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Biomedical subjects

G T Tindall

Publications and source records attributed to G T Tindall.

At least 73 records · Page 4Linked to original sources

A technique for evaluation of ventricular shunts using Amipaque and computerized tomography.

A technique involving the combined use of Amipaque (metrizamide) and computerized tomography scanning is described for the evaluation of ventriculoperitoneal and ventriculoureteral shunt function. The results of three illustrative cases from a series of nine patients are given. In five patients, the technique demonstrated obstruction that was later confirmed at surgery. In the other four patients, it showed patency in the shunt system, and no surgery was performed, thereby obviating unnecessary shunt revisions.

Adult↗

Downbeat nystagmus as the salient manifestation of the Arnold-Chiari malformation.

A case of Arnold-Chiari malformation Type I presented with the isolated finding of downbeat nystagmus. The mechanism of downbeat nystagmus is discussed along with its subjective manifestation referred to as oscillopsia. In addition, the value of metrizamide cisternography in diagnosing the Arnold-Chiari malformation is illustrated.

Adult↗

Evaluation of the abnormal sella turcica.

Current neurodiagnostic and endocrine evaluation for pituitary tumors, empty sella syndrome, and parasellar lesions includes new techniques. Multidirectional polytomography of the sella turcica in detecting very small pituitary adenomas is important. Also, the role of computerized axial tomography (CT scanning) in defining size and extent of sellar and parasellar lesions is increasing. There has been a decline in the use of cerebral angiography and pneumoencephalography, especially the latter, in the diagnostic workup of these patients since the introduction of CT scanning.

Adenoma↗

Intraventricular fiberscopic observations in adult hydrocephalic patients.

A flexible ventriculofiberscope was used to diagnose intraventricular pathological conditions in eight adult hydrocephalic patients. In each case the entire procedure was recorded on videotape for documentation, review, and teaching. Four representative cases are presented to illustrate the use and value of this technique.

Adult↗

Transsphenoidal hypophysectomy for disseminated carcinoma of the prostate gland. Results in 53 patients.

Transsphenoidal microsurgical hypophysectomy was performed in 53 men with disseminated carcinoma (Stage IV) of the prostate gland. The mean age was 64.8 years. Forty-three of the 53 men had severe pain due to their disease. Significant pain relief was obtained following hypophysectomy, usually within 24 hours, in 39 (91%) of these 43 patients. Objective remission occurred in 16 (36%) of 45 patients in whom the follow-up review was adequate to make this decision. Although dramatic, pain relief was not permanent in every patient. Four patients died in the early postoperative period, and in one, death was directly related to the operative procedure. Significant complications included partial diabetes insipidus in 40 cases (75.5%), and cerebrospinal fluid leaks in six (11.3%). The authors conclude that hypophysectomy is an appropriate operation in patients with disseminated carcinoma of the prostate gland, particularly when pain is a significant feature of the illness. Further, the transsphenoidal microsurgical approach appears to be the operative procedure of choice for performing hypophysectomy.

Aged↗

Abdominal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases.

Three cases of rare primary intracranial yolk sac tumor are reported. Two cases had a pineal location, whereas the third presented as a suprasellar mass. After the placement of ventriculoperitoneal shunts for relief of hydrocephalus, all of the patients developed metastases restricted to the peritoneum, as demonstrated by autopsy in one patient (Case 1) and clinical and radiographic evidence in two patients (Cases 2 and 3). The peritoneal metastases were directly associated with the death of one patient, but were successfully treated with chemotherapy in another patient, who is still alive more than 2.5 years after initial presentation. The value of ascitic fluid cytology and alpha-fetoprotein determination in the diagnosis of this complication was demonstrated in one patient. These cases emphasize the need for awareness of this mode of metastasis and its potentially lethal effect.

Adult↗

Evaluation of the plasma scalpel for intracranial surgery: a pilot study.

The plasma scalpel, a new type of thermal knife, was investigated to determine its utility in neurosurgery. A series of 23 dogs underwent cortical resections comparing the use of the plasma scalpel with conventional bipolar cautery. Tissue heating, blood loss, speed of coagulation, wound healing and pathological change associated with use of the plasma scalpel were studied. The device was found to be effective, safe and faster than bipolar cautery. At present, several technical problems, including the large size of the handpiece and the blast effect of the plasma beam, preclude preliminary human clinical trials.

Animals↗

Transsphenoidal microsurgery for pituitary tumors associated with hyperprolactinemia.

The results of transsphenoidal microsurgery in treating 37 patients (30 women and seven men) with pituitary tumors associated with hyperprolactinemia are presented. Immediate (10-day) postoperative fasting prolactin levels were normal (less than 25 ng/ml) in 19 of 26 patients whose preoperative prolactin level was less than 200 ng/ml, and in only three of 11 patients in whom preoperative prolactin was greater than 200 ng/ml. Twelve of 13 patients with normal preoperative pituitary-target organ function maintained normal axes postoperatively. Thirteen other patients had preoperative deficiencies in one or more pituitary-target organ axes. Postoperatively, in these latter 13 patients, a pituitary-target organ axis that was deficient preoperatively returned to normal in six cases; there was no change in five, and there was impairment in another axis in four instances. Although gross total tumor removal was believed to be complete in 35 of 37 patients, serial postoperative prolactin determinations in four of these 35 patients indicate tumor regrowth. The authors conclude that transsphenoidal microsurgery is currently the operative procedure of choice for the majority of pituitary tumors associated with hyperprolactinemia.

Adenoma, Acidophil↗

Unilateral septal technique for transsphenoidal microsurgical approach to the sella turcica. Technical note.

A modification of the transseptal, transsphenoidal appraoch to the sella turcica is described; it consists of a unilateral separation of the nasal mucosa from the nasal septum. Experience with the technique in 215 cases has indicated that it is a useful, practical appraoch. The advantages are that the septum is spared, reoperation is made easier, and the procedure is quicker than the bilateral septal procedure. Asymptomatic nasal septal perforations (less than 3 mm) were seen in eight of 215 cases, and represented the only complication related to the operation.

Humans↗

Hypothalamic hypothyroidism and hypogonadism in prolonged traumatic coma.

Prolonged coma afterhead trauma is associated with depletion of 3', 5' cyclic adenosine monophosphate (cAMP) in the cerebrospinal fluid (CSF). Because cAMP has previously been implicated in neurorendocrine secretion, this study examines the pituitay-hypothalamic function in 15 adult male patients (to exclude the effects of puberty and menses) with traumatic coma lasting longer than 2 weeks. Ventricular CSF cAMP was measured at 2- to 4-day intervals for 10 to 25 days. Simultaneously, plasma hormone concentrations were also determined. In all 15 cases, CSF cAMP and plasma levels of thyroid-stimulating hormone (TSH), thyroxine (T4), free T4, triiodothyronine (T3), luteinzing hormone (LH), follicle-stimulating hormone (FSH), and testerone became subnormal. In 11 patients whose level of consciousness fluctuated, the reduction in plasma T4 and testerone were proportional to both severity of coma ( r greater than 0.81, p less than 0.05) and depletion of CSF cAMP (r greater than 0.81, p less than 0.05). In four patients who remained deeply comatose for 17 to 25 days, the hypothyroidism and hypogonadism persisted. In six patients who regained consciousness, both endocrine defects improved partially or completely. Injection of 1) thyrotrophic-releasing hormone and 2) gonadotrophic-releasing hormone elicited normal or supernormal increases in plasma concentrations of 1) TSH, and 2) LH and FSH, reduced, respectively, suggesting a suprahypophyseal deficiency. These observations demonstrate that suprahypophyseal hypothryoidism and hypogonadism may occur regularly in patients with traumatic coma lasting longer than 2 weeks.

Adult↗