Biomedical subjects
Publications and source records attributed to J W Hanbery.
A 42-yr-old woman had a solitary metastases to her spine (T2) from a malignant struma ovarii. The thyroid was excluded as the site of the primary cancer. The lesion caused paraparesis. The spinal metastasis was treated by surgery and two doses of 131I (200 mCi each time). The patient responded very well and is entirely free of symptoms and signs. Repeat whole-body 131I scan shows no abnormality.
Malignant astroglial neoplasms of the cerebellum are rare and the clinical behavior of these tumors is unpredictable. The authors describe the histological characteristics and clinical outcome in 10 patients; eight had malignant cerebellar astrocytomas, and one each had an astroblastoma and a true polar spongioblastoma. Malignant glial tumors involving the cerebellum usually behave very aggressively. Cerebellar astroblastomas and polar spongioblastomas are too rare to predict their natural history. Some hypotheses are proposed concerning the evolution and interrelationship of malignant glial tumors of the cerebellum.
Ultrasound images of the brain were obtained intraoperatively and on an outpatient basis through a burr hole. The patient's tumor was well visualized, prior to biopsy, after biopsy, and during radiation therapy treatment. The ultrasound images correlated closely to the CT scan findings.
The authors present a case of malignant fibrous histiocytoma (MFH) involving a thoracolumbar myelomeningocele. The patient died of metastases 11 months after diagnosis, in spite of extensive surgery, radiation therapy, and chemotherapy. Meningeal involvement by MFH is very rare; 11 additional cases are reviewed. Glial fibrillary acidic protein staining is critical for proper histological diagnosis, as this tumor can be easily confused with pleomorphic xanthoastrocytoma or glioblastoma involving the meninges. Malignant degeneration within a myelomeningocele is also very rare. Eight additional cases from the literature are reviewed. Our case is the only one with MFH. Chronic irritation to the unrepaired congenital defect appears to be a key to the development of the malignancy. Prophylactic repair in infancy might prevent the occurrence of malignant degeneration.
A case of a cystic encapsulated arteriovenous malformation arising from the tela choroidea of the third ventricle is reported. Although the appearance of this lesion on computerized tomography scan suggested a colloid cyst by its location, it was atypical because of the non-homogeneity both before and after contrast infusion. The increased density on the unenhanced scan was due to hemosiderin pigment in the capsule wall caused by old hemorrhage. The diagnosis in this case was made by histological examination.
An anterior operative procedure using a strut of fibular graft material was performed either alone or in combination with a posterior stabilization in five patients with cervical spine instability secondary to neoplastic disease. Osseous tumor was present in four of the five patients (osteoblastoma, metastatic adrenal carcinoma, metastatic renal cell carcinoma, multiple myeloma) and the fifth had spine instability as a result of a posterior decompression for cervical spinal cord glioma. The anterior approach using fibula to replace diseased vertebrae and provide axial support for the neck was a valuable therapeutic modality in this group of patients, all of whom had a limited life expectancy. Cervical spine stability obtained by operative intervention led to a reduction of neck pain and maintenance of ambulation until the neoplastic condition became terminal.
The most widely used technique for treatment of a carotid-cavernous fistula involves embolization of the fistula with segmental occlusion of the internal carotid artery. An inflatable balloon capping a small flexible catheter becomes a controlled embolus when positioned within the internal carotid artery at the stoma of the fistula. A new double lumen catheter has been designed. Through one lumen the carotid circulation may be displayed, The second lumen allows inflation of the balloon through a self-sealing valve. In twelve patients, results were excellent in eight, fair in two, and poor in two patients intolerant of carotid occlusion.
From 1956-1972, 62 previously untreated patients with chromophobe adenomas received high-dose (average equivalent dose: 5700rads in 6 weeks) megavoltage (4-4.8 MeV) irradiation at Stanford, 33 postoperatively and 29 as the only intended treatment. Initialtreatment failure rates were 18% and 41%, respectively; however, overall control was 85% and 90%, despite 2 uncontrolled "invasive" adenomas in each group. Nine of the 12 failures in the group treated by irradiation alone had cystic tumors, and 9 of the 12 "failed" in less than 3 months. Despite a considerably greater degree of abnormal vision initially in the postoperative irradiation group, improvement of vision with treatment in that group was 83% (19% returned to normal) compared to 46% (only 8% to normal) in the irradiation alone group. Based upon an evaluation of the extent of findings at diagnosis and our results, we recommend surgical decompression followed by 5000 rads in 5 weeks for patients with any one or more of the following findings: 1)more than minimal depression of peripheral visual fields; 2) corrected visual actuity of less than 20/30 in either eye; or 3)more than 1-cm suprasellar extension of tumor. We recommend irradiation alone, as specified, for smaller adenomas accompanied by less extensive or no visual abnormalities.
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