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Biomedical subjects
Publications and source records attributed to E F Binet.
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MRI was performed on 22 patients ranging in age from 3 months to 16 years who had closure of their meningomyelocele shortly after birth. These patients had developed new clinical findings suggestive of spinal cord dysfunction. MRI showed low placement of the spinal cord in all 22. Six patients had lipomas, five had diastematomyelia and six had hydromyelia. Four patients had an obviously dysplastic terminal cord.
A multicenter open, noncomparative evaluation of the safety of iohexol was prospectively conducted in 81 adult outpatients undergoing screen-film lumbar myelography. Iohexol (180 milligrams of iodine per milliliter) was administered via a lumbar route at a dose of 8-17 mL. Computed tomography (CT) was performed after myelography. The safety of iohexol was assessed by monitoring adverse reactions and neurologic status and by measuring vital signs and serum laboratory values. The most frequent adverse reaction was headache (16 of 81 patients [19.7%]). Twelve patients complained of a headache on the day of the myelographic procedure, and four patients reported a headache 24 hours after the procedure. Nausea or vomiting occurred in four of 81 patients (4.9%) only on the day myelography was performed. No other neurologic abnormalities were found. Iohexol produced myelographic and CT studies of good to excellent quality in all patients. This study indicates that iohexol can be employed safely in lumbar myelography of adult outpatients.
The case of a patient with two intraparenchymal brain plasmacytomas without cranial or dural attachment and with intratumoral hemorrhage is presented. Computed tomographic (CT) findings are described. Autopsy revealed two discrete intraparenchymal plasmacytomas with intratumoral hemorrhage, one cerebral and one cerebellar. There have been few case reports of brain plasmacytoma without cranial or dural attachment, and this case of multiple such intracranial, intraparenchymal plasmacytomas with hemorrhage is certainly unique. Intratumoral hemorrhage with intracranial plasmacytoma is extraordinarily rare. The literature of intracranial involvement with myeloma and plasmacytoma and the CT appearance of intracranial plasmacytoma are surveyed.
A suprasellar lesion masquerading as a pituitary tumor causing hyperprolactinemia in a 62-year-old man was found to be a large sphenoid mucocele. After it was successfully resected via a transsphenoidal approach, the patient's condition improved and the prolactin level fell to almost normal.
High-resolution computed tomography in intracranial aneurysms is a highly valuable procedure. Its indications are as follows: to determine the presence of subarachnoid hemorrhage and to predict the location of aneurysms; to identify and characterize saccular and giant aneurysms; to assess the complications of aneurysm rupture; to evaluate operative maneuvers and postoperative complications. The technique of high resolution computed tomography consists of unenhanced and enhanced 10-mm-thick sections followed by 1.5mm thin sections through suspicious areas. A bolus of 100cc of 60% meglumine diatrizoate is given for the enhanced study. A repeat bolus of 60cc of contrast agent is administered prior to the thin sections. Direct coronal scanning and sagittal/coronal reformatting is frequently used. This review will detail the technique used in this procedure as well as present examples of the major indications listed above. This is the procedure of choice for patients suspected of having had a subarachnoid hemorrhage or harboring an intracranial aneurysm.
The clinical and radiographic presentations of 3 patients with intraventricular cavernous hemangioma are described. The accumulated total of 19 cases from the literature are compared to determine whether there is a common clinical and radiographic presentation for this benign intraventricular lesion. The differential diagnosis of intraventricular cavernous hemangioma includes intraventricular meningioma, choroid plexus papilloma, arteriovenous malformation, low grade astrocytoma, and ependymoma.
Diagnostic quality of radiographs and adverse reactions associated with the use of metrizamide and iohexol as contrast agents in lumbar myelography were compared in a prospective randomized double blind study in 350 patients at seven centers. The contrast media were administered in comparable volumes at a concentration of 180 mg I per ml. Overall quality of radiographic visualization was graded good or excellent in 95% of 175 metrizamide studies and in 98% of 175 iohexol studies. Ninety-three patients examined using metrizamide (53%) and 130 patients examined using iohexol (74%) experienced no discomfort during or after myelography. Postmyelographic headache was associated with 38% of metrizamide examinations and 21% of iohexol examinations. Nausea and vomiting were also more common with metrizamide. Five patients examined using metrizamide (3%) experienced transient confusion and disorientation following lumbar myelography. No such reactions were observed following iohexol myelography.
Thin section, high resolution computed tomographic (CT) scans of the lumbar spine produce images that can show herniated intervertebral discs without intravenous or intrathecal contrast enhancement. With this technique, the diagnosis of posterolateral and midline herniation has been greatly facilitated. This communication reports the use of CT discography in the preoperative evaluation of two patients who were shown at discography and proven at operation to have extreme lateral disc herniations.
The value of digital pulmonary arteriography and balloon-occlusion cineangiography was investigated in 118 selected patients. In one series of 40 patients, digital pulmonary arteriography correctly identified pulmonary emboli in 20 (75%) of 26 positive examinations when interpretation was confined to the first three divisions of the pulmonary artery. In a second series of 78 patients with peripheral radionuclide perfusion scan defects, 40 of whom had pulmonary emboli, adjunctive balloon-occlusion cineangiography demonstrated emboli in four patients not seen on standard selective catheter pulmonary magnification studies with cut films. These two procedures (i.e., digital pulmonary arteriography and balloon-occlusion cineangiography) are important adjuncts to radionuclide perfusion scans and selective catheter pulmonary arteriography in the evaluation of patients with pulmonary emboli.
Through the acoustic window of the anterior fontanelle, coronal and parasagittal sonograms of the infant and premature neonate are easily obtained. Supplementary axial images are obtained through the lateral skull vault. The normal anatomy of axial, coronal, and sagittal sonograms will be demonstrated by correlating normal infant brain images with cadaver brain slices at similar levels. The relevant anatomical structures will be identified and labeled. Pathological entities, i.e., intracerebral hemorrhage, brain tumors, arteriovenous malformations, hydrocephalus, and congenital malformation syndromes will be included. Neonatal ultrasound is an inexpensive, innocuous, and noninvasive technique for examining the brain of the newborn infant. It does not require sedation and can be performed either within the radiology department or in the newborn intensive care unit.
High-resolution computed tomography (CT) is superior to other imaging modalities in assessing the extent and degree of spinal fractures. The determination of bone fragments within the spinal canal and the detection of posterior neural arch damage are major advantages offered by computed tomography. The addition of intrathecal contrast allows proper assessment of the oftentimes confusing neurologic picture. Plain roentgenograms of the spine are only the initial diagnostic examinations of spinal fractures. Roentgenograms in conjunction with high-resolution CT, performed with or without intrathecal contrast, provide the best evaluation of thoracolumbar spinal fractures.
The diagnosis of mycotic aneurysm is often elusive, since the patient frequently has signs and symptoms of sepsis only. A patient with a clinically occult mycotic aneurysm was assessed by the combined use of indium-111 leukocyte scintigraphy and computed tomography. While neither study was diagnostic by itself, the combined information obtained from the two noninvasive modalities facilitated the correct diagnosis preoperatively.
Computed tomographic myelography (CTM) is the procedure of choice in patients exhibiting spinal manifestations of neurofibromatosis. Due to the lack of specificity of several of the more important plain spine radiographic findings in this disease, CTM may be necessary to distinguish between surgical and nonsurgical entities. CTM will determine the size, shape, and intraspinal extension of posterior mediastinal neural tumors and separate them from the more common thoracic meningoceles. CTM will likewise elucidate the causes of posterior vertebral body scalloping, distinguishing between dural ectasia and neural tumor. CTM will also frequently demonstrate additional asymptomatic lesions at other levels.
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Of 55 patients undergoing carotid endarterectomy, 16 had abnormal postoperative angiograms by accepted literature criteria. Five of the 16 were symptomatic. The other 11 were neurologically stable or improved from their preoperative condition. None of the 16 patients underwent reoperation. Of those 11 who had abnormal postoperative angiograms but a good clinical result, four had a second postoperative angiogram some months later that demonstrated marked improvement in the appearance of the endarterectomy site. Patients undergoing carotid endarterectomy should not be subjected to routine postoperative angiography without clinical indications nor should they undergo reoperation on the basis of angiographic findings alone without consideration of their clinical status.
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