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Biomedical subjects

P J Hamlyn

Publications and source records attributed to P J Hamlyn.

10 recordsLinked to original sources
PubMed1992

Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study.

Neurovascular decompression is a widely practiced technique for the treatment of trigeminal neuralgia, and yet there is still debate as to whether the beneficial effect results from relieving the nerve of compression by an anatomically abnormal vessel or from the manipulation and trauma the nerve undergoes during the procedure. The development of this operation has been hampered by the lack of adequate anatomical studies in normal controls. The authors present a combined study of clinical and anatomical material employing standardized definitions of the neurovascular relationships in both groups. Detailed simulations of the operative procedure were carried out on fresh cadavers matched for age, sex, and side, and a technique of in situ blood vessel perfusion was developed that enabled the normal neurovascular arrangement to be observed post mortem at physiological pressures. Neurovascular compression, typified by a large vessel distorting and creating a groove in the fifth cranial nerve, was found in 37 of the 41 cases of trigeminal neuralgia; recurrence of pain did not relate to the site of compression. A follow-up study was carried out for a median of 53 months (range 12 to 103 months). No distortion was found in a total of 50 normal cadaveric dissections; however, on perfusion to physiological pressures, the percentage of nerves with vessels adjacent or in simple contact increased from 16% to 40%. This study using this new technique confirms that vascular compression of the fifth cranial nerve is an anatomical abnormality specific to trigeminal neuralgia.

Adult↗
PubMed1991

Protrusion of the first thoracic disk.

A case of lateral prolapse of the T-1/T-2 intervertebral disk is presented. The patient complained of pain radiating down the medial aspect of the forearm into the little and ring fingers. This was associated with a subjective sensory loss in the same distribution, intact reflexes, and no long tract signs. Oculosympathetic paralysis was not present. Twelve cases have been mentioned in the literature, only eight of which contain details of the neurological findings. The varied findings in these cases are also reviewed, and it is noted that unless radiological examination includes the upper thoracic spine in cases of brachial neuralgia, these lesions will be missed.

Aged↗
PubMed1991

Preliminary experience with the Berger neurobiopsy device for ultrasound guided aspiration and biopsy of intracranial lesions.

Our preliminary experience is presented in the use of the Berger neurobiopsy device for ultrasound localization and biopsy of intracranial lesions through a burr hole. The apparatus and technique are described, along with the results of its use in the first 49 patients. In these patients 43 tumours were biopsied, all except one successfully. Three abscesses were aspirated, two intraventricular shunt catheters were sited and in one patient the diagnosis of postradiation gliosis was confirmed and tumour excluded. The advantages and limitations of the technique are discussed. It is advocated as a simple and time-saving alternative to CT stereotactic biopsy in many cases.

Adolescent↗
PubMed1988

Transsphenoidal chiasmopexy for long standing visual failure in the secondary empty sella syndrome.

The development of an empty sella syndrome is a well recognized complication in the treatment of pituitary tumours and usually presents with visual failure. Transsphenoidal chiasmopexy has been successful in reversing the visual loss when performed in the acute stage. A case, where a delay of 18 months in the surgery does not appear to have affected the outcome, is presented and the literature reviewed.

Adenoma↗
PubMed1986

Uncommon malignant tumours of the larynx. A 35 year review.

Sixty-five primary malignant laryngeal tumours, other than simple squamous cell carcinomas, treated at the Royal Marsden Hospital between 1949 and 1984 are presented. Of the 11 histological types pseudosarcomas (24 cases), verrucous carcinomas (9 cases) and lymphoreticular tumours (9 cases) predominated. Determinate three-year follow-up data were available in 50 cases. Sixteen patients (32 per cent) died of their neoplasms but survival was strongly related to histology. Only one death occurred among 24 determinate cases of pseudosarcoma and verrucous carcinoma. Radiotherapy was effective treatment for these two tumour types and for reticuloendothelial tumours. However, combined therapy yielded poor results with the other histological types.

Combined Modality Therapy↗
PubMedDate not supplied

Invasion of the mandible by squamous carcinomas of the oral cavity and oropharynx.

The radiologic and histologic features of mandibular invasion, and its clinical implications, are considered in a retrospective series of 111 patients with squamous carcinomas of the oral cavity and oropharynx treated by composite resection. Eighty percent of the entire group had either recurrent or advanced (T3, T4) local disease, and 33 patients (30%) had histologic evidence of mandibular invasion by tumor. Preoperative radiologic assessment was unreliable in cases in which infiltrating tumor was confined to the periosteum and superficial cortex-44% false negatives. The extent of bone invasion was found to correlate with the size of the tumor, but not with its histologic grade. The mandibular periosteum was not seen as a morphologically discrete "barrier" and infiltration occurred at various points along the mandibular body, mainly related to the course of the inferior dental canal. The gross and microscopic patterns of bone invasion appeared to be similar in irradiated and nonirradiated resections. The incidence and pattern of recurrent disease following composite resection was the same in the groups with and without mandibular invasion: in each group half the patients were dead from disease and one third alive and free of disease at 2 years. Mandibular invasion alone did not appear to influence prognosis in this series.

Adult↗
PubMedDate not supplied

Anatomy of the accessory nerve and its cervical contributions in the neck.

Details of the course of the accessory nerve and the pattern of the cervical contributions to the nerve are essential for planning neck dissection. Based on a recent anatomic description, a technique was devised to preserve the distal accessory nerve; the theory advanced was that the trapezius was supplied by motor fibers from the cervical plexus, which join the accessory nerve in the posterior triangle. Dissections were performed on 23 cadavers to test such a theory. The course of the accessory nerve in the neck was mapped in each dissection, and landmarks for use during surgery determined. Cervical contributions to the nerve usually joined deep to the sternocleidomastoid, and not in the posterior triangle. Branches from the cervical plexus, independent of the accessory nerve, entered the trapezius in the posterior triangle. None of the bilateral dissections showed symmetry of the cervical contributions.

Accessory Nerve↗