Biomedical subjects
Publications and source records attributed to S Rimmer.
We report a 13-year-old girl with recurrent paroxysmal superior division oculomotor palsy as a manifestation of ophthalmoplegic migraine. Neurodiagnostic tests (including head computed tomography scan, cerebral angiography, and Tensilon tests) were normal. This case demonstrates that ophthalmoplegic migraine may selectively affect superior division fibers of the oculomotor nerve.
The pattern electroretinogram (PERG), thought to be generated in retinal ganglion cells, is a recent addition to the neurophysiologic assessment of retinal function. Factors that affect the PERG include type of pattern-reversal stimulus, spatial frequency of the pattern, luminance and contrast of the pattern, method of waveform processing, type of electrode employed, electrode montage, background illumination, position of stimulus on the retina, temporal frequency of pattern reversal, refractive error, and patient age. Clinical entities reported to affect the PERG include glaucoma and ocular hypertension, optic neuritis, other optic neuropathies, maculopathies, and amblyopia. Technical aspects and clinical significance of the PERG are reviewed.
We recorded simultaneous electroretinograms and visual evoked potentials to pattern-reversal stimulus in ten normal subjects employing check sizes subtending 7.5, 15, 30, 60, 120, 240 and 480 min of visual arc. The mean peak latency of the pattern electroretinogram (PERG) b wave decreased logarithmically with increasing check size. The mean peak latency of the pattern visual evoked potential (PVEP) P100 component was shortest for 30 min check size and was longer at both smaller and larger check sizes, a phenomenon termed spatial selectivity. Retinocortical time (RCT) was calculated as the latency difference between the PVEP P100 peak and the PERG b wave. The RCT also exhibited spatial selectivity similar to that of the PVEP P100 component; mean RCT was shortest for 30 min check size and was longer at both smaller and larger check sizes. Implications are discussed in light of our current knowledge of the origins of the PERG and PVEP and visual processing of pattern-reversal stimuli. Simultaneous recording of PERGs and PVEPs in patients with disease of the afferent visual pathways employing a large range of check sizes may increase the diagnostic sensitivity of visual electrophysiologic testing.
A computerized method, using a small pocket computer, has been used to predict the presence of choledocholithiasis in a prospective series of 239 patients undergoing cholecystectomy. From an initial data base of 424 patients 36 factors were evaluated and the most important 2 of these were determined by multivariate analysis for use in the prospective analysis. Satisfactory operative cholangiograms were a prerequisite to evaluation of the statistical method and were obtained in 90.4 per cent of cases. Using the computerized method a common bile duct stone would have been overlooked in only 1 patient but 17 unnecessary explorations would have been carried out. The overall accuracy of the computerized method was 92.5 per cent. When the method was applied to a further study of 97 patients from a separate centre the overall accuracy was 85.6 per cent. If the method was used to aid selective use of operative cholangiography, cholangiograms would be performed in 20 per cent and stones would be overlooked in less than 1 per cent.
From a consecutive series of 2,221 cholecystectomies, 177 patients underwent combined supraduodenal and transduodenal exploration of the common bile duct and 390 were treated by supraduodenal exploration alone. The mortality rate after both exploration procedures was the same (2.8 per cent). However, two patients died of septic complications associated with duodenal fistulas in the combined exploration group. Five patients had retained stones in the common bile duct which subsequently flushed out with a saline solution irrigation administered through the T tube in three patients and the stone passed spontaneously in one patient. Clinically significant and biochemically documented acute pancreatitis occurred in five patients, one of whom died. Four patients had postoperative cholangitis develop which responded to antibiotic therapy. We are not aware of any patient who had common bile duct stones, chronic pancreatitis or ampullary stenosis after the combined procedure at follow-up study of between six months and 13 years.
Data from 424 patients who underwent cholecystectomy were analysed on a computer by both univariate and multivariate methods to determine the factors that identify patients with stones in the common bile duct. The presence of common bile duct stones was associated with increased age (p = 0.003), increased numbers of gallbladder stones (p less than 0.0001), a diagnosis of acute cholecystitis (p = 0.06), and a history of jaundice (chi-square = 22.2; p less than 0.001). A dilated common bile duct was the most significant indicator of the presence of stones (chi-square = 155.5; p less than 0.0001), and a dilated cystic duct was second (chi-square = 47; p less than 0.001). Using multivariate analysis, 89.5 percent of patients were correctly classified as having bile duct stones without the use of cholangiographic data (chi-square = 246.5; p less than 0.0001). Common bile duct diameter and the number of gallbladder stones emerged as the most important variables; additional historical factors, including the presence of jaundice and pancreatitis did not add to their predictive value. If multivariate analysis was used without cholangiographic data, bile duct stones would be missed in 3 percent of patients and unnecessary explorations would be carried out in 7.5 percent.
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A consecutive series of 647 routine neonatal chest x-ray films taken at a known time within 48 hours of birth was reviewed; 48% had been radiographed within 2 hours. Four hundred and twenty-seven had normal x-ray films, 147 showed evidence of delayed clearance of pulmonary fluid, and other diseases were present in 73. Excessive amounts of pulmonary fluid were not rare in neonates radiographed within 2 hours and were not necessarily associated with symptoms. Low birthweight and prematurity predisposed to delayed clearance of pulmonary fluid; with birthweights greater than 2.3 kg excess of pulmonary fluid was unlikely. Persistence of pleural fluid was more common in the right than the left lung. While radiologically there was no difference in the sex incidence of delayed clearance, symptoms were more common in boys.
The pathogenesis of gallstone pancreatitis remains controversial and current thinking supports duodenopancreatic-duct reflux after the passage of a gallstone into the duodenum. A consecutive series of 292 operative cholangiograms was studied: the presence of pancreatic-duct reflux, common-bileduct diameter, presence of gallstones, and duodenal filling were recorded. Of 21 patients who had previously had an attack of acute pancreatitis 11 had pancreatic-duct reflux on their operative cholangiograms (52.4%), whereas of 271 patients who had no history of pancreatic disease, pancreatic-duct reflux occurred in 45 (16.6%). 6 of 11 men with pancreatic-duct reflux had previously had acute pancreatitis, compared with 5 of 45 women. There was no significant correlation between the presence of pancreatic-duct reflux and common-bileduct stones, bileduct diameter, absence of duodenal filling, or history of jaundice. The increased tendency for pancreatic-duct reflux to occur in patients with gallstone pancreatitis is independent of duodenopancreatic-duct reflux and may not be related to the presence or recent passage of common-bileduct stones.
A sample of 500 consecutive women without symptoms of breast disease attending a breast screening clinic were investigated regarding their attitude to breast screening and to the extension of the screening programme to other forms of cancer. Attendance at the screening clinic was found to be reassuring by 94.2%, and 96.4% felt that the screening programme should be extended to include other forms of malignancy. There was a history of either respiratory or alimentary tract symptoms, and of smoking, or a family history of cancer in 41% of these women. The study shows that Edinburgh women are enthusiastic for breast screening and for its extension to include other forms of cancer.
In a prospective double-blind controlled trial the effect of large doses of ascorbic acid on the healing of pressure-sores has been assessed. 20 surgical patients were studied, the pressure areas being assessed by serial photography and ulcer tracings. The mean ascorbic-acid levels in treated and non-treated groups one month after the start of treatment were 65.6 and 25.8 mug per 10-8 white blood-cells. In the group treated with ascorbic acid there was a mean reduction in pressure-sore area of 84% after one month compared with 42.7% in the placebo group. These findings are statistically significant (P less than 0.005) and suggest that ascorbic acid may accelerate the healing of pressure-sores.
Alzheimer's disease is a progressive neurologic disorder which may present with visual disturbance before the diagnosis is clearly established. Central acuity and visual field are initially normal. Alzheimer patients may show anomalies of color vision, spatial contrast sensitivity, susceptibility to visual masks, fundus examination, ocular motility, higher cortical visual function, visual evoked potential, and pattern electroretinogram. Pathologic analysis has shown abnormalities at all levels of the visual axis from retinal ganglion cell to associative visual cortex. Correlations between the visual abnormalities of Alzheimer's disease and corresponding neuroanatomic substrates are discussed.
This study of the outcome and prognostic factors in prenatally diagnosed agenesis of the corpus callosum (ACC) was undertaken to see if there are any differences between subgroups, what relationship they have to neurodevelopmental outcome and whether this information aids the counselling of parents of fetuses with the condition. The outcome of 14 prenatally diagnosed fetuses with ACC and 61 postnatally diagnosed patients was assessed in terms of clinical problems, developmental milestones and neurological signs; each patient was then given a score out of 10, 0 being a normal outcome and 10 being the worst outcome, i.e. death or termination of pregnancy. Comparing patients diagnosed pre- and postnatally, several similarities were found indicating that the postnatal group can provide useful information about the prenatal group. There was a higher incidence of ACC in males than females. In the prenatally diagnosed patients complete ACC was more common than partial ACC, although this might be because partial ACC was easily missed. Complete ACC has a worse prognosis than partial ACC (p = 0.001), and when associated with other anomalies, especially of the central nervous system, the outcome is very bad (p < 0.01). The only neurodevelopmentally normal patients were in the isolated partial ACC group. This study highlights the need to perform a detailed review of fetal anatomy and the desirability of determining the karyotype of the fetus in all newly diagnosed cases of ACC so that as much information as possible is available before parents are counselled about the likely outcome.