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Biomedical subjects

G Costello

Publications and source records attributed to G Costello.

7 recordsLinked to original sources
PubMed2000

Posteroventral pallidotomy in Parkinson's disease.

OBJECTIVE: We analyse the clinical aspects, results and reliability of posteroventral pallidotomy (PVP) carried out as treatment for the principal symptoms and treatment induced complications in patients with Parkinson's disease (PD). PATIENTS AND METHODS: Between August 1995 January 1998, 17 patients with PD were treated surgically, 13 patients with PVP. A pre- and post-surgical clinical evaluation was carried out. Riechert's Stereotactic System (MHT, Freiburg, Germany) was used. Ventriculography under stereotactic conditions was used in the PVP procedures, Laitinen's co-ordinates as anatomical target, and electrical stimulation for physiological determination. 3 4 radiofrequency lesions were made at 83 degrees C for 20". The mean age was 60 +/- 10.8 years, ages ranging from 45-79 years. 8 (60.5%) of the patients were male. The cardinal symptoms of the series were bradykinesia and rigidity. The duration of the illness ranged from 8.6 +/- 3.7 years with a range of 4-15 years. 7 (53.8%) presented with a duration of 10 years or more. 6 (46,2%) of the patients underwent left PVP, the remaining 7 (53.8%) right PVP. Only one patient received treatment with right PVP and ipsilateral thalamotomy in the same surgical procedure. The mean post-surgical follow up was 16 +/- 7 months, with a range of 2 to 26 months. RESULTS: An up to date evaluation was carried out on all patients showing significant changes after PVP in UPDRS motor (P < 0.005), complete rigidity relief (P < 0.005), bradykinesia relief (P < 0.005) and complete tremor relief (P < 0.005). An important improvement in contralateral dyskinesia was noted after PVP. A subjective evaluation of the results showed excellent results in 4 (30.8%) patients, good in 6 (46.2%) and fair in 3 (23%). No significant correlation was found between age and duration of illness (P = 0.7). Two patients suffered slight side effects, one patient with worsening of hypophonia whilst the other suffered subjective visual impairment controlled by normal post operative ophthalmological examinations. There was no peri-operative mortality. CONCLUSION: PVP is considered a safe and effective surgical method for the treatment of both the principal symptoms of PD and the complications of DOPA medication.

Aged↗
PubMed1999

Stereotactic neurosurgery in children and adolescents.

Between March 1992 and January 1998, 100 stereotactic procedures were carried out in our Stereotactic Department. Of these, 24 were performed on patients under 18 years of age, 22 of them under a local anaesthetic and sedation. The ages of these patients ranged between 4 months and 18 years. The stereotactic procedures carried out were: 15 cerebral biopsies, 5 iodine-125 implants, 4 implantations of Rickham reservoirs with ventricular catheter, with additional holes to establish a connection between the cyst content and the ventricular system (internal drainage): 2 of these patients had arachnoidal cysts in the pineal region, 1 a thalamic neuroepithelial cyst and 1 a cystic craniopharyngioma, with excellent control of hydrocephalus. All cerebral biopsies were positive, including 3 in which brain stem tumours were detected. Of the 5 patients treated by brachytherapy, 4 had pilocytic astrocytomas and 1 an anaplastic astrocytoma. The sites of the tumours for which implants were used were the thalamus in 4 cases, and the basal ganglia (corpus striatum) in 1. In only 2 cases was there some transistory morbidity, and mortality was nil. The stereotactic procedures in this varied group were well tolerated, with low morbidity and mortality rates, which proves that this method is effective and safe for patients. It can also be used for the diagnosis of brain stem tumours. Midline cysts can also be treated by means of internal drainage with catheters (a minimally invasive form of surgery).

Adolescent↗
PubMed1995

After care program volunteer: a staff nurse's experience.

A staff nurse who assisted in comforting families through the Trauma Support After Care Program at Hartford Hospital shares her experiences in this article. Her initial hesitation regarding family care and follow-up is described, and her eventual success as a volunteer helping others cope with loss is highlighted.

Aftercare↗
PubMed1988

Works in progress #3. Recurrent symptomatic posterior glenohumeral subluxation.

This paper is a retrospective review of 12 patients (13 shoulders) who were treated surgically for recurrent symptomatic posterior glenohumeral subluxation. The surgical procedure was designed to "fix the pathology." Postoperatively, all patients were immobilized in a shoulder spica for six weeks with the arm in 30 degrees of abduction and 30 degrees of external rotation. This was followed by an intensive rehabilitation program. The patients were evaluated two to six years following surgery; all felt they were significantly improved. Surgical reconstruction for recurrent symptomatic posterior glenohumeral subluxation is a reliable procedure in properly selected patients (particularly those whose instability is trauma-related), provided the surgery is done carefully and the patient managed well postoperatively.

Adolescent↗