Biomedical subjects

C E Gilkes

Publications and source records attributed to C E Gilkes.

4 recordsLinked to original sources

PubMed2004

Inner calvarial erosion from traumatic subdural haematoma in infancy.

CASE REPORT: This is a report of a case of a subdural haematoma in infancy of possible non-accidental aetiology with raised pericerebral pressure, which we postulate has eroded the inner table of the cranial bones and resulted in leakage of marrow precursor cells into the extradural space. RESULT: Subdural tapping via the fontanelle has created a channel allowing subsequent ingress of nucleated red cell precursors into the subdural space. This addition to the subdural collection has prolonged its course necessitating subduro-peritoneal shunting.

Erythrocytes↗

PubMed2003

Clinical databases and data protection: are they compatible?

In the current climate of clinical governance and audit, and in the setting of an active academic unit, an effective clinical database is an invaluable tool. In this article, we will present our neurovascular database, discuss the issues related to setting up the ideal clinical database, discuss the problems related to accurate data input and review the legal requirements of data protection. The success of a clinical database is reflected by the completeness of the data, the accessibility of the information and how useful it has proven to be. After 4 years of experimentation we currently use a database designed on Microsoft Access. The form is a single page. Junior medical staff input the information as medical staff have been found to be the most reliable personnel for data input in terms of accuracy. However, time is generally in short supply amongst this group. For our purposes, the ideal database is one that is simple, that can be used to flag up cases, rather than provide all of the information and ensures a complete dataset. The arrival of the UK 1998 Data Protection Act has put many clinical databases and registries in jeopardy, and introduced further bureaucracy to research. We discuss the Act and its interpretation by the General Medical Council, Medical Research Council, British Medical Association, Department of Health and our own trust with respect to databases and research.

Cerebrovascular Disorders↗

PubMed2001

Pressure compensation in shunt-dependent hydrocephalus with CSF shunt malfunction.

This study is a retrospective analysis of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) data from 56 children with active hydrocephalus and cerebrospinal fluid (CSF) shunt malfunction. The pressures were measured from a separately sited CSF access device placed in the frontal horn of the lateral ventricle. Of the patients, 79% had an elevated ICP (mean 20+/-12 mmHg). A subgroup of patients demonstrated ten different forms of CSF-filled swelling. This group had significantly lower ICP recordings (P=0.000075) with a mean ICP of 8.5 mmHg compared with the remainder (22.9 mmHg). This pressure 'compensation' was because of additional nonphysiological accommodation of CSF volume. Overall the CPP was normal in 35% of cases despite normal ICP occurring in only 11% of cases. The CPPs were not significantly different in those with and without compensation. Measurement of ICP may not always be a reliable indicator of shunt malfunction in shunt-dependent children who present with compensatory CSF-filled spaces.

Adolescent↗

PubMed1999

A classification of CSF shunt malfunction.

A classification of dysfunctional shunts is proposed and clarification of the terminology discussed. This is based on experience of successive shunt malfunctions over a 3-year period with the aid of ventricular pressure measurements, imaging and clinical semiology. The classification system is both anatomical and functional.

Cerebrospinal Fluid Shunts↗