Glomus jugulare tumours: A review of 61 cases

Summary A retrospective study of 61 patients with glomus jugulare tumours treated at the National Hospital for Neurology and Neurosurgery, and at the Royal National Throat, Nose and Ear Hospital, London. The average age at presentation was 41.7 years. The patients were mainly treated by a posterolateral combined otoneurosurgical approach. 42/61 of the patients had total or subtotal excision of their tumours, 7/61 had partial removal and the remaining 11/61 had no operation. Only one case required a 2-staged procedure. There were two deaths in the postoperative period, one from intracerebral haemorrhage and the other from the left hemisphere infarction.Postoperative radiotherapy was given to 5/7 of the patients who had partial removal. 3/40 of the patients with total removal had postoperative radiotherapy, and a further 3/40 had received radiotherapy pre-operatively.Of the 11 patients who did not undergo surgery, 7/11 were treated with radiotherapy and 4/11 had embolisation only.     

Jugular foramen neuromas: a review of 14 cases

We present 14 patients with jugular foramen neuromas treated in the professorial unit at the National Hospital, Queen Square, in the 20-year period from 1969 to 1989. The growth characteristics and associated symptomatology of these tumors are variable, and often they do not give rise to a typical jugular foramen syndrome, making differentiation from other low cerebellopontine angle tumors difficult and occasionally impossible. One tumor presented mainly in the neck, but the remaining 13 were predominantly intracranial and their anatomical relationships as defined radiologically determined the surgical approach used. Nine tumors were resected using a posterior fossa approach, three required a combined posterior fossa and neck dissection, and one a combined supratentorial and infratentorial craniotomy. The aim of operation was total excision of the tumor, which was achieved in 10 patients; the remaining three all suffered recurrence. There was no operative mortality and little long-term disability.     

Simple staining for heat-fixed brain sections after topographical pH analysis or autoradiographic studies

Powerful topographic techniques are now available, among which autoradiographic and fluorescent mapping are the most prevalent. These techniques produce images that usually do not correlate with brain anatomy; subsequent staining is required to allow a precise association between the parameter(s) investigated and brain structures. A simple staining procedure is described, compatible with heat-fixed brain sections, and that was found particularly valuable in association with topographical tissue pH studies using the fluorescent pH indicator umbelliferone.     

Establishing a new university department of rural health: the first 2 years of the South Australian Centre for Rural and Remote Health

ABSTRACT: This study aimed to describe the establishment of a new University Department of Rural Health (UDRH) in South Australia and to report early achievements. In May 1997, the UDRH was established, key staff were recruited, infrastructure was developed and in April 1998 a Joint University Committee on Rural and Remote Health was formed. By mid-1999, 14 full-time equivalent staff were employed in Whyalla and Adelaide. Early achievements include: review of undergraduate rural placements; increased rural clinical placements by 1000 student-weeks; partnership with the Dental School resulting in training opportunities and falling public dental waiting lists; multidisciplinary teaching practices in four rural sites; priority public health projects established; competitive research grants won; and a capital grant to strengthen Aboriginal health services infrastructure secured. These early achievements demonstrate UDRH potential to have a real impact on health worker education, service delivery, and public health status in rural and remote areas. This strong foundation must now be built on.     

The practical management of artifact in computerised physiological data

Computerised physiological data contains artifact that needs to be identified and possibly removed. Whilst computers may eventually satisfactorily perform this function, at present only manual removal is possible for the majority of intensive care computer groups. We assessed the effects of artifact and its removal on the physiological data of 3 patients. Artifact was manually removed from 7 days of data in 4 parameters (heart rate, respiratory rate, systolic blood pressure [sbp] and transcutaneous oxygen [tcpO2]) by 3 independent observers. Six hour time periods were analysed. Median and mean values before and after the manual removal of artifact were compared. Overall. 6.5% of data was removed as artifact. This was greatest for tcp02 (9.9%) and sbp (10.6%), with smaller amounts for respiratory rate (2.8%) and heart rate (2.4%). Sbp showed a marked difference in the amount of data removed between patients, whereas tcp02 data contained quite large volumes of artifact, but this was fairly consistent between patients, Removal of artifact affected mean values more than median values. One observer considered that both physiological and non-physiological artifact should be removed, whereas the other two observers removed only non-physiological artifact. Agreement in results between the latter was good. Our results suggest that interobserver variability should have a minimal effect on values, once rules identifying the type of artifact to be removed are agreed. Removal of artifact did not have a clinically significant effect on results, but may be an important consideration in the statistical analysis of computerised physiological data.Abbreviations CPTM computerised physiological trend monitoring - tcp02 transcutaneous pressure of oxygen - sbp systolic blood pressure     

Extracellular potassium activity, evoked potential and tissue blood flow. Relationships during progressive ischaemia in baboon cerebral cortex.

Extracellular K+ activity (Ke), local tissue blood flow and the cortical evoked potential (EP) were measured concurrently in the cerebral cortex of baboons anaesthetised with a-chloralose. Flows were progressively reduced from normal by occlusion of the middle cerebral artery and controlled steps of exsanguination. Our data suggest that 3 stages may be identified in the disturbance of K+ homeostasis produced by progressive ischaemia. In the first stage, at flow levels similar to those sufficient to abolish the EP (12-16 ml/100 g/min), small, self-limiting increases in Ke occur, probably reflecting K+ efflux into the extracellular space (ECS) with partial impairment of K+ clearance from the ECS. The second stage occurs at distinctly lower (P less than 0.01) levels of flow (8-11 ml/100 g/min), and is characterized by a massive (30-80 mM) increase in Ke, which we attribute to an increase in ionic permeability of cell membranes with further impairment or overloading of K+ clearance mechanisms. In the third stage, at flows below about 6-8 ml/100 g/min, the data indicate an inverse relationship between flow and Ke with persisting high Ke levels, suggesting complete loss of K+ clearance. Transient increases of Ke also occur in the flow range 4-13 ml/100 g/min, the rate of recovery of Ke in their decay phase being positively corelated with flow (P less than 0.005).