Manipulative therapy and physiotherapy for persistent back and neck complaints.
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Back Pain↗
Biomedical subjects
R Bradford
Publications and source records attributed to R Bradford.
Image directed stereotactic surgery for brain stem lesions.
Advances in neurological imaging may have increased the diagnostic accuracy and the detection rate of intrinsic brain stem lesions, but a histological diagnosis is still an essential requirement for rational and appropriate management. Open exploration allows biopsy and resection in cases where an exophytic component is present. The surgical inaccessibility and the resultant morbidity of these approaches, however, associated with a low diagnostic yield in cases with no visible surface abnormality, are important limiting factors. A series of 45 brain stem lesions stereotactically approached with CT or MRI guidance is presented. A transcortical frontal pre-coronal trajectory was used in all of them. Haematoma was preoperatively diagnosed in 10 cases and the procedure was for therapeutic aspiration. Of 35 cases where the diagnosis was uncertain, although intrinsic tumour was suspected, positive results were obtained in 33, while unexpected findings of granuloma, lymphoma, angioma, leucoencephalopathy, vasculitis and radiation necrosis were found in over 10% of the cases. There were no operative deaths and the morbidity was low. In no case was there a permanent neurological deterioration directly related to the procedure, although there was a transient deterioration in two patients and one patient required early reaspiration of a haematoma. Image directed stereotactic approaches to brain stem lesions can combine a high degree of accuracy (offering positive histological diagnoses) with a low operative morbidity. MRI directed biopsies can complement CT guided ones thus increasing the number of suitable cases and improving the success rate. The frontal precoronal transcortical trajectory provides safe access to the majority of the brain stem targets.
Adolescent↗
Occult spinal pseudomeningocele following a trivial injury successfully treated with a lumboperitoneal shunt: a case report.
A patient with a traumatic occult spinal pseudomeningocele is presented. The possible etiology and the use of a lumboperitoneal shunt in this situation are discussed.
Accidental Falls↗
The role of motor evoked potentials in the management of hysterical paraplegia: case report.
The role of motor evoked potentials in the management of a case of presumed hysterical paraplegia precipitated by spinal injury in a man with a previous history of surgery for scoliosis is presented. Motor evoked potentials were elicited with magnetic stimulation 12 days after injury and were within normal limits. The presence of normal motor electrophysiology and observation by the patient of involuntary movement of the lower limbs during stimulation greatly facilitated the patient's management. These findings are discussed with reference to current diagnostic investigations in the presence of a suspected diagnosis of hysterical paraplegia.
Adult↗
Child distress during hospitalization: implications for practice.
This paper investigates distress in 221 children admitted to a district general hospital for ENT surgery. Younger children (5 years and under) were rated by nurses as being most distressed, with girls more so than boys. Presence of a parent in hospital overnight is also found to be associated with higher levels of distress. It is suggested that preparation programmes designed to reduce distress should target younger children and that consideration be given to a preparation programme for parents.
Adenoidectomy↗
Children's psychological health status--the impact of liver transplantation: a review.
Medical audit needs to encompass physical, psychological and social aspects to patient functioning. The aim of this paper is to review the psychosocial impact of liver transplantation on children and their families. Evidence suggests that end stage liver diseases are associated with developmental delays. Emotional and behavioural problems are common and have been found to relate to the child's developmental status, physical appearance as well as family functioning. Post transplant, children and families often experience an exacerbation of preexisting emotional problems. One year post transplant, children typically show continuing developmental delays. Longer term assessments of quality of life suggest that children may experience fewer hospital contacts and that over time psychological difficulties reduce. Many families continue to experience problems in normalizing their interactions within and outside the family. The findings demonstrate the importance of including psychosocial outcomes in auditing the efficacy of medical interventions.
Child↗
The psychological effects of disaster work: implications for disaster planning.
The paper focuses on the psychological consequences of disaster work. The issue of identifying staff who may be more vulnerable to psychological distress is discussed as is the need for services to plan psychological screening and support for staff who will be exposed to the trauma of dealing with the aftermath of disasters. It is concluded that active steps need to be taken to incorporate psychological aspects into disaster planning. Specifically, attention should be paid to staff selection, training, use of resources, supervision, debriefing, counselling and feedback.
Counseling↗
The VM model of glioma: preparation of multicellular tumour spheroids (MTS) and their response to chemotherapy.
A cell line, 497-P(1), derived from the VM spontaneous murine astrocytoma has been used to develop an in vitro therapeutic model of human glioma. In this study we describe the preparation of MTS from this cell line. The in vitro chemosensitivity of 497-P(1) MTS has been examined and compared to the sensitivity of the monolayer culture. BCNU and CCNU both produced growth delay in MTS at doses below the ID50 of the monolayer culture. MTS, however, were considerably more resistant to vincristine and procarbazine when compared to the monolayer culture.
Animals↗
GLUCOPAGE: a computer program for managing diabetic pregnancy.
The microcomputer is an invaluable aid in the management of diabetes mellitus because of its ability to manipulate, summarise, and produce graphical displays from blood glucose data in such a way that new trends, or the effects of changes in therapy, are more readily apparent to the clinician. Currently available software however, while adequate for most purposes, has not been written to cope with the unique problems presented by diabetic pregnancy in which large amounts of data are generated over short periods of time, insulin requirements may change rapidly, and blood glucose control must be extremely tight. We have produced a new program, GLUCOPAGE, specifically for use in the management of diabetic pregnancy. GLUCOPAGE operates in conjunction with the Ames Memory Glucometer, from which it can download data either directly or telemetrically via a modern into the host IBM PC or compatible microcomputer. Large amounts of data can be summarised in various tabular and graphical formats on screen or in printed form. A single A4-size printout, the Glucopage, provides tabular and graphical summaries of a full week's blood glucose data. Copies of the Glucopage may conveniently be filed in the case notes, given to the patient or distributed to other medical staff.
Blood Glucose Self-Monitoring↗
The chemotherapeutic response of a murine (VM) model of human glioma.
Using a cell line derived from the VM spontaneous murine astrocytoma, a reliable in vitro-in vivo model of human malignant glioma has been developed. In this paper we examine the effects of cytotoxic drugs with known activity against other animal brain tumour models and human disease on the in vivo VM model. The drugs BCNU, CCNU and vincristine produced significant volume reduction in tumours growing at a subcutaneous location in syngeneic animals. Procarbazine was ineffective. Similarly, BCNU, CCNU and vincristine produced small but statistically significant increases in survival of VM mice bearing the intracerebral tumour, but procarbazine was again ineffective. The modest, but significant, response of the VM model to the nitrosoureas mimics the human situation more closely than previously described animal models.
Animals↗
Short communication: the importance of psychosocial factors in understanding child distress during routine X-ray procedures.
Thirty-eight children, aged 1-4 years, with a query or definite diagnosis of congenital heart disease (CHD) were observed during an X-ray procedure and their behaviour rated on an amended version of the Observational Scale of Behavioural Distress. Families were followed up and assessed on a number of psychosocial variables. High rates of behavioural distress were found to be associated with children's low stranger sociability and parental style of discipline. Possible patterns of interaction between CHD children and their families are discussed.
Adaptation, Psychological↗
Psychological guidelines in the management of paediatric organ transplantation.
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Child↗
Herniation of a calcified nucleus pulposus in a child: case report.
Herniation of the nucleus pulposus is a very rare complication of intervertebral disc calcification in children. We report a case in an 11-year-old girl. The majority of such cases should be treated conservatively as spontaneous resorption of the calcified lesion will occur.
Calcinosis↗
The development of an animal model of glioma for use in experimental neuro-oncology.
A cell line, 497-P(1), derived from the VM spontaneous murine astrocytoma has been used to develop an in vitro in vivo model of human glioma. This paper describes the growth characteristics of tumours produced after intracerebral or subcutaneous inoculation of 497-P(1) cells into syngeneic VM mice. The results show that cell line 497-P(1) provides the basis for a reproducible animal model of glioma which fulfils many of the criteria required for experimental therapy studies.
Animals↗
Obstacles to collaborative practice.
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Attitude of Health Personnel↗
Computer-directed stereotactic biopsy of intrinsic brain stem lesions.
Despite advances in the neuro-imaging of the brain stem, an accurate diagnosis of intrinsic lesions in this region requires tissue sampling and histological verification. We have performed a series of computer-directed stereotactic procedures in 12 patients with intrinsic brain stem lesions. A positive diagnosis was obtained in 11 cases and therapeutic intervention was possible in four. There was no operative mortality. Because of the importance of an accurate diagnosis in order to avoid inappropriate therapy, together with the relative safety of the technique, computer-directed stereotactic biopsy should be considered in all patients harbouring an intrinsic brain stem mass.
Adolescent↗
MRI-directed stereotactic biopsy of cerebral lesions.
Using a modified CT-directed stereotactic system we have performed MRI-directed biopsies in five patients whose intracerebral lesions were not clearly shown by CT. Tissue sampling from targets defined on the MR image enabled a histological diagnosis to be made in four of the five cases.
Adult↗