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Biomedical subjects

L Mark

Publications and source records attributed to L Mark.

At least 19 recordsLinked to original sources
PubMed1997

Detection of glutamate/glutamine resonances by 1H magnetic resonance spectroscopy at 0.5 tesla.

Midfield proton magnetic resonance spectroscopy (MRS) provides a noninvasive method to monitor glutamate and glutamine (Glx) levels in vivo. Experiments to detect the gamma and beta resonances of Glx have been performed by using commercial 0.5 T and 1.5 T MR scanners on seven patients with elevated blood ammonia and eight normal volunteers. Compared with the spectral sensitivity obtained on an otherwise identical system operating at 1.5 T, the singlet resonance of N-acetyl aspartate (NAA) was decreased by a factor of 1.48, which is significantly less than expected using the ratio of Boltzman populations at the two field strengths. However, the resonances of Glx at 0.5 T increased in signal-to-noise ratio (SNR) by a factor of 2. The increased SNR of Glx is principally due to improved B0 main-field homogeneity and collapse of the strongly J-coupled Glx resonances. Our preliminary results suggest that midfield proton MRS will provide significant clinical utility in the detection of Glx levels in human brain.

Adult↗
PubMed1997

Accuracy of single-voxel proton MR spectroscopy in distinguishing neoplastic from nonneoplastic brain lesions.

PURPOSE: To measure the accuracy of single-voxel, image-guided proton MR spectroscopy in distinguishing normal from abnormal brain tissue and neoplastic from nonneoplastic brain disease. METHODS: MR spectroscopy was performed at 0.5 T with the point-resolved spectroscopic pulse sequence and conventional postprocessing techniques. Subjects consisted of a consecutive series of patients with suspected brain neoplasms or recurrent neoplasia and 10 healthy adult volunteers. Fifty-five lesions in 53 patients with subsequently verified final diagnoses were included. Spectra were interpreted qualitatively by visual inspection by nonblinded readers (prospectively) with the benefit of prior clinical data and imaging studies, and by blinded readers (retrospectively). The nonblinded readers interpreted the spectra as diagnostic or not, and, if diagnostic, as neoplastic or nonneoplastic. The blinded readers classified the spectra as diagnostic or not, and, if diagnostic, as normal or abnormal and as neoplastic or nonneoplastic (when abnormal). The sensitivity, specificity, positive and negative predictive values, and accuracy were calculated from blinded and nonblinded MR spectroscopy interpretations. A receiver operator characteristic (ROC) curve analysis was performed on blinded MR spectroscopy interpretations. RESULTS: The diagnostic accuracy averaged across four blinded readers in differentiating patients from control subjects was .96, while the area under the aggregate (pooled interpretations) ROC curve approached unity. Accuracy in the nonblinded and blinded discrimination of neoplastic from nonneoplastic disease was .96 and .83, respectively. The area under the aggregate ROC curve in the blinded discrimination of neoplasm from nonneoplasm was .89. CONCLUSIONS: Image-guided proton spectra obtained at 0.5 T from patients with suspected neoplasia can be distinguished from spectra in healthy control subjects, and neoplastic spectra can be distinguished from nonneoplastic spectra with a high degree of diagnostic accuracy.

Adult↗
PubMed1996

Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery. Sevoflurane Venture Group.

PURPOSE: Due to the progressive aging of the surgical population, the proportion of patients with coronary artery disease (CAD) is likely to increase. The effects of the new inhalational anaesthetic sevoflurane must be determined in patients with known CAD. METHODS: This multicentre, randomized, open-label study compared the haemodynamic and cardiovascular effects of sevoflurane and isoflurane with fentanyl in 284 ASA physical status II-IV patients undergoing elective coronary artery bypass graft (CABG). RESULTS: Satisfactory records were available in 272 patients, 139 sevoflurane (Group S) and 133 isoflurane (Group I). There were no differences between groups for demographic data except that more patients in Group S were taking preoperative beta-blockers (P = 0.03). The mean end-tidal MAC and MAC.hr requirements between groups were not different (Group S received 0.63 +/- 0.02 MAC and 1.00 +/- 0.05 MAC. hr while Group I received 0.58 +/- 0.02 MAC and 0.92 +/- 0.05 MAC. hr P = NS). The preCPB use of intravenous fentanyl was not different between groups. There was a similar decrease in haemodynamic variables in both groups after induction that persisted throughout the preCPB period. The incidence of preCPB myocardial ischaemia, adverse haemodynamic events and use of vasoactive drugs did not differ between groups. The incidence of postoperative myocardial infarction was 2.2% for Group S and Group I was 4.5% (P = NS). There were five postoperative deaths, one of which was attributed to a cardiac cause (Group I). CONCLUSION: In patients undergoing elective CABG with low risk factors, either sevoflurane or isoflurane, combined with fentanyl, provided an acceptable preCPB haemodynamic profile and cardiac outcomes.

Aged↗
PubMed1996

Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure.

BACKGROUND: Although the cerebrospinal fluid (CSF) is the pathway of anesthetic delivery and the diluent for neuraxially administered drugs, little is known about its volume, including variability among individuals, longitudinal distribution, or influence of body habitus. Models made to investigate subarachnoid anesthetic distribution lack valid dimensions. CSF volume was measured in volunteers, and the effect of obesity and abdominal compression on CSF volume was evaluated using magnetic resonance imaging. METHODS: Low thoracic and lumbosacral axial magnetic resonance images of 25 healthy volunteers were obtained at 8-mm intervals by fast spin-echo sequence, which highlights CSF. A repeat image series was performed in 15 subjects during external abdominal compression. In two subjects, images were obtained without compression for the entire vertebral column. Dural sac and spinal cord areas were determined in a blinded fashion for each image using video/digital analysis. Area of the sac minus area of the cord constituted area of CSF and roots ("CSF/root"); this area multiplied by 8 mm resulted in CSF/root volume per section. RESULTS: There is great interindividual variability in CSF/root volume. From the T11-T12 disc to the sacral terminus of the dural sac, the mean volume for all subjects is 49.9 +/- 12.1 ml (mean +/- SD; range 28.0-81.1 ml). This volume was significantly less in relatively obese subjects (42.9 +/- 9.5 ml) than in nonobese subjects (53.5 +/- 12.9 ml). Abdominal compression decreased CSF/root volume by 3.6 +/- 3.2 ml. Sections through intervertebral foramina showed the biggest decrease with abdominal compression, with a lesser change in sections with veins and no change in the absence of these anatomic features. Total vertebral CSF/root volume in two subjects was 94.84 and 120.01 ml, respectively. CONCLUSIONS: CSF volume is widely variable between individuals. The decreased CSF volume that results from increased abdominal pressure, such as with obesity or pregnancy, may produce more extensive neuraxial blockade through diminished dilution of anesthetic. The mechanism by which increased abdominal pressure decreases CSF volume is probably inward movement of soft tissue in the intervertebral foramen, which displaces CSF.

Abdomen↗
PubMed1995

Autonomic regulation of tissue resistance in the guinea pig lung.

Although the autonomic nervous system is known to influence airway tone and resistance in both the normal and inflamed lung, its effects on tissue resistance (Rti) have not been defined. To characterize autonomic neural control of Rti in the lung, we measured airway resistance (Raw) and Rti, lung elastance, and lung hysteresivity after adrenergic, cholinergic, and nonadrenergic noncholinergic (NANC) blockade in anesthetized mechanically ventilated guinea pigs by using the alveolar capsule technique. Five animals received 1 mg/kg i.v. phentolamine (alpha-blocker), eight received 1 mg/kg i.v. propranolol (beta-blocker), six received 0.1 mg/kg i.v. atropine (parasympatholytic), six had surgical bilateral vagotomy, and five were treated 14 days before study with 50 mg/kg sc capsaicin (peptidergic neurotransmitter depleter). Measurements were recorded at 5- to 10-min intervals for 120 min after pharmacological induction of autonomic blockade. Capsaicin treatment resulted in decreases in lung resistance (RL), Raw, and dynamic elastance (Edyn) compared with controls but Rti was not significantly affected. beta-Blockade resulted in significant increases in RL, Raw, and Edyn but did not affect Rti. alpha-Blockade and vagolytic maneuvers had no effect on RL, Raw, Rti, or Edyn. Furthermore, there was no effect of cholinergic, adrenergic, or NANC blockade on the relationship between Rti or elastance and breathing frequency or mean lung volume during tidal breathing. Our results suggest that, in the normal guinea pig lung, baseline Raw is modulated by both the beta-adrenergic and NANC nervous systems but Rti tone is largely independent of nervous system regulation.

Airway Resistance↗
PubMed1994

Effects of acute lung injury on dynamic tissue properties.

The dynamic properties of lung tissue after acute injury (ALI) were characterized by studying parenchymal strips prepared from guinea pigs endobronchially treated with hydrochloric acid. Forty-eight-hour samples (10 x 4 x 4 mm) from control (C), acid-damaged (D), and uninvolved (U) lungs of treated animals had elastance and resistance measured in a perfused organ bath system during uniaxial length oscillation at a mean force of 750 mg over a 1.5 (0.1-3 Hz)-fold decade frequency range and 5-fold (1-5%) strain amplitude range. Results were interpreted using a quasi-linear viscoelastic model with tissue stress expressed as an exponential function of strain. Among C strips, elastance increased linearly with the logarithm of frequency, whereas resistance decreased hyperbolically with frequency; both were strain amplitude independent. In contrast, elastance among D strips was uniformly greater (P < 0.0001) and was inversely strain amplitude dependent (P < 0.01); resistance was markedly elevated (P < 0.0001) but decreased hyperbolically with frequency similar to C strips. Resistance and elastance changes among U strips were intermediate between those for D and C strips. Histological grading of cellular infiltration, alveolar septal thickening, and hemorrhage correlated with functional changes. The frequency and amplitude dependencies and magnitude changes for resistance and elastance were similar to those previously observed in intact dog lungs after ALI. These findings suggest that ALI can affect the rheological properties of lung parenchyma independently of surfactant and that changes in lung mechanics after ALI may, in part, be determined at the parenchymal level.

Acute Disease↗
PubMed1985

Magnetic resonance imaging of the cavernous sinus.

The magnetic resonance (MR) appearance of the cavernous sinus was studied by correlating the MR images of normal volunteers and cryomicrotomic sections from six cadavers. In addition, MR images of patients with parasellar masses were compared with corresponding intravenously enhanced computed tomographic (CT) scans. The MR appearance of the cranial nerves in the cavernous sinuses is demonstrated, as well as MR signs of a parasellar mass, including obliteration of intracavernous venous spaces, displacement of the intracavernous internal carotid artery, and bulging of the lateral wall of the cavernous sinus. MR proved to be more effective than CT in delineating the parts of the cavernous sinus.

Aneurysm↗
PubMed1984

The pituitary fossa: a correlative anatomic and MR study.

This study characterizes the normal appearance of the pituitary fossa in partial saturation magnetic resonance (MR) images. In sagittal images, the pituitary fossa appears inhomogeneous. Correlation of sagittal MR images in normal subjects with sagittal cryomicrotomic images in cadavers suggests that the highest intensity signal from the posterior-inferior pituitary fossa is due to a fat pad. This conclusion was supported by MR images and postmortem cryotome sections obtained in normal subhuman primates. The cause of the less constant, low intensity signal was less certain. The height of the pituitary gland in sagittal images was usually less than 8 mm, and the upper surface was flat or concave.

Adipose Tissue↗
PubMed1976

Clinical and morphologic features of hepatic angiosarcoma in vinyl chloride workers.

Fifteen male workers exposed to vinyl chloride developed angiosarcoma of the liver. Thirteen died of disease and two are currently living for short periods after diagnosis. Their ages ranged from 36 to 58 years (average 47.5 years). Their exposure time ranged from 4 to 27.8 years (average 16.9 years). The most common presenting symptoms were fatigue, weight loss, and abdominal pain. Hepatomegaly followed by splenomegaly were the most common physical findings. Biochemical profiles yielded variable results and proved to be of little value in the detection or diagnosis. Of eight patients autopsied, distant organ involvement was present in two cases, duodenal involvement in one, and direct extension of tumor to adjacent organs or tissues in four additional ones. The remainder, diagnosed by open liver biopsy, revealed no tumor extension. The gross features of the tumors were hemorrhagic necrosis, cystic degeneration, fibrosis, and apparent multicentricity. The histologic features were those of the typical angiosarcoma found in a variety of sites with a wide range of cellular differentiation. The histologic diagnosis was often impaired by the extensive tumor necrosis. Elsewhere in the liver subcapsular fibrosis, a distinct type of portal fibrosis, and endothelial cell hyperplasia with or without sinusoidal dilatation were noted. The reduction of industrial chemical exposure has already been achieved and will hopefully eliminate this chemically related tumor in the future. There is, however, a significant group of previously exposed workers who will require careful monitoring to detect functional abnormalities of the liver and possible early neoplastic changes.

Adult↗