Pyogenic meningitis due to a vertebral abscess.
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Biomedical subjects
Publications and source records attributed to W R Timperley.
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The value of subtraction angiography and CT scanning in the diagnosis of chemodectomas are illustrated by two cases, a glomus jugulare tumour which exhibited true malignant behaviour, and a carotid body tumour. The characteristic early arterial blush of a chemodectoma, which can be obscured by bone, is clearly seen following subtraction techniques revealing tumours as small as 0.5 cm. The chemodectoma appeared as an isodense tumour on the CT scan with uniform contrast enhancement and well-defined margins. The appearances, however, are not diagnostic of a chemodectoma and may be simulated by other tumours.
beta-Thromboglobulin levels and platelet-aggregate ratios were determined in blood-samples from healthy control subjects and from diabetic patients with and without microangiopathic complications. Patients with diabetic microangiopathy had significantly elevated beta-thromboglobulin levels and also reversible platelet aggregates. In nine newly treated diabetics blood-glucose control was associated with a significant fall in plasma beta-thromboglobulin. Since beta-thromboglobulin is a platelet-specific protein the results indicate that diabetic microangiopathy is associated with evidence of platelet activation and that this may be influenced by the degree of biochemical control.
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Over a two-and-a-half-year period at the Sheffield Royal Infirmary, six patients developed disseminated intravascular coagulation as a serious complication of intestinal disease. There was clinical evidence of cerebral involvement in all six patients, and small vessel thrombi were demonstrated in the brains of all three cases examined post mortem. Where the true significance of the cerebral disorder was not recognised, this led to delay in the diagnosis with serious risk to the patient. In the single case in which the diagnosis was made early, the intravascular coagulation was completely reversed with heparin therapy.
Three cases of midbrain gliomas are descrbied clinically and pathologically. In each case high pressure symptoms were followed by visual disturbance and the onset of syringomyelia symptoms before death. All the patients had hydrocephalus. In one case with concomitant syringobulbia, the syrinx appeared to due to CSF communicating with the cord cavity through the tissues of the brain stem. In the other cases the communication between the CSF pathways and the syrinx was at the usual site, through the central canal at the obex.
A quantitative enzyme analysis of 32 fetal human brains of 6--42 weeks gestational age range was carried out for the major glycolytic and pentose phosphate shunt enzymes. A critical period of raised enzyme levels was observed at 14 weeks. The glycolytic rate was probably controlled by the activities of hexokinase and phosphofructokinase which appear from the development patterns to have independent genetic sites. A rise in most enzyme activities was experienced in the final weeks of gestation towards levels consistent with those of adult tissues. Pentose phosphate shunt enzyme levels remained virtually unchanged during gestation after 14 weeks.
Sural nerve biopsy was performed in twenty-four diabetic patients, with clinical and electrophysiological evidence of diabetic neuropathy. Material from an autopsy case was also examined. Vessels plugged with fibrin were seen within nerve in nine cases. In three cases fibrin was observed tracking into the vessel wall and in four, older thrombus was observed in vessels. Areas of necrosis in nerve bundles were seen in two of the latter. In two patients there had been a preceding episode of intravascular coagulation. Fibrin deposition within small vessels could well play a part in damaging the diabetic nerve and a disturbance of the balance between deposition and removal by fibrinolysis could explain phasic variation in the symptoms of neuropathy.
A case of cerebro-hepato-renal syndrome with some unusual features is reported. The neuropathological findings are described in detail. Electronmicroscopy showed astrocytes in the demyelinated areas of the brain to contain granules composed of laminated osmiophilic material. These structures could be abnormal mitochondria. The parental consanguinity in this case would further support an autosomal recessive mode of inheritance.
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Abnormal platelet function has been demonstrated in 20 patients with diabetic peripheral neuropathy. The results are compared to those obtained from 19 matched diabetic patients with no clinical evidence of complications and 20 matched normal control subjects. Platelets from patients with diabetic neuropathy showed an increased sensitivity to the aggregating agents adenosine diphosphate and adrenaline. Spontaneous platelet aggregation was demonstrated in both groups of diabetic patients.
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In a patient suffering from primary hyperoxaluria with oxalosis a progressive peripheral neuropathy was associated with intra-axonal deposition of microcrystals of calcium oxalate. Probably his neuropathy was the result of mechanical obstruction of axoplasmic flow.
A spinal dermoid cyst with an invasive sweat-gland tumour in its wall is reported. This appears to be the first of this type to be reported in the nervous system.
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