Biomedical subjects
Publications and source records attributed to J M Patton.
We present a common cause of vertigo, benign positional paroxysmal vertigo (BPPV), and its history, diagnosis, and therapy. BPPV is suggested by history, readily diagnosed by office examination, and cured by appropriate exercise therapy. Since the condition is so common and often unrecognized, physicians are encouraged to consider BPPV as a possible cause of treatable dizziness.
An unusual cerebellar tumor composed of mixed mesenchymal and neuroectodermal elements in a 44 year old man is reported. The mesenchymal element is well-differentiated adipose tissue, whereas the neuroectodermal components exhibit a variety of medulloblastomatous, astrocytomatous, oligodendrogliomatous and ependymomatous areas. A possible origin of such unusual mixed neoplasms is briefly discussed.
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Transsphenoidal hypophysectomy offers gratifying palliative relief of pain to patients with metastatic cancer of the breast and prostate. This report represents the results of two years' experience with this procedure at Emory University School of Medicine. The physiologic rationale and clinical indications for hypophysectomy are described, as is the operative technic using the open transsphenoidal microsurgical approach. The series of cases reported here includes 20 men with disseminated prostatic carcinoma and 23 women and one man with metastatic carcinoma of the breast. All 44 procedures were done by the transsphenoidal microsurgical approach. Pain was the preoperative indication for surgery in 41, while three patients were operated on for extensive disease without pain. Satisfactory relief of pain was obtained in 76% of the patients with prostatic cancer and in 83% of the breast cancer patients. While the results are gratifying with regard to relief of pain, the duration of follow-up is not sufficient to comment on the value of the procedure in significantly prolonging life.
A practical protocol for evaluating and monitoring head injured patients has been presented. It has been stressed that monitoring is an ongoing process which begins with the initial evaluation and continues throughout the patient's hospital stay. The level of monitoring and thus the parameters to be monitored are determined on an individualized basis according to the patient's clinical status and his level of stupor and coma. It has been suggested that for mild head injuries, adequate monitoring includes periodic evaluation of the neurological status and vital signs; but the more severely injured patients require extensive and frequent monitoring of a large number of clinical and physiological parameters. Among the many parameters, the continuous monitoring of ICP and the respiratory system are perhaps the most useful indicators of the patient's condition. Several methods for continuous ICP monitoring which are readily adaptable to most neurosurgical practices have been discussed. These include the intraventricular catheter, subarachnoid screw, and the closed Rickham reservoir connected to a ventricular catheter. In our institution, the Rickham reservoir has been used to monitor ICP and at the time of this report, satisfactory ICP recordings have been obtained in 27 of 30 head injury patients. Although this method requires a small surgical procedure, we believe that the decreased incidence of infection, the rapid access to ventricular fluid, and its potential for long term monitoring justify its use. Suggestions for monitoring other physiological parameters have also been presented. Particular emphasis has been placed on the management of infants and children with head injuries. The clinical entity of chronic subdural hematoma in infants and children has been used to illustrate the value of ICP monitoring as a guide to further treatment. Finally, we have briefly discussed the place of computers in day to day patient care, research, and monitoring.
Intracranial pressure monitoring facilitates the management of patients with severe craniocerebral trauma. The advantages of monitoring from the intraventricular space are outweighed by the increased incidence of infections with this technique. A system using an implanted Rickham reservoir attached to an intraventricular catheter with exchangeable external connections has been used successfully for monitoring intracranial pressure in 34 of 35 consecutive head-injured patients, with one minor infection.
This report reviews 41 cases of traumatic cerebral aneurysms, including four cases of our own which are presented in detail. They may follow penetrating or closed head injury, and are usually associated with significant additional intracranial damage. Almost half of the patients presented with a delayed subarachnoid hemorrhage within three weeks of the initial head injury, defining an important neurological syndrome. Those patients whose post-traumatic aneurysms have been surgically obliterated have an associated mortality which is half that of patients treated by nonsurgical methods.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.