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Biomedical subjects

D F Reese

Publications and source records attributed to D F Reese.

At least 19 recordsLinked to original sources

Central nervous system lymphoma: histologic types and CT appearance.

The distribution of histologic types of lymphoma according to the proposed working formulation was determined for 55 patients with primary central nervous system (CNS) non-Hodgkin lymphoma. Fifty-five percent of these patients had diffuse large-cell histologic features. When the relationship between histologic type and computed tomographic (CT) appearance was analyzed, the following trends were noted: A greater percentage of mixed cell tumors were multiple when compared with other types; noncleaved small-cell tumors were more commonly located in the central gray matter or corpus callosum than were other types; all immunoblastic tumors were enhanced homogeneously, unlike other types; and smaller tumors appeared to be associated with an increased histologic grade. Eleven patients had CT confirmation of a CNS recurrence; in eight patients, the recurrent tumor was in a different location than the original lesion. Eleven patients had associated intraocular lymphoma, and four were immunosuppressed.

Brain Neoplasms

Glomus tympanicum chemodectomas: radiographic and clinical characteristics.

Glomus tympanicum chemodectomas are benign neoplasms that develop from normal glomus bodies located along the Jacobson (tympanic) nerve in the middle ear. The medical charts and radiographic studies of 55 patients with these tumors were reviewed. Women outnumbered men in a ratio of 3.5:1, and the patients' average age when they initially reported symptoms was 52 years. Tinnitus, ear pulsations, and diminished hearing were the most frequent symptoms. No patient had a second chemodectoma, and none of seven patients who were tested had elevated neuroendocrine compounds. Review of the radiographic examinations showed that direct coronal, thin-section computed tomography (CT) was the most sensitive means of demonstrating glomus tympanicum chemodectomas. Magnification angiography was also a sensitive diagnostic study, typically depicting a trapezoidal, hypervascular, middle-ear mass that appeared initially in the middle-to-late arterial phase and quickly disappeared in the venous phase. Differentiation from an aberrant internal carotid artery is critical to prevent arterial biopsy.

Adult

Radiographic findings in 32 cases of primary CNS lymphoma.

Computed tomographic (CT) or angiographic (or both) findings were analyzed in 32 cases of pathologically proved primary non-Hodgkin lymphoma of the central nervous system. CT scans were available in 28 of the 32 cases. Thirty lesions were found in the 28 cases. In comparison with previous literature, the frequency of involvement of deep central structures (30%), multiple lesions (11%), and subependymal lesions (4%) was lower and that of lesions in the periphery of the supratentorial compartment was higher (46%). In agreement with previous literature, most of the lesions were of increased density (63%), enhanced (100%), and enhanced homogeneously (71%). Twenty-nine of the 32 patients underwent cerebral angiography. In 12 patients, a homogeneous vascular stain was found that appeared in the late arterial or early venous phase and had a meningiomalike pattern. This staining pattern has not been emphasized sufficiently in previous literature. It was believed that such an angiographic pattern in a dense, homogeneously enhancing parenchymal lesion is suggestive of a primary lymphoma of the central nervous system. Magnetic resonance imaging was performed in one patient with two lesions, and both lesions demonstrated prolonged T2 relaxation times.

Adolescent

Magnetic resonance imaging in a routine clinical setting.

The results of magnetic resonance imaging (MRI) examinations in the first 1,000 consecutive patients who were studied by this technique at our institution were reviewed to determine the disease states encountered, the sensitivity and accuracy of results, and the value of the examination as compared with computed tomography and other imaging procedures. The MRI device was a 0.15-tesla resistive magnet that used a variety of saturation recovery, spin echo, and inversion recovery pulse sequences to produce images. MRI was found equal to or superior to other imaging techniques in most cases. Exceptions included organs or body regions that are prone to excessive respiratory or vascular motion, lesions that necessitate exquisite spatial resolution for diagnosis, and lesions in which angulation of the viewing plane is necessary for optimal depiction. Fresh blood and calcification within a lesion were also difficult to detect with use of MRI.

Adolescent

Meningiomas of the cerebellopontine angle.

The majority of cerebellopontine angle tumors are acoustic neurinomas; however, 10% to 15% are meningiomas. Meningiomas are benign lesions that must be removed but may require surgical approaches different from those used for acoustic neurinomas. To determine if meningiomas could be distinguished from acoustic neurinomas clinically, findings in 20 patients who underwent removal of a meningioma were compared to those in 131 patients who had an acoustic neurinoma removed during the same period. We found that in patients with meningiomas the tumors frequently are large at presentation, the otologic symptoms and audiometric findings are less dramatic, and roentgenograms of the skull and tomograms of the petrous apex rarely show erosion of the internal auditory canal. Computerized tomography is the most useful method for differentiating a meningioma from a neurinoma: when a meningioma is present the characteristic finding is a broad-based mass aligned with the petrous ridge, not centered over the internal auditory canal.

Adolescent

Roentgenographic diagnosis of acoustic neurinoma.

This article reviews the roentgenographic studies performed in 131 patients who had surgically confirmed acoustic neurinomas. In this 5-year study (1978-1982), all patients had computed tomography (CT) and 82% had petrous apex tomography. Approximately 18% of patients underwent angiography, and 18% had positive contrast rhombencephalography. The diagnostic capability with CT scanning has improved remarkably. There were no false-negative results for scans obtained in 1981 and 1982. At the same time the accuracy of other radiographic and audiometric tests was decreasing. The proportion of small tumors diagnosed has increased 200%, with a corresponding decrease in medium and large tumors. Tumors can be diagnosed at an earlier stage; and, because of this, surgical results have improved. No surgical mortality occurred in this series, preservation of the facial nerve was excellent, and in some patients cochlear function was maintained.

Angiography

Benign tumors of the foramen magnum.

The authors reviewed 102 documented cases of benign extramedullary tumors of the foramen magnum treated at their institution between 1924 and 1982. There was 78 meningiomas, 23 neurofibromas, and one teratoma. Approximately 40% of the patients had a normal neurological examination upon first evaluation. The most frequent presenting complaints were suboccipital neck pain, dysesthesias, gait disturbances, weakness, and hand clumsiness. The average time from initial symptoms to diagnosis was 2 1/4 years. The most common findings included hyperreflexia, arm or hand weakness, Babinski sign, spastic gait, sensory loss, and 11th cranial nerve involvement. Based on these cases, an attempt is made to distinguish foramen magnum tumors from other disease entities by a grouping of signs and symptoms. There is no clinical finding that is pathognomonic. Metrizamide computerized tomography scanning and Pantopaque myelography have been the radiographic tests most commonly used to evaluate the foramen magnum. Recent experience suggests that nuclear magnetic resonance scanning will be a very useful noninvasive means of evaluating the foramen magnum region.

Adolescent

Primary lymphoma of the central nervous system.

Primary intracranial lymphoma usually remains localized to the central nervous system, and aggressive radiotherapy will prolong some patients' remission and perhaps cure them. Although the lesion is usually believed to arise from histiocytes or reticulum cells, at least some of the neoplasms are of B-lymphocyte origin. Provisional diagnosis occasionally may be possible by identifying lymphoma cells in the cerebrospinal fluid by using the cytocentrifuge. The use of computed tomography of the head may decrease the need of arteriography for tumor localization.

Adult

High-resolution dynamic ultrasound imaging of the carotid bifurcation: a prospective evaluation.

One hundren patients underwent high-resolution dynamic ultrasound imaging of the carotid bifurcation immediately before cerebral angiography. The examinations were interpreted independently. A positive ultrasound interpretation indicated the presence of moderate to extensive atheromatous plaque, while a negative interpretation indicated normal vessels or minimal atheromatous disease. Ten percent of the ultrasound examinations were technically unsatisfactory. Of the remaining studies, there was satisfactory correlation between ultrasound and angiography in approximately 85% and disagreement in 15%. The majority of ultrasound errors were "false positive" (although these probably represent false-negative angiograms). Although atheromatous disease was accurately detected by ultrasound, stenosis, ulceration, intraluminal thrombus, and vessel occlusion were not reliably identified.

Adolescent

Dynamic sequential scanning with table incrementation.

Dynamic sequential scanning with table incrementation is a method of rapid computed tomographic head scanning in which a complete 10-section scan can be made in 2 minutes 40 seconds or less. Although some measurable and visible loss of low-contrast resolution occurs, there is no loss of high-contrast resolution. Monthly throughput of patients has been increased by about 30% since this technique was instituted.

Brain

Idiopathic ("congenital") spinal arachnoid diverticula. Clinical diagnosis and surgical results.

We reviewed the clinical records of all the patients examined at the Mayo Clinic who were operated on and found to have arachnoid diverticula of he cervical and thoracolumbar regions of the spinal column. Only patients whose lesion did not have a traumatic cause were selected for a study. There were 21 patients: 20 had been operated on at the Mayo Clinic and 1 was seen 43 years after surgery done elsewhere. The symptoms associated with the thoracolumbar lesions were, in order of decreasing frequency, pain, weakness, gait disorder, sensory symptoms, and sphincter dysfunction. The conditions associated with thoracic arachnoid diverticula included congenital pigmented nevus, diastematomyelia, multiple sclerosis, Marfan's syndrome, and syringomyelia.

Adolescent

Computed tomographic mammography (CTM).

Breasts of 724 patients were studied by physical examination, mammography, and computed tomographic mammography (CTM) using a scanner designed for evaluation of the breast. Among cases in which CTM was not accompanied by use of contrast material, there were 60 malignant lesions, of which 10% were missed by mammography, 32% by CTM, and 8% by both. Among cases where CTM was supplemented by a 50 ml injection of 75% contrast material, there were 63 malignant lesions, of which 14% were missed by mammography, 16% by CTM, and 3% by both. Among cases where CTM was supplemented by a 300 ml infusion of 30% contrast material, there were 41 malignant lesions, of which 7% were missed by mammography and 5% by CTM, but none by both. Clinically, 22% of the malignant lesions in the infusion series were occult. There were 44 benign lesions in patients studied with the infusion technique. With mammography 68% were suspicious for malignancy, and with CTM, 56%.

Adenocarcinoma

Computerized tomography in demyelinating disease of the young.

We have used computerized tomography (CT) to look for evidence of cerebral demyelination in children with progressive neurologic disorders. Fourteen patients with a clinical diagnosis of a demyelinating disorder were examined by CT, and five had CT findings suggesting cerebral demyelination. In two patients with a so-called myelinoclastic demyelinating disease, CT showed asymmetric, circumscribed areas of diminished radiodensity, and in three patients with a leukodystrophy, scans showed diffuse symmetric areas of low density in the centrum ovale. Autopsy examination in one patient confirmed the diagnosis of sudanophilic leukodystrophy and substantiated the abnormalities suspected from CT.

Adolescent

A statistical description of the normal computerized brain scan.

A total of 100 CT brain scans performed with an EMI head scanner were analyzed in order to define the statistical limits of normal. The statistical parameters are means and standard deviations. Frequency polygons of the attenuation coefficients for each of five brain slices have been constructed. The concept of the water to brain ratio is introduced.

Adolescent

Spinal cord vascular malformations with symptoms during menstruation. Report of two cases.

Two patients had the initial complaint of fluctuating paraparesis, which was most evident at menstruation. One patient had a semimonthly fluctuating deficit. Spinal cord compression and ischemia, secondary to the vascular mass, were considered the most likely mechanisms. Blood levels of estrogen and progesterone during the menstrual cycle may have had a contributory effect. Fluctuating spinal cord deficits associated with a consistent portion of the menstrual cycle should alert the physician to the possibility of an arteriovenous malformation of the spinal cord.

Adult