Biomedical subjects
Publications and source records attributed to J Hankinson.
The case of a 31 years old woman with multiple intracranial mycotic aneurysms in association with subacute bacterial endocarditis is reported. The authors discuss the clinical and pathological aspects of such lesions. The complete regression of all the aneurysms after antibiotic therapy favours an approach aiming at adequate control of the infection prior to any consideration of surgical treatment.
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Thirty-two elderly patients were reviewed six months to six years after intracranial surgery for subarachnoid haemorrhage. Out of 24 patients whose surgical outcome had been satisfactory, one had died from an unrelated illness and the remainder were well and leading normal lives. Eight patients had a poor outcome, which in some cases was due to factors other than age. In only three could a poor outcome be attributed to early surgery and advanced age. The results confirm that in at least three-quarters of patients aged 60-65 the risk of further haemorrhage can be removed by surgery without causing a major neurological deficit.
Thirty-two cases of carotid-ophthalmic aneurysms are reviewed. As with intracranial aneurysms in other positions they present mainly with subarachnoid haemorrhage but, in spite of their close proximity to the optic nerve, visual involvement is infrequent. They are more common in women, more frequent on the left side, and more prone to multiplicity. In cases of multiple aneurysms a carotid-ophthalmic aneurysm is usually an incidental finding. Detailed angiographic studies employing various projections are required before treatment can be planned. Yet angiography does not always disclose some of the technical difficulties that may be encountered during surgery. Different methods of treating these aneurysms are discussed and suggestions for safe direct surgery made.
Two cases are reported of pupillary sparing in oculomotor palsy from temporal lobe astrocytoma. In one of them it was the first manifestation of recurrence of tumour. Tumour infiltration with resultant nerve ischemia is suggested to be the responsible pathological process.
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A study of the relative sensitivities of forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMF), and closing volume (CV) in the detection of subjects with byssinosis was carried out in a North Carolina cotton mill. Altogether 35 workers participated in the study. Of these, nine showed a decline in FEV1 of 10% or more during the first work shift that followed the weekend break. Twelve subjects showed a decrease in MMF of 15% or more. In contrast only six workers exhibited a 10% increase in closing capacity, while ten showed a 10% increase in CV. Recent evidence of the magnitude of variability in closing volume manoeuvres suggests that our chosen level of change was too low, A 40% change in CV would have identified only five subjects. CV is a more complex manoeuvre for the subject being tested and for the technician to perform, is more time consuming, and is subject to greater variation. To have any advantage over spirometry, CV would have to be appreciably more sensitive. Our study suggests that it is not. However, the MMF may prove to be more sensitive than the FEV1 in the detection of byssinosis.
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Three cases of extradural haematoma during ventricular drainage are reported and the relevant literature has been reviewed. Aetiology, diagnosis, and management are discussed. Defective blood clotting is mentioned as a possible precipitating factor.
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