Cutaneous nodules, pain, and thrombophlebitis as an adverse reaction to gadolinium contrast media.
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Contrast Media↗
Biomedical subjects
K J Murphy
Publications and source records attributed to K J Murphy.
Skull abnormalities on MR of children with sickle cell disease.
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Anemia, Sickle Cell↗
Etidronate therapy decreases the sensitivity of bone scanning with methylene diphosphonate labelled with technetium-99m.
OBJECTIVE: To define the nature, incidence and consequence of a possible interaction between etidronate (for the treatment of hypercalcemia) and methylene diphosphonate labelled with technetium-99m (99mTc-MDP) (for bone scanning). MATERIALS AND METHODS: The authors reviewed hospital pharmacy records for a period of 2 years and identified 18 patients who had received etidronate. Of this group, 6 patients (4 men and 2 women, ranging in age from 56 to 76 years) had undergone bone scanning with 99mTc-MDP while receiving etidronate. Five of the patients had hypercalcemia associated with metastatic disease, and the sixth had hyperparathyroidism. RESULTS: All bone scans demonstrated poor uptake of tracer by bone accompanied by high soft-tissue background. There was loss of bone definition below the mid-thigh, and in 5 of the 6 patients there was indistinguishable rib uptake. In 1 of the patients, there was absence of uptake in 2 previously defined metastatic lesions. CONCLUSION: Recent oral or intravenous administration of etidronate is a contraindication to bone scintigraphy, as it markedly decreases sensitivity for bone disease. Bone scintigraphy should be timed so that it is performed before etidronate treatment or, if that is not possible, more than 2 to 4 weeks after the therapy has been completed.
Administration, Oral↗
3D gadolinium-enhanced MR angiography of the carotid arteries.
PURPOSE: To compare gadolinium-enhanced magnetic resonance angiography (MRA) of the carotid bifurcation with 2D time-of-flight (TOF) MR angiography with regard to image quality and duration of examination. MATERIALS AND METHODS: Gadolinium contrast was administered intravenously during 3D MR imaging at 1.5 Tesla in 46 patients presenting with suspected carotid occlusive disease. 2D time-of-flight MR angiography of the carotid bifurcation had been performed in each patient prior to gadolinium-enhanced MR angiography. RESULTS: Gadolinium MRA eliminated slice misregistration and in-plane saturation artifacts that occasionally degrades 2D TOF MR angiography. Gadolinium MRA required less than 4 min to image from the aortic arch to the skull base compared to 11 min for 2D TOF with comparable signal-to-noise ratio (SNR). Postprocessing was required to eliminate overlapping venous enhancement. Both techniques had susceptibility related artifactual loss of signal at the skull base and both demonstrated a linear artifact paralleling the long axis of arteries. CONCLUSION: Gadolinium-enhanced MR angiography is a promising technique for the evaluation of patients with carotid occlusive disease because it rapidly images the carotid arteries from the aortic arch to the skull base and eliminates some of the artifacts that degrade 2D TOF MR angiography.
Adult↗
Repetitive and transient increases in hippocampal neural cell adhesion molecule polysialylation state following multitrial spatial training.
Polysialylated neurons, located at the inner border of the dentate granule cell layer, have been demonstrated to exhibit time-dependent change in their frequency at 10-12 h following training in the Morris water maze, a spatial learning paradigm. Such a change was not observed in animals required to locate a visible platform or in those rendered amnesic with scopolamine. This frequency response was capable of rapid reactivation following further training stimuli in a manner that was independent of circadian influence. These learning-associated modulations in neural cell adhesion molecule (NCAM) polysialylation state did not increase in magnitude despite improved performance, suggesting their activation is required for processing information rather than contributing to previously stored, task-associated memory. An increase in NCAM polysialylation appears to be a universal learning response to both spatial and nonspatial paradigms as similar time-dependent changes occurred following training in a one-trial, step-through, passive avoidance response subsequent to water maze training.
Animals↗
Adverse reactions to gadolinium contrast media: a review of 36 cases.
OBJECTIVE: We investigated the frequency, manifestations, and severity of reactions to gadolinium contrast media in patients who underwent MR imaging at a single institution. MATERIALS AND METHODS: We reviewed the quality assurance records of 21,000 patients to whom gadolinium contrast media were administered at our institution between January 1990 and October 1994. Of these patients, 36 had adverse reactions. All 36 patients were evaluated by a radiologist at the time of the adverse reaction, and a written report of the findings was completed immediately. RESULTS: We classified adverse reactions into four groups: mild nonallergic reactions (15 patients with nausea or vomiting), mild reactions resembling allergy (12 patients with hives, diffuse erythema, or skin irritation), moderate reactions resembling allergy (seven patients with respiratory symptoms), and life-threatening reactions resembling allergy (two patients with severe chest tightness, respiratory distress, and periorbital edema). Eleven of these 36 patients who had adverse reactions also had an unusual local reaction of skin discomfort in the extremity through which gadolinium was injected. Four of the 36 patients with adverse reactions had histories of adverse reactions to iodinated contrast media. All four of these patients and one of the remaining 32 patients with adverse reactions required treatment. No patients with adverse reactions died. CONCLUSION: Although gadolinium contrast media are safe, we found that patients had adverse reactions at a frequency greater than we expected. Severe anaphylactoid reactions occurred in two patients (0.01%). This rate exceeds the rate of 0.0003% reported in the literature. The indexes of suspicion for the occurrence of reactions to gadolinium, and both the documentation and the management of adverse reactions, must be as rigorous for reactions associated with MR imaging contrast agents as they are for reactions associated with iodinated contrast media.
Anaphylaxis↗
Orbital plain films as a prerequisite for MR imaging: is a known history of injury a sufficient screening criterion?
OBJECTIVE: Before undergoing MR imaging at our institution, all patients with potential occupational, recreational, or educational exposure or known accidental exposure to kinetic metal fragments have orbital radiographs to evaluate for the continued presence of intraorbital metallic foreign bodies. The purpose of this study was to evaluate the potential safety of a protocol that would call for obtaining plain films of the orbit before MR imaging only for patients with a definite history of a known metallic foreign body in the eye or orbit. MATERIALS AND METHODS: A total of 2626 patients underwent plain radiography of the orbit to exclude metallic foreign bodies before MR imaging between March 1991 and January 1995. These patients were identified by a billing code number. Reports from these studies, all interpreted by board-certified radiologists, were reviewed. When a metallic foreign body was detected, we reviewed the patient's response during the initial interview when asked about a history of orbital injury or surgery. RESULTS: Of 2626 patients undergoing orbital radiographic studies, 17 (0.65%) had radiographic evidence of intraorbital metallic foreign bodies. Sixteen of these patients gave a history of known injury or had knowledge of probable orbital metallic fragments. The remaining patient, a welder screened because of occupational history, had a 3 x 1 mm metallic foreign body in his left orbit without a history of injury. CONCLUSION: Screening plain films of the orbit are necessary when a patient has a history of a known intraocular or periorbital foreign body or when a patient has a history of occupational exposure to potential metallic ocular injury, as do welders, grinders, and metalworkers.
Adult↗
Laparoscopic ovarian transposition.
Preservation of ovarian function is both safe and feasible in many young women with pelvic malignancies. Techniques utilized to transpose the ovaries to date have uniformly required a laparotomy either at the time of surgical treatment or as a separate operation in patients about to undergo pelvic radiotherapy. We report our preliminary results in 3 patients who underwent laparoscopic ovarian transposition and pelvic lymphadenectomy as part of an experimental protocol using intracavitary radiation alone in patients with small node negative stage 1B cervical carcinoma desiring preservation of fertility. Dose calculations were performed to estimate the amount of radiation each transposed ovary received from the intracavitary radiation, as well as the dosage that would have been received had external pelvic (4500 cGy) with or without para-aortic nodal irradiation (4500 cGy) been required. The mean estimated distance each ovary was transposed was 14.4 cm for the right ovary and 14.3 cm for the left ovary. Operative times ranged from 2.75-4.0 hours, and the blood loss 100-300 mls. Post-operative hospital stays ranged from 1-2 days, and no complications were encountered. Two of the 3 patients are menstruating regularly 25-32 months after completion of treatment with serum FSH in the normal premenopausal range. Based on the above distances, the mean dose of radiation each transposed ovary received was estimated to be 126 cGy, whereas the range in dosage of radiation each ovary would have received had external pelvic +/- para-aortic nodal irradiation been required was 135-190 cGy, and 230-310 cGy respectively. One patient has become menopausal after her transposed ovaries slipped back into the pelvis. Laparoscopic ovarian transpositions can be performed. This procedure is technically easy to perform for those surgeons skilled in laparoscopic surgery and its preliminary morbidity appears to be low. More experience, longer followup, and refinement in the methods of ovarian transfixation are required.
Adult↗
Radiographic appearance of intrathoracic complications of pregnancy.
The authors reviewed all chest radiographs obtained for pregnant women at a university hospital over a 15-year period to determine the intrathoracic complications of pregnancy and diseases occurring during pregnancy. The characteristic physiologic changes seen on chest radiographs during normal pregnancy are reviewed. Examples of intrathoracic diseases that may occur in pregnant patients include pulmonary embolism, amniotic fluid embolism, beriberi, aspiration pneumonia, community-acquired pneumonia, viral pneumonia, asthma, systemic disease, trophoblastic disease and peripartum pulmonary edema. The authors discuss the radiation biology implications of performing chest radiography during pregnancy and conclude that the benefit that the fetus receives from diagnosis and treatment of the mother's disease may be greater than the risk of radiation exposure.
Adolescent↗
Carcinoma of the vagina--experience at the Princess Margaret Hospital (1974-1989).
The charts of 153 patients with vaginal carcinoma or carcinoma in situ seen at Princess Margaret Hospital between 1974 and 1989 were analyzed with respect to treatment modality, radiation dose and technique, complications, and survival. One hundred and twenty-eight patients were treated with radiation therapy, of which 10 received radiation postoperatively and 26 concomitant chemotherapy. The overall 5-year actuarial cause-specific survival was 66%. The 5-year cause-specific survivals by stage were Stage 0 (C-I-S) 100%, Stages I/II 77%, and Stages III/IV 56%. Late complications from treatment were infrequent and in only 12 patients were such complications classified as severe. Univariate analysis indicated that size and stage of tumor, histological grade, patient age, and radiation dose > 7000 cGy were significant factors in predicting survival, although in a multivariate analysis only size and stage retained significance. Fifty-one patients had a prior gynecological malignancy arising 1-37 years previously, of which 34 had cervical cancers. Radiotherapy is an effective treatment for all stages of carcinoma of the vagina and doses of at least 7000 cGy are recommended to maximize tumor control.
Actuarial Analysis↗
Good outcome associated with a standardized treatment protocol using selective postoperative radiation in patients with clinical stage I adenocarcinoma of the endometrium.
In 1982, a treatment protocol was instituted for the management of patients with clinical stage I adenocarcinoma of the endometrium. All pertinent historical, operative, and pathologic findings were reviewed by a multidisciplinary committee and 384 patients were prospectively assigned to either high- or low-risk categories. Patients were excluded from the study if they had clinically apparent extrauterine disease, clear cell or serous histologies, or microscopic ovarian metastasis. Patients were considered high-risk if they had one or more of the following factors: grade 3 tumor differentiation, myometrial invasion > 50% of the total wall thickness, pathologic cervical involvement, or adenosquamous histology. Two-hundred twenty-seven (59%) low-risk patients were followed without further treatment after surgery, while pelvic radiation was recommended for 157 (41%) high-risk patients. The 5-year relapse-free survival rates in the low- and high-risk groups were 95 and 81%, respectively. There were no treatment-related deaths. Severe or life threatening chronic radiotherapy complications occurred in 6 (5%) patients. Multivariate Cox analysis identified the following significant prognostic factors: grade, myometrial invasion, cervix involvement, and age. This treatment protocol represents a safe and effective method of managing patients with carcinoma of the endometrium and spares the need for radiation therapy in the low-risk patient.
Adenocarcinoma↗
Influence of toxicants on neural cell adhesion molecule-mediated neuroplasticity in the developing and adult animal: persistent effects of chronic perinatal low-level lead exposure.
The expression of neuroplastic neural cell adhesion molecule (NCAM) polysialylated neurons in the dentate of juvenile (postnatal day 40) and adult (postnatal day 80) rats exposed to low-level lead during the early postnatal period has been investigated. At both ages, the number of polysialylated neurons was decreased significantly in lead-exposed animals when expressed per unit area but not total dentate area. This could be attributed to an increase in the number and intercellular spacing of granule cells in the dentate of the lead-exposed animals. These effects are related to NCAM polysialylation dysfunction perturbing early hippocampal neurogenesis.
Age Factors↗
Memory consolidation induces a transient and time-dependent increase in the frequency of neural cell adhesion molecule polysialylated cells in the adult rat hippocampus.
Animals trained in a passive avoidance task exhibit a transient time-dependent increase in hippocampal neural cell adhesion molecule (NCAM) polysialylation at 12-24 h following the initial learning trial. Using immunocytochemical techniques with a monoclonal antibody that specifically recognises NCAM-polysialic acid homopolymers, a distinct population of granule-like cells, at the border of the granule cell layer and the hilus in the dentate gyrus of the adult rat hippocampus, has been demonstrated to exhibit time-dependent change in frequency at 10-12 h following the initial learning of a one-trial, step-through, passive avoidance response. These changes were paradigm specific as they failed to occur in those animals rendered amnesic with scopolamine. These polysialylated dentate neurons are not de novo granule cell precursors as administration of 5-bromo-2'-deoxyuridine every 2 h from the point of learning to the 12-h posttraining time showed no significant difference between trained and passive animals in the small number of heterogeneously distributed, labelled cells. These findings directly identify a morphological substrate of memory, implied by previous correlative and interventive studies on NCAM function.
Animals↗
The evaluation of renal transplant candidates: clinical practice guidelines. Patient Care and Education Committee of the American Society of Transplant Physicians.
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Cardiovascular Diseases↗
Separate neural pathways for the visual analysis of object shape in perception and prehension.
BACKGROUND: Earlier work with neurological patients has shown that the visual perception of object size and orientation depends on visual pathways in the cerebral cortex that are separate from those mediating the use of these same object properties in the control of goal-directed grasping. We present evidence suggesting that the same dissociation between perception and action is evident in the visual processing of object shape. In other words, discrimination between objects on the basis of their shape appears to be mediated by visual mechanisms that are functionally and neurally distinct from those controlling the pre-shaping of the hand during grasping movements directed at those same objects. RESULTS: We studied two patients with lesions in different parts of the cerebral visual pathways. One patient (RV), who had sustained bilateral lesions of the occipitoparietal cortex, was unable to use visual information to place her fingers correctly on the circumference of irregularly shaped objects when asked to pick them up, even though she had no difficulty in visually discriminating one such object from another. Conversely, a second patient (DF), who had bilateral damage in the ventrolateral occipital region, had no difficulty in placing her fingers on appropriate opposition points during grasping, even though she was unable to discriminate visually amongst such objects. CONCLUSIONS: This double dissociation lends strong support to the idea that the visual mechanisms mediating the perception of objects are functionally and neurally distinct from those mediating the control of skilled actions directed at those objects. It also supports the recent proposal of Goodale and Milner that visual perception depends on a ventral stream of projections from the primary visual cortex to the inferotemporal cortex, whereas the visual control of skilled actions depends on a dorsal stream from the primary visual cortex to the posterior parietal cortex.
Adult↗
Health psychology: status and trends.
This study investigated the present status and suggested trends in health psychology as reported by American Psychological Association Division 38 (Health Psychology) members. A 25-item mail-in survey was developed to obtain these data from a randomly selected sample of 300. Information includes a demographic description of the respondents, their selection of influential books, journals, and individuals, and their opinions regarding the current status and desirable future trends in the field of health psychology.
Attitude to Health↗
Walker-Warburg syndrome. Case report and literature review.
The Walker-Warburg syndrome (WWS) is a fatal dysmorphic disorder of unknown etiology, but strongly suggests an autosomal recessive mode of inheritance. It is characterized by severe congenital oculo-cerebral malformations (lissencephaly, congenital hydrocephalus, and ocular lesions). The authors report a case of WWS that occurred in a consanguineous union, with a review of the literature. Possible pathogenesis, and disorders sharing the features of WWS are discussed. Families-at-risk for WWS should be identified for prenatal diagnosis and for genetic counselling.
Abnormalities, Multiple↗