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Biomedical subjects

D J Beale

Publications and source records attributed to D J Beale.

At least 19 recordsLinked to original sources
PubMed2005

Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx.

BACKGROUND: A CSF flow study in patients with Chiari malformation (ChM) who undergo craniocervical junction decompression (CCJD). METHODS: Using spatial modulation of magnetization (SPAMM), cerebrospinal fluid (CSF) flow velocities were measured at the prepontine (PP), anterior cervical (AC), and posterior cervical (PC) subarachnoid spaces (SAS) in healthy subjects (n = 11) and patients with Chiari malformation (ChM) before and/or after CCJD (n = 15). In the syringes, the intrasyrigeal pulsatile CSF motion was estimated qualitatively as present or absent. FINDINGS: In normal subjects, the mean CSF velocities were 2.4 +/- 0.2 cm/s (PP), 2.8 +/- 0.3 cm/s (AC), and 2.4 +/- 0.2 cm/s (PC). Velocities were significantly lower than normal in patients with ChM prior to CCJD, reduced by 38%, 25%, and 79% in the 3 regions, respectively (P<0.001). Post-CCJD, velocities were 20% (PP), 100% (AC), and 40% (PC) greater than preoperatively (P<0.001). CONCLUSIONS: In ChM, the posterior cervical CSF flow velocity was low, increased minimally after CCJD and, by itself, had limited predictive value. Post-CCJD, an increase of the sum of anterior and posterior cervical CSF flow velocities by more than 20% consistently preceded or coincided with marked headache improvement. After CCJD, the finding that the intrasyringeal CSF pulsatile motion had become absent was an earlier and more sensitive predictor of motor or sensory improvement than a reduction in syrinx's size. SPAMM can be used to assess whether CCJD has restored CSF flow, predict outcome and provide pathophysiological insights in ChM and syringomyelia.

Adolescent↗
PubMed1998

Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair.

OBJECT: A classification is proposed to organize anterior cranial base fractures systematically according to their location and size. The goal of this study was to determine whether these two variables, irrespective of cerebrospinal fluid (CSF) rhinorrhea, are related to the long-term risk of posttraumatic meningitis and, hence, to standardize decision making concerning surgical repair of associated CSF fistulas. METHODS: With the aid of high-resolution thin-section coronal computerized tomography (CT) scanning, anterior cranial base fractures were classified into the following four major types: I, cribriform; II, frontoethmoidal; III, lateral frontal; and IV, complex (any combination of the other three types). Fractures with a maximum bone displacement that extended farther than 1 cm in any plane were classified as "large" and those less than 1 cm as "small." The authors used this classification in a study of 48 patients who were treated by conservative (20 patients) or surgical (28 patients) means. The results showed a gradation of risk: the fracture most likely to develop infection was a large cribriform (Type I) and the least likely was a small lateral frontal (Type II). Statistical analysis showed that the trend for an increased infection rate was related to the cumulative effect of three variables in the following order: 1) prolonged duration of rhinorrhea (analysis of variance [ANOVA], p = 0.017); 2) large size of fracture displacement (ANOVA, p = 0.079); and 3) fracture's proximity to the midline (ANOVA, p = 0.015). CONCLUSIONS: In this series, microsurgical repair was accompanied by a minimum complication rate. Hence, the authors recommend that patients with fractures that combine the aforementioned variables should be considered to have a high long-term risk of infection and their injury should be surgically repaired as soon as the posttraumatic edema has subsided. This applies to the following fractures: large cribriform (Type I) with transient rhinorrhea lasting 5 to 8 days and large frontoethmoidal (Type II) with prolonged rhinorrhea lasting longer than 8 days. Furthermore, the authors conclude that this classification can improve the management of posttraumatic CSF fistulas of the anterior cranial base and may provide insights into the mechanisms underlying their spontaneous repair and susceptibility to meningitis.

Adolescent↗
PubMed1997

Giant lumbar meningioma: a common tumour in an unusual location.

We report a 27-year-old woman with atypical sciatica due to a giant, rapidly growing, lumbar (T12-S1) meningioma. The unique features of this case are discussed and the importance of early investigation by MRI of patients with atypical low back pain and sciatica is highlighted.

Adult↗
PubMed1995

Imaging of optic disc drusen: a comparative study.

The choice of imaging technique to identify the presence of optic disc drusen has not been well established. We performed computed tomography (CT), magnetic resonance imaging (MRI), fundus fluorescein angiography and B-mode ultrasonography (B-USG) on four patients with optic disc drusen as the sole identifiable pathological process. CT, MRI and examination for autofluorescence demonstrated the presence of drusen in only one case each. B-USG showed characteristic features of optic disc drusen in all cases. We suggest that B-USG, a non-invasive and inexpensive technique, may be the imaging method of choice in identifying the presence of disc drusen.

Fluorescein Angiography↗
PubMed1993

A cine-SPAMM sequence for NMR imaging of pulsatile cerebrospinal fluid flow.

The technical difficulties in designing a SPAMM sequence to image pulsatile cerebrospinal fluid (CSF) flow at different phases of the cardiac cycle are described. The criteria used to select the most appropriate order of binomial SPAMM sequence are outlined. Data collection times required to view both cephalad and caudad flow for all R-R intervals were considered. The flip angles of the RF pulses required to produce images with equal CSF intensity throughout the cardiac cycle were investigated in detail.

Cerebrospinal Fluid↗
PubMed1992

The foramen lacerum--a route of access to the cranial cavity for malignant tumours below the skull base.

Thirteen malignant neoplasms (seven different tumour types) arising in the postnasal space or surrounding soft tissues extended upwards through the skull base into the middle cranial fossa. Gadolinium-enhanced magnetic resonance imaging (GdMRI) clearly revealed the route of the tumour into the cavernous sinus, parasellar region and floor of the middle cranial fossa. Since this extension alters both management and prognosis, GdMRI in the coronal plane is a necessary investigation for persistent and unexplained facial pain in order to demonstrate such lesions of the trigeminal nerve. Differentiation between neoplasms and aggressive inflammatory disease may be difficult.

Carcinoma, Adenoid Cystic↗
PubMed1992

Unilateral upper cervical posterior spinal artery syndrome following sneezing.

A 35 year old man experienced severe transitory neck pain following a violent sneeze. This was followed by neurological symptoms and signs indicating a left sided upper cervical cord lesion. MRI showed an infarct at this site in the territory of the left posterior spinal artery. This discrete infarct was probably due to partial left vertebral artery dissection secondary to sneezing.

Adult↗
PubMed1992

Magnetic resonance imaging of pulsatile cerebrospinal fluid flow by spatial modulation of magnetization.

Various orders of binomial spatial modulation of magnetization sequences up to (1 4 6 4 1) have been tested to find the optimum sequence for clinical application. Stripe width, stripe sharpness and the tolerance of the sequences to radiofrequency non-linearity have been investigated. The (1 3 3 1) sequence was found to be a good compromise between competing design criteria, and its application to viewing pulsatile cerebrospinal fluid motion is described.

Cerebrospinal Fluid↗
PubMed1987

Osteomas of the temporal bone: a report of three cases.

Osteomas of the petrous temporal bone, inaccessible to clinical examination are rare. Three such cases are reported, one in the internal acoustic meatus, one in the middle ear, and the other on the posterior surface of the petrous ridge, emphasizing the role of radiology in their diagnosis evaluation, and as an aid to management.

Adult↗
PubMed1984

Comparison of highly purified semi-synthetic insulin and highly purified porcine insulin in the treatment of type I diabetes: interim report of a multi-centre randomised single blind study.

This is an interim report of a long term single-blind study of the effects of changing diabetic patients treated with highly purified porcine insulin to semi-synthetic human insulins of identical formulation. Twenty four insulin dependent diabetics were randomly allocated to continue with porcine insulin (n = 11) or human insulin (n = 13). There were no significant changes within the groups nor differences between the groups in mean preprandial capillary blood glucose, glycosylated haemoglobin or insulin dose during the first 24 weeks of the study. Insulin antibody levels remained low and did not differ between the groups. No local or systemic adverse reactions were observed. In this group of patients conversion to human insulin did not result in a change in diabetic control or insulin dose.

Adolescent↗
PubMed1977

Plasma lipoprotein patterns in patients receiving dialysis therapy for chronic renal failure.

A study is reported of the prevalence, nature and possible aetiology of the hyperlipidaemia found in a group of 74 patients receiving maintenance dialysis. Sixty patients were receiving haemodialysis and 14 peritoneal dialysis. Sixty-four per cent of the male and 83% of the female patients had a lipoprotein abnormality which was predominantly of the Type IV pattern, probably due to a combination of increased hepatic triglyceride synthesis and diminished peripheral clearance.

Adolescent↗
PubMed1977

Plasma triglyceride secretion and metabolism in chronic renal failure.

Endogenous very low density lipoprotein triglyceride (VLDL-TG) production rate has been studied in 13 patients with chronic renal failure who were not on dialysis treatment. In these patients the VLDL-TG plasma concentration was significanlty raised when compared with the control group; the fractional turnover rate was reduced but the absolute turnover rate was increased. The results suggest that increased hepatic production of VLDL-TG is a contributory factor to the hypertriglyceridaemia of chronic renal failure.

Female↗
PubMed1973

Postinfective malabsorption: a sprue syndrome.

Thirteen cases are described of temporary malabsorption in adults presenting after an episode of apparent infective enteritis. Clinical features included diarrohea, anorexia, and weight loss. Investigations indicated diffuse impairment of function in the small bowel, including the ileum, with well-preserved mucosal morphology in the upper jejunum and a tendency to rapid folate depletion. Spontaneous recovery usually occurred within weeks but two cases ran a more prolonged and severe course.The clinical features of this syndrome are those of tropical sprue, but the outcome of the illness is probably influenced by nutritional as well as environmental factors. There may be a gradation of severity of illness from megaloblastic anaemia to florid malabsorption syndrome.

Adult↗