Biomedical subjects
Publications and source records attributed to A E Booth.
A vein of Galen aneurysm occurring in a 55-year-old woman is presented. The pathogenesis and treatment of this condition, which is rare in adults, is discussed and the literature reviewed.
A randomized prospective double-blind trial of intrathecal morphine for postoperative pain relief following lumbar spine surgery is described. Intrathecal morphine significantly reduced the mean pain score in the postoperative period (p less than 0.01) and there was a corresponding significant reduction in the need for additional postoperative analgesia (p less than 0.05). The possible mechanism of action of intrathecal morphine and the potential advantages of this technique are discussed. Possible side effects are also considered, and caution is urged until wider experience has been obtained.
A case of multiple meningiomas without the stigmata of von Recklinghausen's disease is reported. The patient was followed up with serial computed tomography scanning over a 3-year period. The literature on multiple meningiomas is reviewed.
Experience over a 2-year period with the use of porcine dermis as a dural substitute is reported. In this series, porcine dermis was used for dural repair in a total of 72 patients. In a further 28 patients, one of the authors (A.E.B.) used porcine dermis to wrap lumbar nerve roots at the time of surgery for either prolapsed intervertebral disc or extradural lumbar nerve root adhesions. The authors report the advantages of this material which include ready availability and low cost. It is extremely pliable, easy to handle, and can be applied to relatively inaccessible areas. It appears to become rapidly adherent so that suture fixation is frequently not required. No evidence of a foreign-body inflammatory response has been found. No untoward result has been encountered in the 28 patients in whom porcine dermis was used to wrap lumbar nerve roots but it remains too early to show whether this will reduce the incidence of postoperative extradural adhesions.
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Subcutaneous cerebrospinal fluid (Ommaya) reservoirs were inserted in 23 patients wich acute leukaemia and 2 patients with malignant lymphoma. In 9 leukaemia patients reservoirs were used for the prophylaxis of central nervous system leukaemia: only 1 patient developed meningeal leukaemia but less invasive therapy has now been shown to achieve effective prophylaxis and prophylactic use of Ommaya reservoirs has been discontinued. In 16 patients, reservoirs were inserted as aids to the treatment of meningeal leukaemia or lymphoma. Intracranial disease was successfully controlled and recurrences were prevented but patients eventually died from relapse of their systemic disease. The principal complications of the subcutaneous reservoirs were obstruction, misplacement, and one case of infection. Leucoencephalopathy in several patients was attributable to irradiation and cytotoxic drugs and not to the reservoirs. Problems due to misplacement of the reservoir occurred in 3 out of 13 reservoirs inserted by the occipital route and in only 1 of 12 reservoirs inserted by a frontal approach. With adequate supervision, the reservoirs are valuable aids to intrathecal therapy in patients with established meningeal leukaemia or lymphoma.
A patient is reported who presented with manifestations of a space-occupying lesion in the left temporal lobe thought to be a metastasis, but on radiological examination and surgical exploration appeared to be a diffuse infiltrative glioma. Some 21 months earlier he had received a course of fast neutron therapy to a carcinoma of the left parotid gland. Diagnosis by microscopic examination revealed changes characteristic of delayed radiation necrosis.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.