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Biomedical subjects

M Magdinec

Publications and source records attributed to M Magdinec.

4 recordsLinked to original sources
PubMed1992

Application of magnetic resonance angiography to neurosurgical practice: a critical review of 150 cases.

The potential role of magnetic resonance angiography (MRA) in clinical neurosurgical practice was evaluated in 150 consecutive patients in an attempt to define clinical situations in which it aided in diagnosis, helped guide treatment options, and/or possibly eliminated the need for conventional catheter angiography. Among patients with nonvascular pathology (n = 42), MRA provided useful clinical information in 55% of cases, and could have effectively replaced catheter angiography in 76% of cases. In this group of patients, MRA provided excellent depiction of tumour and vessel relationships, and in conjunction with conventional imaging modalities reliably ruled out the question of tumour versus aneurysm whenever that question was raised. Among patients with vascular lesions (n = 108), MRA visualized the lesion in 18 of 20 (90%) aneurysms, 11 of 11 (100%) vascular malformations, 31 or 31 (100%) cases with known occlusive vascular disease, and reliably excluded occlusive vascular disease in 19 of 30 (63%) cases. The MRA potentially could have replaced conventional catheter angiography in less than 8% of cases with vascular pathology treated surgically, and in 76% of cases with vascular pathology treated medically or expectantly. Imaging time was relatively short, 10 to 20 minutes for intracranial vessels and 6.5 to 13 minutes for extracranial vessels. Shortcomings included the lack of spacial resolution required for surgical planning and the possible misleading information in the settings of low flow and partial thrombosis. It is concluded that currently available MRA modalities contribute useful information in a wide spectrum of neurosurgical clinical situations including screening and serial follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1991

Alternating sequential intracarotid BCNU and cisplatin in recurrent malignant glioma.

The authors entered 43 patients with recurrent malignant glioma in a trial of alternating sequential intracarotid BCNU and cisplatin. Protocol design was alternating courses of BCNU (2 doses, 300 to 400 mg each) and cisplatin (2 doses, 150 to 200 mg each) each at 4-week to 6-week intervals. Eight of 40 patients (20%) evaluable after the first course of BCNU showed partial or minor response. Only 18 patients were evaluable after the first course of cisplatin, and 5 were evaluable after the second course of BCNU. Median survival was 9 months (range, 2 weeks to 6 years). Cerebral or ocular toxicity unique to this method of chemotherapy administration and failure to show clinical improvement were the most common reasons for removal from study. Because of the high attrition rate, the authors were unable to determine a meaningful response to alternating sequential BCNU and cisplatin or to test the clinical degree of cross-resistance to these agents in human malignant glioma.

Adult↗
PubMed1990

Constant infusion of morphine for intractable cancer pain using an implanted pump.

In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief. A multidisciplinary team (neurosurgeon, anesthesiologists, psychiatrists, oncologists, and nurse clinicians) evaluated and treated all of the patients studied. Percutaneous placement of temporary epidural catheters for a trial assessment was performed by the anesthesiologists. Pain evaluations were conducted independently by psychiatrists using both verbal and visual analog scales. From 1982 to 1988, 41 (59.4%) of 69 patients evaluated for eligibility experienced good pain control during trial assessment and were subsequently implanted with Infusaid infusion pumps. Preinfusion pain analog values were 8.6 +/- 0.3 and postimplantation values at 1 month were 3.8 +/- 0.4 (p less than 0.001). Over this same 1-month period. requirements of systemic morphine equivalents decreased by 79.3% with epidural infusions as compared to preinfusion requirements (p less than 0.001). There were no instances of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockage. One patient developed apparent drug tolerance and three patients required further catheter manipulations. This series strongly suggests that significant reductions in cancer pain can be obtained with few complications and a low morphine tolerance rate using chronic epidural morphine infusion. Anesthesiology and psychiatry input, along with temporary catheter infusion screening and quantitative pain evaluations using analog scales, are essential.

Adult↗