RESUMEN
Nerve root retraction is a component of lumbar disc surgery. The authors describe a transdural approach for lumbar microdiscectomy through the nerve root, instead of retracting the root. This technique can be safely used in rare cases where root manipulation is considered to be difficult and dangerous.
Asunto(s)
Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Adulto , Anciano , Discectomía/efectos adversos , Duramadre/cirugía , Femenino , Humanos , Masculino , Raíces Nerviosas EspinalesAsunto(s)
Aneurisma Intracraneal/genética , Proteínas de la Membrana/genética , Riñón Poliquístico Autosómico Dominante/genética , Proteínas/genética , Adulto , Anciano , Anciano de 80 o más Años , Salud de la Familia , Femenino , Ligamiento Genético , Humanos , Aneurisma Intracraneal/complicaciones , Masculino , Persona de Mediana Edad , Linaje , Riñón Poliquístico Autosómico Dominante/complicaciones , Canales Catiónicos TRPPRESUMEN
The syntheses of a group of spermine polyamine analogues and their evaluation as antidiarrheals are described. Each compound was assessed in a rodent castor oil-induced diarrhea model for its ability to reduce stool output and weight loss in a dose-dependent manner. The spermine pharmacophore is shown to be an excellent platform from which to construct antidiarrheals. The activity of the compounds is very dependent on both the nature of the terminal alkyl groups and the geometry of the methylene spacers separating the nitrogens. The toxicity profile is also quite dependent on these same structural features. On the basis of subcutaneous dose-response data and toxicity profiles, two compounds, N(1),N(12)-diisopropylspermine and N(1),N(12)-diethylspermine, were taken forward into more complete evaluation. These measurements included formal acute and chronic toxicity trials, drug and metabolic tissue distribution studies, and assessment of the impact of these analogues on tissue polyamine pools. Finally, the remarkable activity of N,N'-bis[3-(ethylamino)propyl]-trans-1,4-cyclohexanediamine underscores the need to further explore this framework as a pharmacophore for the construction of other antidiarrheal agents.
Asunto(s)
Antidiarreicos/síntesis química , Ciclohexilaminas/síntesis química , Espermina/análogos & derivados , Espermina/síntesis química , Administración Oral , Animales , Antidiarreicos/química , Antidiarreicos/farmacología , Antidiarreicos/toxicidad , Aceite de Ricino , Ciclohexilaminas/química , Ciclohexilaminas/farmacología , Ciclohexilaminas/toxicidad , Diarrea/inducido químicamente , Diarrea/tratamiento farmacológico , Perros , Femenino , Dosificación Letal Mediana , Espectroscopía de Resonancia Magnética , Masculino , Espectrometría de Masas , Ratones , Ratas , Ratas Sprague-Dawley , Espermina/química , Espermina/farmacología , Relación Estructura-Actividad , Distribución Tisular , Pruebas de Toxicidad AgudaRESUMEN
The evaluation of a group of polyamine analogs as agents to ameliorate diarrhea-predominant irritable bowel syndrome is described. Each compound was assessed when administered subcutaneously in a psychological stress-induced model of irritable bowel syndrome in rodents for its ability to reduce stool output in a dose-dependent manner. The spermine pharmacophore is shown to be an excellent platform from which to construct compounds to treat irritable bowel syndrome. The activity of the compounds is very dependent on both the nature of the terminal alkyl groups and the geometry of the methylene spacers separating the nitrogens. In addition to the subcutaneous studies, several compounds, N1,N11-diethylnorspermine, N1,N12-diethylspermine, N1,N12-diisopropylspermine, N1,N14-diethylhomospermine, N,N'-bis[5-(ethylamino)pentyl]-1,4-butanediamine, N,N'-bis[2-(4-piperidinyl)ethyl]-1,4-diaminobutane, and N,N'-bis[3-(ethylamino)propyl]-trans-1,4-cyclohexanediamine, were subsequently evaluated for oral efficacy. The remarkable activity of N,N'-bis[3-(ethylamino)propyl]-trans-1,4-cyclohexanediamine underscores the need to explore this framework further as a pharmacophore for the construction of other analogues to relieve the symptoms of diarrhea-predominant IBS.
Asunto(s)
Enfermedades Funcionales del Colon/tratamiento farmacológico , Poliaminas/farmacología , Espermina/análogos & derivados , Animales , Enfermedades Funcionales del Colon/prevención & control , Ratones , Ratones Endogámicos , Poliaminas/química , Poliaminas/uso terapéutico , Ratas , Ratas Sprague-Dawley , Relación Estructura-ActividadRESUMEN
This report describes a new method of custom making cranial titanium plates for the repair of skull defects. We have combined 3D CT imaging and surface modelling with rapid prototyping (RP) technology to produce physical models of our patients' skulls from which custom titanium plates were made. We have expanded the use of image processing tools applied to the CT image data to fabricate a representation of the skull defect. Medical RP models are relatively expensive and particular attention has been paid to developing image processing methods to reduce costs. Our technique used the patient as their own model and generated data from the contralateral side of the head where appropriate. We present the results of 10 patients who have had a custom made cranial titanium plate fitted and discuss the models for these cases. The benefits of our custom made titanium plates are reduced patient attendances to hospital and a more accurate titanium plate which has improved fitting and cosmesis.
Asunto(s)
Placas Óseas , Diseño Asistido por Computadora , Procesamiento de Imagen Asistido por Computador/métodos , Prótesis e Implantes , Diseño de Prótesis , Cráneo/cirugía , Titanio , Tomografía Computarizada por Rayos X/métodos , Diseño Asistido por Computadora/economía , Control de Costos , Estética , Humanos , Procesamiento de Imagen Asistido por Computador/economía , Ajuste de Prótesis , Propiedades de SuperficieRESUMEN
As anyone who has worked with a computer knows, technology doesn't always solve problems. But when it comes to planning for health care institutions, operation simulation modeling can help executives make better decisions and create more efficient operations--by bringing more information, issues and communication power to the table.
Asunto(s)
Simulación por Computador , Sistemas de Apoyo a Decisiones Administrativas , Innovación Organizacional , Técnicas de Planificación , Asignación de Recursos para la Atención de Salud , Administración de Instituciones de Salud , Programas Informáticos , Estados UnidosRESUMEN
We report a case of giant cell tumour of the temporal bone arising in a 31-year-old man. The presenting symptoms were unusual, being rotational vertigo, unilateral tinnitus, and hearing loss. A computed tomography (CT) scan showed a large mass within the right temporal bone and the infratemporal fossa. The radiological appearance was suggestive of an aggressive primary neoplasm arising within bone. Biopsy and subsequent resection showed a giant cell tumour of bone. The tumour was histological grade 1. At two-year follow-up, there was no evidence of tumour recurrence or metastasis.
Asunto(s)
Tumor Óseo de Células Gigantes/complicaciones , Neoplasias Craneales/complicaciones , Hueso Temporal , Vértigo/etiología , Adulto , Humanos , MasculinoRESUMEN
OBJECTIVE: We assessed the endocrine outcome after transsphenoidal surgery for Cushing's disease. DESIGN: Five-year (mean) follow-up (range 1 month-12 years) of patients undergoing transsphenoidal surgery for Cushing's disease between 1977 and 1990; review of case notes, current clinical and biochemical assessment including 24-hour urinary free cortisol. SETTING: Northern Ireland. SUBJECTS: Forty-one patients (33F: 8M); mean age at diagnosis 39.1 years (9-72 years). MAIN OUTCOME MEASURES: Measurements of early post-operative 0800 h serum cortisol and 24-hour urinary free cortisol at least 24 hours after withdrawal of oral hydrocortisone therapy. This was followed by low dose dexamethasone testing. Current 24-hour urinary free cortisol measurements. Retrospective definition of cure. RESULTS: Twenty-seven patients were either cured or improved by surgery, 14 were considered definite failures. Of 19 patients cured, eight had unmeasurable early post-operative 0800 h serum cortisol levels while of 15 tested, 13 had complete suppression with dexamethasone and two suppressed normally but to still measurable levels (39 and 60 nmol/l respectively). Seventeen patients in total have subsequently had bilateral adrenalectomy of whom two have developed Nelson's syndrome. Seven of the 41 patients were shown to have definite cyclical cortisol secretion first diagnosed post-operatively in three patients. Hormone deficiency included TSH (5), LH/FSH (1), cortisol (1) and ADH (temporary in 7, permanent in 1). In all, seven patients had some type of permanent hormonal deficiency post-operatively. CONCLUSIONS: Transsphenoidal surgery offers a worthwhile cure rate without the necessity of life-long endocrine therapy. Post-operative endocrine assessment must be rigorous so that early further management can be planned in the significant percentage of patients in whom cure is not achieved. Early complete suppression on low dose dexamethasone testing is very suggestive of cure but repeated and long-term monitoring of 24-hour urinary free cortisol is advisable.
Asunto(s)
Adenoma/cirugía , Síndrome de Cushing/cirugía , Hipófisis/fisiopatología , Neoplasias Hipofisarias/cirugía , Adolescente , Adrenalectomía , Hormona Adrenocorticotrópica/sangre , Adulto , Anciano , Niño , Síndrome de Cushing/sangre , Síndrome de Cushing/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Hidrocortisona/metabolismo , Hipofisectomía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Periodo PosoperatorioRESUMEN
A baby with unilateral cleft lip, midline cleft palate and hypertelorism developed meningitis in the first 48 h of life. Examination of the nasopharynx showed a soft tissue mass, which was confirmed as a basal encephalocele by computed tomography. There was also congenital hydrocephalus and the corpus callosum was absent. Surgical treatment included repair of the anterior basal skull defect, repair of the lip and palate, and ventriculo-peritoneal shunt. There is currently evidence of developmental delay and right-sided visual impairment due to Morning Glory syndrome. This case demonstrates that basal encephalocele should be considered in any baby with midline facial deformity who develops meningitis.
Asunto(s)
Encefalocele/diagnóstico , Cara/anomalías , Meningitis/diagnóstico , Labio Leporino/complicaciones , Labio Leporino/cirugía , Fisura del Paladar/complicaciones , Fisura del Paladar/cirugía , Encefalocele/diagnóstico por imagen , Encefalocele/cirugía , Humanos , Recién Nacido , Masculino , Meningitis/etiología , Tomografía Computarizada por Rayos XRESUMEN
The prevalence of known cases of acromegaly in Northern Ireland in 1984 was 6.3 per 100,000 population. The incidence of newly-diagnosed cases over the preceding 25 years was 5.5 patients per year, or 0.4 patients per 100,000 population per year. This rate would be equivalent to about 200 new cases per year in the United Kingdom. Four options have been available to most of these patients--surgical hypophysectomy (transfrontal or transsphenoidal), pituitary radiotherapy (usually external cobalt beam), drug treatment with bromocriptine, or no treatment. Choice of treatment has been mainly influenced by tumour size, with the larger pituitary adenomas having surgery initially. No single form of treatment has been successful in achieving a clinical remission or cure in more than a minority of cases. The most successful outcome has been where total pituitary ablation has been achieved. Life-table analysis for the whole group shows life expectancy which is not markedly different for that of an age-matched population from Northern Ireland. Morbidity related to long term osteoarthritis and treatment complications remain a major problem. The incidence of malignant tumours is higher than would be expected.
Asunto(s)
Acromegalia/epidemiología , Acromegalia/mortalidad , Acromegalia/terapia , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Irlanda del Norte/epidemiologíaRESUMEN
Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms with specific radiological and surgical features. Previous reports have stressed the predilection of these lesions for the carotid circulation, particularly the middle cerebral artery. Two cases of serpentine aneurysm affecting the posterior circulation are reported and the problems of diagnosis and treatment of this lesion are discussed.
Asunto(s)
Circulación Cerebrovascular , Aneurisma Intracraneal/fisiopatología , Angiografía Cerebral , Niño , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Twenty-two patients with subdural haematomas associated with long term oral anticoagulation have been reviewed. Clinical presentation was similar to other subdural haematomas, but patients were generally older and the clinical course was more rapid. The incidence of over-anticoagulation was 23% and there was no correlation between anticoagulant status and the extent of bleeding or prognosis. Mortality was 27%, a residual neurological deficit was present in 14% and 59% made a complete recovery. The results suggest that morbidity and mortality could be reduced by early diagnosis and treatment and any patient on oral anticoagulant therapy who develops a headache or confusion should have urgent neurological investigation, including a CT scan. The indications for long term anticoagulation, particularly in the elderly, should be critically reassessed.
Asunto(s)
Anticoagulantes/efectos adversos , Hematoma Subdural/inducido químicamente , Administración Oral , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Femenino , Hematoma Subdural/diagnóstico por imagen , Hematoma Subdural/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Direct measurements of arterial blood pressure and intracranial pressure were recorded in 39 patients aged 3.6 months to 5 years 11 months with Reye's syndrome judged to be stage 2 or beyond. Of 33 patients who survived, 27 made a full recovery and six were severely handicapped. Measurement of cerebral perfusion pressure, which is greatly reduced in the more severe forms of Reye's syndrome, was a better guide to prognosis and management than intracranial pressure alone. The findings emphasise that maintenance of cerebral perfusion pressure is essential if mortality and morbidity are to be reduced. Intracranial monitoring is mandatory in all but the mildest cases of Reye's syndrome.
Asunto(s)
Presión Intracraneal , Síndrome de Reye/fisiopatología , Presión Sanguínea , Preescolar , Humanos , Lactante , Monitoreo Fisiológico , PronósticoAsunto(s)
Síndrome de Reye/fisiopatología , Glucemia/análisis , Preescolar , Femenino , Humanos , Lactante , Irlanda , Masculino , Pronóstico , Síndrome de Reye/sangre , Síndrome de Reye/terapiaRESUMEN
Reye's syndrome, an uncommon childhood encephalopathy of uncertain aetiology, is an important cause of mortality and permanent handicap. Since its recognition treatment has changed, current management focusing upon prevention or control of raised intracranial pressure. Prognosis is radically improved by early recognition and prompt transfer to a specialist centre.