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Biomedical subjects

P F Statham

Publications and source records attributed to P F Statham.

13 recordsLinked to original sources
PubMed2001

Surgery for cervical radiculomyelopathy.

BACKGROUND: Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability, but is associated with a small but definite risk. We sought to assess the balance of risk and benefit from surgery. OBJECTIVES: To determine whether: 1) surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, compared with conservative management and 2) timing of surgery (immediate or delayed upon persistence/progression of relevant symptoms and signs) has an impact on outcome. SEARCH STRATEGY: We searched Medline (between 1966 and 1998), Embase (between 1980 and 1998) and the Cochrane Controlled Trials Register. Authors of the identified randomised controlled trials were contacted to detect any additional published or unpublished data. SELECTION CRITERIA: All unconfounded truly or quasi-randomised controlled trials allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management" 2) "early decompressive surgery" or "delayed decompressive surgery". DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS: Two trials involving a total of 130 patients were included. One trial with 81 patients compared surgical decompression with either physiotherapy or cervical collar immobilization in patients with cervical radiculopathy. The short-term effects of surgery, in terms of pain, weakness or sensory loss were superior, however, at one year no significant differences between groups were present. One trial with 49 patients compared the effects of surgery with those of conservative treatment in patients with mild functional deficit associated with cervical myelopathy. No significant differences were observed between groups, up to two years following treatment.

Cervical Vertebrae↗
PubMed2001

Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and alpha-subunit.

A 44-year-old woman presented to her GP with excessive tiredness. She had positive thyroid microsomal and thyroglobulin autoantibodies and was found to have an elevated serum thyroid-stimulating hormone (TSH) concentration of 8.37 (normal = 0.15-3.5)mU/L and a low normal total thyroxine (T4) of 86 (reference range 60-145)nmol/L. She was rendered symptom free on a dose of 150 microg of thyroxine per day. However, her TSH failed to return to normal, and following a further increase in her thyroxine dose she was referred to the endocrine clinic for further assessment. Her TSH at this stage was 14mU/L, free T4 (fT4) 28 (normal = 10-27)pmol/L and free T3 (fF3) 10 (normal = 4.3-7.6)pmol/L. She denied any problems with adherence to her medication. Her serum prolactin was elevated at 861 (normal = 60-390)mU/L. A pituitary tumour was suspected and an MRI scan showed a macroadenoma of the right lobe of the pituitary, extending into the suprasellar cistern. The tumour was resected trans-sphenoidally. Electron microscopy showed a dual population of neoplastic cells compatible with a thyrotroph cell and prolactin-secreting adenoma. Immunocytochemistry and cell culture studies confirmed the secretion of TSH, prolactin and alpha-subunit. Postoperative combined anterior pituitary function tests did not demonstrate any deficiency of anterior pituitary hormones. A repeat MRI scan showed no significant residual tumour; however, her serum TSH and prolactin levels remained high and she was given a course of pituitary irradiation. This case illustrates the difficulty of diagnosing a TSHoma when it coexists with autoimmune hypothyroidism. We believe the combination of pathologies reported here is unique.

Adrenocorticotropic Hormone↗
PubMed2000

How often is haemosiderin not visible on routine MRI following traumatic intracerebral haemorrhage?

Intracerebral haemorrhage may be visible indefinitely on MRI, due to persistence of haemosiderin in macrophages around the lesion, but it is not clear whether all haemorrhages produce haemosiderin or, if not, what proportion cannot be identified as former haemorrhages on routine MRI. We performed routine MRI (spin-echo T2- and proton-density weighted images) in 116 survivors of moderate to severe head injury, 1-5 years after injury. We reviewed the images blindly and correlated them with CT in the acute stage, to determine how many haemorrhages from the acute stage were identifiable by virtue of haemosiderin deposition on late MRI. Of 106 haemorrhages in 78 patients on CT at the time of injury, 96 (90 %) were visible as haemosiderin on late MRI. Of the old haemorrhages without haemosiderin, seven of ten were in patients where another haemorrhage with haemosiderin was still visible elsewhere in the brain. No patient or haemorrhage features explained the formation or absence of haemosiderin. Thus about 10 % of definite haematomas show no trace of haemosiderin on routine spin-echo MRI. Radiologists should be alerted to supplement routine spin-echo with gradient-echo sequences if there is a reason to suspect, or specifically exclude, prior haemorrhage.

Adolescent↗
PubMed1998

A clinical evaluation of the Codman MicroSensor for intracranial pressure monitoring.

The strain-gauge Codman MicroSensor intracranial pressure (ICP) transducer has shown consistently good laboratory performance. To assess the practical performance of the system in patients following acute brain injury, 10 patients were fitted with a MicroSensor and a second ICP monitor. In five cases this was a fibre-optic transducer and in five cases an intraventricular fluid-filled device. Paired ICP values were recorded every 5 min. ICP values ranged from 0 to 31 mmHg. Altman-Bland plots showed that individual readings could differ by as much as 9 mmHg. Further analysis showed that much of this disagreement could be explained by a constant offset on each occasion. Comparison traces of ICP in individual patients show high agreement in timing and size of changes. The unexplained constant offset leads to uncertainty about the true ICP. Treatment decisions are often based upon absolute levels of ICP and patient care may therefore differ depending upon the monitor used.

Brain Injuries↗
PubMed1998

Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color "power" transcranial Doppler ultrasound.

OBJECT: The authors sought to determine whether the increased pulsatility of aneurysms, compared with normal intracranial arteries, on color "power" transcranial Doppler (TCD) ultrasound was due to a true change in aneurysm size and whether aneurysm dimensions change with intracranial pressure (ICP). METHODS: The authors studied nine patients who had suffered recent subarachnoid hemorrhages complicated by hydrocephalus requiring intraventricular cerebrospinal fluid drainage, in whom the presence of an aneurysm was confirmed on angiographic examination. Color "power" TCD studies of the intracranial arteries and aneurysm were obtained through the temporal bone window before and after insertion of the ventricular drain and then at different known ICPs. Of the nine patients studied, four were examined both before and after insertion of a ventricular drain. At high ICPs, aneurysms appeared very "pulsatile" and the maximum cross-sectional area was small, whereas at low ICPs, aneurysms appeared larger and were much less pulsatile. The normal arteries did not change significantly in terms of pulsatility or maximum cross-sectional area at different levels of ICP. CONCLUSIONS: The change in aneurysm size visualized with the aid of color power TCD is likely to be real. Aneurysm dimensions vary with ICP levels; the lesions are larger and less pulsatile at low ICPs and smaller but more pulsatile at high ICPs.

Anatomy, Cross-Sectional↗
PubMed1996

Management of poor grade patients after subarachnoid haemorrhage: the importance of neuroradiological findings on clinical outcome.

The prognosis for patients in poor neurological grade (WFNS grades IV and V) after subarachnoid haemorrhage (SAH) is grave. Previous reports of such patients have analysed outcome without defining either the cause or the course of the depressed level of consciousness. We report a retrospective study of the outcome of 62 consecutive patients in poor grade after SAH analysed with respect to their clinical course and the predominant computed tomographic feature. Neuroradiological findings were (1) intracranial haematoma, (2) hydrocephalus with or without intraventricular haemorrhage (IVH) and (3) SAH alone. Sixteen patients (25.8%) had a Glasgow Coma Score (GCS) < or = 12 on admission to hospital and subsequently deteriorated. The predominant computed tomographic feature of these patients was hydrocephalus/IVH. Twelve patients (19.4%) had a GCS < or = 12 on admission and subsequently improved without intervention; all had SAH on computed tomography (CT) on admission. Thirty-four patients (54.8%) had a GCS < or = 12 on admission and did not improve or improved only after emergency surgical intervention. Haematoma (44%) and hydrocephalus/IVH (47%) were the predominant CT features in this group. The overall mortality in the 62 patients was 44%. Fifty-two per cent of patients achieved a good outcome or were moderately disabled. Patients harbouring an intracerebral haematoma had a significantly poorer prognosis when compared with the other groups. Patients in poor neurological grade after SAH are a heterogenous group both clinically and neuroradiologically. Management approaches must consider the cause of clinical deterioration and the related CT findings.

Adult↗
PubMed1996

Central nervous system trauma.

Preventing and treating cerebral ischaemia is the main goal of management of head injured patients. Initial care focuses on achieving oxygenation, airway control and treatment of arterial hypotension. Repeated neurological assessment to exclude intracranial haematoma is mandatory.

Brain Diseases↗
PubMed1994

Role of intracranial pressure monitoring in severely head-injured patients without signs of intracranial hypertension on initial computerized tomography.

Previous studies have suggested that only a small proportion (< 15%) of comatose head-injured patients whose initial computerized tomography (CT) scan was normal or did not show a mass lesion, midline shift, or abnormal basal cisterns develop intracranial hypertension. The aim of the present study was to re-examine this finding against a background of more intensive monitoring and data acquisition. Eight severely head-injured patients with a Glasgow Coma Scale score of 8 or less, whose admission CT scan did not show a mass lesion, midline shift, or effaced basal cisterns, underwent minute-to-minute recordings of arterial blood pressure, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) derived from blood pressure minus ICP. Intracranial hypertension (ICP > or = 20 mm Hg lasting longer than 5 minutes) was recorded in seven of the eight patients; in five cases the rise was pronounced in terms of both magnitude (ICP > or = 30 mm Hg) and duration. Reduced CPP (< or = 60 mm Hg lasting longer than 5 minutes) was recorded in five patients. Severely head-injured (comatose) patients whose initial CT scan is normal or does not show a mass lesion, midline shift, or abnormal cisterns nevertheless remain at substantial risk of developing significant secondary cerebral insults due to elevated ICP and reduced CPP. The authors recommend continuous ICP and blood pressure monitoring with derivation of CPP in all comatose head-injured patients.

Adolescent↗
PubMed1991

MRI in the management of suspected cervical spondylotic myelopathy.

One hundred and two patients with suspected cervical spondylotic myelopathy were prospectively investigated using MRI as the initial imaging technique. The aim was to discover if clinicians could manage patients with MRI alone, or if they would find a second investigation necessary. Eighty two patients were managed using MRI alone, 34 of whom were treated surgically. Twenty patients had a second investigation: a myelogram in 18 and a CT myelogram in two. This was performed in nine patients to exclude structural pathology in the thoracic or lumbar region (which was not examined with MRI), and in 11 to obtain more specific information about the cervical region. Only five of these 20 patients had surgical treatment. The diagnosis changed after the second investigation in four patients, but management was not influenced in any of these. MRI is a satisfactory alternative to myelography for most patients with suspected cervical spondylotic myelopathy.

Adult↗
PubMed1990

Intracerebral haematoma: aetiology and haematoma volume determine the amount and progression of brain oedema.

In a study of 182 patients with a traumatic, 'spontaneous', or aneurysmal intracerebral haematoma (ICH) a significant correlation was found between the amount of focal brain oedema seen on computed tomogram (CT) and both the aetiology and the size of the haematoma. Traumatic haematomas were associated with twice the oedema per unit volume of haematoma, and a doubling of median oedema volume on second CT (performed in 18 patients), compared to spontaneous or aneurysmal haematomas.

Brain Edema↗
PubMed1989

Delayed deterioration in patients with traumatic frontal contusions.

The clinical course of 18 head injured patients in whom CT had shown frontal contusions without diffuse brain injury or intracranial haematoma was reviewed. All 10 patients with unilateral frontal contusion made a good recovery. Only two of five patients with limited bilateral frontal contusions made a good recovery. Two of three patients with extensive bilateral frontal contusions deteriorated more than 24 hours after injury, and one died. Delayed deterioration is an important complication of extensive traumatic bifrontal contusions.

Adolescent↗