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Biomedical subjects

R G Perrin

Publications and source records attributed to R G Perrin.

At least 19 recordsLinked to original sources
PubMed2003

The relations between social support, life stress, and quality of life following spinal decompression surgery.

STUDY DESIGN: Assessed social support, life stress, and quality of life among degenerative spine disease patients. OBJECTIVE: To examine how social support and life stress relate to quality of life following spinal decompression surgery among patients with degenerative spine disease. SETTING: Neurosurgical clinic at Saint Michael's Hospital in Toronto, Canada. METHODS: A total of 19 patients with degenerative spine disease who had undergone spinal decompression surgery within the past 14 months filled out social support, life stress, and quality of life questionnaires. Correlational techniques were used to assess the relations among the variables. RESULTS: The correlations between social support scores and health-related and nonhealth-related quality of life scores were r=0.72, P=0.001, and r=0.50, P=0.028, respectively. The correlations between life stress scores and health-related and nonhealth-related quality of life scores were r=-0.83, P<0.001, and r=-0.72, P=0.001, respectively. CONCLUSIONS: Degenerative spine disease patients experiencing more social support and less life stress tend to report greater satisfaction in medical outcome and overall quality of life following spinal decompression surgery than those with less social support and more life stress. Assessing social support and life stress in patients with degenerative spine disease and including a consideration of social support and life stress in the management of patients with degenerative spine disease could help to improve patients' satisfaction with their medical outcome and general quality of life following spinal decompression surgery.

Adult↗
PubMed2001

Evaluation and treatment of spinal metastases: an overview.

Metastases to the spine are a common and somber manifestation of systemic neoplasia. The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. Historically, surgery for spinal metastases has consisted of simple decompressive laminectomy. Results obtained in retrospective case series, however, have shown that this treatment provides little benefit to the patient. With the advent of better patient-related selection practices, in conjunction with new surgical techniques and improved postoperative care, the ability of surgical therapy to play an important and beneficial role in the multidisciplinary care of cancer patients with spinal disease has improved significantly. Controversy remains, however, with respect to the relative merits of surgery, radiotherapy, chemotherapy, or a combination of these treatments. In this topic review, the literature on spinal column and spinal cord metastases is collated to provide a description of the presentation, investigations, indications for surgical therapy, and the role of adjuvant cancer therapies for patients with spinal metastases. In addition, the authors discuss the different surgical strategies available in the armamentarium of the neurosurgeon treating patients with spinal metastasis.

Adrenal Cortex Hormones↗
PubMed1998

Iatrogenic seeding of anaplastic astrocytoma following stereotactic biopsy.

We present a case of probable tumor seeding along the needle tract following computer tomography-guided stereotactic biopsy of an anaplastic astrocytoma in a 23 year old male. Six months after the initial biopsy and 3 months following a second stereotactic procedure for cyst aspiration, a second lesion appeared directly along the biopsy trajectory at a distance from the primary tumor. This lesion is presumed to be recurrent tumor and appears to have been spread iatrogenically following the biopsy of the initial tumor and the subsequent cyst aspiration along the same tract.

Adult↗
PubMed1997

Management and outcomes of posterior fossa subdural hematomas in neonates.

OBJECTIVE: To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging. METHODS: A retrospective chart review identified all neonates with PFSDHs for whom neurosurgical consultations were obtained for treatment planning. RESULTS: There were nine male and six female patients. The mean gestational age was 39 weeks. Nine of the 15 mothers of the patients were primiparous. Instrument-assisted delivery (forceps and/or vacuum extractor) was undertaken for seven patients. The mean birth weight of the infants was 3165 g (range, 2160-3930 g). The mean 5-minute Apgar score was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure to thrive, irritability, seizures, apnea, and bradycardia. Lumbar punctures to rule out central nervous system sepsis were performed in six neonates. Hemograms revealed that six neonates were anemic with low hemoglobins, five had low platelets, and four had abnormal prothrombin and/or partial thromboplastin times at the time of diagnosis. Computed tomography established the diagnosis of PFSDH in all cases. Magnetic resonance imaging was performed for two neonates. The median time to diagnosis by imaging studies was 10 hours after birth. Surgical evacuation of the PFSDHs was performed in eight neonates. Seven neonates were followed conservatively with serial imaging studies. There was no mortality in either treatment group. Follow-up ranged from 2 to 10 years, with a mean of 4.5 years. Functional outcome assessment revealed that seven neonates were neurodevelopmentally normal, three were mildly delayed, two were moderately delayed, and three were profoundly delayed. In addition to traumatic causes of the PFSDHs, three neonates were observed to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth. CONCLUSION: PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.

Birth Injuries↗
PubMed1992

Metastatic tumors of the axial spine.

Spinal metastases are the most common tumors of the axial spine. Symptomatic spinal metastases in children and adults differ in a number of respects including culpable primary tumors, the degree of spinal column involvement, surgical strategies, and results of treatment. Magnetic resonance imaging has become the imaging method of choice for spinal tumors. The management of symptomatic spinal metastases is undertaken to relieve pain and to preserve or restore neurologic function. Radiation therapy is generally regarded as the initial treatment of choice. However, there has been a steady evolution in concepts and execution of surgical strategies for spinal secondaries. A prospective, randomized study should be undertaken to clarify the respective roles of therapeutic irradiation and surgery for metastatic tumors of the axial spine.

Adult↗
PubMed1990

Experience with Ommaya reservoir in 120 consecutive patients with meningeal malignancy.

The Ommaya Reservoir plays an important role in a select group of neuro-oncology patients with meningeal malignancy. The benefits derived must be balanced against potential complications associated with insertion and use of the apparatus. Side effects may be minimized by careful attention to patient selection, pre-operative CAT scan (or MRI), precise surgical technique, perioperative prophylactic antibiotics and meticulous procedure during use of the reservoir.

Adolescent↗
PubMed1990

Complications associated with Ommaya reservoirs in patients with cancer. The Princess Margaret Hospital experience and a review of the literature.

The complications associated with the use of Ommaya reservoirs in 106 patients with meningeal involvement due to malignant disease are reviewed. Twenty-seven patients had acute lymphoblastic leukemia, 12 acute myelogenous leukemia, 3 chronic lymphocytic leukemia, 34 lymphoma, 29 carcinoma, and 1 chronic myelocytic leukemia. There were 11 technical complications, including 1 death due to misplacement of the catheter, 2 mild intraventricular hemorrhages, and 5 malfunctioning reservoirs; 3 required craniotomies (1 for subdural hematoma and 2 for subdural hygroma); 13 cases of bacterial meningitis occurred in 10 patients. One patient died of Staphylococcus aureus meningitis. The organisms causing the other infections were mainly coagulase-negative staphylococci (8 cases) or Propionibacterium acnes (2 cases). The projected infection rate for all patients (by Kaplan-Meier analysis) during the first year following insertion of a reservoir was 15%. Successful use of Ommaya reservoirs requires expert surgical implantation and meticulous care during accessing to minimize complications.

Adult↗
PubMed1989

The role of surgical management for symptomatic spinal cord compression in patients with metastatic prostate cancer.

Spinal cord compression is a devastating complication of metastatic prostate cancer. We reviewed the experience at our center with 28 patients who underwent laminectomy for spinal cord compression secondary to adenocarcinoma of the prostate between January 1980 and November 1985. Patient age ranged from 46 to 82 years (mean age 65.5 years). The most common presenting complaints were back pain (75 per cent), loss of sensation (68 per cent) and loss of bladder function (39 per cent in retention). Postoperatively, 22 patients (79 per cent) had improvement of the presenting complaints. Of the 13 bedridden patients at presentation 8 (62 per cent) were ambulatory postoperatively. Of the 11 patients in retention 6 (55 per cent) were able to void postoperatively. There was no perioperative mortality. Four patients required further surgery, 2 had postoperative pneumonia and there were 2 wound infections. The average postoperative life span for the 17 patients not surviving to last followup was 9.5 months (range 1 to 60 months). The management of prostate cancer patients who have back pain and/or neurological findings is discussed. We believe that the rate of palliation and improved quality of life that decompressive laminectomy can afford patients with spinal cord compression due to prostate cancer justify its use in patients medically fit for the procedure.

Adenocarcinoma↗
PubMed1989

Vertex epidural hematomas.

Four cases of vertex epidural hematomas are presented to illustrate the unique management problems which set them apart from their more common counterparts located over the temporal convexity. Diagnosis requires a high degree of suspicion as vertex epidural hematomas are often missed by conventional horizontal scanning. Coronal computed tomographic scanning should be undertaken in all suspected cases. Clinical symptoms exceeding the small volume of clot may be present due to venous obstruction and disruption of cerebrospinal fluid absorption. Evacuation of the clot usually leads to clinical improvement.

Adult↗
PubMed1989

Symptomatic spinal metastases.

Pain is the earliest and most prominent feature of symptomatic spinal metastases. In some cases, pain may have been present for months and dismissed as arthritis or back strain. Local back or neck pain occurring in a cancer patient is due to spinal metastasis until proved otherwise. Once weakness occurs, the disease progresses to paraplegia unless treatment is undertaken. Pedicle erosion is the most common abnormality on spinal films. Irradiation is often effective, but surgery is indicated for radiation failure, unknown diagnosis, pathologic fracture-dislocation and rapid disease progression.

Back Pain↗
PubMed1988

Spinal fixation after anterior decompression for symptomatic spinal metastasis.

Surgical strategies for the treatment of symptomatic spinal metastases must take into account both decompression of the spinal cord and stabilization of the spinal column. A method is described for securing spinal stabilization in patients who have undergone surgical decompression for symptomatic spinal metastases by an anterior approach. The fixation device used is a tailor-made prosthesis consisting of a U-shaped stainless steel plate permitting screw fixation to secure axial and rotational stability with an interposed methyl methacrylate strut to provide axial strength and support. The device has been used successfully in 51 patients who have undergone anterior decompression procedures for symptomatic spinal metastases.

Aged↗
PubMed1987

Anterior versus posterior decompression for symptomatic spinal metastasis.

Management of patients with symptomatic spinal metastasis is designed to (1) relieve pain, and (2) restore or preserve neurologic function. The surgical strategy must include provisions for decompression of the dural sac and nerve roots, and stabilization of the spinal column. The optimal surgical approach, whether from in front or from behind is determined by a number of factors including (1) tumour location, (2) spinal level, (3) fixation factors, (4) patient debility.

Adult↗
PubMed1987

Herniated lumbar disc disease in patients with malignancy.

Six patients with cancer presented with signs and symptoms of a lumbar herniated disc syndrome due to a herniated lumbar disc. The differential diagnosis and literature are reviewed. In four of the six, the patients' complaints were attributed to the malignancy, with delay in diagnosis and institution of appropriate therapy. In two of the patients, treatment was administered for presumed spinal metastasis with radiation therapy and/or chemotherapy with castration before the correct diagnosis was made. Surgery was performed on all six patients confirming the diagnosis of a herniated lumbar disc at the involved level and relieving the patients' pain.

Adult↗
PubMed1984

Radiation-induced cerebellar chondrosarcoma. Case report.

The authors report a case of chondrosarcoma arising in the cerebellum 16 years after treatment of a cerebellar malignant astrocytoma by subtotal resection and irradiation. It is thought that the chondrosarcoma arising within the intracranial cavity was a probable consequence of previous ionizing radiation.

Adult↗
PubMed1983

Successful surgical decompression of spinal extradural metastases of liposarcoma.

Two patients with metastatic liposarcoma to the spine developed neurologic deficits that were successfully reversed by laminectomy and partial tumor resections. Recurrences at later dates were treated similarly with comparable outcomes. Paraplegia was forestalled for approximately two years by each of the surgical interventions.

Aged↗