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Biomedical subjects

A D Mendelow

Publications and source records attributed to A D Mendelow.

At least 37 records · Page 2Linked to original sources
PubMed2004

Elderly patients with severe head injury in coma from the outset--has anything changed?

Advancing age is known to be a determinant of outcome in head injury. We have sought to discover whether there has been any change in the outcome of elderly patients with severe head injury in Newcastle, where these patients have continued to be treated with maximum intervention. A review of prospectively collected data from the Newcastle Head Injury Database for the period 1990 to 2000 was carried out. All patients aged 70 years and above who had sustained a severe head injury (Glasgow Coma Score of 8 or less from the outset) were included. The Glasgow Outcome Score (GOS) was determined at 6 months. Seventy-one patients were identified. Fifty-seven (80%) died and 2 (3%) were in a vegetative state, 11 (16%) had severe disability, 1 (1%) had moderate disability and no patients made a good recovery. The natural history of this condition remains unchanged and due consideration should be given to this when evaluating interventions for elderly patients with a severe head injury.

Aged↗
PubMed2003

The International Surgical Trial in Intracerebral Haemorrhage (ISTICH).

At the XIth International Brain Oedema Symposium we reported that 208 patients had been randomized in this trial from 65 centres. At the time of submission of this manuscript we have randomized 985 patients from 107 centres including Japan. The trial will continue randomising patients until the end of February 2003. The objective is to determine whether "Early Surgical Intervention" or "Initial Conservative Treatment" is the best option in patients with spontaneous supratentorial Intracerebral haemorrhage (ICH). Patients with trauma, tumours, aneurysms and angiographically proven arteriovenous malformations are excluded. Ascertainment logs from the various centres have revealed substantial variation in the rate of operation for ICH from 2% in Hungary to 90% in Lithuania. The results will remain blinded until all 6 month follow-up information has been obtained. It is anticipated that these results will therefore be known towards the end of 2003. The pooled results have shown that patients with larger Haematomas and depressed consciousness are more likely to end up with a worse outcome.

Cerebral Hemorrhage↗
PubMed2003

Endovascular treatment of anterior communicating artery aneurysms: results of clinical and radiological outcome in Newcastle.

The results of endovascular management of anterior communicating artery aneurysms (ACoAA) using Guglielmi Detachable Coils (GDC) are presented. We detail the clinical and radiological features, and postoperative clinical and radiological outcome in a consecutive series of patients. We have prospectively collected comprehensive data on our patients with SAH since 1989. This study reports on patients admitted between January 1990 and December 1998, and focuses on 30 patients who had their ACoAA endovascularly treated. An independent observer (TE) carried out long-term follow-up in January 2002. Statistical analysis was performed to study the relationship between clinical factors, the radiological morphology of aneurysms and the long-term outcome. The age ranged from 25 to 74 years (median: 54) and endovascularly treated ACoAA were more common in women, 19 (63%) compared with men, 11 (37%). Seventy-seven per cent were in good grade (WFNS 1 & 2) before treatment. Three patients rebled before treatment. The aneurysms were less than 10 mm in maximal diameter in 27/30 patients. The follow-up period was from 1 to 53 months (mean 32.5, median 36.6 months). Excellent outcome was recorded for 11 patients (36.7%), good in seven patients (23.3%), fair in three patients (10%) and poor in four cases (13.3%). Five patients had died (mortality 16.7%). Favourable outcome was achieved in younger patients, women, and in those who presented in grades 1 and 2. The long-term radiological follow-up revealed residual necks in 13 patients. Only one has required retreatment and no rebleed has occurred in 3-6 years. This study reports a contemporary experience with the endovascular management of ACoAA. Long-term stability of the coil and good outcome is demonstrated. Endovascular treatment using GDC is an efficient technique for treating acutely ruptured ACoAA with little additional morbidity. The clinical and radiological results are comparable with those in the literature.

Adult↗
PubMed2003

Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension.

The authors present a 37-year-old lady with symptoms and signs suggestive of benign intracranial hypertension (BIH). Routine CT and MRI scans were normal. Further investigations were performed with magnetic resonance venography (MRV) and cerebral venography. These revealed obstruction of the right transverse sinus with high pressure (40 mmHg) proximal to the obstruction and low pressure (15 mmHg) distally. She was treated by transvenous stent deployment with resolution of her symptoms and the bilateral papilloedema. Evaluation of the cerebral venous system with MRV and or with formal cerebral venography should be included in routine investigations of patients with suspected BIH.

Adult↗
PubMed2002

Assessment of vessel wall thickness in carotid atherosclerosis using spiral CT angiography.

OBJECTIVES: the purpose of this study was to evaluate the amount of vessel wall thickening in the internal and common carotid arteries in patients undergoing spiral CT angiography for the investigation of significant atherosclerotic disease. MATERIALS AND METHODS: forty-five carotid systems in patients with a 70% or greater stenosis (according to carotid duplex) were imaged with CT spiral angiography using a standardised protocol. The vessel wall thickness of the distal common and mid internal carotid artery was measured using axial CT sections. RESULTS: vessel wall thickness was greater and more variable within the common carotid artery than within the internal carotid artery. The mean proportion of total vessel diameter constituted by vessel wall thickness was significantly greater in the common carotid artery as compared to the internal carotid artery: 28+/-12% (SD) vs 15+/-6%, respectively (p < 0.001). CONCLUSIONS: significant and extended wall thickening is commonly present in the internal and common carotid arteries of patients with atherosclerotic disease, but the internal carotid artery is significantly less affected than the common carotid artery. These observations question the validity of using the common carotid artery as a reference vessel for angiographic stenosis measurements.

Adult↗
PubMed2002

Epidemiology of adult brain tumours in Great Britain and Ireland.

The objective of this study was to review published reports on the epidemiology of primary brain tumours in adults and present the body of knowledge related to these tumours in Great Britain and Ireland. A literature search of all published epidemiological data on brain tumours was conducted in Pre-Medline, Medline, Embase and the Cochrane databases from 1966 to the present. A hand search of all the references alluded to was conducted and older studies identified. The articles were reviewed and tabulated. The papers were subjected to descriptive analysis. Information available to the public and held with the Cancer Registries was reviewed, and cross-referenced with published evidence. To our knowledge, only seven papers have discussed the epidemiology of primary brain tumours in adults. The different methodology of the population-based studies of brain tumours and the different time periods they investigated makes them incomparable. Two papers with comprehensive and detailed strategies for case ascertainment have both recorded tumour incidences of 21 per 100,000 person years. The results of the better studies are at variance with reports from the Cancer Registries. On the basis of the current studies, Cancer Registries appear to under-estimate the incidence of such tumours in adults. It is apparent that a significant number of tumours especially benign varieties are not recorded by some Cancer Registries. The previous estimates, patterns of incidence, prevalence, and survival of brain tumours in Great Britain and Ireland, may thus be incorrect. Patterns of primary brain tumours in adults have not been widely reported in GB and Ireland and the aetiology remains largely unknown. The need for current estimation of geographical and secular variations was identified. This demands closer co-operation between medical and allied staff, and the Cancer Registries. Prospective regional studies of incidence patterns and up to date epidemiological appraisal is deemed necessary. Meanwhile, Cancer Registries should seriously consider the inclusion of all primary brain tumours in their database.

Adolescent↗
PubMed2001

Comparison of protein carbonyl and antioxidant levels in brain tissue from intracerebral haemorrhage and control cases.

BACKGROUND: In an attempt to develop a clearer understanding of the pathological mechanisms underlying intracerebral haemorrhage (ICH), the objective of this investigation was to obtain evidence for free radical-induced oxidative damage in brain tissue following intracerebral haemorrhage. METHODS: Brain cortex samples were obtained from the ischaemic penumbra (overlying the haematoma) from 10 patients with spontaneous ICH and from six control cases (normal tissue obtained during tumour removal or aneurysm repair). Following extraction via homogenization and subsequent derivatization with dinitrophenylhydrazine (DNPH), tissue samples were analysed for the presence of protein carbonyl moieties (a hallmark of tissue protein oxidation). This procedure involved SDS-polyacrylamide gel electrophoresis and Western immunoblotting using a commercially available primary monoclonal antibody to DNPH, with final visualization of oxidized protein bands via enhanced chemiluminescence. RESULTS: Samples from ICH cases showed a number (10-15) of well-defined bands of medium to strong staining intensity (not present in nonderivatized samples), corresponding to proteins of molecular mass 25-200 kDa, indicating the presence of oxidatively damaged proteins in these samples. However, tissue samples from control cases also showed the presence of oxidized protein bands, with fractionation patterns for individual ICH or control samples being qualitatively and quantitatively similar. In addition, there was no significant difference in the levels of the following antioxidants (as additional indirect markers of free radical activity) in ICH or control brain tissue: glutathione, glutathione peroxidase, glutathione reductase, catalase, superoxide dismutase, and total antioxidant status. CONCLUSIONS: It is concluded from the above data that (i) evidence for free radical involvement in ICH based on protein carbonyl analysis should be interpreted with caution, since normal brain tissue contains a surprisingly high proportion of oxidized proteins; (ii) since there is no evidence for increased protein oxidative damage or decreased tissue antioxidant levels in ICH, therapeutic strategies aimed at salvage of potentially viable tissue would not benefit from inclusion of protein protecting antioxidants.

Antioxidants↗
PubMed2001

Computed tomography angiography in the investigation of carotid stenosis.

The assessment of carotid atherosclerotic disease is an essential pre-requisite for determining a patients suitability for carotid endarterectomy to prevent ischaemic stroke. Catheter angiography is regarded as the most accurate investigative tool for this purpose. However, with its finite morbidity and invasiveness, there is an increasing reliance upon non-invasive methods to accurately assess carotid disease. We present a review of the technique and applications of computed tomography angiography.

Carotid Artery, Internal↗
PubMed2001

Intracranial pressure within a developing intracerebral haemorrhage.

We report the time course of intracranial pressure within a developing intracerebral haemorrhage. Simultaneous readings of intracranial pressure were obtained from a contralateral parenchymal monitor and ventricular fluid pressure monitor. This recording demonstrates the existence of large pressure gradients in patients with expanding mass lesions.

Accidents, Traffic↗
PubMed2001

Trends over time in the management of subarachnoid haemorrhage in newcastle: review of 1609 patients.

This article reviews trends in the management of subarachnoid haemorrhage (SAH) at the Regional Neurosurgery Unit in Newcastle over 9 years. This is a comprehensive analysis of prospectively collected data on patients with SAH. We review the changes in clinical therapy and outcome with regards to conservative (non-surgical), surgical and endovascular therapy. Since 1990, the demographic and management/outcome details of patients with SAH have been recorded systematically. This study involves patients admitted over the 9 years, from January 1990 to December 1998. The data were computerized using Microsoft Access (Microsoft Inc. USA), and analysed using SPSS statistical package. A total of 1609 had aneurysmal SAH confirmed with CT, lumbar puncture and/or angiography. Sixty-seven per cent (1,073 patients) were female with a female to male ratio of 2:1. This ratio was maintained from 1990 to date. The mean age has slowly increased from 49 years in 1990 to 55 years of age in 1998, (range 18-91). Overall, 53.9% (from 66.3% in 1990 to 35.3% in 1998) were surgically treated, 8.1% had embolization (range 0.6-18.4%) and 38% (range 28.2-46.4%) were managed without surgical intervention for the aneurysm. The proportion of patients undergoing surgery has decreased since 1994 with improvements in endovascular therapy, participation in the ISAT trial and increased admission of poor grade patients (WFNS grades 4 and 5, from 17% in 1990 to 31% in 1998). The mortality rate has doubled over the years under review (18-32%). The percentage of severely disabled patients has remained constant at about 7% with none in a vegetative state. Only 54% had a favourable outcome in 1998 compared with 78% in 1990. Total morbidity and mortality has increased particularly during the last 3 years. This has been associated with double the number of admissions in grade 5. Favourable outcome occurred in 90% of good grade patients (WFNS 1 and 2) with 6.2% mortality in surgical candidates and 5.5% in patients treated endovascularly. The mortality for poor grade (WFNS 4 and 5) patients was 64%.

Adolescent↗
PubMed2001

Serum concentration of adhesion molecules in patients with delayed ischaemic neurological deficit after aneurysmal subarachnoid haemorrhage: the immunoglobulin and selectin superfamilies.

OBJECTIVES: Adhesion molecules are involved in the pathogenesis of cerebral ischaemia and may play a part in the pathophysiology of delayed ischaemic neurological deficit (DIND) after aneurysmal subarachnoid haemorrhage. It was hypothesised that after aneurysmal subarachnoid haemorrhage, adhesion molecules may play a part in the pathophysiology of DIND as reflected by significantly altered serum concentrations in patients with and without DIND. METHODS: In a prospective study, mean serum concentrations of ICAM-1, VCAM-1, PECAM, and E, P, and L-selectin were compared between patients without (n=23) and with (n=13) DIND in patients with World Federation of Neurological Surgeons (WFNS) grades 1 or 2 subarachnoid haemorrhage. Serum was sampled from patients within 2 days of haemorrhage and on alternate days until discharge. Concentrations of adhesion molecules were measured by standard procedures using commercially available enzyme linked immunoabsorbent assays. RESULTS: There were non-significant differences in serum concentrations of ICAM-1 (290.8 ng/ml v 238.4 ng/ml, p=0.0525), VCAM-1 (553.2 ng/ml v 425.8 ng/ml, p=0.053), and PECAM (22.0 ng/ml v 21.0 ng/ml, p=0.56) between patients without and with DIND respectively. The E-selectin concentration between the two patient groups (44.0 ng/ml v 37.4 ng/ml, p=0.33) was similar. The P-selectin concentration, however, was significantly higher in patients with DIND compared with those patients without DIND (149.5 ng/ml v 112.9 ng/ml, p=0.039). By contrast, serum L-selectin concentrations were significantly lower in patients with DIND (633.8 ng/ml v 897.9 ng/ml, p=0.013). CONCLUSIONS: Of all the adhesion molecules examined in this study, P and L-selectin are involved in the pathophysiology of DIND after aneurysmal subarachnoid haemorrhage.

Adult↗
PubMed2001

Clinical comparison of the Spiegelberg parenchymal transducer and ventricular fluid pressure.

The Spiegelberg brain pressure catheter is a low cost implantable intracranial pressure measuring system which has the unique ability to perform regular automatic zeroing. A new version of the catheter has become available with a subdural bolt fixation to allow insertion of the device into the brain parenchyma. The accuracy of this system has been evaluated in comparison with a ventricular fluid pressure method in a series of patients to determine its accuracy and utility in the clinical environment. Hourly readings from the Spiegelberg system have been compared with those obtained using a standard pressure transducer connected to an external ventricular drain. Measurements continued while there was a clinical need for CSF drainage. Eleven patients were recruited to the study and data were recorded for periods ranging from 40 to 111 hours. A good agreement between the two systems was obtained. In 10 cases the mean difference was less than +/-1.5 mm Hg and the dynamic changes in value were contemporaneous. In one case an intracerebral haemorrhage developed around the tips of the Spiegelberg catheter and significant differences occurred between the two methods of measurement. In conclusion, the Spiegelberg parenchymal transducer provides an accurate measurement of intracranial pressure when compared with ventricular pressure. The transducer was found to be robust in the clinical environment and very popular with the nursing staff. Further studies may determine whether the complication rate of this system is comparable with other available devices.

Calibration↗
PubMed2001

Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients.

OBJECT: Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are frequently monitored in severely head injured patients. To establish which one (ICP or CPP) is more predictive of outcome and to examine whether there are significant threshold levels in the determination of outcome, receiver-operating characteristic (ROC) curves were used to analyze data in a large series of head-injured patients. METHODS: Data were obtained from a total of 291 severely head injured patients (207 adults and 84 children). Outcome was categorized as either independent (good recovery or moderate disability) or poor (severely disabled, vegetative, or dead) by using the Glasgow Outcome Scale; patients were also grouped according to the Marshall computerized tomography scan classification. CONCLUSIONS: The maximum value of a 2-minute rolling average of ICP readings (defined as ICPmax) and the minimum value of the CPP readings (CPPmin) were then used to calculate the sensitivity and specificity of the ROC curves over a range of values. Using ROC curves, a threshold value for CPPmin of 55 mm Hg and for ICPmax of 35 mm Hg appear to be the best predictors in adults. For children the levels appear to be 43 to 45 mm Hg for CPPmin and 35 mm Hg for ICPmax. Higher levels of CPPmin seem important in adults with mass lesions. These CPP thresholds (45 mm Hg for children and 55 mm Hg for adults) are lower than previously predicted and may be clinically important, especially in children, in whom a lower blood pressure level is normal. Also, CPP management at higher levels may be more important in adults with mass lesions. A larger observational series would improve the accuracy of these predictions.

Adolescent↗
PubMed2000

Changes in cerebral blood flow as measured by HMPAO SPECT in patients following spontaneous intracerebral haemorrhage.

Lack of an effective treatment for spontaneous intracerebral haemorrhage (ICH) is partly because the mechanism of neuronal damage in ICH is not fully understood. Animal experiments have shown that there is a zone of ischaemia and oedema around the haematoma which can be reduced by early evacuation of the mass lesion. We set out to study Cerebral Blood Flow (CBF) changes in patients with ICH. We present data on 13 patients (mean age 60). SPECT scans were performed within 48 hours of ictus and 4-7 days later. Four patients had surgical evacuation of the clot; 9 were managed conservatively. The ratio of uptake of the isotope in the cerebral hemisphere containing the haematoma to the isotope uptake in the contra-lateral (un-affected) cerebral hemisphere was taken as an index of perfusion of the affected cerebral hemisphere. The perfusion index of the affected hemisphere improved between the first and the second scans in all the surgically treated patients; in the conservatively managed group, it was worse in 6 patients, the same in 1 and very slightly better in 2. There was an overall mean improvement of 3.87% in the surgical group, and an overall mean deterioration of 3.61% in the medical group. This data suggests that surgical evacuation of the clot may improve perfusion in the ipsilateral cerebral hemisphere in ICH. It underlines the importance of a prospective randomised trial to assess the value of surgery in patients with ICH. The Surgical Trial in Intracerebral Haemorrhage (STICH) is currently underway worldwide. We also describe the application of Difference Based Region Growing (DBRG) to SPECT image analysis. This method overcomes the difficulties posed by 1) the presence of a mass lesion and 2) surgical evacuation of haematoma.

Brain↗