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Biomedical subjects

J R Van Dellen

Publications and source records attributed to J R Van Dellen.

17 recordsLinked to original sources
PubMed2004

Unilateral avulsion fracture of the transverse atlantal ligament: successful treatment in a rigid cervical collar.

A 34-year-old male sustained a unilateral avulsion fracture through the origin of the transverse atlantal ligament following a road traffic accident. This was successfully treated in a rigid neck collar for 8 weeks. Injuries to the transverse atlantal ligament are often associated with significant bony injury and atlanto-axial instability. Isolated injuries to the transverse ligament are extremely rare and the present case suggests that a trial of conservative management may be worth pursuing.

Accidents, Traffic↗
PubMed2000

Traumatic cranial empyemas: a review of 55 patients.

A 15-year (1983-1997) review of our unit's computed tomographic experience with traumatic cranial empyema (TCE) is reported. Fifty-five patients with documented history and clinical evidence of neurotrauma with secondary cranial empyema at surgery were identified. The clinical records and CT scans were analysed. TCE [four extradural and 51 subdural collections (SDE)] accounted for 7.86% of the total cranial empyemas seen during the study period. Most of the patients were young males (44 patients) and neurological deficits on admission were found only in the SDE group. Forty-one of 53 patients presented with septic compound skull fractures. Fifty-four patients had urgent surgical drainage. Eighty per cent of patients experienced a good outcome (GOS 4 or 5). A morbidity of 16.4% (including postoperative seizures) was noted and eight patients died (mortality rate 14.5%). Urgent surgical drainage, removal of osteitic bone, wound debridement and high dose intravenous antibiotic therapy form the mainstay of treatment.

Adolescent↗
PubMed1999

Cytokine expression in patients with treated congenital hydrocephalus: a preliminary report of five patients.

BACKGROUND: Previous studies have described the elaboration of cytokines in experimental models of congenital hydrocephalus using rats or mice. However, there have been no reports of similar studies in humans. OBJECTIVE: To determine the cytokine expression pattern in the cerebrospinal fluid (CSF) of patients with treated congenital hydrocephalus. DESIGN: A prospective study. SETTING: Wentworth Hospital, Durban, South Africa. SUBJECTS: Five patients (three infants and two older patients) with congenital hydrocephalus treated by means of a ventriculoperitoneal shunt. INTERVENTIONS: Immunophenotyping of peripheral blood was performed on a flow cytometer. The isolation, in-vitro stimulation of peripheral blood and CSF mononuclear cells, and intracellular cytokine determination by flow cytometry were performed. MAIN OUTCOME MEASURES: Peripheral blood and CSF cytokine measurements. RESULTS: Although not statistically significant, all measured mean cytokine levels in the peripheral blood of the infant group were consistently higher than that of the adult group. CSF cytokine levels in both groups were similar and unremarkable. CONCLUSION: No clear pattern of CSF cytokine elaboration, either type-1 (T helper 1) (Th1) or Type-2 (T helper 2) (Th2), could be demonstrated in either of the groups. The significance of higher peripheral blood cytokine levels in the infants is unclear, but may be age-related, and is not apparent in the CSF.

Age Factors↗
PubMed1996

Invasive mole presenting as a spinal extradural tumor: case report.

The most common sites of metastatic lesions that are caused by an invasive mole are lung, liver, and brain. Spinal spread is very rare. We present a 24-year-old patient with paraparesis that was caused by an extradural spinal invasive mole. Surgery, for decompression and biopsy, and subsequent chemotherapy resulted in complete recovery.

Adult↗
PubMed1995

Transcranial Doppler ultrasonography in hydrocephalic children with tuberculous meningitis.

Studies have shown a close correlation between congenital hydrocephalus (CH) and the Gosling pulsatility index (PI) determined by transcranial Doppler ultrasonography (TCD). There have not previously been similar studies in children with hydrocephalus from tuberculous meningitis (TBM), and in particular where arteritis is a prominent feature. Fifteen children from each of these two groups were prospectively examined by TCD before and after CSF diversion. Fifteen children without hydrocephalus were similarly evaluated as controls. The fall in PI following surgery was compared. The mean fall in PI in the congenital hydrocephalic group was 0.723 (SD, 0.42) as compared with 0.089 (SD, 0.16) in the TBM group (p = 0.0001). Ten of the 15 children in the TBM group had infarcts revealed by CT. In these, the PI significantly postoperatively (p = 0.004), (0.014; SD, 0.12) when compared with values obtained (0.24; SD, 0.11) in five children without infarcts. These findings indicate that the clinically relevant fall in PI following CSF diversion in children with congenital hydrocephalus does not necessarily occur in children with hydrocephalus secondary to TBM, especially when complicated by cerebral infarcts.

Blood Flow Velocity↗
PubMed1994

The use of transcranial Doppler ultrasonography as a method of assessing intracranial pressure in hydrocephalic children.

Previous studies in children have shown a strong correlation between raised intracranial pressure (RICP) and the Gosling pulsatility index (PI) as determined by transcranial Doppler ultrasonography (TCD). This diagnostic modality can, therefore, be used as a non-invasive method for the indirect evaluation of shunt function in children with hydrocephalus. Transcranial Doppler waveform analyses were done in 15 children with hydrocephalus, before and after insertion of a ventriculo-peritoneal shunt. All had clinical evidence of raised intracranial pressure (ICP) prior to surgery. CT had demonstrated dilated ventricles and, in some, additional features of RICP. Fifteen children without clinical and CT evidence of hydrocephalus were examined in an identical manner to act as a control group. The results clearly demonstrated that TCD may be a useful, non-invasive means of assessing the need for a cerebrospinal fluid (CSF) diversionary procedure and also for follow-up and monitoring.

Child↗
PubMed1994

Cellular localization of atrial natriuretic peptide and tissue kallikrein in the human hypothalamus.

In the kidney, renal atrial natriuretic peptide (ANP) is considered to play an important role in water and salt homeostasis. Immunoreactive ANP in the brain of lower invertebrates, such as the rat, has been shown to be localized in the hypothalamus and septum. Several studies have investigated the possibility of a regulatory system in the brain similar to that of the kidney. Since neuronal function is acutely sensitive to disturbances of the intracranial water and salt balance we have attempted to immunolocalize ANP-containing cells in the normal human hypothalamus, using a polyclonal antiserum specific to ANP. Also, we have observed tissue kallikrein (TK), using a polyclonal antiserum specific to TK, in the same areas as ANP. A regulatory role for TK on prolactin has been suggested as the rationale for the co-localization of these two hormones in human prolactinomas. Therefore, it could be suggested that TK plays a similar role in the processing of precursor ANP in the brain. It is contemplated to examine the status of these peptides in patients with cerebral oedema.

Atrial Natriuretic Factor↗
PubMed1993

Experimental evaluation of collagen sponge as a dural graft.

Early collagen products, when used as dural substitutes, promoted severe inflammatory responses and fell into disrepute. A more recent advance, collagen sponge, which is derived from bovine flexor tendons was used in this experimental study. Collagen sponge was surgically implanted as an onlay dural replacement graft following skull trephination and dural excision in 12 primates. Macroscopic, histological and electron-microscopical evaluations were performed at periods of 1, 3 and 9 months. This preliminary animal study indicated that collagen sponge is suitable to use as a graft since it does not induce any inflammatory response or adhesions in the absence of pia arachnoid injury. If forms an ideal scaffold for the early ingrowth of fibroblasts to effect dural repair.

Animals↗
PubMed1986

Schistosomiasis (Bilharzia) of the spinal cord: case reports and clinical profile.

Eight cases of schistosomiasis of the spinal cord are described. These fall into two groups. Four patients had clinical and myelographic evidence of lesions in the conus medullaris and were found to have bilharzial granulomas at operation. Four patients had normal or equivocal myelographic appearances, but the coincidence of unexplained lower cord or cauda equina lesions with evidence of bilharzia led to the presumed diagnosis of spinal cord bilharzia. These patients, together with data from 39 cases reported in the world literature since 1969, have been used to compile a clinical profile of this condition. The clinical picture is the product of two types of reaction to bilharzial infestation, granuloma and necrotic myelitis, affecting the lower cord and cauda equina in varying proportions. Granuloma is the better defined entity because it is diagnosed following operation and biopsy. Myelitis is seldom proved and its diagnosis depends on circumstantial evidence. Both S. mansoni and S. haematobium may be responsible for either type.

Adolescent↗
PubMed1986

Pituitary tumours in African and Indian patients.

Over a five year period 55 patients with pituitary tumours (35 African and 20 Indian patients) were seen at the Endocrine Unit, King Edward VIII Hospital. Of the 33 patients with secretory tumours 20 had GH-secreting tumours (acromegaly), 8 prolactinomas and 5 ACTH-producing tumours (Cushing's disease); in addition 4 of the patients with acromegaly probably had combined GH and prolactin secreting tumours. The group with non-secretory tumours comprised 13 patients with craniopharyngioma, 7 with chromophobe adenomas and 2 patients with parasellar tumours. The majority of patients with non-secretory tumours were of African descent. Hormonal deficiencies present in the patients tested, were as follows: GH deficiency 73.3%; hypocorticolism 66.7%; hypogonadism 35.9% and hypothyroidism 14%. It thus appears that the patients in the present study differ from populations studied elsewhere with respect to the relative frequency of the various secretory tumours and the prevalence of certain hormonal deficiencies.

Acromegaly↗
PubMed1984

Mycotic intracavernous carotid artery aneurysm in childhood.

A mycotic aneurysm of the intracavernous carotid artery which presented in an apparently classical manner during childhood, and was treated by surgery is described. The outcome was satisfactory. The literature relating to this rare condition is reviewed.

Aneurysm, Infected↗
PubMed1980

Intracavernous traumatic aneurysms.

Five traumatic aneurysms of the intracavernous carotid artery are presented. Two cases were approached directly, employing the adjuncts of profound hypothermia and circulatory arrest. The remaining cases were treated by trapping or ligation. Although intracavernous sinus surgery is possible, the false traumatic aneurysms of the carotid artery in the cavernous sinus appear not to be amenable to direct clipping techniques and are better treated by trapping.

Adult↗
PubMed1978

Lumbar puncture--an innocuous diagnostic procedure?

The correct technique and indications for lumbar puncture are described. Possible and probable complications are discussed. The need for early recognition and consultation when complications arise is emphasized.

Coma↗
PubMed1977

A mastoid osteoma causing intracranial complications. A case report.

A case report of a mastoid sinus osteoma with intracranial complications is presented. This is the first report of a mastoid osteoma causing intracranial complications. The tumour is one of the paranasal osteoma group. It produced displacement and compression of the posterior fossa structures. The patient was operated on by means of a combined intra- and extradural approach.

Cranial Nerves↗