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Biomedical subjects

J E Boggan

Publications and source records attributed to J E Boggan.

At least 19 recordsLinked to original sources
PubMed2000

Spinal oligodendroglioma with gliomatosis in a child. Case report.

The authors present a rare case of oligodendrogliomatosis in a child, which they believe originated from a primary spinal cord tumor. At 2.5 years of age this boy developed poor balance, neck stiffness, and a regression in developmental milestones. A computerized tomography (CT) scan of the head initially revealed ventriculomegaly and multiple cystic cerebellar lesions. In addition, magnetic resonance (MR) imaging revealed a cystic intramedullary lesion involving the cervical spinal cord. A CT scan of the head and an MR image obtained 3 years later demonstrated diffuse small cysts on the surface of the brainstem, cerebellum, medial temporal and inferior frontal cortices, subcortical white matter, and corpus callosum suggestive of leptomeningeal tumor spread. Analysis of pathological specimens obtained at surgery showed neoplastic glial cells with small, uniform nuclei and perinuclear clear zones. The cells appeared to migrate along the subpial space but no tumor cells were present in the subarachnoid space. These findings were compatible with a diagnosis of oligodendrogliomatosis cerebri. Despite having a complicated course, chemotherapy with carboplatin has provided the patient with long-term palliation and a high quality of life. This case may represent the fifth report in the literature of oligodendrogliomatosis occurring in a child but only the third occurring with a spinal primary tumor.

Brain Neoplasms↗
PubMed1999

Intrathecal morphine delivered via subcutaneous pump for intractable pain in pancreatic cancer.

BACKGROUND: Pain secondary to unresectable pancreatic cancer is frequently severe and extremely difficult to control with traditional methods of analgesia. This retrospective study reports the analgesic effects of intrathecal morphine sulfate by implanted infusion pumps in nine patients with unresectable adenocarcinoma of the pancreas. METHODS: Nine patients were implanted over a 2-year period. Preoperative morphine i.v. equivalents were a mean of 81.51 mg/day, with a range of 20-140 mg/day. Patients were hospitalized for a trial dose of 1-2 mg of intrathecal Duramorph, 1 mg/ml, via lumbar puncture to assess whether adequate pain relief could be achieved and whether there would be drug-related side effects. RESULTS: All patients who received a trial dose experienced excellent pain relief, and subsequently underwent implantation of a lumbar subarachnoid catheter and infusion pump during the same hospitalization. The mean number of days from diagnosis to pump implant was 119, with a range of 3-587 days. The mean maximum daily dose was 21.28 mg, with a range of 3-73.10 mg. No patient experienced respiratory depression or excess sedation which prevented achievement of pain control. Minor supplemental narcotic use was documented in three of the nine patients. Assessment of pain control was made by the level of activity and the analog pain scale, with 0 being no pain and 10 being the worst pain imaginable. All of the patients experienced good to excellent relief of pain. The mean duration of intrathecal morphine sulfate use until death was 137.3 days, with a range of 52-354 days. CONCLUSIONS: This series of nine patients indicates that long-term administration of intrathecal morphine via implanted infusion pump in patients with pancreatic cancer is both efficacious and safe. All patients and their families reported an improved quality of life with an increased level of activity.

Adenocarcinoma↗
PubMed1999

Spinal sonography and magnetic resonance imaging in patients with repaired myelomeningocele: comparison of modalities.

The goals of this study were to evaluate the feasibility of using ultrasonography of the spine in the follow-up evaluation of patients with repaired myelomeningocele at birth and to compare sonography with the accepted modality of magnetic resonance imaging. Over a period of 4 years we performed 165 sonographic studies in 101 patients; 107 sonographic studies had MR imaging results for comparison. We collected our data prospectively. The quality of the sonograms was good in 110 of 129 studies, acceptable in 17 of 129, and poor in two of 129. The sonographic examinations failed in 33 of 165 studies (20%). Concordant information was obtained between ultrasonography and magnetic resonance imaging in the following percentage of studies: level of the distal end of the cord in 82%, position of the cord in the canal in 59%, presence of hydromyelia in 63%, cord duplication in 96%, adhesions in 16%, intradural mass in 37%, cord measurements in 85%, and dural sac measurements in 83%. At the lumbosacral level, we saw no cord pulsation in 57% of the studies in patients with cord adhesions and in 20% of those without adhesions. At the lower thoracic level, we saw no pulsation in 35% of the studies in patients with cord adhesions and in 7% of those without adhesions. Postoperative studies of cord release surgery in eight patients showed varied findings. We conclude that in those patients who have a spinal defect or interlaminar space allowing proper visualization of the lumbosacral spinal canal, ultrasound can provide fairly similar information to that obtained with magnetic resonance imaging of that area with no need for sedation and at a reduced cost. Ultrasonography seems more sensitive than magnetic resonance imaging in the detection of cord adhesions, which is particularly relevant in the diagnosis of tethering.

Adolescent↗
PubMed1998

Surgical pathology of the skull base: a 7-year experience.

A significant diversity of tissue types interface at the base of the skull and contribute to the diagnostic challenges of skull base surgical pathology. Advances in surgical technique now permit biopsy and resection of lesions previously termed "inoperable." Retrospective review was made of all pathology specimens from skull base surgeries performed at the University of California Davis Medical Center from 1990 to 1996. Surgical biopsies and resections were performed on 186 patients who had 33 distinctive diagnoses. Any preoperative biopsy or tissue from referring institutions was reviewed prior to skull base surgery. One hundred eighteen patients had benign lesions, the most frequent of which were pituitary adenoma (55) and acoustic neuroma (27). Other benign lesions included angiofibroma, meningioma, fibrous dysplasia, and paraganglioma. Sixty-eight patients had malignant tumors, 32 of which were squamous cell earcinoma. Other malignancies included salivary carcinomas, basal cell carcinoma, neuroblastoma, melanoma, and several sarcomas. Unexpected findings were two metastatic carcinomas and five inflammatory lesions. Nearly 1500 intraoperative consultations were performed to establish resection margins and less commonly to confirm the diagnosis. The discrepancy rate between the intraoperative and final diagnosis was 1.8%. Immunohistochemistry and/or electron microscopy was utilized in 44% of the specimens to confirm the diagnosis. Surgical pathology is an essential ingredient to a successful skull base surgery program. Pathologists are involved in both pre- and intraoperative decisions. The diversity of lesions that arise from the skull base often has overlapping histologies that require careful attention to morphology and the use of ancillary studies for accurate diagnosis. The need for frequent intraoperative interpretations contributes to the significant challenge for the surgical pathologist.

Journal Article↗
PubMed1997

Estrogen and progesterone receptor expression in neuroendocrine and related neurons of the pubertal female monkey hypothalamus.

Expression of hypothalamic estrogen receptors (ER) and progesterone receptors (PR) is barely evident in prepubertal monkeys but is prominent in adults. To investigate whether adult patterns of ER and PR expression are established in mid-pubertal female cynomolgus monkeys, we labeled neuroendocrine (NEU) neurons by microinjection of retrograde tracer into the median eminence, and then identified ER and PR by specific immunostaining in separate sets of hypothalamic sections. ER and PR appeared in the cytoplasm and nuclei of cells identified exclusively as neurons, and retrograde tracer remained clearly visible in the cytoplasm of NEU neurons after immunostaining. Numbers of NEU and related neurons expressing ER or PR were quantified in principal hypothalamic regions. In the supraoptic nucleus, almost all neurons analyzed (n = 580) contained ER (94%) with many also NEU (73% ER + NEU), while lesser amounts of the neurons examined (n = 214) expressed PR (75%) and were NEU (53% PR + NEU). In the paraventricular nucleus, most of the neurons analyzed (n = 302) contained ER (90% ER; 54% ER + NEU), but few of the neurons studied (n = 269) contained PR (34% PR; 19% PR + NEU). In the periventricular zone, nearly all neurons examined (n = 795) contained ER (95% ER; 48% ER + NEU), but fewer of those studied (n = 298) exhibited PR (79% PR; 47% PR + NEU). In the arcuate-periventricular zone, all neurons examined (n = 542) contained ER (100%) but few were NEU (4% ER + NEU), while nearly all neurons studied (n = 418) contained PR (95%), some of which were NEU (21% PR + NEU). Neurons expressing ER were also prevalent in areas without NEU labeling, including the diagonal band of Broca, medial preoptic area, and mammillary bodies, but were less common in the septum and dorsomedial hypothalamus. Likewise, neuronal PR expression was seen frequently in the mammillary bodies, but occurred less often in the diagonal band of Broca, medial preoptic area, and dorsomedial hypothalamus. Neurons in the suprachiasmatic nucleus and lateral hypothalamic area lacked retrograde labeling. These results identify the principal sites and subsets of NEU and related neurons which express ER and PR in the mid-pubertal female monkey hypothalamus. They appear to correlate well with known populations of steroid-sensitive NEU neurons present in these areas in adults. The data also suggest that functional patterns of ER and PR expression arise upon reactivation of the hypothalamic-pituitary-gonadal axis at puberty. The degrees of receptor expression and of nuclear translocation most likely reflect peripubertal changes in the levels of gonadal steroids. Taken together, these results provide important insights into the mechanisms and development of neuroendocrine control during the pubertal period in primates.

Animals↗
PubMed1997

Urodynamic findings in the tethered spinal cord syndrome: does surgical release improve bladder function?

PURPOSE: We retrospectively reviewed 39 patients with a tethered spinal cord to evaluate whether surgical release positively influenced urological symptoms or urodynamic findings. MATERIALS AND METHODS: The patients were divided into 2 groups: group 1-11 with occult spinal dysraphism and group 2-28 with secondary spinal cord tethering after previous closure of a myelomeningocele or resection of a lipomyelomeningocele. Diagnosis was confirmed in all cases by magnetic resonance imaging or spinal ultrasound. A comprehensive urodynamic evaluation was done immediately preoperatively and 2 to 21 months (mean 7) postoperatively. RESULTS: In group 1 the most common preoperative urodynamic finding was hyperreflexia, which improved or resolved after untethering in 62.5% of the patients. Four adults also reported improved bladder sensation or decreased urgency. In group 2 the most common urodynamic finding was impaired compliance, followed closely by detrusor hyperreflexia. Urodynamic patterns of detrusor hyperreflexia or compliance improved in only 30% of the patients, while 48% had worsened patterns. Only 14% of group 2 had improved symptoms of urinary control but 28% had improved lower extremity function. CONCLUSIONS: Urological symptoms and urodynamic patterns may be improved by early surgical intervention in patients with occult spinal dysraphism. However, untethering did not consistently benefit patients with secondary spinal cord tethering.

Adolescent↗
PubMed1996

Expansion and shrinkage of central nervous system tumor coinciding with human growth hormone therapy: case report.

OBJECTIVE AND IMPORTANCE: The influence of human growth hormone (hGH) therapy on the recurrence rates of childhood central nervous system tumors is controversial. Because growth hormone has the ability to increase cell proliferation, it is recommended that hGH therapy wait until central nervous system lesions are inactive and antitumor therapy complete, usually 1 to 2 years. CLINICAL PRESENTATION: We report the enlargement and decrease in size of a hypothalamic pilocytic astrocytoma in a 12-year-old boy after two trials of hGH. Partial resection and radiation of the tumor were performed at 3 years of age, with no change noted over the next 9 years. His height was less than the 5th centile with midparental height at the 90th to 95th centiles. Growth velocity was 3.3 cm/yr. Bone age was normal and there were no signs of puberty. There was no GH response to clonidine and L-dopa testing. INTERVENTION: Volume measurements were performed on gadolinium enhanced tumor images. Growth rate increased to 11.7 cm and the tumor volume increased 230% over the 12 months of hGH therapy. Significant tumor shrinkage (42%) and growth deceleration occurred within the 3 month interval of stopping hGH. Tumor volume again increased (134%) and decreased (22%) after restarting and then stopping hGH. No evidence of tumor necrosis or alteration in ventricular size was found. The patient was asymptomatic. CONCLUSION: These observations indicate that tumor size change is associated with the metabolic response to hGH therapy. It is unclear whether the volume increase represents altered blood-brain or selective blood-tumor barrier permeability, growth factor receptors, and/or tumor cell growth.

Astrocytoma↗
PubMed1995

Sphenoid sinus malignancies.

The sphenoid sinus has traditionally been considered a poorly accessible structure, situated deep in the center of the head and surrounded by vital structures. Aggressive benign and malignant tumors are usually considered to be inoperable because of the proximity of such structures, thus precluding the possibility of total extirpation. Using the transfacial-subcranial approach, lesions at this site can be totally excised. Significant tumor-free survival rates can be anticipated.

Carcinoma, Mucoepidermoid↗
PubMed1995

Traumatic aneurysm: a complication of stereotactic brain biopsy: case report.

Aneurysms involving cerebral cortical vessels are distinctly unusual. An aneurysm of a frontal cortical artery was discovered when a craniotomy was performed to excise a well-differentiated astrocytoma in a 3-year-old child. The aneurysm was located at the site where a computed tomography-guided stereotactic biopsy of the tumor had been performed. Although significant complications of stereotactic procedures are rare, they are most often related to vascular injuries and can be devastating to affected patients. The complications of stereotactic procedures are reviewed, and suggestions to minimize the development of these unusual events are provided.

Aneurysm, False↗
PubMed1993

Intraoperative frozen section diagnosis in skull base surgery.

During January 1990 through June 1992, we performed 39 surgeries for base of skull tumors with extracranial and intracranial involvement on 33 patients. Intraoperative frozen section was requested on 581 of 904 specimens submitted (64%). There was a discrepancy between the frozen section diagnosis and final diagnosis in 15 specimens for an error rate of 3%. There were two false-positive diagnoses of malignancy and 13 false-negative diagnoses. The discrepancies were a result of sampling error in ten cases and of interpretive error in five cases. Four of the five interpretive errors involved intradural tissues. Only two of the discrepancies were clinically significant. One involved the evaluation of adequacy of surgical margins and a second involved the misinterpretation of metastatic renal cell carcinoma for hemangioblastoma. We recommend careful attention to cryostat sectioning and interpretive experience in head and neck pathology and neuropathology. The importance of vigilant communications between surgeon and pathologist before, during, and after surgery cannot be overstated. We are utilizing a video-linked microscopic network that allows the surgeon to view the frozen section histologic sections in the operating room. Future trends may include the use of monoclonal antibodies and morphometry to improve accuracy in frozen section diagnosis.

Journal Article↗
PubMed1993

In vitro photodynamic effects of lysyl chlorin p6: cell survival, localization and ultrastructural changes.

The in vitro cell survival, localization and ultrastructural changes following irradiation were examined in 9L glioma cells sensitized with a new photosensitizer, lysyl chlorin p6 (LCP). In clonogenic assays, LCP was 10-100-fold more phototoxic than photofrin II on a microgram/mL basis. Lysyl chlorin p6 uptake was blocked when cells were incubated at 2 degrees C. In view of the chemical properties of LCP, this finding indicates that uptake probably occurred through the endocytic pathway. Fluorescence studies showed LCP localized in a region of the endocytic compartment similar in size, shape and distribution to that labeled by lucifer yellow CH (LY), as well as localizing diffusely throughout the perinuclear cytoplasm. Cells stained with both LY and LCP, however, had distinctly separate regions of staining. Lysyl chlorin p6 localization differed from that of fluorescent probes labeling the mitochondria, Golgi apparatus and endoplasmic reticulum. Ultrastructural changes at both 2 and 30 min after laser irradiation were similar. Mitochondria were often condensed or swollen and also had constrictions and cytoplasmic invaginations. The Golgi apparatus, perinuclear space and rough endoplasmic reticulum (RER) were dilated. These data demonstrate that LCP localizes in a portion of the endosomal compartment, but that morphologic damage initially occurs in the mitochondria, Golgi apparatus and RER.

Animals↗
PubMed1993

Normal brain tissue response to photodynamic therapy using aluminum phthalocyanine tetrasulfonate in the rat.

The effects of photodynamic therapy (PDT) on normal brain tissue and depth of brain necrosis were evaluated in rats receiving 2.5 mg/kg aluminum phthalocyanine tetrasulfonate. Twenty-four hours later brains were irradiated with 675 nm light at a power density of 50 mW/cm2 and energy doses ranging from 1.6 to 121.5 J/cm2. Brains were removed 24 h after PDT and evaluated microscopically. When present, brain lesions consisted of well-demarcated areas of coagulation necrosis. When plotting the depth of necrosis against the natural log of energy dose, the data fit a piecewise linear model, with a changepoint at 54.6 J/cm2 and an x intercept of 7.85 J/cm2. The slopes before and after the changepoint were 2.04 and 0.21 mm/ln J cm-2, respectively. The x intercept suggests a minimum light dose below which necrosis of normal brain will not occur, whereas the changepoint indicates the energy density corresponding to an approximate maximum depth of necrosis.

Animals↗
PubMed1993

Neuropeptide Y system of the female monkey hypothalamus: retrograde tracing and immunostaining.

Neuropeptide Y (NPY) stimulates the release of hypothalamic gonadotropin-releasing hormone (GnRH) as well as pituitary gonadotropins in the presence of ovarian steroids, but inhibits release in their absence. In primates, however, the effects of NPY depend largely upon the site and method of administration. In ovariectomized monkeys, NPY infusion into the stalk-median eminence reportedly causes a dose-response increase in GnRH secretion in the absence of gonadal steroids. To help elucidate these findings, we investigated the NPY system and its neuroendocrine (NEU) component in the primate brain by retrograde tracing and immunostaining. One adult female and 1 juvenile female cynomolgus monkey were given microinjections of retrograde tracer into the median eminence (ME). Two weeks later, they were perfused with fixative, and series of 40-microns frontal vibratome sections were collected at 500-microns intervals through 4 mm of the forebrain. Injection sites were not visible in the juvenile female monkey ME, so this animal served as a neurosurgical and injection control. Sections were immunostained using a polyclonal NPY antiserum and the peroxidase antiperoxidase (PAP) technique. NPY immunostaining in another adult female cynomolgus monkey and in a late fetal female and a neonatally castrated adult male rhesus monkey gave essentially similar results. NPY-immunoreactive (NPY-IR) neurons were widely distributed throughout the caudate nucleus, but appeared concentrated within specific hypothalamic areas. Their number, as well as the number of NEU neurons, was nearly equal in bilaterally paired areas and on both sides of the hypothalamus overall. Ratios of retrogradely labeled NPY-IR neurons to the number of NPY-IR somata were expressed as percentages of NEU NPY-IR neurons for each side and in each area. These averaged 65% in the supraoptic nucleus (SON), 41% in the paraventricular nucleus (PVN), 32% in the medial preoptic area (MPOA), which has only one quarter of their number of NPY-IR cells, and 11% in the medial basal hypothalamus (MBH). NPY-IR fiber densities were highest in the area olfactoria, medial septal and ventromedial nuclei. They were high in the tuberculum olfactorium, lateral septum, nucleus accumbens, MPOA, PVN, dorsomedial nucleus and regions of the MBH including the arcuate nucleus, tuber cinereum and ventral hypothalamic tract (VHT). NPY fiber densities were moderate in the vertical portion of the diagonal band of Broca, the ventral part of the caudate nucleus, the anterior commissural nucleus and the lateral preoptic area, as well as the anterior and lateral hypothalamic areas, the anterior ventral periventricular area, the suprachiasmatic nucleus and the dorsolateral SON.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

Effectiveness of a lysyl chlorin p6/chlorin p6 mixture in photodynamic therapy of the subcutaneous 9L glioma in the rat.

A new photosensitizer, LCP, a combination of lysyl chlorin p6 and chlorin p6, was synthesized and tested for effectiveness in photodynamic therapy using s.c. implanted 9L glioma tumors in rats. Tumors were irradiated with 664-nm light 4 h after LCP injection. Mean intratumoral temperature elevations were less than 4 degrees C using a power density of 50 mW/cm2 for 33.3 min (100 J/cm2). Subsequent experiments examining histological changes and tumor regrowth used a power density of 50 mW/cm2 and total energy densities of 25, 50, and 100 J/cm2. Microscopically, an energy density-dependent coagulation necrosis of tumor cells occurred in treated tumors. Long term inhibition of tumor growth was achieved only at an energy density of 100 J/cm2. Side effects of treatment were seen only in the irradiated area and consisted of coagulation necrosis of normal tissues in rats treated at 50 and 100 J/cm2, including severe skin necrosis. Exposure of rats to fluorescent room light did not cause any macroscopically detectable skin damage. Our data indicate that photodynamic destruction of s.c. 9L glioma tumors using LCP as a photosensitizer results in significant tumor growth inhibition and that further study of LCP is warranted.

Animals↗
PubMed1992

Craniofacial resection for intracranial inverting papilloma and frontal sinus mucocele.

Inverting papilloma is a locally aggressive neoplasm; however, intracranial extension is very rare. The authors herein report a case of massive inverting papilloma with intracranial extension and an associated frontal sinus mucocele, causing marked frontal lobe compression. Treatment consisted of combined anterior craniofacial resection. Magnetic resonance imaging provided accurate preoperative differentiation between neoplasm and inflammation. Skull base reconstruction may prove more difficult when there is significant frontal dead space resulting from chronic brain displacement by an associated mucocele. The management of this unusual neoplasm and a review of the literature is presented.

Journal Article↗