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Biomedical subjects

J Caird

Publications and source records attributed to J Caird.

15 recordsLinked to original sources

Craniotomy with prosthetic heart valves: a clinical dilemma.

The authors report two cases of spontaneous intracranial haemorrhage after elective craniotomy for resection of cerebral tumour. Both patients had mechanical aortic valve prostheses and were on regular warfarin therapy. In both cases, warfarin therapy was discontinued 5 days prior to surgery and unfractionated heparin administered intravenously until 12 h before surgery. Both patients were re-anticoagulated with subcutaneous low molecular weight heparin within the first week postcraniotomy-both developed life-threatening intracranial haemorrhage requiring urgent evacuation. The authors emphasize the risk of re-anticoagulation without postoperative imaging and the disadvantages of therapeutic dose, low molecular weight heparin in the postoperative period.

Anticoagulants↗

Matrix metalloproteinases 2 and 9 in human atherosclerotic and non-atherosclerotic cerebral aneurysms.

Matrix metalloproteinases 2 and 9 (MMP 2 and -9) have been implicated in the pathogenesis of atherosclerosis and aneurysm formation. The goal of the study was to establish the role of these metalloproteinases in both human atherosclerotic and non-atherosclerotic cerebral aneurysms. Eleven cerebral aneurysms (four atherosclerotic, seven non-atherosclerotic) were immunohistochemically stained for MMP 2 and -9. As controls, atherosclerotic and normal Circle of Willis arteries were similarly immunostained. All specimens were retrieved at autopsy and were paraffin-embedded. In order to evaluate the real MMP 2 and -9 activities, gelatin zymography was also performed in only two available specimens of non-atherosclerotic intracranial aneurysms, because of the relative unavailability of fresh intracranial aneurysm tissue (i.e. reluctance to excise the aneurysm fundus at surgery). Our data establish that MMP 2 and -9 were expressed minimally or not at all in normal Circle of Willis arteries but were strongly expressed in medial smooth muscle cells of atherosclerotic Circle of Willis arteries. In the aneurysm group, both MMP 2 and -9 were strongly expressed in the atherosclerotic aneurysms, but MMP 2 alone was detected in the non-atherosclerotic aneurysms. Zymography revealed a weak enzyme activity correlating to MMP 9 standard recombinant protein. MMP 2 activity was not demonstrated in either specimen. This study shows that the expression of MMP 2 and -9 is associated with atherosclerosis, be it in aneurysmal or non-aneurysmal cerebral vessels but MMP 2 appears to be specifically expressed in aneurysms devoid of atherosclerosis perhaps suggesting a pathogenic role for MMP 2 in the alteration of the extracellular matrix of cerebral arteries during aneurysm formation.

Adolescent↗

Preoperative cervical traction in cases of cranial settling with halo ring and Mayfield skull clamp.

Rheumatoid cervical myelopathy presents one of the most daunting challenges in neurological surgery. Preoperative cervical traction can help to distract the dens from the brainstem prior to performing occipitocervical fusion in cases of cranial settling. Valuable millimetres gained in preoperative traction can be lost in placing the patient in the prone position after removing the halo to allow application of the Mayfield skull clamp. The authors have found that traction can be adequately maintained during surgery by applying the Mayfield skull clamp with skull pins to the halo ring itself.

Arthritis, Rheumatoid↗

Posterior fossa tumours in childhood: evaluation of presenting clinical features.

A retrospective review was performed of the age profile and clinical features at presentation of 79 children with posterior fossa tumours. The mean age at presentation in this series (6.6 years) is consistent with a decreasing trend over the past 70 years. Headaches, ataxia and torticollis emerge as significant symptoms worthy of further investigation whilst abdominal pain and constipation might herald the presence of a posterior fossa tumour on rare occasions.

Adolescent↗

March 2000: 5 month old boy with occipital bone mass.

A 5 month old boy was found by his mother to have a bony mass behind the left ear which extended intracranially on MRI scan. At surgery it was entirely extradural in location. Microscopically, a biphasic appearance consisting of large pigmented cells arranged into tubules and small nonpigmented basophilic cells arranged into nests gave rise to a diagnosis of melanotic neuroectodermal tumour of infancy [MNETI]. One year after a wide local excision the patient is tumor-free and developing normally. The prognosis for MNETI in general is excellent with no requirement for additional radiotherapy or chemotherapy.

Humans↗

Extradural haematoma--a preventable cause of death.

Traumatic extradural haematoma (EDH) complicates 1-4% of all head injuries and is a major factor contributing to morbidity and mortality. Clinical awareness and early diagnosis are the keys to successful management. With the advent of computerised tomographic (CT) scanning a trend towards 'zero mortality' has been reported. We report four adolescent cases presenting with mild head injury (Glascow Coma Score 13-15) who subsequently died as a result of EDH. We suggest that excessive delay both in recognising the condition and the subsequent referral and transfer are factors contributing to the mortality of these patients.

Adolescent↗

Peripheral counter-urbanization: findings from an integration of census and survey data in Northern Scotland.

"This paper systematically relates local survey data to national census data in an investigation of one peripheral form of counter-urbanization now regarded as widely present in developed countries. The recent growth and spatial distribution of long-distance English migration to the Highlands and Islands of Scotland is described, and then 'explained' through multivariate analysis of cross-sectional data and through the stated motivations and characteristics of surveyed migrants to some of the remoter, rural parts of the region. The study reveals the importance of environmental and quality of life considerations." (summary in FRE, GER)

Behavior↗

Necrotising fasciitis in a HIV positive male: an unusual indication for abdomino-perineal resection.

We report a case of necrotising fasciitis of the genitoperineum (Fournier's gangrene) in a HIV positive male following incision and drainage of bilateral ischiorectal fossa abscesses. During surgery to debride the necrotic tissue the rectum was found to be perforated necessitating laparotomy and subsequent abdomino-perineal resection. Although previous reports of Fournier's gangrene in the HIV positive population exist, rectal involvement requiring excision has not previously been reported.

Fournier Gangrene↗

Altered regulation of cholesterol metabolism in type I diabetic women during the menstrual cycle.

This study examines the relationship of cellular cholesterol metabolism to oestrogen and progesterone during the menstrual cycle in diabetic and non-diabetic subjects. Nine premenopausal diabetic women were compared to nine non-diabetic women of the same age. Oestrogen, progesterone, lipoproteins, including lipoprotein (a) (Lp(a)) and cholesteryl ester transfer protein (CETP) were determined in serum. Cellular cholesterol content and cellular cholesterol synthesis were measured in mononuclear leucocytes. There was no significant change in serum lipoproteins including Lp(a) during the cycle in either group. CETP activity was significantly higher over the 4 weeks in the diabetic patients compared with non-diabetic subjects (mean 463 +/- 30 mumol l-1 h-1 vs 405 +/- 28 mumol l-1 h-1, p < 0.01). Serum high density lipoprotein (HDL) cholesterol was significantly lower during the 4 weeks in the diabetic patients (1.7 +/- 0.1 mmol l-1 vs 1.8 +/- 0.1 mmol-1, p < 0.05). Cellular cholesterol synthesis decreased steadily up to the third week in cells from the control subjects whereas there was no significant change in cells from diabetic patients whose cellular cholesterol synthesis was higher at week 3 compared with non-diabetic subjects (663 +/- 54 nmol mg-1 cell protein vs 432 +/- 43 nmol mg-1 cell protein, two-way interaction p < 0.05). There was a significant negative correlation between cellular cholesterol synthesis and serum oestrogen in the non-diabetic subjects (p < 0.05) but not in the diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗

The impact of antithrombotic therapy on neurosurgical emergency referral load.

The authors sought to determine the impact of antithrombotic therapy on emergency referrals at one neurosurgical centre. All emergency telephone referrals over a 90 day period were carefully documented with particular attention paid to current antithrombotic medications and their indication. Details regarding age, gender, diagnosis, radiological findings and treatment were also recorded. 713 emergency referrals were documented in the data collection period. 174 (24.4%) patients presented with intracranial or spinal haemorrhage and 75 (43.1%) of these were on antithrombotic therapy, ranging in age from 46-94 years (mean 71.1 years) with 29 (31.8%) on warfarin, 43 (47.2%) on aspirin and 15 (16.4%) on clopidogrel alone or in combination with another antithrombotic agent. 17 (22.6%) had no documented indication for antithrombotic therapy (all of these were on aspirin therapy) and 9 (31%) of those on warfarin had an INR in excess of 3.5 on presentation. Almost one quarter of those on antithrombotic therapy who presented with a haemorrhagic complication had no obvious indication for such therapy. One third of those on warfarin were over anticoagulated.

Aged↗