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Biomedical subjects

S Lipton

Publications and source records attributed to S Lipton.

At least 19 recordsLinked to original sources
PubMed1992

The location and function of respiratory fibres in the second cervical spinal cord segment: respiratory dysfunction syndrome after cervical cordotomy.

After high cervical percutaneous cordotomy for pain in malignant disease, 12 patients died during sleep at postoperative intervals between 1 and 8 days. Nine died after a first cordotomy and three after a second (contralateral) procedure. All except one had known pulmonary disease before operation. The operated segment of the spinal cord (C2) was studied histologically after death. Superposition of lesion outlines made it possible to determine those parts of the lesioned areas common to all unilateral and bilateral cases respectively. All cases dying of presumed respiratory dysfunction syndrome had lesions involving the region of the anterolateral funiculus in the C2 segment containing "pain" fibres activated from the second to fifth thoracic dermatomes. The fibres whose destruction appeared to be responsible for respiratory dysfunction syndrome were completely intermingled with ascending "pain" fibres. The possibility of these fibres being afferent in function is discussed.

Aged↗
PubMed1991

Pain mechanisms and management.

Pain is one of the most important human experiences, and also one of the most complex. The International Association for the Study of Pain has defined pain as: 'An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. It is unquestionably a sensation in a part of the body, but it is also unpleasant, and therefore also an emotional experience. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is no way to distinguish their experience from that due to tissue damage, if we take this subjective report.'

Acute Disease↗
PubMed1991

The aponeurotic repair of inguinal hernia.

Inguinal hernia repair has relied on sewing supporting structures to a fixed ligament, and suture line tension has been recognized as a cause of operative failure. Aponeurotic inguinal hernia repair does not rely on suturing fasciae to ligaments; it is a tension-free repair that does not require relaxing incisions to relieve tension. Aponeurotic repair can be performed for primary or recurrent hernias. It use will enlarge the choices of procedures best suited to the needs of a specific hernia.

Abdominal Muscles↗
PubMed1989

Diverticular disease of the appendix.

A retrospective study of diverticular disease of the appendix was made in 3,343 consecutive instances of appendectomies. A 2 per cent incidence of diverticular disease was found. These instances were classified into four morphologic types: 1, acute diverticulitis; 2, acute appendicitis with acute diverticulitis; 3, acute appendicitis with diverticulum, and 4, appendix with diverticulum. Types 1, 2 and 3 were divided into subgroups with or without perforation. The elements of clinical behavior in each group were examined in detail. Diverticulitis of the appendix is presented as a clinically variant form of the inflamed appendix. Some followed the pattern of typical acute appendicitis. However, most were distinctive at a later age of onset, longer interval of disease, fewer or absent symptoms of the gastrointestinal tract, failure of typical abdominal pain progression, delay in surgical treatment and a remarkably high incidence of perforation. In a chi-square analysis of 56 patients with acute diverticulitis of the appendix compared with 2,503 patients with acute appendicitis, more than a fourfold incidence of perforation in acute diverticulitis was significant beyond the 0.001 level. These findings of variant behavior and high incidence of perforation are cautionary features of this frequently overlooked disease.

Acute Disease↗
PubMed1987

Computed tomography application to lumbar epidurography.

The application of current-generation computed tomography scanning to lumbar epidurography has resulted in a better appreciation of epidural anatomy and improved ease of interpretation of non-ionic contrast material within the epidural space. The development of extended window width has greatly improved imaging of the more variable levels of attenuation encountered in contrast material within the epidural space. The procedure of distribution of contrast material by catheter technique via the sacral canal approach is described. The experience obtained on examination of 24 patients is discussed, along with the possible adjunctive and primary roles of this type of imaging in evaluation of the lumbar spine.

Catheterization↗
PubMed1987

Varicella-like illness caused by live varicella vaccine in children with acute lymphocytic leukemia.

A varicella-like illness occurred in five of 52 children with acute lymphocytic leukemia following the administration of live varicella vaccine. Only one of the children required treatment with acyclovir. Virus isolated from two of the children was "vaccine-like" but differed slightly from the original vaccine strain when tested by restriction enzyme analysis. There did not appear to be a reversion to virulence because two of the household contacts who seroconverted had mild or subclinical infections. Vaccinees in whom this reaction developed tended to have a poor cellular immune response to varicella-zoster virus.

Antibodies, Viral↗
PubMed1985

Percutaneous radio frequency gangliolysis in the treatment of trigeminal neuralgia.

37 procedures were carried out in 32 patients with trigeminal neuralgia who were unrelieved by anticonvulsants. Initial relief was achieved in 31 patients (98%). 5 patients (16%) suffered a relapse during a follow-up period of 15-26 months. Corneal anaesthesia occurred in 6 patients, 1 of whom subsequently developed a corneal ulcer. Anaesthesia dolorosa appeared in 5 patients. Ipsilateral reduction in hearing was reported by 2 patients. Despite its limits and complications percutaneous radio frequency gangliolysis is an effective alternative in the treatment of trigeminal neuralgia.

Aged↗
PubMed1985

Percutaneous cervical cordotomy: results and complications in a recent series of 100 patients.

One hundred and twenty-two percutaneous cervical cordotomies were performed in 100 patients. Of these, 95 suffered from pain associated with malignant disease. Complete pain relief was achieved in 64% of patients, partial relief in 23% and no relief in 13%. Mortality was 6% and exclusively related to postoperative respiratory dysfunction. The results and complications observed in this recent series are discussed in relation to our previous and other authors' experience. For selected patients with cancer pain, percutaneous cordotomy is the most effective operative method available at the present time.

Adult↗
PubMed1984

Changes in the concentration of somatostatin and substance P in the cerebrospinal fluid following injection of alcohol into the pituitary gland.

The concentration of immunoreactive somatostatin and Substance P in the cisternal cerebrospinal fluid (CSF) of patients with pain due to malignant disease has been measured before and after injection of alcohol into the pituitary fossa. Following the first injection, a rise of 108 +/- 66% in CSF somatostatin levels was observed in 7 out of 13 patients, and a rise of 87 +/- 26% in 4 out of the 5 patients undergoing a second injection. A rise of 179 +/- 99% in levels of Substance P in CSF was observed in 4 out of 8 patients after a single injection. No change in peptide concentration was detected in peripheral plasma. Changes in CSF levels did not correlate with the degree of pain relief obtained, but patients with the greatest increase in somatostatin subsequently developed diabetes insipidus. The data are consistent with our previous experience that injection of alcohol into the pituitary fossa can cause destruction to nervous tissue, in addition to the obvious destruction of pituitary gland tissue. They do not support the suggestion that hypothalamic damage is necessary in order to obtain pain relief.

Ethanol↗
PubMed1981

Intractable pain--the present position.

The broad changes that have occurred in the treatment of intractable pain are considered. There is a new understanding of the anatomy and physiology of pain pathways and pain appreciation. Thus gate control theory, the spinal laminae, and the descending inhibitory pain pathway through the raphe nuclei are discussed in relation to the recent discovery of the opioid (enkephalin) systems. Out of this arises the stimulation methods of pain relief--transcutaneous neural stimulation, periaqueductal stimulation, and acupuncture. These are valuable in patients with a normal expectation of life. For patients with a shortened expectation of life other methods, especially destructive ones, are valuable (though in all types of chronic pain drug therapy is still the most used method). Basic changes in techniques and the equipment used to bring this about are detailed broadly. In particular, the use of the image intensifier X-ray machine and the stimulation and destruction available from the modern lesion generator when used in combination provide accuracy and safety. Techniques and methods are constantly altering and examples of this are given. All this costs money in time, personnel, and equipment; the costings of the Liverpool Centre for Pain Relief are given. Finally, the Pain Relief Foundation is in being in Liverpool in the grounds of Walton Hospital. This has been made possible by a large 'seed' donation by the Wolfson Foundation.

Electrocoagulation↗
PubMed1980

Hypocomplementemia and Campylobacter fetus infection.

A middle-aged alcoholic man had low C3 levels during two consecutive episodes of bacteremia with Campylobacter fetus, with a return of C3 levels to normal during the interbacteremic period. Total complement levels remained below normal throughout the patient's illness, whereas C4 and C3 activator values were in the normal or supranormal range. A rise and fall in hemagglutinating antibody titers, documenting an immune response, coupled with reasonable antimicrobial therapy were not sufficient to prevent the development of chronic infection. It is suggested that complement may play an important role in the pathogenesis of C fetus infections.

Adult↗
PubMed1980

Pain relief and pituitary function following injection of alcohol into the pituitary fossa.

Eleven patients were investigated for pituitary function after the injection of alcohol into the pituitary fossa; all had persistent pain and 8 had carcinoma of the breast. Most of the patients showed varying degrees of reduction of pituitary activity; 8 patients obtained significant pain relief and 3 patients exhibited polyuria. These 3 observations could not be completely correlated; the possible mechanisms which may lead to pain suppression by this method are discussed.

Adult↗