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Biomedical subjects

C J Moran

Publications and source records attributed to C J Moran.

At least 73 records · Page 4Linked to original sources

Theoretical basis for controlling minimal tumor temperature during interstitial conductive heat therapy.

This paper describes simulation of steady-state intratumoral temperatures achieved by a simple modality of local heat therapy: interstitial treatment with parallel arrays of warmed, conductive heating elements. During "conductive heating" power is directly deposited only in the interstitial probes. Adjacent tissue is warmed by heat conduction. Simulations of interstitial conductive heating involved solution of the bioheat transfer equation on a digital computer using a finite difference model of the treated tissue. The simulations suggest that when the complete temperature distributions for conductive interstitial hyperthermia are examined in detail, substantial uniformity of the temperature distributions is evident. Except for a thin sleeve of tissue surrounding each heating element, a broad, flat central valley of temperature elevation is achieved, with a well defined minimum temperature, very close to modal and median tissue temperatures. Because probes are inserted directly in tumor tissue, the thin sleeve of overheated tissue would not be expected to cause normal tissue complications. The temperature of the heated probes must be continuously controlled and increased in the face of increased blood flow in order to maintain minimum tumor temperature. However, correction for changes in blood flow is possible by adjusting probe temperature according to a feedback control scheme, in which power dissipation from each probe is the sensed input variable. Conductive interstitial heating with continually controlled probe temperature deserves investigation as a technique for local hyperthermia therapy.

Computer Simulation↗

Hyperthermia catheter implantation and therapy in the brain. Technical note.

For the treatment of malignant gliomas, a technique for implanting hyperthermia catheters was developed that utilized a stereotactic template and head-stabilization frame mounted on a computerized tomography (CT) scanner. Computerized tomography scans were used to measure tumor dimensions and to determine the number, implantation depths, and active heating lengths of the catheters, which were implanted through twist-drill holes while the patient was in the CT room. Heat was subsequently delivered via implanted catheters using a computer-controlled hyperthermia system, which partially compensates for heterogeneous and time-varying tumor blood flow.

Brain Neoplasms↗

Hyperthermia treatment of brain tumors.

Hyperthermia is a promising new therapy for malignant glioma, a brain tumor with grim prognosis. The authors describe their work with hyperthermia delivered directly to tumor tissue via heating catheters.

Brain Neoplasms↗

Dosimetry of CT-guided volumetric IR-192 brain implant.

Over the past 2 years, an afterloading technique has been developed and refined to implant radioactive Ir-192 sources into brain tumors. The implantation procedure integrates a stereotaxic system with computerized tomography (CT), which provides tumor position, volume, and guides the placement of catheters. A radiolucent ring-frame immobilizes the head as holes are made at 1 cm intervals with the aid of a template. Catheters containing dummy sources 1 cm apart are then inserted to the desired depth, and their position verified in three dimensions to insure complete coverage of visible tumor volume as defined by contrast enhancement. Once catheters are secured, the anesthetized patient is moved to the intensive care unit where the dummy sources are replaced by ribbons of Ir-192 seeds (specific activity 0.6-1.0 mg Ra eq). CT scans with the dummy sources in place are used to designate spatial coordinates of the active sources. A computer program converts position data and source strength into isodose contours in any plane. The implant duration (70-100 hours) for the desired dose to the tumor periphery (60-120 Gy) is then calculated. Dose rate contours are superimposed on preimplant CT scans. Maximum and minimum doses are determined in each of the various planes. Verification dosimetry has been carried out with thermoluminescent dosimeters placed in a catheter located in a plane along the tumor periphery. In vivo isodose values compared to idealized plans agree within +/-5%-10%.

Brachytherapy↗

CT-guided needle placement in the central nervous system: results in 146 consecutive patients.

The authors present their experiences with 185 computed tomography (CT)-guided needle placement procedures in 146 consecutive patients. There was 100% accuracy in first-pass entry into the lesion using a needle guide; 100% success in drainage of intracranial abscesses; 100% success in palliative decompression of intracranial cystic lesions including tumor cysts; and 97% accuracy in histologic diagnosis of unknown lesions. CT-guided aspiration biopsy corrected clinically incorrect diagnoses and altered patient management in 23% of all cases biopsied. Tabulation of complications revealed 0% incidence of scalp infection, bone infection, dissemination of tumor, or dissemination of infection; 13.5% incidence of clinically insignificant postprocedural bleeding; and 0.5% incidence of serious postprocedural hemorrhage leading to death (one patient only). Transient hemipareses were observed in three of 22 procedures for implantation of 192Ir but in none of 163 procedures for aspiration biopsy alone.

Abscess↗

Plasma exchange in systemic lupus erythematosus.

Eight out of 10 patients studied longitudinally received benefit from plasmapheresis. The patients were used as their own controls, being treated in a steady state as far as was possible. Levels of circulating complexes did not bear a close relationship with clinical results. On the evidence plasma exchange alone does not appear to represent an important part of the long-term management of patients with systemic lupus erythematosus but may well be of value in combination with other therapy.

Adult↗

Computed tomography of the lumbar thecal sac.

With a high resolution modification of a translate--rotate body scanner (EMI CT5005), radiologists may now demonstrate the epidural fat, thecal sac, and axillary pouches of the lower thoracic, lumbar, and sacral spinal canal without using contrast agents. Preliminary results with a newer rotary motion scanner (EMI CT7070) suggest that this scanner achieves sequally good delineation of intracanalicular anatomy.

Adipose Tissue↗

Precise anatomic localization of atraumatic sphenoethmoidal cerebrospinal fluid rhinorrhea by metrizamide CT cisternography.

Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single procedure. Clinical evaluation has disclosed no renewed leakage during a follow-up period from 6 to 18 months.

Cerebrospinal Fluid Rhinorrhea↗

Central nervous system lesions biopsied or treated by CT-guided needle placement.

Computed tomography has been utilized to guide a needle into central nervous system lesions as small as one centimeter in diameter. Direct puncture has drained many abscesses effectively, provided material for immediate Gram stain and subsequent culture, and permitted irrigation with appropriate antibioties, Multilocular cerebral lesions and loculated extracerebral fluid collections have been aspirated and treated with this technique. Aspiration of known cystic tumors has reduced their mass and obviated some palliative decompressions. Unresectable gliomas and metastases have been biopsied prior to chemotherapy or radiotherapy. Hemorrhage and other rare complications of biopsy may be detected and immediately treated.

Adolescent↗