TH) in 12 (85.7%) of 14 patients. The intracarotid amobarbital procedure revealed impaired memory of the epileptogenic side in 59% of patients. Seventeen patients underwent en-bloc resections and five lesionectomies and resection of the epileptogenic area. There was no surgical morbidity or mortality. Forty-three percent had hippocampal sclerosis, 28.5% gliosis, 14% low-grade tumors, 9.5% cavernous angiomas, and 5% had no pathologic findings. Follow-up (6 months to 12 years) was available for 21 patients; 76% became seizure free, 19% had rare seizures, and 5% had a worthwhile improvement. TLE can be safely treated surgically in younger patients with excellent results. The clinical manifestations were similar to adult patients. PET-TH was present even at a younger age, suggesting that the focal functional deficits appear early in patients with medically refractory TLE, which may help in the early identification of these patients.

Adolescent↗
PubMed1999

Longitudinal follow-up in 145 patients with medically refractory temporal lobe epilepsy treated surgically between 1984 and 1995.

PURPOSE: There are few studies of prolonged longitudinal follow-up after temporal resections. METHODS: We analyzed 145 consecutive patients with temporal lobe epilepsy treated surgically. Patients had a comprehensive presurgical evaluation, including video-EEG, psychometric testing, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), intracarotid amobarbital procedure (IAP), and recently, volumetric head MRIs and F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scans. Most had en bloc temporal resections, and a few had lesionectomies and resection of the epileptogenic zone. There was no surgical mortality. Longitudinal follow-up data of the seizure outcome were analyzed by actuarial analysis. Patients were followed up at 6 weeks, 3 months, 6 months, and then on a yearly basis. The mean follow-up was 5.6 years. RESULTS: Sixty-six percent were seizure free at 1 year, 63% at 2 years, 60% at 5 years, and 55% at 10 years follow-up. Moreover, 85%, became seizure free for > or =2 at the time of last follow-up or had rare seizures. Patients who were seizure free for 1 and 2 years after surgery, had an 83% and 92% probability, respectively, of remaining seizure free at the time of last follow-up. Ninety-one percent of patients with small tumors and cavernous angiomas became seizure free compared with 69% of patients with hippocampal sclerosis. CONCLUSIONS: Actuarial analysis showed that the long-term surgical outcome of temporal lobe epilepsy remains favorable. Follow-up at 1 and 2 years is highly predictive of the long-term outcome. Patients with discrete lesions had the best outcome. Most of the patients with late recurrences had hippocampal sclerosis or temporal lobe gliosis. Some patients with postoperative seizures eventually became seizure free, reflecting the running-down phenomenon.

Actuarial Analysis↗
PubMed1998

FDG-PET and MRI in temporal lobe epilepsy: relationship to febrile seizures, hippocampal sclerosis and outcome.

OBJECTIVE: To correlate the volumetric head magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan findings with the history, intracarotid amobarbital procedure, pathology, and outcome in patients with medically refractory temporal lobe epilepsy. MATERIAL AND METHODS: Thirty-eight patients with temporal lobe epilepsy treated surgically following a comprehensive presurgical evaluation. Follow-up ranged from 12 to 44 months. RESULTS: Volumetric MRI showed ipsilateral hippocampal atrophy in 29 (76%), and PET scan showed ipsilateral temporal hypometabolism (PET-TH) in 31 (81.5%) of patients. Eighty-three percent of those patients with hippocampal sclerosis on MRI (MRI-HS) had ipsilateral PET-TH. Sixty-six percent of patients with MRI-HS had a history of prolonged febrile convulsions or a childhood febrile illness accompanied by convulsions, and 77% of patients with MRI-HS had pathologically proven hippocampal sclerosis (HS). Ninety percent became seizure free or had rare seizures. CONCLUSION: FDG-PET scans and head MRIs were complementary; 95% of patients had either MRI-HS or temporal hypometabolism. MRI-HS correlated with a history of febrile seizures and pathologically demonstrated hippocampal sclerosis. Ninety-three percent of patients had focal functional deficits on the epileptogenic side. Concordance between PET temporal hypometabolism and MRI-HS correlated with better outcome.

Adolescent↗
PubMed1997

Comparative study of interictal PET and ictal SPECT in complex partial seizures.

OBJECTIVE: To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluoro-deoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS). MATERIAL AND METHODS: Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total = 67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of focal hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis. RESULTS: Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (chi 2y = 0.18, DF = 1, P = 0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information. CONCLUSION: Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.

Adolescent↗
PubMed1994

Clinical characteristics and predictive factors in 98 patients with complex partial seizures treated with temporal resection.

OBJECTIVE: To analyze the preoperative and operative factors predictive of outcome in patients undergoing surgery for temporal lobe epilepsy. DESIGN: From 1984 to 1992, 98 patients with medically refractory temporal lobe epilepsy underwent surgery. Evaluation included the following: video electroencephalography (13 patients had intracranial recordings), head magnetic resonance imaging, interictal and ictal single photon emission computed tomography, psychometric testing, and Wada testing. Seizure-free groups and non-seizure-free groups were analyzed. Follow-up of 1 year to 8 years was available for 89 patients (mean, 3.2 years). SETTING: Indiana University Epilepsy Surgery Program, Indianapolis. OUTCOME: Sixty percent (53/89) were seizure free, 16% (14/89) had rare seizures, 13% (12/89) had worthwhile improvement, and 11% (10/89) showed no improvement. Forty-two percent of seizure-free patients had a history of febrile seizures compared with 5% of non-seizure-free patients. Ictal single photon emission computed tomography showed increased flow on the side of seizure onset in 86% of seizure-free patients compared with 62% of non-seizure-free patients. Ninety-seven percent of seizure-free patients had a pathologic diagnosis; mesial temporal structures were identified in 61%. Only 64% of non-seizure-free patients had a pathologic diagnosis, and mesial temporal structures were identified in only 36% of non-seizure-free patients. CONCLUSIONS: Eighty-nine percent (79/89) of our patients benefited from surgery. The following factors were predictive of good outcome: a history of febrile seizures; ictal single photon emission computed tomography showing increased blood flow ipsilateral to the epileptogenic zone; a pathologic diagnosis; and the presence of mesial temporal structures in the resected tissue.

Adolescent↗
PubMed1989

Spinal claudication in systemic amyloidosis.

We describe a patient with hereditary amyloidosis who developed the syndrome of spinal claudication. Myelography and computerized tomography of the lumbar spine demonstrated stenosis of the spinal canal and surgical exploration confirmed dense amyloid infiltration of ligamentous structures compressing the nerve roots. Two cousins of our patient and 2 patients with immunoglobulin amyloidosis had similar clinical syndromes. Spinal stenosis can be demonstrated by myelography or by computerized tomography. Diagnosis of this syndrome is important since wide decompression may be needed to relieve symptoms. Patients who had only disc extraction did not improve after the operation; their symptoms persisted and even worsened.

Amyloidosis↗
PubMed1985

Glycosylated haemoglobin in normal pregnancy: a longitudinal study with two independent methods.

Twenty-one women completed a longitudinal study of glycosylated haemoglobin in normal pregnancy. Glycosylated haemoglobin levels were measured using two independent techniques (ion-exchange column and colorimetric). Concurrent serial oral glucose tolerance tests (75-g glucose load) and erythrocyte indices were obtained. Changes in mean glycosylated haemoglobin were similar with both techniques with a nadir at 17 weeks, a peak at delivery (p less than 0.002 versus 17 weeks) and a fall post-partum. Glycosylated haemoglobin levels in abnormal pregnancies, e.g. diabetic, should be interpreted in the knowledge of these physiological changes.

Adolescent↗
PubMed1985

A prospective study of the immunogenicity of porcine insulin in HLA-typed new insulin-treated diabetics.

Fifty-four diabetics were started on insulin therapy with highly purified porcine insulin (Velosulin, Insulatard, Mixtard) and treated for at least 1 yr with blood samples drawn at regular intervals for insulin antibody determinations. In 43 patients the insulin antibody response was correlated with HLA A, B, and DR antigens. Approximately half of the patients formed insulin antibodies within 6 months of treatment, and this incidence remained constant for up till 2 yr. In those patients who developed insulin antibodies a plateau of 12% insulin binding capacity was reached after 9-12 months which remained constant for up till 2 yr. Formation of antibodies to proinsulin and pancreatic polypeptide proved completely avoidable, and no local reactions at the injection sites were observed. There was indication of a positive association between HLA DR4 tissue types and the tendency to immune response to injected insulin (p = 0.07).

Adolescent↗
PubMed1984

The response of blood intermediary metabolite levels to 24 hours treatment with a blood glucose-controlled insulin infusion system in type 1 diabetes.

Blood intermediary metabolite and hormone concentrations have been assessed in 10 insulin-dependent diabetic patients on SC injection therapy and during 24 hr of relative normoglycaemia on an artificial pancreas (GCIIS). Mean blood lactate (0.96 +/- 0.07 mmol/l) and pyruvate (0.087 +/- 0.004 mmol/l) levels remained elevated compared to normal controls (0.76 +/- 0.04 and 0.064 +/- 0.003, p less than 0.05 and less than 0.001, respectively). No tendency was detected for these levels to regress towards normal over the 24 hr period on the GCIIS. Mean individual 24 hr blood lactate concentrations correlated significantly with mean free insulin levels (r = 0.85, p less than 0.002), but inversely with prior out-patient diabetic control (r = 0.64, p less than 0.05). The shape of the 24 hr profiles of blood lactate and pyruvate changed between SC therapy and the GCIIS, corresponding in both studies to the form of the free insulin profile. Blood alanine and glycerol profiles were not abnormal on either regime. Blood 3-hydroxybutyrate levels were abnormal on both SC therapy (0.16 1.14 mmol/l) and the GCIIS (0.15 1.20 mmol/l, controls 0.04 1.31 mmol/l), with concentrations on SC therapy correlating positively with previous control. Abnormalities of intermediary metabolite levels persist during feedback normalization of blood glucose levels, with evidence of influences from both prior diabetic control, and current insulin delivery.

3-Hydroxybutyric Acid↗
PubMed1983

Glycosylated haemoglobin in cord blood following normal and diabetic pregnancies.

Cord and maternal blood samples were obtained at delivery in 25 normal and 14 diabetic pregnancies (13 insulin-dependent, one gestational). Total glycosylated haemoglobin, measured by the colorimetric thiobarbiturate method (mmol hydroxymethylfurfural/mol haemoglobin), was lower in cord than maternal blood (mean 18.7 +/- 1.7 versus 26.5 +/- 2.1, mean +/- SD, p less than 0.001). Glycosylated haemoglobin was higher following diabetic pregnancies, both in cord (diabetic 19.9 +/- 1.6 versus normal 17.9 +/- 1.4, p less than 0.001) and maternal samples (diabetic 27.7 +/- 1.5 versus normal 25.6 +/- 2.1, p less than 0.005). Cord and maternal glycosylated haemoglobin correlated in the normal (r = 0.60, p less than 0.01) but not in the diabetic group (r = 0.02, NS). Birth weight ratio was higher in infants of diabetic than of normal mothers (1.10 +/- 0.16 versus 0.99 +/- 0.13, p less than 0.05) but failed to correlate with cord or maternal glycosylated haemoglobin or, in the diabetic group, with mean blood glucose.

Birth Weight↗
PubMed1982

Intensive attention improves glycaemic control in insulin-dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial.

Forty-six diabetics treated with twice-daily insulin were seen every two weeks for six months in an intensive education programme aided by regular home urine glucose testing. Control was improved with a decrease in 24-hour urinary glucose excretion (median 138 mmol/24 h (24.8 g/24 h) falling to 70 mmol/24 h (12.6 g/24 h); p less than 0.002), glycosylated haemoglobin concentration (mean 11.4 +/- SD 2.3% falling to 10.4 +/- 1.5%; p less than 0.001), and Diastix score (median 3.0 falling to 1.3; p less than 0.001). There was no reported increase in hypoglycaemia. Thirty-eight of the diabetics proceeded to a nine-month randomised cross-over study of the effect on blood glucose control of monitoring urinary glucose or blood glucose measured visually or by a reflectance meter using appropriate reagent strips. No further improvement in control was observed after home blood glucose monitoring. Nevertheless, 29 out of 37 patients preferred blood to urine glucose monitoring. During both the education and cross-over studies there was evidence of an initial improvement in control followed by deterioration. This was independent of the monitoring method used in the cross-over period and may have been due to waning enthusiasm. Despite patient enthusiasm and other reports to the contrary, home blood glucose monitoring offered no improvement in control over intensive attention and conventional urine glucose monitoring.

Adolescent↗
PubMed1982

Systemic candidiasis: diagnosis from cutaneous manifestations.

Three patients are described who developed systemic candidiasis. Each had either leukaemia or lymphoma, and developed a similar erythematous maculopapular rash which, in places, was purpuric. In the first patient the nature of the rash was not appreciated during life, but postmortem histology revealed candida within the lesions. In the other two patients, a diagnosis of systemic candidiasis was successfully established by skin biopsy. This paper emphasizes that a maculopapular rash can be relatively characteristic clinical manifestation of systemic candidiasis and that skin biopsy can be diagnostic.

Adolescent↗
PubMed1982

Paraganglioma of the cauda equina. Case report.

An unusual, well demarcated, and encapsulated neoplasm of the cauda equina is presented. At first, the tumor was considered to be a variant of myxopapillary ependymoma, but the reaction for glial fibrillary acidic protein was negative. At the ultrastructural level, the neoplastic cells contained many small dense core vesicles, and the diagnosis of paraganglioma was established. The literature and histogenesis of paraganglioma of the cauda equina is reviewed.

Aged↗