Biomedical subjects
Publications and source records attributed to A Roper.
A choristoma is a benign tumour-like mass consisting of mature tissue derived from one or more germ cell layers that are foreign to the site at which they are located. Choristomas of the pharynx are rare with few cases being reported in the English literature. Management of these lesions is usually complete surgical excision. We report a case of osteocartilaginous choristoma arising from the pharynx.
Our aim was to replicate Active Support, a staff training intervention designed to increase the assistance given to adults with severe mental retardation living in community residences in order to increase their participation in activities. Training was conducted in 38 residences, involving 303 staff members and 106 persons with mental retardation. Active Support resulted in significant increases in assistance and engagement in activity. Significant correlations between participant abilities, receipt of assistance, and levels of engagement were found. Active Support was found to be of greater benefit to people with lower adaptive behavior and to have a diminishing value for people with higher adaptive behavior, implying that its implementation should be matched to the support needs of residents.
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.
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A schedule is described for rating the symptoms of mental illness over a period of time which includes several episodes. The reliability was measured in a study involving six raters. The sources of information required were studied, in 20 patients, by comparing an interview with the patient, a similar interview with an informant and an analysis of the case records. A synopsis of interview and record data are necessary to obtain adequate information about longitudinal psychopathology and 'lifetime' diagnosis.
Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness has been made. DSM-III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a 'schizodepressive continuum', but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.
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Dysplasia of the hip is almost unknown in the Bantu peoples of Africa, except in cases of arthrogryposis and in those with partly European ancestry. Evidence is produced to show that the importance of intrinsic genetic factors in hip dysplasia far outweighs that of the extrinsic factors. These are of great importance only if allowed to act on a hip in which genetic factors have already determined dysplasia. Evidence is also produced to contradict the theory that the "piggyback" carrying method used by Bantu mothers is the reason for the immunity from dysplasia of the hip. The absence of "primary" osteoarthritis of the hip is noted, and the range of hip disorders leading to "secondary" osteoarthritis in the adult African is compared with that in the adult European. Three patients are described, one in each of the groups mentioned above, the third having an isolated "typical" congenital dislocation of one hip. The methods of study used were enquiry into obstetric history and into carrying methods, and arthrography to confirm clinical findings. The experience of other surgeons working in Africa is recorded.
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