Biomedical subjects
Publications and source records attributed to J E Gillespie.
A case of leptomeningeal melanoma metastases with a confusing clinical picture is presented. Despite repeated cytological examinations of the cerebrospinal fluid proving negative, the diagnosis was eventually made by magnetic resonance imaging with gadolinium DTPA enhancement.
The fate of capsular fragments left attached to vital structures at the time of otherwise total tumour removal was studied in 14 of 21 such patients who underwent acoustic neuroma surgery. Imaging using magnetic resonance Gd-DTPA at post-operative intervals of 6 months-12 years (mean 70 months) showed evidence of persistent tumour in half the patients. None of the patients had developed new symptoms and computed tomography had failed to demonstrate tumour recurrence. Persistence of the tumour was more likely if the residual fragments were not cauterized at the time of operation. Four of the seven persisting tumour rests showed evidence of gradual enlargement. The implications for patient management, particularly if an attempt is made to preserve hearing, are discussed.
Clinical features, contrast-enhanced lumbar tomographic findings, and biochemical plasma fibrinolytic parameters were critically assessed in 70 patients suffering severe, chronic postsurgical low-back and radicular pain to determine the cause of their persisting symptoms. Patients exhibited gross functional disability and significant impairment of plasma fibrinolytic activity, compared with 84 normal control subjects. This fibrinolytic defect appeared attributable to disproportionate increases in circulating plasminogen activator inhibitor-1 levels. Clinical features were slightly worse in patients with radiologic epidural fibrosis, whereas the frequency of radiologic abnormalities, including epidural fibrosis, was higher in patients with fibrinolytic abnormalities. The results, however, demonstrated no significant associations between patients' symptoms and signs and their biochemical and radiologic abnormalities.
This case report describes a patient with sciatica resulting from lumbar root compression by a gas-containing cyst in the extradural space. Removal of the cyst provided prompt relief. The origin and anatomic distribution of gas collections in the spine are considered based on a review of the literature.
Three-dimensional (3D) computed tomographic reformations have been used successfully as an adjunct to standard axial computed tomography (CT) in the evaluation of disorders affecting areas of complex anatomy. The basic requirements for high-quality 3D reformations are an absence of patient movement and narrow-width transaxial sections. Speed of examination is an important factor in optimizing image quality. One hundred examinations were performed on an IGE CT 9800 scanner. For bone studies, 80 mAs and, for certain soft tissues, 140 or 200 mAs were employed with 120 kVp. The advantages of such a "low-dose" technique are significant reduction in patient skin dose and a faster examination. The main disadvantage is a reduction in signal-to-noise ratio. The image quality obtained in 3D presentations has nevertheless been sufficient to enable all bony abnormalities to be identified. Three-dimensional examinations are now being performed routinely using a dynamic mode and this "low-dose" technique.
Explore the source record for details and available documents.
The purpose of this study was to determine whether diagnostically useful three-dimensional (3D) reformations could be obtained from unmodified high resolution pituitary CT scans. Twelve CT examinations in 9 patients in whom an enhancing tumour or extensive bone destruction was identified around the sella, were studied using 3D images obtained on soft tissue and bone thresholds. 3D images were considered superior to conventional CT sections and reformations for the assessment of the vascular relations of tumours with large supra-sellar components, and in cases of extensive bone erosion. In selected cases, 3D CT imaging may facilitate a faster and more comprehensive appraisal of high resolution CT studies by clarifying otherwise complex spatial relationships.
Standard radiography and computed tomography (CT) produce two-dimensional representations of anatomical structures under investigation. Recent developments in computer software now enable the production, from a series of conventional CT sections, of three-dimensional images of complex anatomical structures thus providing an opportunity for improved diagnosis and treatment planning.
Three-dimensional (3D) computed tomography (CT) reformations were obtained in 15 patients presenting with facial injuries of differing severity. The 3D images were compared with standard radiographs and high resolution CT, including multiplanar reformations, and assessed under the headings of fracture detection, extent and displacement using a simple scoring system. 3D was valuable in severe trauma with multiple fractures, providing a clear demonstration of fraction extent and fragment displacement. 3D was much less useful in minor trauma in which little or no fragment displacement had occurred, and demonstrated fewer fractures overall than either radiography or CT in all categories of facial injury. When used as part of a high resolution CT examination 3D imaging can provide useful information to both radiologist and surgeon in cases of severe facial trauma.
Benign tumors of the middle fossa components of the trigeminal nerve are rare. The authors describe the case history, radiological investigation, and operative findings of a patient with a large trigeminal neurofibroma of the middle fossa. The unusual mode of presentation is discussed. Valuable information was provided by magnetic resonance imaging prior to successful removal of this tumor.
Explore the source record for details and available documents.
The aim of the study was to assess the reliability of magnetic resonance imaging (MRI) in the detection of syrinx cavities and to determine the proportion of cavities associated with Chiari malformation. MRI was performed in over 120 patients with neurologic deficits referable to the cranio-cervical junction. Forty-one patients were also evaluated by CT myelography (CTM). CTM demonstrated appearances consistent with intramedullary cavitation in 14 patients. MRI detected 11 of these but in 3 the appearances, including cord size, were normal. In the entire study 27 syrinx cavities were demonstrated by MRI, 8 associated with trauma, posterior fossa or spinal tumours, or spinal dysraphism. Of the remaining 19, tonsillar ectopia was present in 10 (53%). It is concluded that a lack of concordance between MRI and CTM exists in the detection of small cavities in the normal sized cord, and that syringomyelia without evidence of tonsillar ectopia is identifiable by MRI more frequently than might be anticipated.
Fifty children had an upper abdominal radiograph performed 24 hours after cardioangiography with Hexabrix (meglumine/sodium ioxaglate). The gallbladder was clearly visualised in 32 patients (64%) in the absence of clinical or radiographic evidence of renal impairment. Total contrast dose would appear to be the main determining factor. Hexabrix differs significantly in this respect from conventional uro-angiographic contrast media (diatrizoate and iothalamate) in which opacification of the gallbladder is unusual and strongly associated with renal impairment. Possible reasons for this difference are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Thirty-three eyes of 22 patients with primary open-angle glaucoma or severe ocular hypertension had topical timolol maleate added to their maximally tolerated medical regimens. With minimal side effects, 25 eyes (76%) could be treated medically for one year, and only eight eyes (24%) required filtering surgery. Thirteen (39%) of the medically treated eyes achieved intraocular pressures of 21 mm Hg or less. After the addition of timolol, 17 of the 33 eyes (52%) completed the one-year protocol with final mean intraocular pressure decreases of 5 mm Hg or more on medical therapy.
Explore the source record for details and available documents.