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Biomedical subjects

C B Adams

Publications and source records attributed to C B Adams.

At least 19 recordsLinked to original sources
PubMed1991

Young adults' expectations about sex-roles in midlife.

Male and female college students (N = 106) in the developmental stage of transition to young adulthood (mean age = 19.9 yr.) were asked to imagine themselves at midlife in three life settings: work, personal relationships/family, and leisure. For each setting they described themselves on the instrumental and expressive scales of the Personal Attributes Questionnaire and on scales of agentic and communal competencies. Subjects anticipated more instrumental traits, more agentic competency, and less communal competency in work settings than in personal relationships, with no differences between men and women. Gender and setting interacted for expressiveness: women anticipated more expressive traits than men in personal relationships, with no difference in the other settings. The anticipated traits and competencies of these subjects were related more to setting than to gender. This may reflect a shift in the definition of sex-role boundaries in American culture.

Adolescent↗
PubMed1990

Transsphenoidal surgery for Cushing's disease: does what is removed determine the endocrine outcome?

Fifty-seven patients with pituitary-dependent Cushing's syndrome and eight with Nelson's syndrome underwent transsphenoidal pituitary exploration, with removal of macroscopically abnormal tissue in 64 patients and detailed histology of this in 63. The cure rate by stringent criteria 1 month later was 48 (83%) of the 58 with assessable data, who were followed for 225 patient-years. Two patients relapsed later, a rate of one per 112 patient-years of follow-up. In 27% of patients, the macroscopically abnormal tissue removed was histologically indistinguishable from normal pituitary gland but the cure rate was 82%, and a quarter of the patients in this group assessable for recovery of normal ACTH function gained it. Another 53% of biopsies showed corticotroph adenomas, and the cure rate in these was 89% though rather more (69%) recovered normal ACTH function. The remaining 20% of biopsies were consistent with corticotroph hyperplasia. The cure rate varied little whether the lesion was diffuse or localized, whether or not it was in the invasion zone/interlobar cleft, whether or not there was pituitary enlargement, or whether the surgery was radical or selective. Six patients, of whom three are cured, showed surgical or radiological evidence of invasion outside the pituitary fossa. The data are consistent with the idea that pituitary adenoma is merely the end stage of some other process in the corticotrophs, and cure often follows removal of a lesion other than adenoma. Of patients who were permanently cured, 47% regained normal ACTH function within 3 years of operation (none later), 53% remaining ACTH-deficient at 3 years or more. Of all patients 48% acquired gonadotrophin deficiency, 28% have TSH deficiency and 25% permanent diabetes insipidus. All these pituitary function deficits were more common after radical surgery and in patients with normal histology, The literature contains so little objective data on these functions that we cannot say whether the endocrine damage in our patients is exceptional or not.

Adenoma↗
PubMed1990

Pasteurella multocida: a rare case of shunt infection.

Pasteurella multocida, the major pathogen following an animal bite, is a rare cause of intracranial infection. This report documents the first case of ventriculo-peritoneal shunt infection with Pasteurella multocida.

Adult↗
PubMed1990

Factors influencing the preservation of the facial nerve during acoustic surgery.

We reviewed the last 30 acoustic neuromas excised in our department and attempted to find out the factors associated with preservation of the facial and cochlear nerves. While the size of the tumour was the most important factor, vascularity and consistency were both important. Facial and cochlear nerves were preserved in 63% and 10% of the patients respectively. The importance of early diagnosis cannot be overemphasized.

Adult↗
PubMed1989

The presentation and management of pituitary tumours in the elderly.

Twenty-two patients presenting with pituitary tumours (16 non-functioning) after the age of 70 years were identified in a review of all patients assessed in Oxford hospitals between 1982 and 1986. They were matched with younger patients, to compare modes of presentation and treatment outcome. Younger patients presented more commonly than elderly with symptoms of deficiency of adrenocorticotrophic hormone, thyroid-stimulating hormone or gonadotrophin, although the prevalence of biochemical deficiency was similar in the two groups. Trans-sphenoidal adenomectomy was performed on 12 elderly patients with visual impairment. Of those with field loss, seven improved, one was unchanged and two deteriorated after surgery, though one of the last was improved by haematoma evacuation, and two cranial nerve palsies resolved. There were no other peri-operative complications in the elderly. Transsphenoidal surgery is the treatment of choice for non-functioning tumours causing visual failure; it decompresses the adenoma with minimal morbidity and endocrine impairment, and is well tolerated by elderly patients.

Adenoma↗
PubMed1989

Studies of two thyrotrophin-secreting pituitary adenomas: evidence for dopamine receptor deficiency.

Of 22 previously reported patients with TSH-secreting pituitary adenomas challenged with dopamine agonists, 18 showed no decrease in serum TSH. There have been few in-vitro studies of these rare tumours so the mechanism of the dopaminergic resistance has remained obscure. We describe two further patients with thyrotrophinomas; the first was thyrotoxic (T3 6.1 nmol/l, TSH 7 mU/l) and the second was diagnosed after radioiodine for presumed Graves' disease. The second patient had an alpha-subunit: TSH molar ratio less than unity (0.27). In-vivo TSH responses to TRH, bromocriptine and domperidone were compared with those of the resected tumour cells in vitro, the latter studied using a continuous perifusion system. Dopamine receptors were sought in membranes from each tumour using a radioreceptor assay employing 3H-spiperone. Patient 1 showed significant increases in serum TSH (7 to 13 mU/l) and alpha-subunit (18.7 to 385 ng/ml) after 200 micrograms TRH (i.v.) but patient 2 showed no such increases (TSH: 69 to 72 mU/l, alpha-subunit: 4.9 to 5.2 ng/ml). Neither patient showed a change in serum TSH following bromocriptine 2.5 mg (orally) or domperidone 10 mg (i.v.), though serum PRL responded normally. Serum TSH from patient 1 was of apparently normal molecular size but increased bioactivity (B/I ratio 3.8) and that from patient 2 was of increased molecular size but reduced bioactivity (B/I ratio 0.1). Tumour cells from each patient immunostained for TSH beta and alpha-subunit, and secreted TSH in vitro. The first showed dose-dependent TSH release after TRH (1-100 ng/ml) which could not be inhibited by dopamine (5 mumol/l) but the second was unresponsive to TRH in vitro. Neither tumour showed inhibition of TSH release by dopamine (5 mumol/l) or bromocriptine (0.01-10 nmol/l) and neither contained membrane-bound dopamine receptors. The results suggest that the dopaminergic resistance typical of most TSH-secreting pituitary adenomas may be due to altered or absent membrane-bound dopamine receptors.

Adenoma↗
PubMed1989

Intrasellar gangliocytoma containing gastrin and growth hormone-releasing hormone associated with a growth hormone-secreting pituitary adenoma.

A 74-year-old acromegalic found to have an intrasellar gangliocytocytoma and GH-secreting pituitary adenoma is described. The gangliocytoma contained immunoreactive gastrin and, to a lesser extent, GHRH, and the adenoma immunostained for GH. Gastrin has not been previously reported in hypothalamic gangliocytomas. Since this peptide has been demonstrated in normal hypothalamus and pituitary, and provokes GH release when administered intraventricularly, it may have caused GHRH release from the gangliocytoma by a local paracrine action and led to adenoma formation and acromegaly.

Adenoma↗
PubMed1989

Indolent glioma: a cause of epilepsy.

We studied eight patients with indolent gliomas. In all eight cases, despite characteristic radiological features, there was a delay in diagnosis because of misinterpretation of the initial computed tomogram. These tumours are an important cause of epilepsy of childhood, and surgery may well alleviate the epilepsy and possibly achieve a long term 'cure'. Therefore it is important that a diagnosis is made early and the lesion completely excised.

Astrocytoma↗
PubMed1989

Persistent CSF leucocytosis associated with intrathecal gentamycin.

A case where the administration of intrathecal gentamycin, used to treat a ventriculitis consequent upon a ventriculoperitoneal shunt infection, with a persistent elevation of the CSF leucocyte count is described. In a situation where the number of white cells in the CSF is taken to indicate resolution of infection, it is important to recognise that apparent failure of resolution of infection may be due to the gentamycin itself and not persistent infection.

Brain Diseases↗
PubMed1989

Microvascular compression: an alternative view and hypothesis.

The concept of microvascular compression (MVC) is discussed critically. The root entry or exit zone is defined: it is much shorter than generally realized. The anatomy of the intracranial vessels is considered, as well as known facts concerning trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia relating to MVC. The results of microvascular decompression (MVD) are analyzed; one-third of patients do not obtain an optimum result. The evidence used to support the hypothesis of MVC, including neurophysiology, is discussed and it is believed to be insufficient and unconvincing. The basis of MVC could be trauma of the nerve during operative dissection and "decompression." The concept of MVC might be more convincing if MVD can be shown to cure a condition such as spasmodic torticollis, which cannot be remedied by damage to or section of the same cranial nerve or nerves.

Cerebrovascular Circulation↗
PubMed1989

Neurosurgery for epilepsy.

'Consideration of operative therapy should be given to more patients with refractory partial epilepsy...there can be little doubt that resources for the evaluation and surgical treatment of patients should be more widely available and more widely used in the UK.'

Brain↗
PubMed1979

Intracranial compliance during the post-operative period after surgery for intracranial aneurysms.

Generalised post-operative cerebral vasospasm is a major factor in delineating poor operative results following direct ruptured intracranial aneurysms. Continuous monitoring of intracranial pressure seems to be particularly helpful on such occasions, and intracranial compliance determination as well. High intracranial compliance values suggest that even small intracranial volume increases may induce rapid intracranial pressure and situations likely to produce neurological deterioration.

Humans↗
PubMed1978

Tumours of the cauda equina.

A retrospective study of 70 consecutive patients with a cauda equina tumour who were admitted to Neurosurgical Department at the Radcliffe Infirmary, Oxford is presented. The diagnosis of these tumours is often difficult and delayed. The quality of life largely depends upon the neurological disability at presentation. The diagnostic features and investigations are discussed together with the treatment and prognosis.

Adolescent↗