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Biomedical subjects

B Milner

Publications and source records attributed to B Milner.

12 recordsLinked to original sources
PubMed1992

The multidisciplinary management of a family with epithelial ovarian cancer.

OBJECTIVE: To describe the management of a family with an inherited predisposition to ovarian and breast cancer. Particular attention is paid to the problems of contraception, screening, prophylactic surgery and hormone replacement therapy. SETTING: The multidisciplinary Grampian Familial Epithelial Ovarian Cancer Study Group. SUBJECTS: 162 members of a family extending over five generations. In the third generation, five of the 10 women died with epithelial ovarian cancer. Three women in generation IV have developed pre-menopausal breast cancer. There are now 78 family members in the fifth generation aged between 2 and 22 years. INTERVENTIONS: Counselling of female family members is started at the age of 18 years. The combined oral contraceptive pill is advocated to suppress ovulation. Gynaecological follow-up after the age of 28 includes yearly pelvic examination, transvaginal ultrasonography and serum CA125 estimation. Laparoscopy with peritoneal cytology is indicated if any part of this yearly assessment is abnormal. Prophylactic oophorectomy is advised between the ages of 35 and 40 years after the family is complete. In generation IV, 20 of the 29 women have undergone prophylactic oophorectomy. Oestrogen hormone replacement therapy with a cyclical progestogen is recommended after prophylactic oophorectomy. Breast cancer screening starts at the age of 25 and involves annual clinical breast examination augmented by mammography and breast ultrasound. CONCLUSIONS: Only by the careful questioning and recording of family history, including at least third degree relatives (cousins), will similar groups with familial ovarian/breast cancer be identified. When predisposing genes are characterized it will be possible to identify carriers within the family and concentrate clinical effort on them while offering appropriate reassurance to those with decreased risk.

Adult↗
PubMed1991

Frontal-lobe contribution to recency judgements.

Three recency-discrimination tasks (involving concrete words, representational drawings and abstract paintings) were administered to 117 patients who had undergone unilateral cortical removals, and to 20 normal control subjects. Frontal or anterior temporal-lobe excision did not impair simple item recognition, and neither left nor right anterior-temporal lobectomy affected recency judgements on any task. In contrast, excisions that encroached on the mid-lateral frontal cortex impaired verbal recency judgements, the deficit being mild after right frontal lobectomy. Patients with right frontal-lobe removals showed the greatest impairment in recency discrimination on the two pictorial tests. The results provide evidence for hemispheric specialization related to the nature of the stimulus material and some support for a functional role for the left mid-lateral frontal cortex in verbal recency judgements.

Adolescent↗
PubMed1991

Right temporal-lobe contribution to global visual processing.

The performance of 92 patients with unilateral temporal- or frontal-lobe excisions and 35 normal control subjects was tested under two experimental conditions (global, local) of a Stroop-type reaction-time task, employing either hierarchically structured letters or abstract designs as stimuli. In the local condition, subjects were asked to focus their attention on the small forms and to ignore the large form, whereas they were instructed to do the reverse in the global condition. The results showed that, in the local condition, the patients with right temporal-lobe lesions were less affected than the other groups by interference from the global aspect of the stimulus. This reduced sensitivity to the overall configuration of the stimulus was unrelated to the extent of hippocampal removal or to the presence of visual-field defects. These findings support the hypothesis that the human right temporal neocortex contributes to the global processing of visual information.

Adolescent↗
PubMed1991

The frontal cortex and memory for temporal order.

Patients with unilateral frontal- or temporal-lobe excisions and normal control subjects made relative-recency decisions about objects presented sequentially. Several objects within each series were presented in the context of actions to be performed using them, such as "squeeze the sponge", whereas others had only to be named. Both left and right frontal-lobe groups were impaired on order judgements for named items, but their performance was normal for action items. The results suggest that providing salient and distinctive items, involving meaningful actions and multimodal cues, helps compensate for deficits in memory for temporal information associated with frontal-lobe damage.

Adolescent↗
PubMed1991

Role of the right temporal lobe in visual-cue learning during repeated pattern discriminations.

The ability to acquire visual cues for discriminating between two targets against a background of visually similar items was examined in 64 patients with unilateral temporal- or frontal-lobe excisions and 20 normal control subjects. The subjects were tested on two versions (letters and abstract designs) of a visual cue-learning task that was an adaptation and extension of RABBITT's (Am. J. Psychol. 80, 1-13, 1967) visual-search paradigm. For both versions, the material consisted of two packs of cards, each containing a different set of background letters or designs. Subjects were required to sort the cards into two piles according to which of two targets was present on the card. On the letter task, all groups took longer to sort when the background letters were changed after three learning trials. With abstract designs, patients with right temporal-lobe lesions failed to show this interference effect after three learning trials, but they, like other groups, did so after six. This slowness in learning was related neither to the extent of hippocampal removal nor to visual-field defects. It is argued that the right temporal neocortex plays a role in incremental learning of visual cues during repeated pattern discriminations.

Adolescent↗
PubMed1991

Contribution of the right frontal lobe to the encoding and recall of kinesthetic distance information.

Sixty-two patients with unilateral temporal- or frontal-lobe excisions and 16 normal control subjects were tested on a kinesthetic task, which required the monitoring of peripheral feedback in order to duplicate the distance of examiner-defined arm movements. Temporal lobectomy did not interfere with performance. Patients with left frontal-lobe or small right frontal-lobe excisions also performed normally, whereas those with large right frontal-lobe removals were impaired, the deficit being equal for the two arms. The results point to an important role played by the right frontal lobe in the monitoring of kinesthetic feedback both during the presentation of the movements and during the recall attempt.

Adolescent↗
PubMed1991

Recall of the end-position of examiner-defined arm movements by patients with frontal- or temporal-lobe lesions.

Sixty-three patients with unilateral temporal- or frontal-lobe excisions and 14 normal control subjects were tested on a kinesthetic task in which they had to recall the end-position of arm movements determined by the examiner. Patients with left frontal-lobe or small right frontal-lobe excisions performed normally, whereas patients with temporal-lobe excisions that included extensive removal of the hippocampus performed poorly, but only after a delay during which an interpolated task was carried out. Subjects with large right frontal-lobe removals were impaired in delayed recall, and the presence of an interpolated task did not exacerbate the impairment, which was equal for the two arms. The results point to an important role played by the right frontal lobe in the maintenance of kinesthetic-location cues over time, but not in their initial encoding.

Adolescent↗
PubMed1977

The role of early left-brain injury in determining lateralization of cerebral speech functions.

Preparatory to craniotomy for the relief of medically refractory focal epilepsy, the lateralization of cerebral speech functions was determined by the Wada intracarotid Amytal test in 134 patients with clinical and radiologic evidence of an early left-hemisphere lesion. Their results were compared with those for 262 patients (140 right-handed, 122 left-handed), who were tested in a similar way. One-third of the patients with early lesions were still right-handed, and 81% of these right-handers were left-hemisphere dominant for speech. In the non-right-handers, speech was represented in the left cerebral hemisphere in nearly a third of the group, in the right hemisphere in half the group, and bilaterally in the remainder. Bilateral speech representation was demonstrated in 15% of the non-right-handers without early left-brain injury and in 19% of those with evidence of such early injury, whereas it was extremely rare in the right-handed groups. In addition, nearly half the patients with bilateral speech representation exhibited a complete or partial dissociation between errors of naming and errors in the repetition of verbal sequences after Amytal injection into left or right hemispheres. This points to the possibility of a functionally asymmetric participation of the two hemispheres in the language processes of some normal left-handers. The results of the Amytal speech tests in this series of patients point to locus of lesion as one of the critical determinants in the lateralization of cerebral speech processes after early left-brain injury. It is argued that in such cases the continuing dominance of the left hemisphere for speech in largely contingent upon the integrity of the frontal and parietal speech zones.

Adolescent↗