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Biomedical subjects

C A Romanowski

Publications and source records attributed to C A Romanowski.

17 recordsLinked to original sources
PubMed2001

Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) and surgical clipping of intracranial aneurysms are associated with substantial morbidity and mortality. OBJECTIVE: To compare cognitive outcome and structural damage in patients with aneurysmal SAH treated with surgical clipping or endovascular coiling. METHODS: Forty case-matched pairs of patients with aneurysmal SAH treated by surgical clipping or endovascular coiling were prospectively assessed by use of a battery of cognitive tests. Twenty-three case-matched pairs underwent MRI 1 year after the procedure. Matching was based on grade of SAH on admission, location of aneurysm, age, and premorbid IQ. RESULTS: Both groups were impaired in all cognitive domains when compared with age-matched healthy control subjects. Comparison of cognitive outcome between the two groups indicated an overall trend toward a poorer cognitive outcome in the surgical group, which achieved significance in four tests. MRI showed focal encephalomalacia exclusively in the surgical group. This group also had a significantly higher incidence of single or multiple small infarcts within the vascular territory of the aneurysm, but both groups had similar incidence of large infarcts and global ischemic damage. CONCLUSION: Endovascular treatment may cause less structural brain damage than surgery and have a more favorable cognitive outcome. However, cognitive outcome appears to be dictated primarily by the complications of SAH.

Cognition↗
PubMed2001

Multimodality MR imaging depiction of hemodynamic changes and cerebral ischemia in subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is a common and serious neurologic emergent condition. We tested the hypothesis that multimodality MR imaging depicts changes in cerebral blood flow SAH, before any surgical or endovascular intervention, and that the frequency of these changes increases with time after ictus. METHODS: We prospectively examined 37 patients with suspected SAH and three with symptoms of acute stroke but who subsequently had SAH. Routine CT and multimodality MR imaging were performed within 18 h of presentation. Standard MR imaging, diffusion-weighted MR imaging, time-of-flight MR angiography, and dynamic first-pass gadolinium-enhanced MR perfusion imaging were performed. Images were reviewed for abnormalities in cerebral blood flow, ischemia, and infarction. Nine patients did not have SAH at CT and CSF investigations. Of 31 patients with proved SAH, 13 were examined during the acute stage (within 4 d of ictus) and 18, during the subacute stage (4-14 d after ictus). RESULTS: MR imaging showed alteration in cerebral blood flow parameters in 16 of 31 patients before surgery or endovascular treatment. The frequency of blood flow changes and associated complications increased with worsening clinical grade and increasing time after ictus. CONCLUSION: Multimodality MR imaging provides information not available from CT in patients with SAH. MR imaging shows oligemic and ischemic areas in SAH before surgery or endovascular treatment. MR imaging is a simple noninvasive method of assessing cerebral blood flow and its complications in SAH. It can be performed in a clinical environment.

Adult↗
PubMed2000

Acute neuromedical and neurosurgical admissions. Standard and ultrafast MR imaging of the brain compared with cranial CT.

PURPOSE: To evaluate the role of standard and ultrafast MR brain imaging and compare the information with CT. MATERIAL AND METHODS: This was a prospective study of 114 patients with acute neurological symptoms and signs. CT brain examinations consisted of axial non-enhanced images. MR imaging consisted of standard spin-echo/fast spin-echo sequences and a series of rapid techniques including echoplanar and single shot fast spin-echo sequences. RESULTS: Using standard MR methods, 41% of the patients had all five sequences of good technical quality, while using ultrafast methods 81% of the patients had good technical quality examinations in all five sequences. In 3% of the cases, ischaemic stroke was incorrectly reported on CT. In 24% of the cases, MR gave extra diagnostic information not reported on CT and in a further 8%, one neuroradiologist reported the abnormality in agreement with the MR, whilst the other neuroradiologist reported the CT as normal. In 2 cases, subarachnoid haemorrhage was missed on MR. Subarachnoid haemorrhage was not shown on the ultrafast sequences. CONCLUSION: MR can be used to image acute neurological admissions with a high success rate, particularly using ultrafast methods. In many cases, MR provided extra information of direct clinical relevance not shown on CT.

Acute Disease↗
PubMed2000

Subcortical hypoperfusion following surgery for aneurysmal subarachnoid haemorrhage: implications for cognitive performance?

The incidence and severity of cognitive deficits after surgery for aneurysmal subarachnoid haemorrhage and their relationship to aneurysm site remains controversial. The aim of this study was to investigate the pattern of regional cerebral blood flow which exists in patients one year post-surgery and to identify whether different patterns exist which may be related to the type of cognitive deficit or the location of the aneurysm. 62 patients underwent cognitive assessment and HMPAO SPECT imaging at a mean time of 12 months following surgery. Results were compared to those from healthy control subjects (n = 55 for neuropsychological testing; n = 14 for SPECT imaging). In the patient group, significant stable cognitive deficits occurred in all cognitive domains but no cognitive measure differentiated aneurysm site. On SPECT images, statistical parametric mapping identified a large common area of subcortical hypoperfusion in the patient group as a whole. The findings of this study suggest a possible link between reduced subcortical function and the extent and severity of cognitive deficits.

Journal Article↗
PubMed1998

Tuberous sclerosis, von Hippel-Lindau disease, Sturge-Weber syndrome.

The neurocutaneous disorders frequently involve the central nervous system. This is the second in a pair of articles describing and illustrating the radiological appearances of the central nervous system manifestations of these disorders, this article looking at tuberous sclerosis, von Hippel-Lindau disease and Sturge-Weber syndrome.

Humans↗
PubMed1998

Neurofibromatosis types I and II: radiological appearance.

The neurocutaneous disorders frequently involve the central nervous system. This, the first in a pair of articles which describe and illustrate the radiological appearances of the central nervous system manifestations of the most common neurocutaneous disorders, looks at neurofibromatosis types I and II.

Adolescent↗
PubMed1997

Construction of a standard reference for PET studies of methionine accumulation using a computerised brain atlas.

Positron emission tomography (PET) is valuable for assessing the biochemistry and physiology of the human brain. A computerised brain atlas has been developed which allows demonstration of anatomical regions of PET images and manipulation of these images into a standardised anatomical space. Once the images are in this standardised three-dimensional space it is possible to make comparisons between individuals and groups of individuals. We describe the use of this atlas in the generation of a set of mean reference images using methionine PET images of normal volunteers.

Adult↗
PubMed1995

Sciatica.

Explore the source record for details and available documents.

Female↗
PubMed1995

Neurosarcoidosis masquerading as glioma of the optic chiasm in a child.

We present a case of sarcoidosis in a 14-year-old girl who presented with a short history of visual disturbance. Computed tomography and magnetic resonance imaging (MRI) demonstrated enlargement of the optic chiasm and prechiasmic optic nerves. Post-contrast MRI showed marginal enhancement of the affected areas of the optic pathways. A diagnosis of optic nerve glioma and arachnoid gliomatosis was made; surgical confirmation was not sought due to the risk to vision associated with biopsy. A rapid clinical deterioration led to repeat MRI which demonstrated extensive enhancing soft tissue throughout the basal cisterns with extension into the brain. Biopsy confirmed a diagnosis of sarcoidosis.

Adolescent↗
PubMed1994

Reduction of radiation doses in leg lengthening procedures by means of audit and computed tomography scanogram techniques.

Children with congenital bone dysplasias may benefit from leg lengthening procedures. Such procedures, by necessity, require frequent and regular imaging. It is necessary to minimize the total radiation dose to these patients, and particularly the dose to the gonads. In the present study the films of 13 patients who had completed leg lengthening procedures were reviewed. The number of films was assessed together with the use of appropriate gonad shielding. In a second part of the study, thermoluminescent dosemeter measurements of radiation doses to a phantom were made for both plain radiographs (with and without gonad protection) and computed tomography (CT) scanograms. The results show that audit plays an important role in assessing radiographic practice with respect to accurate placement of gonad protection and confirm that a significant dose reduction can be accomplished by careful use of this lead shielding. Dose reduction can also be achieved by using alternative radiographic techniques such as CT scanograms. Other techniques such as ultrasound or dual-energy X-ray absorptiometry are briefly discussed. These may play an important additional part in the reduction of total radiation dose to the patients.

Adolescent↗
PubMed1992

The accessory navicular--an important cause of medial foot pain.

The accessory navicular is a commonly occurring accessory ossicle of the foot. In most instances this is an incidental finding. In some patients, the accessory navicular is the direct cause of foot pain. We present 10 such cases. The typical clinical picture is of a young female patient who presents with chronic or acute on chronic medial foot pain centered over the medial side of the navicular. The patient is usually physically active on her feet and localizes the pain accurately. Plain radiography reveals an accessory navicular united to the navicular by a synchondrosis (Type II). The diagnosis can be confirmed by showing increased localized uptake of isotope on a technetium 99m MDP bone scan. In some cases, the accessory navicular is mistaken for a fracture. Awareness of this accessory ossicle causing such symptoms should lead to the correct diagnosis.

Adult↗
PubMed1992

Percutaneous transluminal angioplasty of the subclavian and axillary arteries: initial results and long term follow-up.

The early and long term outcomes of 25 subclavian and axillary angioplasties in a series of 19 patients treated at one centre over a period of 10 years were assessed. The eventual outcome was long lasting improvement in most cases. Two of 25 PTAs were technical failures as defined as > 30% residual stenosis. Twenty-three of 25 PTAs were technical successes: 17 of these were first procedures, one was a repeat after an initial failure, two were repeats for restenosis and three were for separate new lesions. Clinically, 13 of the 19 patients were asymptomatic at long term follow-up. Four had only occasional, mild symptoms (in one of those they were due to shoulder arthropathy). Two patients had technically successful dilatations but developed problems with arterial occlusion distally which in one patient required amputation of that limb.

Adult↗
PubMed1985

The organisation of the efferent projections of the zona incerta.

The hypothesis that the six cytoarchitectonically distinct subdivisions of the zona incerta send efferent projections to different parts of the brain was tested using retrograde fluorescent tracing techniques. Injections of tracer in the superior colliculus, pontomesencephalic tegmentum, thalamus or spinal cord resulted in characteristic and distinctive patterns of labelling in the zona incerta, suggesting that the different subdivisions of the zona incerta give rise to different sets of efferent projections. Thus, injections into the deep layers of the superior colliculus resulted in retrogradely labelled neurons predominantly in the zona incerta pars ventralis, whereas injections into the pontomesencephalic tegmentum, avoiding the superior colliculus, labelled neurons mostly in the zona incerta pars dorsalis. Parafascicular thalamic injections resulted in labelled neurons in the zona incerta pars rostropolaris, pars dorsalis, pars caudalis and a few in the pars ventralis. The spinal cord injections labelled predominantly the magnocellular cells of the zona incerta. The results of the double labelling experiment also give support to the conclusion that different areas of the zona incerta give rise to largely individual sets of efferent projections. Combined injections of tracers into the superior colliculus and thalamus resulted in the labelling of two essentially independent cell groups, the tectal projecting cells being found mainly in the zona incerta pars ventralis and the thalamic projecting cells being found in the zona incerta pars rostropolaris, pars dorsalis and pars caudalis. However, a small number of double labelled cells was found. These cells, which presumably send collateral projections to both the tectum and the thalamus, were found mainly in the dorsal part of the zona incerta pars ventralis, immediately next to the pars dorsalis. In the light of these findings it would appear that the zona incerta may be organised into largely distinct subdivisions, each of which has its own set of cytoarchitectonic and efferent projection characteristics.

Animals↗
PubMedDate not supplied

Brain arteriovenous malformations: assessment with dynamic MR digital subtraction angiography.

BACKGROUND AND PURPOSE: Conventional catheter angiography (CCA) is the current reference standard for the diagnosis, assessment, and management of pial brain arteriovenous malformations (AVMs). The purpose of this study was to develop an MR angiographic technique that produces dynamic images comparable to those provided by CCA and to apply the technique to the investigation of pial brain AVMs. METHODS: Twenty patients with brain AVMs referred for stereotactic radiosurgery were recruited. All patients had CCA performed on a 1.5-T superconducting system. Sixty images were obtained at a rate of one image per second. Slices were orientated to produce Towne, lateral, and anteroposterior projections. A set of mask images was taken and then a series during the passage of a bolus of contrast material. MR examinations were assessed independently by neuroradiologists blinded to the conventional catheter angiographic findings. RESULTS: The nidus of the AVMs was depicted in 19 of the 20 patients, and correlation with CCA was excellent for measurements of maximum diameter. Venous drainage was correctly assessed in 18 of 19 cases. CONCLUSION: MR digital subtraction angiography shows promise as a noninvasive, dynamic angiographic tool for planning stereotactic radiosurgery of AVMs already delineated by catheter angiography. At present, it suffers from temporal and spatial resolution, which impede the assessment of some brain AVMs.

Adolescent↗
PubMedDate not supplied

Osteochondroma in a British neolithic skeleton.

The skeletal remains of past populations provide an important source of information on the natural history of disease. Relatively few cases of bone tumours have been reported in archaeological material. This paper describes one of the oldest occurrences of osteochondroma to have been identified in a human skeleton.

Adolescent↗