Biomedical subjects
Publications and source records attributed to A E Holmes.
Infection is a frequent problem affecting cysto-peritoneal shunts, the usual causative organisms being Staphylococcus epidermidis and Staphylococcus aureus. Fungi are rarely isolated from such infections. We present the first report, as far as the authors are aware, of a case of Trichosporon beigelii shunt infection that responded to shunt removal and antifungal therapy.
This investigation sought to determine whether the pattern of performance differed between young and elderly normally hearing adults on a closed v. open-set discrimination task. The California Consonant Test was administered at 32 dB SL (re:SRT) to 20 young and 20 elderly normally hearing subjects under two conditions: one which required subjects to mark their response on a multiple choice answer form; and a second which required subjects to provide a one-word written response on a blank answer form. The only significant difference occurred within the young group between conditions (closed-set, open-set). The young group's speech discrimination was significantly better in the closed-set condition then in the open-set condition. No other differences were significant. The results question the concept of phonemic regression as a concomitant of ageing.
We report here a case in which a frontotemporal meningeal tumor was found to be an isolated, apparently primary, deposit of nodular sclerosing Hodgkin's disease in an otherwise well man. The presentation of Hodgkin's disease as a primary, solitary intracranial lesion is rare; only 13 cases have been found in the world literature. The histological appearance of the tumor in the present case fulfills all the requirements for nodular sclerosing Hodgkin's disease according to current criteria of classification; the morphologic diagnosis is supported by appropriate immunohistochemical staining of the neoplastic cells for Leu M1 and LN2 markers, with absence of staining for the common leucocyte antigen. No recurrent local or disseminated disease has been manifest in a 14-month follow-up of the patient.
This paper presents the clinical and pathological data obtained from 42 patients with oligodendroglioma diagnosed over a 20 year period at Addenbrooke's Hospital, Cambridge. In all cases the diagnosis was established unequivocally by histological examination. The principal conclusions of this study were: (1) the outcome was not as favourable as anticipated, nine patients dying within 1 year of diagnosis, and only 10 patients surviving 5 years, (2) age at the time of diagnosis was the single most important prognostic factor, patients under 45 years at diagnosis having a significantly greater survival time than older patients, (3) two other factors had a significantly adverse effect on prognosis, namely the presence of a focal neurological deficit at the time of diagnosis and the presence of nuclear pleomorphism in the tumour when examined histologically, (4) although cells containing glial fibrillary acidic protein were demonstrated in almost every tumour, their number and distribution did not appear to influence the prognosis.
The purpose of this investigation was to evaluate the speech perception of a patient fitted with a multichannel processor under different electrode conditions. The subject was evaluated with the speech processor programmed with electrode arrays varying in number from one to nineteen. The results suggested that with an increased number of programmed electrodes, the subject's speech perception improved. Comparisons were also made among three speech processing strategies. The processor was programmed with: (1) one electrode pair that provided fundamental frequency information; (2) nineteen electrode paris that provided fundamental frequency plus second formant information (F0/F2); and (3) nineteen electrode paris that provided fundamental frequency plus first and second formant information (F0/F1F2). The subject did better with the F0/F2 strategy compared to the F0 strategy and best with the F0/F1F2 strategy.
Norepinephrine (NE) 10(-6) M or vasopressin (VP) 12.5 microU/ml were injected into the isolated carotid sinus of anesthetized rabbits. The sinus was exposed either to the arterial pressure or to a pressure controlled reservoir. Multifiber and single fiber recordings were made. Both NE and VP increased baroreceptor activity at all sinus pressures but decreased activity in a few fibers. The results are consistent with the drugs having their effects on smooth muscle fibers in the adventitia.
The concentration of drug after oral administration of 1 g misonidazole to patients undergoing neurosurgery has been studied in samples taken from intracerebral tumours, normal brain, cerebrospinal fluid and brain tumour cyst fluid. A total of 31 patients yielded samples at various times 2-8 h after drug administration. Results show a considerable range of tumour/plasma percentages but from about 2-5 h after drug administration this averaged between 65-80%. Normal brain and CSF showed similar good penetration but drug entry into cyst fluid was lower (30-50%). A further study with desmethylmisonidazole given to 11 additional patients showed a similar range of tumour penetration but lower concentrations in CSF and cyst fluid (10-20%). Low values were also seen in some but not all of the normal brain tissue samples. Necrotic tumour also had much lower concentrations than macroscopically viable tissue. These results are discussed in terms of their clinical relevance to sensitiser studies on patients with brain tumours with drugs of different lipophilicities.
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The effect of dehorning Brahman crossbred cattle of four age groups on their subsequent bodyweight performance was monitored in 4 drafts of cattle between 1975 and 1980. During the 6 weeks following dehorning, bodyweight change of dehorned cattle was less (P less than 0.05) than that of horned cattle in half of the groups. There were no differences between treatments, in bodyweight gain to 12 months after dehorning, following any dehorning date or in final bodyweight, for each draft. The data suggest that age of dehorning is not critical.
The results are reported of a small clinical trial carried out to assess the potential value of the hypoxic cell radiosensitizer misonidazole in the radiation treatment of Grade 3 and 4 supratentorial astrocytomas. A total of 55 patients were randomly allocated to one of 3 treatment groups. No significant differences were seen between the median survivals of patients in the 2 control radiation groups and that of the third group in which oral misonidazole at a dose of 3 g/m2 preceded each of 4 weekly radiation doses. Possible reasons why no improvement was seen are discussed in detail.
Analysis of results on 83 survivors of spina bifida cystica showed the following: (1) in the seven children who had had central nervous system (CNS) infection, intelligence was impaired, six being severely retarded. (2) In the nine children who did not suffer CNS infection or require a shunt, intelligence was normal. The need for a shunt was related to radiological appearance (craniolacunae) and to the sensory level at birth. (3) In the 67 children who did not suffer CNS infection but did require a shunt, intelligence was related to sensory level found at birth and to thickness of the pallium measured within four weeks of birth. Their intelligence did not relate to the occipitofrontal circumference at birth, or to its increase before the insertion of the shunt. Intelligence did not relate to the function of the shunt at the time of assessment or to the number of times it had been revised.
The 83 survivors of a consecutive series of children with spina bifida cystica, born between 1963 and 1971 and treated non-selectively since birth, were assessed by intelligence and developmental testing. In nine of the children who had not required shunts the distribution of intelligence was within the normal range. The need for a shunt was significantly related to the presence of craniolacunae and to the sensory level of the lesion recorded at birth. Seven of the 74 shunt-treated children had suffered ventriculitis, meningitis or septicaemia, and their intelligence was significantly worse than the others. In the 67 shunt-treated children who had not suffered infection, intelligence was significantly related to the thickness of the pallium when the shunt was inserted during the first four weeks of life, and to the sensory level of the lesion recorded at birth. Intelligence was not related to the function of the shunt at time of assessment, to the number of revisions of the shunt, or to the rate of increase in head size during the first four weeks of life. It is concluded that the best indication of later intelligence can be gained at birth from the thickness of the pallium and the sensory level of the lesion.
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Studies of cerebral blood flow and distal intravascular pressure changes were studied in 11 patients at the time of common carotid artery ligation for the treatment of intracranial aneurysm. No neurological deterioration was observed while these patients were under observation. Cerebral blood flow in the ipsilateral hemisphere recovered rapidly while reduction in pressure, and in particular diminution of pulse pressure, persisted affording protection to the aneurysm.
Sixty-four consecutive cases of ruptured posterior communicating aneurysms were investigated. Fifty-one cases were treated by abrupt ligation of the common carotid artery with no operative mortality and a small temporary operative morbidity.
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Telephone handsets have a built-in side-tone feedback because the transmitter feeds back sound through the receiver, allowing users to monitor their voice levels. However, the side-tone feedback system also picks up background noise which interferes with the incoming speech signal. This study investigated the influence of side-tone feedback on the telephone listening ability of 30 normal-hearing subjects in a background of multitalker (MT) and white noise (WN) presented at 65, 75, and 85 dB SPL in two conditions where the side-tone feedback was present and in three conditions where the side-tone was eliminated. Telephone listening ability significantly decreased as the level of the noise increased for both MT and WN and for all listening conditions. Telephone listening ability was significantly poorer in the background of MT than WN for each noise level and listening condition. The primary finding was that telephone listening ability in a background of MT or WN at the higher levels was significantly improved when the side-tone feedback was eliminated by electronically disengaging or more simply by occluding the transmitter with the palm of the hand.