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Biomedical subjects

T Hindmarsh

Publications and source records attributed to T Hindmarsh.

At least 19 recordsLinked to original sources
PubMed1992

Magnetic resonance imaging of the brain before and after open heart operations.

Magnetic resonance imaging of the brain was performed in 29 adult male patients before and 1 week after elective coronary artery bypass grafting to study the cerebral effect of cardiopulmonary bypass. The mean age of the patients was 60 years (range, 45 to 69 years). During cardiopulmonary bypass, either a bubble oxygenator without an arterial line filter (n = 9), a bubble oxygenator with a depth adsorption filter (n = 10), or a flat-sheet membrane oxygenator without a filter (n = 10) was used. The mean bypass time was 88 minutes (standard deviation, 31 minutes) and did not differ significantly between the three groups. Preoperative magnetic resonance imaging revealed high signal intensity foci on T2-weighted images (white matter abnormalities) in 17 (59%; 95% confidence limits, 39% to 76%) of the 29 patients, all of which were nonspecific and of the common type considered to be related to aging, and all were unchanged at the postoperative examination. Preoperative and postoperative frontal horn indices, bicaudate diameters, and third ventricle widths did not differ significantly regardless of oxygenator type or whether or not an arterial line filter was used during cardiopulmonary bypass. Two patients (7%; 95% confidence limits, 1% to 23%), both receiving bubble oxygenation (1 without a filter and 1 with an arterial line filter) sustained a cerebral infarction during cardiopulmonary bypass.

Aged↗
PubMed1990

[The value of magnetic resonance scanning in the diagnosis of small acoustic neurinomas].

This article describes three cases of acustic neurinoma in which both clinical examination and audiovestibular investigations raised strong suspicions of acustic neurinoma but no tumours could be demonstrated by CT. Magnetic resonance scanning employing gadolinium-DTPA revealed small intrameatal acustic neurinomas in all three cases. Attention is drawn to the fact that magnetic resonance scanning provides a new diagnostic possibility for acustic neurinoma and is a valuable supplement to the established diagnostic procedures in suspected acustic neurinoma even although CT reveals normal anatomical conditions in the internal auditory meatus.

Adult↗
PubMed1990

Central nervous system malformations and white matter changes in pseudo-neonatal adrenoleukodystrophy.

Clinical, biochemical and morphological findings in a 16-month-old infant girl with pseudo-neonatal adrenoleukodystrophy are reported. The parents were first cousins and the baby was born at term, small for gestational age. The neonatal period was characterized by convulsions resistant to treatment, generalized, severe muscle hypotonus, feeding difficulties and poor weight gain. Developmentally she remained at a neonatal level. A CT-scan showed low density of cerebral white matter and MR examination white matter changes, a thin corpus callosum, cerebellar malformation and dorsal displacement of the brainstem. There was an accumulation of very long chain fatty acids (VLCFA) in serum lipids and cultured skin fibroblasts but plasmalogen and phytanic acid levels were normal. A liver biopsy revealed enlarged peroxisomes staining for catalase. Three similar cases have been reported previously; in two of these there was a deficiency of acyl-CoA oxidase. MR evidence of leukodystrophy combined with gross cerebral and cerebellar morphologic changes have not been reported earlier.

Acyl-CoA Oxidase↗
PubMed1989

Influence of improved drinking habits on brain atrophy and cognitive performance in alcoholic patients: a 5-year follow-up study.

In the period 1977-1979, a sample of consecutively admitted alcoholic in-patients was studied with CT scan of the brain and neuropsychological tests. A subsample of 52 patients met the following criteria: age less than 46 years, no history of severe head injury or focal signs of traumatic brain damage, and no history of liver disease, drug abuse, or long-lasting anticonvulsant therapy. However, 72% of the patients showed brain atrophy and 49% intellectual impairment as compared to 16% and 13%, respectively, in an age-matched sample of men from the general population. Five years later, after excluding patients with head trauma, serious alcoholic liver disease and drug abuse, 37 patients were reinvestigated. Sixteen patients were abstinent or had greatly improved drinking habits during the 5-year follow-up period and 21 were still drinking. Alcohol abstinence was found to be associated with a regress of cortical atrophy and central atrophy as assessed by the width of the 3rd ventricle. However, the recovery was not complete as compared with the prevalence of atrophy in the sample from the general population. Among the patients a significant improvement in one cognitive test and a trend to improvement in some other tests associated with improved drinking habits was observed. Regression of central atrophy as assessed by a decreased diameter of the 3rd ventricle was associated with improvement in the very same cognitive tests. The results suggest that both atrophy of the brain and cognitive ability can improve in alcoholics who give up drinking.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Does successful interferon treatment of tumor patients require life-long treatment?

Case histories of 5 tumor patients treated with natural leukocyte interferon-alpha (IFN-alpha) are presented. One patient with juvenile laryngeal papillomatosis responded well to interferon treatment, but the disease recurred when therapy was withdrawn. Upon reinstitution of treatment, the patient once again responded well. Another patient with myelomatosis also responded well to interferon therapy and in this case, too, the tumor recurred when interferon treatment was withdrawn. Reinstitution of interferon therapy was, however, unsuccessful. One patient with generalized giant cell tumor of bone responded with regression after more than 5 years of interferon treatment. Another patient with pulmonary osteosarcoma metastases, having received irradiation and interferon combination therapy followed by sole interferon treatment, responded well with a lasting stationary radiogram after 6 years of interferon treatment. One patient with malignant glioma, showing signs of tumor growth during the first few months of interferon therapy, eventually responded, and became disease-free after 6 years. The latter 3 patients are continuously receiving interferon therapy although more than 5 years have elapsed since their interferon therapy was initiated. It is suggested that interferon therapy for malignant tumors be given for life (or to progression of disease) in responding patients. Such a concept entails biological implications for interferon therapy in general and for antitumor action of interferons in particular. Other possible clinical schedules should only be constructed within the framework of controlled clinical trials.

Adult↗
PubMed1987

Magnetic resonance images related to clinical outcome after psychosurgical intervention in severe anxiety disorder.

Postoperative verification of radiosurgical lesions in white matter has been difficult to obtain with CT. With magnetic resonance (MR) imaging, however, lesions could be demonstrated in patients undergoing a psychosurgical procedure, gamma capsulotomy, for anxiety disorder. The appearance and location of the lesions were related to the irradiation dose and to the long-term clinical outcome studied prospectively by two independent evaluators who had not been involved in the selection or the treatment of the patients. Seven consecutive cases were examined. CT was also included for comparison reasons. Lesions were clearly visible with MR in patients who improved after surgery. Conversely, lesions were inadequate in cases who did not benefit. MR proved to be more accurate than CT both in detecting the lesions and in defining their configuration. The observations argue for the use of MR for post-operative verification of radiosurgical lesions. MR may facilitate the determination of a clinically effective radiation threshold estimate for radiosurgical lesions, which should be of value for the planning of studies of this type of limbic system surgery.

Adult↗
PubMed1986

A comparison of computed tomography and myelography in the diagnosis of lumbar disc herniation.

Ninety patients suspected to have a herniated lumbar disc were examined by myelography and computed tomography (CT). Of these, 37 were subjected to surgery. The surgical findings were in agreement in 21 patients (57%) with the myelograms and in 28 patients (76%) with the CT examinations. False-positive CT examinations were found in only one patient. CT is as reliable as myelography in the primary diagnosis of disc herniation.

Adult↗
PubMed1986

The clinical versus radiological diagnosis of alcoholic cerebellar degeneration.

We report the clinical characteristics of 65 patients with alcoholic cerebellar degeneration as verified by computerized tomography of the brain. Thirty-two patients (49%) had clear clinical signs of the disease such as broad-based staggering gait, impaired heel-to-toe walking, terminal oscillations in heel-knee test and slow (3/s) leg tremor. These signs were virtually absent in 33 patients (51%) who, nevertheless, had radiological signs of cerebellar degeneration. Traumatic brain injuries were more frequent in those patients who had both clinical and radiological signs of alcoholic cerebellar degeneration. Furthermore, this group showed longer periods of heavy drinking, more severe cerebral atrophy and more profound neuropsychological impairment than a control group of 92 alcoholics with neither clinical nor radiological signs of cerebellar disease. We conclude that careful clinical neurological examination is needed to diagnose alcoholic cerebellar degeneration which is apparently a more common disease than first realized. Subclinical cases can be diagnosed with the help of computerized tomography of the brain.

Adult↗
PubMed1986

Radiation therapy of ovarian carcinoma: presentation of a six-field technique.

A new technique for radiotherapy in ovarian carcinoma is presented. The aim was to deliver a homogeneous radiation dose to the entire abdominal cavity. The whole abdomen, except for 20% of the upper compartment, received a homogeneous dose of 40 Gy, while 2/3 of the kidneys and the posterior part of the liver received a dose ranging from 40 to 20 Gy. No clinically significant impairment of liver function was seen during follow-up.

Adult↗
PubMed1986

Accuracy of computed tomography in the diagnosis of herpes simplex encephalitis.

The accuracy of computed tomography (CT) in the diagnosis of herpes simplex encephalitis (HSE) was assessed in 121 patients who during a 2 1/2 year period entered a prospective Swedish joint study with participation of six University Centres. The patients presented with symptoms and signs of febrile focal encephalopathy. The age ranged from 1 month to 76 years (mean 37.3 years). Only 6 were infants less than one year old. HSE was diagnosed in 50 patients by the demonstration of intrathecal HSV antibody production and/or by HSV isolation or antigen detection in brain tissue specimens. A total of 308 CT examinations--the majority performed during the first 5 days after onset of CNS symptoms--were evaluated under blind conditions. The correct diagnosis of HSE was usually suggested within 5 days after onset of neurologic symptoms yielding a sensitivity of 0.73 and a specificity of 0.89. Predominant location of the HSE lesions was the temporal lobes (88%), which rarely were involved in the non-HSE group (11%). Haemorrhage was a rare finding (12% ) and enhancement after intravenous contrast administration was insignificant. Repeat examinations further increased accuracy. It is concluded that the good reliability of high resolution CT, further improvement of immunologic techniques and the advent of new atoxic antiviral drugs all are factors which may in the future obviate the need for brain biopsy.

Adolescent↗
PubMed1986

Magnetic resonance imaging of stereotactic radiosurgical lesions in the internal capsule.

Confirmation of radiosurgical lesions in white matter has earlier been difficult to obtain, which has hampered the evaluation of clinical outcome in relation to the site and the size of the lesions. In this investigation 7 consecutive patients subjected to bilateral stereotactic gamma capsulotomy for intractable anxiety disorders were re-examined several years after treatment. The protocol included both magnetic resonance imaging (MRI) and computed tomography (CT) interpreted under blind conditions and prospective psychiatric evaluations performed by two independent evaluators who had not been involved in the selection and the treatment of the patients. The lesions were clearly visible with MRI in all patients who improved after treatment. MRI proved to be more accurate than CT both in detecting and in defining the size and the configuration of the lesions. The extent of the tissue reaction following the irradiation seemed to be best defined in T2 weighted images. A high correlation (p less than 0.01) was obtained between ratings of clinical outcome and radiosurgical precision as reflected by MRI. It is concluded that MRI may provide the clinician with more information than CT does. In the future MRI may also facilitate the determination of a radiation threshold value for white and grey matter lesions and provide a more detailed knowledge of the time course of the development of such lesions.

Adult↗
PubMed1986

A methodologic assessment of studies comparing magnetic resonance imaging and computed tomography of the brain.

To evaluate the methods used in studies comparing magnetic resonance imaging (MRI) and computed tomography (CT) of the brain, we reviewed English language articles published between 1981 and early 1986. Of 83 studies comparing the accuracy of MRI and CT in 10 or more patients, few met methodologic standards for evaluations of the efficacy of new diagnostic tests. Limitations were found in how study populations were assembled, in test performance and interpretation, and in analysis of study findings. Greater attention to design and execution of comparison studies could overcome these limitations and help demonstrate MRI's true diagnostic value.

Brain↗
PubMed1985

Autotraction in lumbar disc herniation. A myelographic study before and after treatment.

Autotraction is a method of diminishing lower back pain and sciatica in which the patient stretches himself on a specially designed traction table. The pulling force ranges between 400-800 N. Clinical results are encouraging and the method can be recommended as a temporary treatment especially in lumbago with sciatica. The influence on a herniated disc is discussed with respect to the suggestion that autotraction will diminish the herniation. In this study myelographic examination revealed that herniation was the same in location and size before and after autotraction. However, there was a marked clinical improvement in all patients but one.

Adult↗
PubMed1979

Left ventricular pump function in effort angina.

The successive deterioration of left ventricular pump function during exercise-induced angina pectoris was studied in 20 candidates for aortocoronary bypass surgery. Left ventricular stroke work and power were calculated from continuous left ventricular pressure recordings and repeated measurements of cardiac output every 30 sec using the thermodilution technique. The average left ventricular enddiastolic pressure (LVEDP) increased continuously during exercise whereas stroke work index (SWI) did so only in the beginning of the exercise period up to a maximum value and then fell towards the end of exercise. The onset of angina occurred at an average LVEDP of 34 mm Hg when SWI had already started to fall in most patients. During exercise all patients had markedly lower SWI than normals. Patients with high coronary arteriographic score and patients with a previous myocardial infarction had significantly lower SWI during exercise than those with low score or those without a previous infarct. At rest there were no differences between these groups which emphasises the importance of haemodynamic measurements under stress conditions in patients with ischaemic heart disease.

Adult↗