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Biomedical subjects

A Servo

Publications and source records attributed to A Servo.

At least 37 records · Page 2Linked to original sources

Cervical myelography with iohexol and metrizamide. A randomized double blind clinical study.

A randomized double-blind study with iohexol and metrizamide in cervical myelography was performed in 100 patients. The concentration of the contrast medium was 240 mg I/ml. The image quality was equal with both contrast media. Forty-two per cent of the patients receiving iohexol had side effects (headache 22%, nausea 6%, vomiting 2% and mental reactions 6%), in contrast to 80 per cent of the patients receiving metrizamide (headache 56%, nausea 34%, vomiting 24% and mental reactions 26%). The majority of side effects appeared within 6 hours after injection of contrast medium. Two patients had a late onset of symptoms - one in each group. Once appearing, the side effects tended to be equally severe.

Adolescent↗

Diagnosis of intracranial haemangiopericytomas with angiography and CT scanning.

Twenty-one primary intracranial haemangiopericytomas (HPC) were operated on from 1953 to 1983. The mean age of the 12 male and nine female patients was 38 years (17-64). Plain skull films showed well-defined bone destruction in two patients. Angiograms of 18 tumours (14 primary and four recurrent) showed the following when analysed according to the criteria of Marc et al. [4]: dual arterial supply (17/18), one-three main feeders giving rise to many irregular corkscrewlike vessels (16/18), dense, well-defined and long-lasting tumour strain (17/18), but early venous drainage rarely (1/18). The overall impression was that eight tumours appeared to be typical HPCs on angiogram. Five tumours had suggestive features, though not enough to justify specific angiographic diagnosis, and five were more like classical meningiomas. The larger tumours were more typical of HPCs, the smaller ones resembled meningiomas. CT scans of eight tumours (three primary and five recurrent) were available. The tumours were attached with a broad base to the convexity or other dural surfaces, often bilaterally. No calcifications were seen. There was little, if any, surrounding oedema. Contrast enhancement was strong and homogeneous. Four of the tumours were ring like, but the ring was thick and regular, in contrast to that in glioblastomas. The tumour margin was well-defined and smooth in three tumours, and nodular margins were seen in five; two of the latter grew extensively along dural surfaces. This sign may suggest aggressive biological behaviour. If both angiograms and CT scans are available, HPCs can be differentiated from glioblastomas and classical meningiomas, but perhaps not from anaplastic meningiomas.

Adolescent↗

Accidental introduction of contrast medium into the cervical spinal cord. A case report.

The density of metrizamide injected accidentally into the spinal cord during cervical CT myelography was measured with CT scanning and compared with a series of dilutions of metrizamide scanned with a special phantom. The test suggests that the metrizamide is diluted rapidly in the spinal canal, and in an accidental intraspinal injection of metrizamide, it is not the contrast medium itself but the mechanical effect of the introduction of a volume of fluid that causes the neurological symptoms.

Aged↗

Computed tomographic myelography (CTM) in atlanto-axial rheumatoid arthritis.

Thirty-two patients with severe cervical rheumatoid arthritis were investigated preoperatively with cervical myelography (CeM) and computed tomographic myelography (CTM). The severity of their clinical symptoms correlated excellently with a combination of the deformation of the spinal cord at the atlanto-axial level, the lateral dislocation of the cord at the same level, and the deformation of the cord at some lower cervical level. Obstructing soft-tissue excrescences seemed to have little significance. No correlation was found in this study between the deformation of the cord and the main findings of the plain films: the atlanto-axial subluxation (AAS), the vertical subluxation (VS), or their combination.

Adult↗

Intracranial hemangiopericytoma: radiology, surgery, radiotherapy, and outcome in 21 patients.

At operation, 21 meningeal intracranial hemangiopericytomas resembled meningiomas, but differed histologically. They were frequently attached to sinuses, occipitally located, bled profusely at operation, and had a higher risk of recurrence and metastasis. Specific preoperative diagnosis is possible: computed tomography scan showed a meningiomalike tumor, which on the angiogram looked malignant and highly vascular. Two tumors showed a malignant growth pattern on computed tomography scan, "mushrooming." After a radical removal, three patients have lived for more than 10 years without recurrence; two of them were irradiated postoperatively. Three recurrent tumors were treated with radiotherapy only; one responded favorably.

Adolescent↗

Diagnosis of cavernous haemangiomas by computed tomography and angiography.

Computed tomography and angiographical findings of cavernous haemangiomas of the brain are reported on the basis of six cases of the authors, and a review of the literature. Computed tomography showed well demarcated, round densities with tiny calcifications, and mild contrast enhancement (0-25 HU), with no mass effect and with open sulci round the lesion. The angiographical findings were normal except in one patient with an early draining vein and in another with a late draining vein; consequently an injection of at least 10 to 15 ml of contrast medium, and a prolonged angiographical series are recommended. According to the literature, capillary blush may also be seen in angiography. If both CT and angiography are used the diagnosis is definitive, and a neoplasm can be excluded. In five of our patients the diagnosis was verified surgically and histologically, while the sixth patient was not operated on because the frontoparietal lesion was near the motor region. In most cases, surgical removal is easy and successful.

Adult↗

Variable filling of an arteriovenous malformation during carotid angiography. A case report.

An 11-year-old girl was operated on for a frontal arteriovenous malformation in 1978; a postoperative carotid angiogram showed no filling of the AVM. The patient still had epilepsy. In 1981 a carotid angiogram showed no AVM. Some months later a new carotid angiography was done. In the first lateral series no AVM was seen but on the second injection with one more millilitre of contrast medium a large frontal AVM became apparent. The reasons for such variable filling are discussed.

Carotid Arteries↗

Diagnosis of ependymal intraventricular cysts of the third ventricle by computed tomography.

The radiological features of seven patients with surgically verified intraventricular ependymal cyst of the third ventricle are presented. In two patients the pre-operative diagnosis was made by ventriculography, in two by ventriculography and computed tomography (CT), and in the last three patients CT alone was sufficient for correct diagnosis: ventriculography was no longer necessary. The third ventricle is indistinguishable from a cyst with an oval or nearly round configuration with a width-to-length ratio varying between 0.53 and 0.91 (mean 0.79). The density of cerebrospinal fluid within the third ventricle/cyst is a little higher than that of the lateral ventricles. A cyst can also be seen within the suprasellar cistern. The septum pellucidum is not widened, and the internal cerebral veins are pushed up between the lateral ventricles. These diagnostic signs show up well in coronal CT sections. The round third ventricle together with the rounded and enlarged frontal horns of the lateral ventricles often give an impression of the head of Mickey Mouse.

Adolescent↗

The superior ophthalmic vein and tumours of the sellar area.

The venous drainage dynamics of the cavernous sinus were studied by means of 50 carotid angiograms and 18 orbital phlebographies performed on 47 patients with various tumours of the sellar area. Normal blood flow direction in the superior ophthalmic vein (SOV) (from the facial veins into the cavernous sinus) was seen in supra- and small intrasellar tumours, but not in parasellar tumours. In bigger intrasellar tumours and in parasellar tumours the reversed blood flow direction visible in the SOV (from the cavernous sinus into the facial veins) indicated infiltration or compression of the cavernous sinus by tumour. The sign of reversed flow together with CT findings is useful in differential diagnosis and in planning surgical treatment for tumours of the sellar area.

Adenoma↗

Subdural effusions re-appearing after shunts in patients with non-tumoural stenosis of the aqueduct.

Three patients shunted for non-tumoural stenosis of the aqueduct suffered from progressive clinical symptoms about four months after the shunting. Computed tomography (CT) showed bilateral subdural effusions. The effusions were evacuated, and the shunts revised. One month later all patients suffered from symptoms of increased intracranial pressure, and CT showed enlargement of the supratentorial cerebral ventricles. The effusions had disappeared. After shunt revision the symptoms decreased again. The fluctuation in the ventricular size, the thickness of the subdural effusions, and the clinical deterioration were related to the change in the opening pressure of the shunt valve in all patients. Patients with large supratentorial cerebral ventricles (Evans index over 0.40) should be monitored by intraventricular pressure recording in order to select the exact opening pressure of the shunt valve before inserting a relieving shunt; a clinical check-up and a CT examination should be carried out about three months after the operation in order to investigate any changes in the function of the shunt.

Adult↗

Sphenoid sinus fluid level in skull-base fractures.

The value of a sphenoid sinus fluid level in the diagnosis of a skull-base fracture was studied in two materials: one of 41 accident victims who died from brain injury an had their skull-base fracture verified at autopsy; and another of 36 patients with a sphenoid sinus fluid level visible on their emergency skull radiographs. The inclusion of sphenoid fluid in the diagnostic criteria for skull-base fracture improved the diagnostic accuracy from about 65% to about 80%. The false positive cases were caused by facial fractures. The false negative cases mainly occurred among severely ill patients, who had a small amount of sphenoid fluid and suboptimal radiographs.

Adolescent↗

Visualization of the superior ophthalmic vein on carotid angiography.

Visualization of the superior ophthalmic vein (SOV) on carotid angiography was investigated based on a prospective sample of 452 carotid angiograms performed during one year. The SOV with normal blood flow direction, from facial veins into the cavernous sinus (CS), was seen on 26% and with reversed flow direction in 7% of the angiograms. A hypothesis was suggested that the anatomical variations of the middle cerebral (MCV) and uncal veins (UV) affected the visualization. When both the MCV and UV drained into the CS, the SOV was seen in 11% of 179 angiograms. If the MCV and UV bypassed the CS, the SOV was seen on 51% of 118 angiograms. The difference is significant. Intubation of the patient increased the visualization of the SOV with normal flow direction but did not affect the visualization of the SOV with reversed flow. No SOV with normal blood flow direction was seen on selective internal carotid angiogaphy.

Brain↗

Metrizamide cisternography in the diagnosis of acoustic neurinomas.

Seventy-three cisternographies with metrizamide were performed on 69 patients, mainly for diagnosis of an acoustic neurinoma. Of the 31 patients with pathological findings on cisternography 26 underwent surgery for 23 acoustic neurinomas, one neurinoma of the facial nerve, and two meningiomas. For diagnosing small tumours of the cerebellopontine cistern, cisternography is superior to all other neuroradiological methods. Tomography of the porus acusticus internus and CT scanning are the initial radiological methods in patients with signs of cerebellopontine angle lesions; if no lesion is disclosed by these two methods cisternography with metrizamide should be performed to exclude a small tumour, particularly a small acoustic neurinoma.

Adolescent↗

Double-contrast ventriculography with oxygen and water-soluble positive contrast medium, metrizamide (Amipaque).

A technique for ventriculography using both gas and a positive contrast medium metrizamide (Amipaque) is presented. This ventriculographic method proved superior to computerized tomography (CT) scanning in revealing the cause of obstructive hydrocephalus. Small central tumors and intraventricular cysts, often missed with CT, were also well demonstrated. This technique has been used since 1975, and is simple and safe.

Adult↗

Medullary emergency.

32 patients with symptoms and signs of medullary compression were submitted as emergencies to clinical and radiological examination in our hospital during a 5-year period. None of the patients was able to walk on admission. 27 emergency operations were performed to relieve medullary compression. If a single lesion in plain radiographs was well correlated with clinical symptoms and signs, the myelogram did not reveal crucial information. Young patients--aged 29 years or less--or patients with moderate symptoms on admission usually regained their ability to walk; as well as patients with a negative myelogram. On the other hand, old patients--aged 60 years or more--were only exceptionally able to walk later on. Other unfavourable signs were: a lesion of the thoracic spine, a total block in the myelogram, and a metastatic lesion. Our results of an emergency treatment were not better than the results of unhurried series reported in the literature.

Adolescent↗