PubMed Health⌕ Search

Biomedical subjects

M D Shaw

Publications and source records attributed to M D Shaw.

At least 37 records · Page 2Linked to original sources
PubMed1991

The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management.

It is not known whether conservative or early aggressive (resective surgery with or without radiotherapy) management is better for tumours presenting with epilepsy. The prognosis of 560 patients with a clinical and CT diagnosis of intrinsic supratentorial tumour was examined retrospectively. Epilepsy was the first symptom in 164 patients. Histological confirmation of diagnosis was available in 391 (70%) of cases. Median survival was 37 months in the group presenting with epilepsy and six months in those presenting with other symptoms (p less than 0.0001). Patients presenting with epilepsy were more likely to have a normal clinical examination, a non-enhancing low density lesion on CT scan and a low grade tumour. From Cox's stepwise proportional hazards model, significant independent variables adversely affecting prognosis were increasing age, focal neurological signs and enhancing CT lesions at diagnosis, non-resective surgery and male sex. Of those presenting with epilepsy 80 patients had surgical treatment within two months of CT diagnosis. The Cox's model failed to identify any beneficial effects for either early resective surgery or radiotherapy. In primary intracerebral tumours with presentations other than epilepsy, resective surgery and radiotherapy were amongst the important factors associated with prolonged survival. Primary intracerebral tumours presenting with epilepsy are relatively benign and their outcome appears to be chiefly determined by clinical factors.

Adolescent↗
PubMed1991

Epilepsy after craniotomy and the place of prophylactic anticonvulsant drugs: discussion paper.

A retrospective study of 1000 patients who had undergone supratentorial neurosurgery and with prolonged follow-up revealed an overall postoperative incidence of epilepsy of 17%. The incidence varied with different pathologies but anticonvulsants given prophylactically in a randomized trial did not significantly alter the incidence. Routine anticonvulsant prophylaxis cannot be recommended.

Carbamazepine↗
PubMed1990

Post-operative epilepsy and the efficacy of anticonvulsant therapy.

Several supratentorial pathologies, including anterior/middle cerebral artery aneurysms, arteriovenous malformations, spontaneous intracerebral haematomas, meningiomas and abscesses, are associated with a high incidence of post-operative epilepsy. Prophylactic anticonvulsant therapy does not significantly reduce this incidence.

Anticonvulsants↗
PubMed1990

Dissection of the cervical internal carotid artery. The role of Doppler/Duplex studies and conservative management.

Cervical internal carotid dissection is not rare. Doppler ultrasound screening of young patients presenting with stroke, identified 10 patients with reduced common and internal carotid blood flow without any evidence of atheroma. Eight, on angiography proved to have a dissection of the cervical internal carotid artery. All were managed conservatively. Seven received anticoagulant therapy, stopping any further neurological symptoms.

Adolescent↗
PubMed1990

Blood flow distribution and brain metabolism during tolazoline-induced hypotension in newborn dogs.

Tolazoline is used in neonatal intensive care to treat hypoxia secondary to persistent pulmonary hypertension of the newborn. Its use is often complicated by systemic hypotension. We compared the effect of tolazoline-induced hypotension on organ blood flow, regional brain blood flow, and cerebral metabolism in hypoxic newborn dogs whose mean arterial pressure fell by more than 20% with a second group whose blood pressure fell by less than 20%. Blood flows were measured by the radioactive microsphere technique. We found no changes in organ blood flow, regional brain blood flow, and cerebral metabolism in hypoxic animals whose mean arterial blood pressure decreased less than 20% during tolazoline administration. However, in those animals whose mean arterial blood pressure decreased more than 20%, we found a decrease in cerebral blood flow. As a consequence of decreased cerebral blood flow, cerebral oxygen delivery decreased. However, oxygen extraction increased so that cerebral metabolic rate was preserved.

Animals↗
PubMed1990

Verrucous carcinoma of the base of the skull.

A case of verrucous carcinoma extensively destroying the base of the skull and involving the upper two cervical vertebrae is reported. Death resulted from cranio-cervical dislocation. Verrucous carcinoma, its aetiology and the relationship to the underlying chronic inflammatory process found in this case, are discussed.

Carcinoma, Papillary↗
PubMed1989

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial.

OBJECTIVE: To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage. DESIGN: Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence of cerebral infarction of 15% a minimum of 540 patients was required. SETTING: Four regional neurosurgical units in the United Kingdom. PATIENTS: In all 554 patients were recruited between June 1985 and September 1987 out of a population of 1115 patients admitted with subarachnoid haemorrhage proved by the results of lumbar puncture or computed tomography, or both. The main exclusion criterion was admission to the neurosurgical units more than 96 hours after subarachnoid haemorrhage. There were four breaks of code and no exclusions after entry. One patient was withdrawn and in 130 treatment was discontinued early. All patients were followed up for three months and were included in the analysis, except the patient who had been withdrawn. INTERVENTIONS: Placebo or nimodipine 60 mg was given orally every four hours for 21 days to 276 and 278 patients, respectively. Treatment was started within 96 hours after subarachnoid haemorrhage. END POINTS: Incidence of cerebral infarction and ischaemic neurological deficits and outcome three months after entry. MEASUREMENTS: Demographic and clinical data, including age, sex, history of hypertension and subarachnoid haemorrhage, severity of haemorrhage according to an adaptation of the Glasgow coma scale, number and site of aneurysms on angiography, and initial findings on computed tomography were measured at entry. Deterioration, defined as development of a focal sign or fall of more than one point on the Glasgow coma scale for more than six hours, was investigated by using clinical criteria and by computed tomography, by lumbar puncture, or at necropsy when appropriate. All episodes of deterioration and all patients with a three month outcome other than a good recovery were assessed by a review committee. MAIN RESULTS: Demographic and clinical data at entry were similar in the two groups. In patients given nimodipine the incidence of cerebral infarction was 22% (61/278) compared with 33% (92/276) in those given placebo, a significant reduction of 34% (95% confidence interval 13 to 50%). Poor outcomes were also significantly reduced by 40% (95% confidence interval 20 to 55%) with nimodipine (20% (55/278) in patients given nimodipine v 33% (91/278) in those given placebo). CONCLUSIONS: Oral nimodipine 60 mg four hourly is well tolerated and reduces cerebral infarction snd improves outcome after subarachnoid haemorrhage.

Administration, Oral↗
PubMed1989

Penetration of ceftazidime into intracranial abscess.

The penetration of ceftazidime into intracranial abscess was investigated in nine patients receiving intravenous ceftazidime. Concentrations of antibiotic in pus were measured by a microbiological agar diffusion assay (12 samples) and high performance liquid chromatography (8 samples) at varying times following ceftazidime administration. Concentrations of ceftazidime varying between 2.7 and 27.0 mg/l were detected. The role of ceftazidime in the therapy of intra-cranial abscess of otogenic origin is discussed.

Adult↗
PubMed1989

Central pain complicating infarction following subarachnoid haemorrhage.

It is well recognised that delayed ischaemia following subarachnoid haemorrhage can lead to infarction. Seven such cases are described in which the latter led to the development of central pain, often called the 'thalamic syndrome'. Treatment of this condition remains difficult particularly if there is delay in the recognition of the problem.

Adult↗
PubMed1988

Clinical prosection for dental gross anatomy: a medial approach to the pterygomandibular space.

This paper describes a prosection of the pterygomandibular space from a medial perspective, as the dentist would encounter it. The prosection is performed on a bisected head, with vertebrae removed. The preparation can be used to demonstrate to the student the exact course of a needle during an inferior alveolar nerve block. The anatomical structures involved in performing the conventional, Gow-Gates, or Akinosi injection techniques are directly compared. The impingement of a misplaced needle on neighboring structures can be demonstrated.

Dissection↗
PubMed1988

Post-ictal blood pressure in aneurysmal subarachnoid haemorrhage.

A prospective study in which the effect of the post-ictal systemic blood pressure levels on the outcome following surgically treated aneurysmal subarachnoid haemorrhage (SAH) in 325 patients is reported. No differentiation was made between pre-existing essential and prolonged reactive hypertension. A significant association was found between the trend for rising diastolic blood pressure levels and the tendency towards a poor outcome. There was a similar trend for rising systolic blood pressure levels which did not reach statistical significance. Patients with definite hypertension (blood pressure of 160/95 mmHg or greater) were 1.6 times as likely to have a poor outcome than were those with lower blood pressures.

Adult↗
PubMed1988

The natural history of subarachnoid haemorrhage with negative angiography: a prospective study and 3-year follow-up.

One hundred and forty-eight patients with negative cerebral angiography after subarachnoid haemorrhage are reported. Good grade, normotension and normal CT are associated with a favourable outcome. In 89 patients with negative four-vessel angiography the overall annual risks of rebleeding and fatal rebleeding were 1.5% and 0.4% respectively. In 52 patients undergoing appropriate limited angiography corresponding risks were 2.5% and 1.9%. No fatal rebleeds occurred after 6 months. Initial CT scanning in 104 patients was abnormal in 34. Of these, 14 had SAH alone, in whom no episodes of rebleeding occurred, although SAH on CT was associated with an increased chance of a poor outcome. Twenty had other abnormalities, three of whom rebled, two (both with ICH on CT) being fatal. The annual risks of rebleeding and fatal rebleeding in patients with these CT abnormalities were 5.0% and 3.33% respectively. Fifty-two patients were hypertensive, of whom six rebled, four fatally. Two of the 89 normotensive patients rebled, neither fatally.

Female↗
PubMed1988

Recurrent aneurysmal subarachnoid haemorrhage: incidence, timing and effects. A re-appraisal in a surgical series.

A series of 510 patients with proven aneurysmal subarachnoid haemorrhage (SAH) is reported. The incidence of recurrent haemorrhage during the period awaiting surgery was 13.7%. There was no significant difference in incidence between good and poor grade patients. Following rebleeding there was an immediate mortality of 34% in good grade patients and 52% in poor grade patients. In the long term only 44.4% of good grade and 8% of poor grade patients made a good recovery following a second bleed as compared to 70.6% and 52.8% respectively for those who did not rehaemorrhage.

Humans↗