Biomedical subjects
Publications and source records attributed to D Bates.
Advances in resuscitation create the risk that patients may be saved with a brain so damaged that they can never recover cognition. It is imperative that those who provide intensive care facilities determine the prognosis of such patients at a relatively early stage. This review suggests ways in which such predictions may be derived for patients in medical coma.
A randomised controlled trial of endarterectomy in patients with carotid artery disease showed that operation significantly reduced the frequency of transient ischaemic attacks (TIA) in the relevant vascular territory. Because of the high post-operative morbidity in the surgical group, the trial was abandoned before conclusions could be drawn as to the influence of endarterectomy on long-term survival or on the incidence of subsequent strokes.
The Mental Function Index is a weighted combination of scores on three brief tests. The Index was developed to aid in the discrimination of elderly persons with early cases of senile dementia from nondemented elderly individuals. In a previous report (Am J Epidemiol 1981;114:515-27), the authors described preliminary results with the Index in 195 elderly persons in a southern California retirement community. The present study seeks to assess whether similar results can be achieved in samples other than that from which the discriminant function defining the Index was derived. Seven separate studies were done on a total of 210 persons, comprising subjects recruited from a teaching hospital which serves a predominantly lower to lower-middle class population, referrals from the same physicians as in the earlier study, and (for the reliability sample) persons from the upper-middle class community which was the major referral source. It was found that scores on the brief measures correlate 0.86 with those on the three Halstead-Reitan subtests most sensitive to brain damage and to aging. The Index provides a graded measure of disease severity comparable to global neurologic assessment (r = -0.84) and level of social function (r = 0.76). Entry Index is a crude predictor of cognitive status in older adults after several years. Changes in the Index over time parallel those in independent measures of change. The results suggest that the Index will be useful for assessment of disease severity and of longitudinal change, as well as for diagnostic screening, in population studies of senile dementia.
The frequencies of lymphocytes of different types in the blood of 96 multiple sclerosis patients in different phases of the disease were examined by rosetting, in relation to the HLA antigens present. In the total series of patients, there is a significant deficit of A2, and this is also suggested in the active and progressive cases, but there is no evidence of association of particular HLA haplotypes with the different phases of the disease. There was little variation among the patient categories in the frequency of T cells of different types, but patients in relapse showed a higher proportion of cells showing surface IgG. In general, there is little association of cell surface markers with HLA type, but when B8 is present there appear to be fewer E and EAC rosettes in patients in exacerbation, fewer E and IgG surface markers in remission, and more of the IgG markers in progression.
A 63-year-old man developed delayed cerebral radiation necrosis following radiotherapy to a nasopharyngeal carcinoma. Complete resolution of his neurological deficit resulted from corticosteroid therapy alone. Serial CT scans showed the disappearance of the patients' mass lesion. The literature on cerebral necrosis following radiotherapy of extracranial neoplasms is reviewed with particular emphasis on management.
A 50-year-old man with a 20-year history of myelofibrosis developed mild impairment of dorsal column sensation and ataxia of gait. A myelogram and subsequent peroperative biopsy demonstrated spinal cord compression due to extramedullary haematopoiesis. There was an excellent clinical response to surgery and radiotherapy. The characteristic clinical features and the pathogenesis of this unusual complication of myelofibrosis and extramedullary haematopoiesis are discussed.
Data from three double-blind trials of linoleic acid in the treatment of multiple sclerosis (MS) were reanalyzed to examine whether inconsistency in the results was due to a relationship between patient characteristics and treatment response. The combined data consisted of neurologic assessments over 2 1/2-year trials for 87 treated patients and 85 control patients. Treated patients with minimal or no disability at entry had a smaller increase in disability than did controls (p less than 0.05). In addition, treatment reduced the severity and duration of relapses at all levels of disability and duration of illness at entry to the trials.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A study of 206 patients with multiple sclerosis in the north-east of England and their families shows no evidence of monogenic involvement in the disorder. Much more likely is a multifactorial etiology in which the genetic component is polygenic. On this model the heritability is calculated at 52.1% or 40.9% if age variation in incidence is allowed for. The genetic component is present but no more then moderate in extent.
A 58-year-old woman presented with the classical features of polymyalgia rheumatica. She also had a global dementia; CT scan and EEG showed diffuse cerebral disease. After steroid treatment, the polymyalgia rheumatica and dementia rapidly resolved and the CT scan and EEG became normal. The inter-relationships of the giant cell arteritides are discussed in the light of this report of the association of polymyalgia rheumatica and steroid-responsive diffuse cerebral disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
To validate a senile dementia survey diagnostic tool, 195 individuals aged 61-91 and referred by their physicians as normal or mildly demented were examined. The etiologic diagnosis used as criterion was the consensus of two experienced neurologists, assisted by clinical and laboratory data from referring physicians and by neuropsychologic evaluation of questionably affected persons. Agreement between the neurologists was high, as indicated by a weighted Kappa coefficient of 0.97 (95% confidence interval (Cl) (0.94, 1.00)). Agreement between the instrument and criterion diagnosis was also excellent (kappa w = 0.93; 95% Cl (0.88, 0.98)). Used alone as a screening diagnostic tool, the cognitive function portion of the instrument was much more sensitive (0.929) than previously used brief tests and was acceptably specific (0.800). Because normals complete this cognitive test in 15-20 minutes, it should be a major advance in population-based studies of senile dementia and normal aging.
Explore the source record for details and available documents.