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Biomedical subjects

M H Lipper

Publications and source records attributed to M H Lipper.

At least 19 recordsLinked to original sources
PubMed2001

Calvarial hemangiomas: report of two cases and review of the literature.

BACKGROUND: Primary hemangiomas of the bone are uncommon tumors, accounting for less than 1.0% of all bone neoplasms. These tumors are mostly found in vertebral bodies. Hemangiomas are rarely seen in the calvarium, where their frequency is 0.2% of all bone neoplasms. Because of their infrequent appearance in the skull, vague symptoms, and absence of prototypical radiological findings, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. CASE DESCRIPTION: We report two cases of calvarial hemangiomas: one with a single mass on the right sphenoid wing, and another with two similar lesions on the right occipital and left parietal bones. The diagnoses could be established only by histopathologic analysis. CONCLUSION: Histopathologic confirmation of the tumor is the definitive method for diagnosis of intraosseous hemangiomas. Radiological findings are not always characteristic for calvarial hemangiomas. Due to possible complications and the possibility of effective treatment, this lesion should always be considered in the differential diagnosis of skull lesions.

Adult↗
PubMed2000

Needle diameter in outpatient myelography: rates of adverse effects and current practice trends.

Telephone calls were made to 1251 consecutive patients one day following outpatient myelography. Data were available on 518 patients punctured with 22-gauge (g) (large-diameter) and 465 with 25-g (small-diameter) spinal needles. We surveyed 48 academic and private practice groups regarding needle diameter use in myelography; data were obtained from 34 private practice and 14 academic radiology departments. Patients reported adverse effects including mild and severe headache, back pain and nausea. The percentage of total adverse effects was significantly greater in the 22-g than in the 25-g needle group. The percentage of patients with headache was higher in the 22-g than in the 25-g group, but this difference was not statistically significant. Only 19% of private practice groups and 17% of academic centers use 25-g needles; the remainder use 20-g or 22-g needles.

Adult↗
PubMed2000

Cerebral atrophy in Cushing's disease.

BACKGROUND: Cushing's disease causes significant pathological changes throughout the body as a result of elevated cortisol levels. Very few systematic investigations have focused on the morphologic effects of hypercortisolism on the central nervous system. The validity of using premature cerebral atrophy as a diagnostic tool for Cushing's disease remains unknown. METHODS: This study includes 63 patients with Cushing's disease who were evaluated and treated at the University of Virginia Medical Center. Radiologists randomly compared these individuals with age- and sex-matched controls in a blinded protocol, assessing the degree of cerebral atrophy on computed tomography and magnetic resonance scans. RESULTS: Patients with Cushing's disease showed significant premature atrophy when compared with controls. This trend continued after subdividing the groups based on age and duration of symptoms except in the following groups: age greater than 60, duration of symptoms less than 1 year, and symptoms lasting between 4-5 years. CONCLUSIONS: Excluding the three aforementioned groups, the hypercortisolemic state manifested in patients with Cushing's disease promotes the premature development of cerebral atrophy, which can be identified on routine radiologic imaging and may assist in the clinical diagnosis of the condition.

Adult↗
PubMed1999

Sinus histiocytosis (Rosai-Dorfman disease) of the suprasellar region: MR imaging findings--a case report.

Sinus histiocytosis with massive lymphadenopathy (SHML) is an uncommon disorder that typically manifests as systemic symptoms and lymphadenopathy. Extranodal, intracranial disease is uncommon. The authors report on a 15-year-old adolescent girl who had a suprasellar mass at magnetic resonance imaging. Biopsy results demonstrated lymphophagocytosis consistent with a diagnosis of SHML. The clinical, radiologic, and histologic aspects of the disease are discussed.

Adolescent↗
PubMed1998

Brown-Séquard syndrome of the cervical spinal cord after chiropractic manipulation.

We report a case of increased signal in the left hemicord at the C4 level on T2-weighted MR images after chiropractic manipulation, consistent with contusion. The patient displayed clinical features of Brown-Séquard syndrome, which stabilized with immobilization and steroids. Follow-up imaging showed decreased cord swelling with persistent increased signal. After physical therapy, the patient regained strength on the left side, with residual decreased sensation to pain involving the right arm.

Braces↗
PubMed1997

Sinonasal undifferentiated carcinoma: CT and MR imaging of an uncommon neoplasm of the nasal cavity.

PURPOSE: To determine the computed tomographic (CT) and magnetic resonance (MR) imaging appearance of sinonasal undifferentiated carcinoma. MATERIALS AND METHODS: Findings from 11 patients with histopathologically proved sinonasal undifferentiated carcinoma were retrospectively reviewed. All 11 patients had undergone CT, and six of them had undergone MR imaging. RESULTS: The tumors usually were large (larger than 4 cm in maximum dimension in eight patients), had poorly defined margins, and arose within the ethmoid sinuses and superior nasal cavity. The aggressive nature of the tumor was demonstrated by bone destruction (n = 10) and by invasion of adjacent structures, including paranasal sinuses (n = 10), anterior fossa (n = 7), orbits (n = 4), pterygopalatine fossa (n = 2), parapharyngeal space (n = 1), and cavernous sinus (n = 1). On contrast material-enhanced CT scans, all tumors were enhanced to varying degrees. They tended to be noncalcified (n = 10) and often caused sinus obstruction (n = 10). MR signal intensity of the lesions was isointense to muscle on T1-weighted images in all six patients and iso- to hyperintense on T2-weighted images in five patients. Heterogeneous enhancement of tumors was seen on gadolinium-enhanced images. CONCLUSION: Sinonasal undifferentiated carcinoma cannot be distinguished from other tumors of this region (with the possible exception of melanoma) on the basis of imaging features.

Adolescent↗
PubMed1995

Ownership and utilization of MR imagers in the Commonwealth of Virginia.

PURPOSE: To assess distribution, operation, and ownership of magnetic resonance (MR) imagers in Virginia in 1991. MATERIALS AND METHODS: Questionnaires regarding ownership, location, hours of operation, annual throughput, sources and amounts of revenue, and expenses were mailed to identified providers. Data, specifically regarding ownership and location, were analyzed. RESULTS: Staff from 95% of MR facilities responded. Most facilities were located in and around major metropolitan areas. Population density per imager ranged from one per 76,000 to one per 222,000 persons. Imagers in larger metropolitan areas were operated for longer hours with higher revenues and greater expenses than were those in lower-population-density areas. Imagers owned by physicians in a position to self-refer had the highest patient throughput, the most revenue, and a much lower percentage of revenues from Medicare and Medicaid than did other ownership types. CONCLUSION: Patient access to MR services in Virginia is inhomogeneous. Important aspects of utilization are location and ownership. Ownership by physicians who can self-refer is associated with higher use, greater overall revenues, and less service to the poor and elderly.

Costs and Cost Analysis↗
PubMed1993

Limbic encephalitis occurring in association with Alzheimer's disease.

Paraneoplastic limbic encephalitis is a rare cause of subacute dementia. A patient with limbic encephalitis and small-cell lung carcinoma is reported in whom the onset of subacute cognitive impairment was obscured by concurrent Alzheimer's disease. MRI revealed increased T2 signal in medial temporal lobes which corresponded to inflammatory pathology demonstrated at necropsy. High titres of antineuronal antibody (type II, anti-Hu) were present at death. Direct immunofluorescent staining of necropsy tissue revealed IgG bound to most remaining neurons in the temporal lobe. Antineuronal antibody screening and MRI are important in detecting limbic encephalitis.

Aged↗
PubMed1991

Chordoma of the petrous bone.

We have presented two cases of chordoma arising from an unusual location within the skull. Chordomas in the skull usually arise from within the body of the clivus, reputedly from notochordal remnants. The first case, which was diagnosed both with CT and MRI, had its origin from the petrous bone, with extension into the left cerebellopontine angle. Chordoma was not considered high on the list of differential diagnoses. A right pontine hemorrhage, which was evacuated surgically, was diagnosed in the second case both from its clinical appearance and from that on CT scan. Only when bone windowing technique was used with CT was a lytic lesion of the right petrous bone evident. Chordoma was only diagnosed on autopsy. In reviewing these two cases and the literature, it is evident that chordoma must be considered in the differential diagnosis of erosive lesions of the petrous bone.

Adult↗
PubMed1989

Relationship between CT attenuation changes and post-traumatic CSF-CKBB-activity after severe head injury in man.

In order to evaluate if it is practically possible to assess the volume of contused brain tissue from the CT pictures, a comparison has been carried out between the size of the cerebral contusion(s)--as estimated from the CT scans--and the post-traumatic CSF-CKBB activity, in a series of 29 patients with severe head injury. A clearance curve for the elimination of CKBB from the CSF was constructed. The relation between contusion volume and CSF-CKBB-activity was not statistically significant, while the relationships between contusion volume and outcome, and between CSF-CKBB, as estimated at 6 hours after from the clearance curve, and outcome, were.

Adolescent↗
PubMed1986

Large brain metastasis not shown by computerized tomography.

We have described a patient with metastatic small cell carcinoma of the lung in whom cranial CT and contrast-enhanced CT failed to show metastases. When the patient died four days later, two sizable intracerebral metastatic foci were found at autopsy. Reviewing previously reported causes of nonvisualization of lesions, we have speculated on reasons for the lack of CT findings in this case.

Aged↗
PubMed1985

Computed tomography in the prediction of outcome in head injury.

To determine the prognostic significance of computed tomographic (CT) findings in head injury, retrospective analysis was performed in 128 randomly selected severe head-injury patients managed with a standardized protocol. The minimal criterion for entry into this study was that the patients were unable to obey simple commands or utter formed words. Serial CT was performed on admission and 3-5 days, 2 weeks, 3 months, and 1 year after injury. A scale of severity of abnormalities was devised taking into account the size of the traumatic lesions on CT. The CT findings using the proposed scale were correlated with the clinical outcome and analyzed using linear logistic regression. Other characteristics such as midline shift, multiplicity, and corpus callosum and brainstem lesions were not included in the analysis either because they did not affect the prognosis or because too few of these lesions were present for statistical analysis. The correct prediction rate of outcome using the proposed scale for CT findings alone was found to be 69.7%. When CT findings were combined with the Glasgow Coma Scale score this rate was increased to 75.8%.

Cerebral Hemorrhage↗
PubMed1981

Computed tomography in the evaluation of incidence and significance of post-traumatic hydrocephalus.

Two hundred consecutive patients with severe head injury underwent sequential computed tomography (CT) on admission, after 4, 14, and 90 days, and after one year. Ventricular enlargement was evaluated in the surviving patients, based upon serial CT examinations. Significant ventricular enlargement was further evaluated with radionuclide cisternography. A significant correlation was shown between clinical outcome and presence or absence of ventricular enlargement. Radionuclide cisternography provided an additional means of determining those patients whose recovery was impaired by persistent obstruction of cerebrospinal fluid circulation and who would therefore benefit from cerebrospinal fluid shunting.

Adult↗
PubMed1981

Craniopharyngioma: Unusual computed tomographic presentation.

Craniopharyngioma usually presents on a computed tomographic (CT) scan as a hypodense or isodense lesion, with calcification, in the suprasellar region. A case with atypical CT findings of a huge, homogeneous, high density, apparently solid, lobulated suprasellar mass is presented. An explanation for the appearance of the tumor is discussed based upon clinical analysis of the tumor contents.

Child↗
PubMed1981

Significance of CT in head injury: correlation with intracranial pressure.

The authors correlated the computed tomographic (CT) findings and intracranial pressure (ICP) in 150 consecutive comatose head injury patients to determine if noninvasive CT can help identify the patients not requiring ICP monitoring. The study reveals that a majority of patients (55%) with hemorrhagic lesions shown by CT suffer from intracranial hypertension and require ICP monitoring for proper management. Of the patients with normal initial CT, 98% had normal ICP during the first 24 hr. Of the patients with normal CT, 15% developed intracranial hypertension later, irrespective of the initial Glasgow coma scale score or age. More than half of the patients who developed intracranial hypertension subsequently had normal ICP through the first 48 hr. The study indicates that ICP monitoring need not routinely be performed on admission on severe head injury patients with a normal CT. However, repeat CT at 24--48 hr before ICP monitoring in patients with initially normal CT may be valuable, particularly if their clinical status deteriorates.

Adolescent↗