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Biomedical subjects

F J Gillingham

Publications and source records attributed to F J Gillingham.

At least 19 recordsLinked to original sources
PubMed1988

Surgical treatment of epilepsy. Restoration of personality?

352 epileptic patients were studied by basic science, clinical neurological and psychological teams to assess the effects of epilepsy and its treatment on personality. Those who did not response to well-tried medication were subjected to surgical treatment and short- and long-term follow-up of the results of treatment carried out. The changes in personality following operation and their relationship to the reduction of seizures were recorded. Temporal lobe epilepsy is closely related to personality disorder and the benefits of classical temporal lobectomy on the reduction of seizures and restoration of personality is confirmed. However it is also confirmed that for the best results the earliest referal is necessary i.e. as soon as the failure to respond to adequate therapy is evident. This equally applies to amygdalotomy for violent and destructive behaviour associated with epilepsy particularly in children and also to stereotactic "central" lesions for non-focal intractable epilepsy. The "prefered" pathway for the propagation of the epileptic discharge and its relationship to neurochemical changes occurring during the increased neuronal activity associated with focal motor seizures is described.

Adolescent↗
PubMed1982

Double-blind trial of aspirin in patient receiving tranexamic acid for subarachnoid hemorrhage.

Antifibrinolytic agents have been claimed to reduce the rebleed rate in patients with subarachnoid haemorrhage from intracranial aneurysms. However, these agents may in themselves increase the incidence of delayed cerebral ischaemia in these patients. We have used aspirin in an attempt to reduce the incidence of this complication. In a prospective, double-blind trial of aspirin against placebo, 53 patients with subarachnoid haemorrhage were all treated with the antifibrinolytic agent tranexamic acid. Twenty-seven patients received aspirin and 26 patients received placebo. The morbidity and mortality was similar in each group. A further breakdown into patients who had their aneurysms clipped at craniotomy (21 patients) similarly failed to show a more favourable outcome in either group. It is concluded that aspirin does not affect the outcome in patients with subarachnoid haemorrhage treated with tranexamic acid.

Angiography↗
PubMed1981

Decerebrate rigidity produced in cats by focal stereotactic radiofrequency lesions.

A method of producing decerebrate rigidity in cats by means of a radio frequency current was developed. Adequate control of the extent an shape of the lesions necessitated a preliminary investigation of the relationship between the intensity and duration of current, the size of the lesion, and the tissue impedance before and after destruction; this was performed on guinea pigs. The mesencephalic reticulum in cats was identified by depth microelectrode recording and electrical stimulation. Unilateral, midline, and combined stereotactic radiofrequency lesions were made. The anatomical location, the pathological characteristics, and the physiological significance of the lesions with regard to the production of decerebrate rigidity and of the other clinical reactions of the animals are discussed.

Animals↗
PubMed1980

The effect of intracarotid perfusion of cerebrospinal fluid from patients with subarachnoid hemorrhage on cerebrovascular reactivity in rats.

Cerebrovascular resistance was measured in 10 rats with increasing dosages of 5-Hydroxytryptamine (5-HT). The internal carotid artery was perfused at constant flow with cerebrospinal fluid (CSF) from patients with ruptured intracranial aneurysms, and dose-response curves to 10 mu 1 boluses of 5-HT were compared with similar dose-response curves obtained during perfusion with Krebs' solution and with normal CSF (CSF-N). CSF from patients with subarachnoid hemorrhage (CSF-SAH) produced increased sensitivity to 5-HT.

Animals↗
PubMed1980

Two methods of measuring muscle tone applied in patients with decerebrate rigidity.

Two methods were used to measure muscle tone in patients with decerebrate rigidity. In the first method forces of square waveform were applied and the calculated compliance of the joint was used as an index of rigidity. Oscillatory transients were seen at the same frequency as the physiological tremor. The range of normal variation in compliance was large and the values measured in the patients flucuated markedly which limited the value of this index. In the second method, where forces of sinusoidal waveform were employed, the resonant frequency of the joint was measured and used as an index of rigidity. This index proved reliable and reproducible.

Adolescent↗
PubMed1980

The long-term results of stereotaxic surgery and L-dopa therapy in patients with Parkinson's disease. A 10-year follow-up study.

Sixty patients with Parkinson's disease underwent sterotaxic surgery in Edinburgh between 1965 and 1967, and were examined every 2 years for a total follow-up period of 10 years. Although stereotaxic surgery had been extremely effective in treating tremor and rigidity, the other manifestations of Parkinson's disease were noted to progressively affect more patients at each follow-up examination. L-dopa therapy was instituted in 36 patients after 1968. The effect of L-dopa on bradykinesia was remarkable, but the long-term benefit on the other manifestations of Parkinson's disease was negligible. Furthermore in most cases L-dopa became progressively ineffective for bradykinesia after 3 to 5 years. L-dopa-induced tremor and involuntary movements were less frequently noted in limbs contralateral to the side of a previous stereotaxic procedure. It was concluded that in patients presenting with tremor and rigidity as the major problem in their parkinsonian syndrome, the most effective form of palliative therapy is stereotaxic surgery, and that L-dopa should be reserved for the management of bradykinesia.

Activities of Daily Living↗
PubMed1979

Extradural haematoma: effect of delayed treatment.

The case records of patients with extradural haematomas treated in the Lothian region during 1951-60 and 1968-77 were analysed to assess the effect of delay in treatment on morbidity and mortality. Delay was defined as the time from deterioration in level of consciousness to surgical evacuation of clot. There were 83 supratentorial extradural haematomas unassociated with intradural clot or contusion. The mean delay in patients who died was 15.7 hours, while in good-quality survivors the mean delay was 1.9 hours. Mortality decreased from 33.3% during 1951-60 to 8.9% during 1968-77. In addition, good recovery without morbidity occurred in 40.7% of patients in the earlier period and 67.9% in the later period. Mean delays from deterioration in level of consciousness to operation were 9.8 and 2.4 hours in the earlier and later periods respectively. The results emphasise the need for immediate operation in patients deteriorating with extradural haematomas. Direct admission of all head-injured patients to a head and spinal injuries unit staffed by neurosurgeons resulted in minimal delay times as well as a reduction in morbidity and mortality.

Hematoma, Epidural, Cranial↗
PubMed1979

Prognostic signs during continuous monitoring of the ventricular fluid pressure in patients with severe brain injury.

The presence of CSF in cases with intracranial hypertension is a favourable prognostic sign; its absence is indicative of a progressive and potentially lethal intracranial hypertension. 2. A series of characteristic changes in the absolute value of the VFP as well as in the amplitude and rate of the cerebral pulse can provide reliable evidence of the integrity of the cerebral circulation. 3. Short-lasting disappearance of the diastolic pressure towards the end of the ultimate plateau wave and subsequent significant lowering of both the systolic and diastolic pressures is an additional bad prognostic sign.

Adolescent↗
PubMed1979

The effect of decerebrate rigidity on the intracranial pressure: an experimental study.

The mechanical effect of acute decerebrate rigidity upon the ICP and the mechanisms underlying the relationship between them have been investigated with experiments performed on 26 cats. It has been shown that: a) Extreme rigidity of the peripheral musculature with or without partial activation of the trunkal muscles produces no change in ICP, b) the simultaneous elevation of the intra-thoracic and intra-abdominal pressures is the factor primarily operative in raising and maintaining the elevated ICP, c) when cerebrovascular homeostasis is already defective a subsidiary but not unimportant role is played by the elevation of the systemic arterial pressure, d) under conditions of normal brain elastance mild and short-lasting spasms produce no effect on the ICP. In an animal, however, in which the brain elastance had been increased by inflating a small air-filled balloon, similar spasms produced a marked increase in ICP.

Animals↗
PubMed1979

The effect of focal twitching on the intracranial pressure during paralysis and mechanical ventilation.

Three patients with head injuries developed minor facial twitching while their intracranial, intrathoracic and systemic arterial pressures were being monitored and they were on mechanical ventilation. These twitches were disclosed by the coincided great and damaging increases in the intracranial pressure, while the intrathoracic and arterial pressures were virtually unchanged. The intracranial hypertension was attributed to cerebral vasodilatation which was presumed to be due to the accumulation of cerebral metabolites since other causative factors such as systemic hypertension and hypoxia were under control. Cerebral elastance modulated the rise in intracranial pressure.

Acid-Base Equilibrium↗