Brain stem dermoid cyst.
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Brain Neoplasms↗
Biomedical subjects
P L May
Publications and source records attributed to P L May.
Hemispherectomy for intractable seizures: a further modification and early experience.
Hemispherectomy is well recognized as an effective treatment for some types of intractable epilepsy, but the procedure is also known to be associated with significant late complications. A number of modifications to the original operation have been developed to try and minimize such late complications. These are reviewed and a further modification is described using a Zenoderm graft to isolate the hemispherectomy cavity from the remaining CSF pathways. We present our early experience with this new modification in seven patients with intractable epilepsy.
Adolescent↗
Brain stem dermoid cyst.
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Brain Neoplasms↗
Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus.
The case notes of all newborn infants with posthemorrhagic hydrocephalus (PHH) operated over the past 10 years at our institution were reviewed to establish the incidence and the effect of necrotizing enterocolitis (NEC) on morbidity and mortality following cerebrospinal fluid (CSF) shunting. Thirteen neonates had both PHH and NEC (group A); 7 of these patients were initially treated by ventriculoatrial (VA) shunt and six by ventriculoperitoneal (VP) shunt. Seventy-five patients had PHH alone (group B); all were treated by VP shunt. Eight patients in group A required an abdominal operation for NEC. The two groups were comparable for birth weight, gestational age, and other complications of prematurity. Episodes of shunt malfunction (infection and/or obstruction) and deaths occurring within 12 months from shunt insertion, in the two groups were compared. Shunt malfunction was more frequent in group A (72%) than in group B (27%) (P < .001). Shunt infection was observed in 39% of group A patients versus 14% in group B (P = .03). Distal shunt obstructions occurred in 28% of group A patients and only 3% of group B patients (P = .001). There were more deaths in group A (62% v 9%; P < .001). Thirty-one percent of group A patients and 4% of group B patients died following shunt complications (P = .006). In group A, there was no significant difference in mortality and shunt malfunction between patients with VA or VP shunts. The method of treatment and the stage of NEC did not influence morbidity and mortality after internal drainage for PHH.(ABSTRACT TRUNCATED AT 250 WORDS)
Cerebral Hemorrhage↗
The bactericidal activity of magainins against Pseudomonas aeruginosa and Enterococcus faecium.
The antimicrobial activities of two synthetic magainins, MSI 94 and MSI 93, were investigated in vitro against 20 clinical isolates each of Pseudomonas aeruginosa and Enterococcus faecium. The ranges of the MICs of both agents were 6.25-50 mg/L for P. aeruginosa and 3.13-12.5 mg/L for E. faecium. In time-kill studies, the magainins demonstrated rapid, concentration-dependent bactericidal activity against selected isolates of both species. This bactericidal effect was inoculum-dependent for P. aeruginosa in both the logarithmic and stationary phases of growth. Bacterial regrowth was regularly observed after 24 h of incubation in the time-kill studies; this was due to loss of antimicrobial activity during overnight incubation rather than to the development of resistance. More rapid and sustained bactericidal activity was noted when the magainins were combined with either silver nitrate (AgNO3) or gentamicin against P. aeruginosa and with gentamicin against E. faecium. Neither agent produced a post-antibiotic effect on P. aeruginosa.
Animals↗
Prediction of recurrence in pituitary tumours: a flow cytometric study using in vivo bromodeoxyuridine.
Although most pituitary tumours are regarded as benign, there is a significant risk of local recurrence and a few are frankly malignant. The prediction of clinically aggressive behaviour by histopathological means is inadequate and the selection of patients for postoperative radiotherapy has often been empirical. The flow cytometric analysis of the DNA content of certain intracranial tumours has suggested a correlation between a high proliferative index and a tendency to recur. The in vivo administration of bromodeoxyuridine (BUdR) yields a reliable and accurate S-phase labelling index and evaluation by flow cytometry allows a much greater and therefore more representative number of cells to be examined. We report our results for the flow cytometric evaluation of the S-phase fraction in a group of 11 human pituitary tumours following the preoperative administration of BUdR and discuss the correlation between high values of S-phase fraction and clinically aggressive behaviour. Initial results suggest a correlation between radiological evidence of tumour invasion and an S-phase greater than 2%.
Adenoma↗
Paediatric neurosurgery.
Surgical disorders of the central nervous system of children differ significantly from those of adults. The management of these disorders requires an integrated multidisciplinary practice of paediatric specialists in an appropriate paediatric environment. An increasing number of neurosurgeons are now restricting themselves to this field resulting in the more effective diagnosis and treatment of children with neurosurgical disorders.
Brain Neoplasms↗
Dupuytren's contracture. Surgical principles, nursing implications.
Successful Dupuytren's surgery requires the cooperation of the patient, the surgeon, and the therapist. Cooperation of the patient is enhanced by nursing care. Preoperative and postoperative teaching by the nurse also contribute to positive outcomes. The type of incision or surgery performed does not affect the time of recovery if the diseased tissue is removed and there are no postoperative complications.
Dupuytren Contracture↗
Benign intrinsic tectal "tumors" in children.
A specific group of intrinsic dorsal midbrain tumors was identified in six children by computerized tomography (CT) and magnetic resonance (MR) imaging. Each patient presented with raised intracranial pressure as a result of hydrocephalus due to obstruction of the sylvian aqueduct. No patient had brain-stem signs referable to the tectal tumor initially or subsequently. All six children underwent cerebrospinal fluid (CSF) diversionary procedures. The radiological features were consistent and specific, with all patients showing tectal calcification or primary increased attenuation of the tectal plate on CT scans. In addition, lack of contrast enhancement was noted initially in four patients and eventually in all six patients. In all patients MR imaging showed a focal tectal tumor distorting the collicular plate with no cystic component and increased signal intensity on T2-weighted images. There has been no evidence of progression in these six patients in the follow-up period ranging from 8 months to 17 years (8 months and 2 1/2, 4 1/2, 8, and 17 years). Diversion of CSF has been the only surgical treatment and no patient underwent deep x-ray therapy. Five patients have had normal intellectual development. In contrast to the majority of previously described periaqueductal and tectal tumors, this group of lesions appeared to be truly benign. The authors suggest that patients presenting with these clinical and radiological features may be managed by CSF diversion, serial examination, and MR imaging.
Adolescent↗
Propionibacterium encephalitis.
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Bacterial Infections↗
Giant epidermoid cysts of the skull.
The authors describe two cases of giant intradiploic epidermoid cysts of the cranial vault and a case of a large epidermoid arising from the frontal sinus and extending intracranially. The aetiology of epithelial cysts is reviewed. The characteristic radiological and CT scan appearances of diploic epidermoid cysts are described, their clinical presentation and surgical management briefly discussed.
Adult↗
Acute isodense extradural haematoma.
A case of acute isodense extradural Haematoma in a 30-year-old woman is reported. This uncommon computed tomography finding is discussed and the pathophysiology is reviewed.
Adult↗
The prediction of recurrence in meningiomas. A flow cytometric study of paraffin-embedded archival material.
Despite the complete macroscopic excision of meningiomas, there is a significant rate of recurrence approaching 20% at 20 years. The prediction of recurrence by clinical and histopathological means is inadequate. Flow cytometric analysis of deoxyribonucleic acid (DNA) in meningiomas has shown a correlation between a high proliferative index based on tumor cell-cycle stage (%S + %G2/M) and clinically aggressive behavior. Accordingly, the DNA analysis of meningioma tissue may be of value in predicting recurrence of these tumors. To test this hypothesis, the DNA of paraffin-embedded archival tissue from known recurrent meningiomas was compared with an age- and sex-matched nonrecurrent group. Both groups had comparable follow-up periods. Forty patients with total macroscopic removal at the time of surgery were analyzed. The paraffin blocks of these tumors were retrieved and reclassified histologically according to the World Health Organization system. Sections were then taken for flow cytometric study. The DNA analysis showed that the proliferative index of the recurrent group was significantly higher than that of the nonrecurrent group (p less than 0.002), although the histological subtyping of the two groups was similar. These results support the suggestion that flow cytometry may be of value in the prediction of recurrence of histologically benign, macroscopically removed meningiomas.
Flow Cytometry↗