Successful use of recombinant FVIIa (Novoseven) in the management of intractable post-surgical intra-abdominal haemorrhage.
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Adult↗
Biomedical subjects
J Moriarty
Publications and source records attributed to J Moriarty.
The prevalence of Gilles de la Tourette's syndrome in children and adolescents with autism.
Thirty-seven pupils attending a special school for children and adolescents with autism were observed for the presence of motor and vocal tics. Subsequent family interviews confirmed the diagnosis of comorbid Gilles de la Tourette's Syndrome (GTS) in three children with autism, giving a minimum prevalence rate of 8.1 %. Family history data also suggested this was heritable. The presence of GTS was not associated with superior intellectual, language, or social development. Results suggest that the rate of GTS in autism may exceed that expected by chance. The limited sample size constrains this conclusion. A large-scale epidemiological study testing this association study would appear merited.
Adolescent↗
Effect of projective aspects variations on estimates of changes in bone mass using digital subtraction radiography.
This study tests the hypothesis that estimates of changes in bone mass derived from subtraction data obtained in accord with published methods are independent of the spatial aspect of the lesion being evaluated when calibrations are performed independently. Nineteen sliver-shaped bone chips ranging in mass from approximately 1 to 35 mg were orientated with broad side parallel to the facial surface of a hemisectioned dry human mandible and radiographed using conventional exposure parameters on conventional E-speed dental X-ray film. Also attached to the film was a standardized aluminium calibration wedge that facilitated quantitative analysis of resulting subtraction data using established methodology. The effects of scatter were simulated by the addition of a 1-cm-thick slab of tissue-equivalent plastic. A second series of exposures then was produced using the same respective spatial chip locations and projection geometries but each chip was reorientated such that its broad side was now positioned perpendicular to the mandibular facial surface. Finally, a comparable series of control exposures was produced without any chips or calibration wedge to facilitate subtraction. When paired bone estimates derived from the two chip orientations were compared (paired comparisons) using Student's t-test, a statistically significant difference (p < 0.05) was observed. These results also were tested for statistical significance using the non-parametric Wilcoxon test. As with the parametric analysis, the discrepancy between the parallel and perpendicular mass estimates was found to statistically significant (p < 0.05). The methods employed in this investigation thus resulted in bone mass estimates that varied significantly depending upon lesion orientation.
Absorptiometry, Photon↗
A prospective study of the early postsurgical psychiatric associations of epilepsy surgery.
OBJECTIVES: To examine prospectively the frequency and nature of psychiatric symptoms seen in patients during the first three months after temporal lobe surgery for chronic intractable epilepsy and in addition to study the relation between presurgical mental state, laterality of surgery, and postsurgical seizure and psychiatric course. METHOD: A consecutive series of 60 patients being assessed for temporal lobe surgery for intractable epilepsy were studied. They were interviewed before surgery and at six weeks and again at three months after operation. RESULTS: At six weeks after surgery half of those with no psychopathology preoperatively had developed symptoms of anxiety or depression and 45% of all patients were noted to have increased emotional lability. By three months after surgery emotional lability and anxiety symptoms had diminished whereas depressive states tended to persist. Patients with a left hemispheric focus were more likely to experience persisting anxiety. CONCLUSION: The early months after surgery for epilepsy are characterised by the relatively common presence of psychiatric symptoms. It is proposed that presurgical and early postsurgical neuropsychiatric involvement in programmes of surgery for epilepsy will help to improve the quality of the treatment package offered to patients.
Adolescent↗
HMPAO SPET does not distinguish obsessive-compulsive and tic syndromes in families multiply affected with Gilles de la Tourette's syndrome.
BACKGROUND: Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive-compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive-compulsive disorder have shown, in contrast, hyperperfusion of similar areas. METHODS: Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET. RESULTS: There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion. CONCLUSIONS: Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.
Adolescent↗
Psychiatric profiles and patterns of cerebral blood flow in focal epilepsy: interactions between depression, obsessionality, and perfusion related to the laterality of the epilepsy.
OBJECTIVES: In a study of patients with focal epilepsy the hypothesis was explored that different measurements of psychopathology are related to specific distributions of cerebral perfusion. METHODS: Forty patients had SPECT performed with (99m)Tc-HMPAO. In addition, patients received a psychiatric evaluation with the following psychiatric questionnaires: the Beck depression inventory, the Leyton obsessionality inventory, the Bear-Fedio questionnaire, and the social stress and support interview. Patients were analysed in two groups according to the laterality of the epilepsy. Nine patients were excluded based on poor quality scans (n = 1), unlateralised epilepsy (n = 4), and left or ambidextrous handedness (n = 4). RESULTS: There were no overall differences between the left and right epilepsy groups on measures of psychopathology. Associations were found between scores on some of the rating scales and regional cerebral blood flow. Specifically, for patients with left sided epilepsy, higher scores on the Beck depression inventory were associated with lower contralateral temporal and bilateral frontal perfusion, and higher occipital perfusion. For patients with right sided epilepsy higher scores on the Leyton obsessionality inventory were associated with increased perfusion in ipsilateral temporal, thalamic, and basal ganglia regions and bilateral frontal regions. CONCLUSION: The results do not support the notion that lateralised epileptogenic lesions are associated with different levels of depression, obsessionality, or personality traits. They support the view that certain psychopathological symptom patterns are related to specific regional dysfunctions depending on the laterality of a hemispheric lesion.
Adolescent↗
A volumetric MRI study of Gilles de la Tourette's syndrome.
The neuroanatomic or neuropathologic basis of Gilles de la Tourette's syndrome (GTS) remains unknown. Recent studies have suggested abnormalities of cerebral asymmetry and basal ganglia volumes. We studied 17 patients with GTS and eight normal controls using volumetric MRI techniques for measuring the caudate nucleus, amygdala, and corpus callosum. One subject with GTS was subsequently excluded because he was left handed. No absolute differences in caudate nucleus volumes between patient and control groups were evident. There was an increase in corpus callosum (CC) cross-sectional area and a loss of the normal asymmetry of the caudate nucleus in the patient group. A loss of the normal correlation between cross-sectional area of the CC and whole brain index (WBI) in the patient group also was found. The amygdala measurements had a poor interrater reliability.
Adolescent↗
Prosthodontic and periodontal considerations for implant-supported dental restorations.
In the past two years, many reports concerning the outcome of treatment using dental implants have included more detailed data which allow insight into prosthodontic and periodontal considerations that affect success. It has become evident that unique biomechanical sequelae reflect the screw-joint character of the dental implant prosthesis. The relative stability of the screw joint and the biomechanical integrity of the components and prostheses themselves are new issues to contend with for restorative dentistry. The biologic sequelae of maintaining the implant-supported prostheses are revealed by bone maintenance and peri-implant mucosal health. The microbiologic similarity of tooth and implant-associated plaque at inflamed sites suggests that infected teeth are sources of potentially pathogenic bacteria at implants. However, the pathogenesis of inflammatory disease at implants is not fully defined. The evaluation and prognostic criteria of peri-implant inflammation remain controversial topics. The present aggregate data indicate that the long-term evaluation of implant-supported dental prosthesis must be performed with cautious optimism and attention to general biomechanical and biologic factors.
Dental Implants↗
Acute psychological disorders in patients with epilepsy: a nation-wide study.
Acute psychological disorders (APDs) are more common in epilepsy than in the general population, with estimates varying from 2 to 16% depending on the population of patients sampled. APD has traditionally been classified by seizure activity (ictal), the early post-ictal period (post-ictal) and unrelated to seizure activity (inter-ictal). APD may also occur as a consequence of the use of antiepileptic drugs (AEDs). An ongoing prospective active surveillance system was utilised which surveys all neurologists and associated specialists in the United Kingdom run by the British Neurological Surveillance Unit (BNSU). Incident cases were ascertained, using the BNSU, for a period of 1 year and were defined as patients with epilepsy who developed an acute psychological disorder, whatever the cause, such as a psychosis or depression. Sixty-four cases were ascertained. The ages were between 17 and 69 (mean 36); there were 38 males and 26 females. The majority of patients had location-related epilepsy (52, 81%), either cryptogenic (29, 45%) or secondary to a symptomatic lesion (23, 36%), of which the most common were mesial temporal sclerosis (6, 9%) and trauma (4, 6%). Thirty-one (48%) patients were considered to have APD due to ictal or post-ictal activity. Thirty-three (52%) were inter-ictal. Carbamazepine was the most common AED prescribed (42, 66%), and of the new AEDs lamotrigine was prescribed in 17 patients (27%) and vigabatrin in 16 (25%). The APD in 19 (30%) patients was reported by the referring physician as being secondary to an AED. In 12 patients this was attributed to vigabatrin. However, the relative frequency of APD due to AEDs, or to the different new AEDs, could not accurately be calculated as this was not a true incidence study. In the 19 drug-related APD patients, there was no change in seizure frequency in 8 (42%) and in 7 (37%) the seizure frequency had decreased (in 3 (16%), ceasing altogether prior to the APD). In 4 of the 19 patients (21%) the seizure frequency increased. The overall outcome was good with 17/19 (89%) of the AED attributed cases resolving.
Adolescent↗
HMPAO SPECT in non-epileptic seizures: preliminary results.
The diagnosis of non-epileptic seizures (NES) is problematic. Although diagnosis can be achieved by videotelemetry, these facilities are expensive and not widely available. HMPAO SPECT studies show focal hypoperfusion interictally in focal epilepsy. SPECT has not been studied in any detail in NES previously. Two groups (10 patients each) were studied, one with NES and one with complex partial seizures and localisation related epilepsy. SPECT scans were normal in 7 of 10 (70%) NES patients, while showing clear focal hypoperfusion in 8 of 10 patients (80%) with epilepsy. In the NES group, 1 patient showed hypoperfusion indistinguishable from that seen in epilepsy, while 2 patients in the epilepsy group showed only equivocal focal hypoperfusion. The remaining 2 patients in the NES group showed bifrontal and equivocal focal hypoperfusion. A normal HMPAO SPECT study supports the diagnosis of NES in patients with seizures of uncertain aetiology.
Adolescent↗
Felbamate as add-on therapy.
Felbamate is a novel anti-epileptic drug (AED) which has recently been associated with reports of aplastic anaemia and liver failure. We have conducted an open-label add-on assessment of the tolerability and efficacy of this compound in 111 adult patients with refractory epilepsy attending a tertiary referral centre. The mean follow-up period was 4 months (range 1-8 months). Sixty-three (57%) were ongoing, 38 (34%) had discontinued felbamate and a further 10 (9%) were withdrawing. Reasons for discontinuing felbamate were adverse events in 23 (21%), increase in seizures in 11 (10%) and lack of efficacy in 14 (12%). Behavioural disturbances occurred in 14 patients, being the most likely adverse event to result in discontinuation. No cases of aplastic anaemia or liver failure were observed in this group. Felbamate appears to be a broad-spectrum AED. Seven percent of the patients had more than 95% seizure reduction (2 patients were seizure free), whilst a further 13% had significant improvement ( > 50% reduction in seizure frequency). In conclusion, felbamate seems to be an effective AED. In view of its association with potentially life-threatening complications, its use should however be restricted to patients with medically refractory epilepsy.
Adult↗
Optimised interictal HMPAO-SPECT in the evaluation of partial epilepsies.
Interictal blood flow single photon emission computed tomography (SPECT) has been considered to be of limited value in the investigation of patients with partial epilepsies. Newer SPECT technologies using brain dedicated multiple detector systems have not been fully evaluated. To study the usefulness of an optimized SPECT technique, we scanned 40 epilepsy patients and ten normal subjects. Interictal [99mTc]hexamethylpropylene amine oxime (HMPAO) SPECT scans were acquired using the GE/CGR Neurocam triple-headed brain-dedicated system. The results of a qualitative analysis of the scans were compared to EEG and optimised MRI findings. Eight of the normal subjects and one of 40 patients had normal SPECT scans. There was a comparable concordance of lateralization between SPECT, MRI and EEG. The majority of our patients had mesial temporal pathology on MRI. Perfusion abnormalities extending beyond the mesial temporal area were common and did not simply relate to structural abnormalities. Quantification of blood flow in multiple brain regions revealed that hypoperfusion did not occur at random. Perfusion in the mesial temporal lobe was related to perfusion in anatomically and functionally related ipsilateral and contralateral brain regions. These hypoperfused areas probably reflect dysfunctioning areas which are related to the epileptogenic process.
Adult↗
Radiographic evaluation of alveolar crest obscured by dental implants.
This study evaluated the diagnostic accuracy of periapical, tomographic, and cross-sectional occlusal radiographic techniques in the assessment of facial and lingual bone loss at implant obscured sites. An edentulous dry human mandible was prepared with implants in the incisor, premolar, and molar regions. Successive round bur sizes (No. 1 to 6) were used to create circumferential infrabony periodontal defects in the alveolar crest adjacent to the implants. Periapical radiographs were made with custom stents and imaged each site in a conventional parasagittal orientation. Linear tomograms imaged sites in a cross-sectional coronal orientation. Cross-sectional occlusal radiographs imaged anatomy in the axial plane. Radiographic anatomy mesial and distal to each implant was masked with opaque tape before evaluation by a panel of six observers. Images were displayed in pairs consisting of an image at baseline and a second image having an equal chance of displaying an increment of bone removal or no bone removal. Image pairs were displayed in random order. A five-point scale was used to evaluate accuracy of detection of the presence or absence of changes in bone density as well as observer confidence in that assessment. ANOVA demonstrated significant variation due to image modality and increment of bone removal. Cross-sectional occlusal views provided significantly greater mean observer confidence scores than either periapical images or tomograms (P < .01). However, tomograms may provide greater utility in actual clinical practice.
Alveolar Bone Loss↗
Mass versus activity: validation of an immunometric assay for bone alkaline phosphatase in serum.
A detailed investigation of the performance of an immunometric assay for the quantitation of bone alkaline phosphatase (ALP) in serum showed that precision of this assay was similar to that of lectin precipitation and electrophoretic methods. Relationships for mass and activity measurements of the bone isoform using samples from children and patients with Paget's disease were similar for lectin and electrophoretic methods. Purified liver enzyme showed 100% cross reactivity in the immunometric assay. However, comparison of the slopes between bone ALP mass and total ALP activity using only samples with predominantly liver or bone isoforms showed that the cross reactivity of the liver isoform in serum was 18.3%. Experiments in which increasing amounts of a sample containing 90% of liver isoform adding to a serum sample from a patient with Paget's disease showed a cross reactivity of 16.5%. The reference range for bone ALP mass was 7-28 micrograms/L for men (n = 77) and 5-20 micrograms/L for women (n = 110) in the age group 20-50 years. In women over 50 years bone ALP was 28% higher. Increased bone ALP mass was also demonstrated in patients with Paget's disease (n = 59), liver disease (n = 95), chronic renal failure (n = 41) and hyperthyroidism (n = 17).
Adolescent↗
Brain perfusion abnormalities in Gilles de la Tourette's syndrome.
BACKGROUND: Functional brain imaging with technetium-99m d,l-hexamethyl propyleneamine oxime (HMPAO) Single Photon Emission Tomography (SPET) allows us to explore the cerebral pathophysiology of Gilles de la Tourette's Syndrome (GTS). METHOD: Fifty patients and 20 controls were examined. Patients were rated for tic severity and mood. Scans were analysed quantitatively using internal ratios to the occipital cortex. RESULTS: Patients different from controls on measures of relative blood flow to the left caudate, anterior cingulate cortex and the left dorsolateral prefrontal cortex. Severity of tics was related to hypoperfusion of the left caudate and cingulate and a left medial temporal region. Hypoperfusion in the left dorsolateral prefrontal region was related to mood. CONCLUSIONS: The areas found to be hypoperfused in this study are consistent with known functions of fronto-striatal circuits. A wide range of perfusion patterns is seen, however, and no characteristic patterns for behavioural subgroups has been documented with this technique.
Adolescent↗
Information leaflets on contraception.
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Contraception↗
Striatal dopamine receptor binding in epileptic psychoses.
In order to study the nature of dopaminergic activity in epileptic psychoses we investigated striatal dopamine receptor binding in 14 patients with epilepsy. Seven of the patients were acutely psychotic when studied, having recently developed a periictal schizophreniform psychosis. The remaining patients were not psychotic. All patients were scanned using single photon emission tomography (SPET) with 123I-IBZM, a specific dopamine D2 receptor ligand. A region of interest analysis was performed. Comparison of mean basal ganglia to occipital cortex activity ratios in the two groups demonstrated significantly reduced specific binding of 123I-IBZM to striatal D2 receptors in the psychotic patients compared to those without psychosis.
Adult↗
Stimulus induced behaviours in Tourette's syndrome.
Three cases of Gilles de la Tourette's syndrome (GTS) who experienced different tic related behaviours in response to both external and internal stimuli are described. Such behaviours might represent sensory tics, reflex motor tics, exaggerated startle responses, or obsessive compulsive behaviours. It is suggested that there is a continuum of stimulus induced behaviours, and that, in some cases, separations into individual descriptive entities may be difficult. There also seems to be a continuum between internal and external phenomena that induce the behaviours. Implications for the relation between GTS and obsessive compulsive disorder are also discussed.
Acoustic Stimulation↗