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Biomedical subjects

J P Jenkins

Publications and source records attributed to J P Jenkins.

At least 19 recordsLinked to original sources

Epicardial controlled-release verapamil prevents ventricular tachycardia episodes induced by acute ischemia in a canine model.

Sustained-release preparations composed of verapamil-polymeric controlled-release matrices were characterized in vitro and utilized as epicardial implants in dogs with ischemic ventricular arrhythmias. Anesthetized open-chest dogs were subjected to 5 hourly, 10-min complete occlusions of the left anterior descending coronary artery followed by reperfusion. A controlled-release matrix preparation (20% verapamil, 80% polyurethane), placed on the left ventricular epicardium prior to the third occlusion, resulted in successful inhibition of ventricular tachycardia (VT) during acute ischemia in a dose-dependent manner. The largest matrix size used, 300 mg (20% verapamil), provided a net systemic dose of 0.52 +/- 0.18 mg/kg over 140 min and significantly reduced VT episodes during acute ischemia (fifth occlusion) compared to untreated controls (0.16 +/- 0.04 vs. 1.01 +/- 0.35 episodes/min, respectively; t = 2.62, p = 0.01). In controls, by the fifth occlusion ventricular fibrillation (VF) occurred after 5.41 +/- 0.78 min in 89% of animals. However, after a 300-mg verapamil matrix was placed on the left ventricular ischemic zone, VF occurred in only 45% (chi-squared = 4.1, p = 0.04, vs. controls) of the animals after 7.87 +/- 0.92 min (fifth occlusion). Systemic venous plasma verapamil levels during the 2 h following the 300-mg matrix ischemic zone implantation ranged from 8.4-22.0 ng/ml, while simultaneous regional coronary venous levels were 125.0-387.0 ng/ml. Sonomicrometry studies of left ventricular wall thickening carried out with a series of 300-mg verapamil matrix cardiac implants did not demonstrate any significant myocardial dysfunction. It is concluded that controlled-release verapamil, administered directly to the heart, was effective for preventing VT and VF associated with acute coronary ischemia, and that this route of administration was not associated with any significant deterioration of cardiac function.

Animals

Investigation of children with suspected spinal dysraphism by magnetic resonance imaging.

Findings on Magnetic Resonance Imaging (MRI) of 52 children with suspected spinal dysraphism have been reviewed. In 24, no significant spinal abnormality was demonstrated. Seven patients had scoliosis or vertebral segmentation anomalies without demonstrable abnormality of the underlying soft tissues and one had an isolated subcutaneous haemangioma. In 20 children with spinal dysraphism, a low tethered cord was the most frequent finding, occurring in 80%. Other manifestations included myelo- or meningocoele (60%), syringomyelia (30%), lipoma (25%), congenital tumour (20%), diastematomyelia (15%) and thickened filum terminale (5%). The relationship between the clinical reason for requesting MRI and the scan results are discussed.

Adolescent

Musculoskeletal haemangiomas: comparison of MRI with CT.

MRI and CT findings were reviewed from 11 patients with musculoskeletal haemangiomas. With MRI, morphological characteristics and extent of haemangiomas were optimally demonstrated on T2-weighted spin echo scans. High-resolution contrast-enhanced CT provided equivalent information regarding lesional characteristics and extent for small, localized haemangiomas. In CT evaluation of the extent of large haemangiomas, the radiation dose, transaxial scan plane, amount of intravenous contrast medium required and the necessity for correct timing of post-contrast scans became limiting factors. For such lesions, particularly those extending into the trunk, MRI supplemented by a plain radiograph is the optimum method of evaluation.

Adolescent

Magnetic resonance imaging of musculoaponeurotic fibromatosis.

Musculoaponeurotic fibromatosis can be mistaken for soft-tissue sarcoma both clinically and on X-ray computed tomography. Magnetic resonance imaging (MRI) in three patients with this condition enabled the correct diagnosis to be made prospectively in two. The appearance on MRI of a heterogeneous mass with well-defined, predominantly peripheral areas of very low signal intensity due to dense fibrous tissue and areas of medium to high signal intensity corresponding to a more cellular stroma should raise the the suspicion of musculoaponeurotic fibromatosis. Cellular areas within the tumour showed moderate enhancement after gadolinium diethylene triamine pentaacetic acid administration.

Adult

Accuracy in staging carcinoma of the bladder by magnetic resonance imaging.

Thirty-four patients with a presumptive diagnosis of carcinoma of the bladder diagnosed at EUA and cystoscopy have been staged by MRI and the findings correlated with pathology in 15 patients and clinical follow-up, including repeat cystoscopy, in the remainder. MRI is accurate in identifying tumours confined to the bladder wall or extending beyond the wall to involve perivesical fat or adjacent organs. Whilst it is not possible to distinguish between T1, T2 or early T3a tumours they can be distinguished from advanced T3a lesions and this may affect management. MRI is superior to clinical staging, particularly in detecting lymphadenopathy and provides information for optimal radiotherapy planning. The problem of distinguishing between the effects of radiotherapy and suspected recurrent tumour is discussed.

Aged

Diagnosis and assessment of mitral and aortic valve disease by cine-flow magnetic resonance imaging.

Seventy-six aortic and mitral valves, in 44 patients and 5 normal volunteers, were studied by Cine-Flow MRI (on a 0.26-T superconducting magnet system), utilizing compound oblique imaging planes and a Field Echo Even Rephasing sequence. All patients had had cardiac catheterization and echocardiography. All patients with valvular stenosis and aortic sclerosis (n = 45) showed complete signal loss distal to the respective valve. Length of signal loss distal to the aortic valve in those in whom it was measured (n = 15) allowed differentiation of aortic stenosis (n = 9) from sclerosis (n = 6). This also permitted grading of stenosis with highly significant correlation (T = 0.86; P less than 0.002) with pressure gradient measurement. In mitral stenosis (n = 12) calculation of the area of signal loss distal to the mitral valve as a percentage of left ventricular cross-sectional area showed a highly significant correlation (T = 0.77; P = 0.001) with pressure gradient measurement. Clinically significant valvular regurgitation was graded by size and duration of signal loss proximal to the value with concordance with angiocardiography. It is concluded that Cine-Flow MRI has a clinical role in the diagnosis and assessment of valvular heart disease.

Adult

Gadolinium-DTPA as a contrast agent in magnetic resonance imaging of the brain.

One hundred patients with CT-proven intracranial disease have been studied by magnetic resonance imaging (MRI) before and after intravenous injection with Gadolinium-DTPA (Gd-DTPA), in order to assess the role and clinical efficacy of Gd-DTPA. T2-weighted spin echo sequences, although sensitive to the detection of intracranial disease, in general fail to differentiate macroscopic tumor from oedema. Following Gd-DTPA, T1-weighted spin echo sequences in primary tumours demonstrated a variable degree of contrast enhancement unrelated to histological type. Small tumours, especially acoustic neuromas and meningiomas in the posterior fossa, were rendered more conspicuous. Optimum time for scanning was between five and 25 min following injection for all lesions except those adjacent to normal enhancing structures such as nasal/sinus mucosa and pituitary gland when delayed scans up to 45 min were necessary. No differences were observed between the 0.1 and 0.2 mmol/kg Gd-DTPA concentrations used and no complications attributable to Gd-DTPA were detected. Clinical advantages of Gd-DTPA include shorter scan times, macroscopic tumour/oedema separation and improved detection of certain tumours, particularly acoustic neuromas.

Adolescent

An unusual posterior cranial fossa tumour causing hearing loss.

Clivus meningioma is an uncommon tumour arising from the region of the synchrondrosis between the basal portions of the sphenoid and occipital bones. We report a case of a patient with a large meningioma of the clivus whose presenting symptom was auditory change. Alteration of hearing is a rare mode of presentation for such a tumour although it may present at a later stage in about 50 per cent of cases. The discrepancy between the size of the tumour and the paucity of physical findings, the value of a multiple test auditory screening strategy, and the surgical approach in this case are discussed.

Cranial Fossa, Posterior

Detection of coronary artery bypass graft patency as assessed by magnetic resonance imaging.

In a study of 22 patients with 60 coronary artery bypass grafts, magnetic resonance imaging (MRI) correctly assessed graft patency or occlusion in 90% of cases when compared with selective coronary graft angiography and computed tomography. It is concluded that MRI can detect a normally functioning coronary artery bypass graft and could be used as a non-invasive technique to assess graft patency in patients presenting with post-operative angina.

Adult

Magnetic resonance imaging of acoustic neuromas: the role of gadolinium-DTPA.

Magnetic resonance imaging (MRI) was performed in 20 patients with evidence on computed tomography (CT) of 21 acoustic neuromas before and after intravenous administration (0.1-0.2 mmol/kg body weight) of gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA). Multi-section spin-echo (SE) sequences of varying repetition (TR) and echo (TE) times were performed in the transverse and coronal planes with a section thickness of 10 mm. All acoustic neuromas displayed marked enhancement on the T1-weighted (short TR/TE) SE sequence post-Gd-DTPA. The intrameatal component was particularly well demonstrated compared with non-enhanced magnetic resonance (MR) images and contrast-enhanced CT. Identification of intrameatal tumour was difficult on T2-weighted SE images and one tumour was not identified on the T1-weighted SE sequence prior to Gd-DTPA. Four of five intrameatal tumours measuring less than 8 mm could only be demonstrated on CT by using CT air meatography. Extrameatal tumour extension was demonstrated on contrast-enhanced CT, although the assessment of brain-stem involvement and displacement was not as clearly seen as on coronal MR images. In two patients with large acoustic neuromas and a cyst, the true relationship of the cyst to the tumour could only be identified on the post-Gd-DTPA scan. Magnetic resonance imaging with gadolinium-DTPA is a relatively quick, safe, well tolerated and effective method for the diagnosis of acoustic neuroma.

Adolescent

Quantitative tissue characterisation in pancreatic disease using magnetic resonance imaging.

Twenty-nine patients, 27 of whom had either inflammatory disease of the pancreas or pancreatic tumour, were studied by magnetic resonance imaging (MRI) and computed tomography (CT). Six healthy volunteers were studied by MRI alone. The pancreatic T1 and T2 relaxation times were calculated using a multipoint iterative method with data from seven total saturation recovery and six spin echo sequences. Magnetic resonance imaging can demonstrate the normal pancreas and a variety of pathological processes greater than 1-2 cm in size, but with less spatial resolution than CT. The relaxation-time results indicated no significant discrimination between chronic pancreatitis and pancreatic tumour. A significant elevation in the relaxation times was observed, however, in those patients with calcific chronic pancreatitis compared with the non-calcific chronic pancreatitic group and normal controls, suggesting a different pathophysiology for the two subgroups of chronic pancreatitis. The active phase of acute pancreatitis was associated with significantly elevated relaxation times, which returned to normal levels during the resolved phase of the disease. Associated extrapancreatic fluid collections were characterised by their very long relaxation times. The problems associated with spatial resolution, respiratory motion and lack of quantitative tissue characterisation suggest that MRI of the pancreas, using present methods, is unlikely to contribute to the overall management of patients with exocrine pancreatic disease.

Acute Disease

Quantitative magnetic resonance imaging in rectal carcinoma.

T1 and T2 relaxation times have been calculated in 30 patients with rectal carcinoma and seven patients with a fibrotic pelvic mass. The relaxation times were calculated using a multipoint iterative method with data from seven total saturation recovery and six spin-echo sequences. The results show that the calculated T1 relaxation value is a useful discriminant between carcinoma and pelvic fibrosis and should improve the detection of early tumour recurrence.

Adenocarcinoma