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Biomedical subjects

L D Cromwell

Publications and source records attributed to L D Cromwell.

At least 37 records · Page 2Linked to original sources
PubMed1981

Treatment of intracerebral arteriovenous malformations with isobutyl 2-cyanoacrylate: initial clinical experience.

From November 1976 to September 1979, 46 patients with intracranial arteriovenous malformations or fistulas participated in a clinical study using isobutyl 2-cyanoacrylate (IBCA), with tantalum, for palliative or preoperative occlusion of the blood supply to the abnormalities. Although failure to obtain satisfactory position of a functioning microcatheter precluded deposition of IBCA 10 times, a total of 51 of a possible 62 feeding vessels were occluded with the tantalum-impregnated glue. The technique, results, and complications are discussed in light of the clinical follow-up, which varied from 12 to 48 months.

Adolescent↗
PubMed1981

Primary demyelinating disease simulating glioma of the corpus callosum: report of three cases.

Computerized tomography (CT) has made it easier to distinguish tumoral from nontumoral diseases of the central nervous system. In the presence of mass effect, however, this distinction may be difficult or impossible to make. Primary demyelinating disease may occasionally present as a focal cerebral mass. The authors report three cases of primary demyelinating disease of the brain involving the corpus callosum and periventricular white matter and associated with mass effect, which proved difficult to differentiate from infiltrating "butterfly" gliomas.

Adult↗
PubMed1981

Computed tomography in patients with psychiatric illnesses: advantage of a "rule-in" approach.

Computed tomography (CT) is used commonly to "rule-out" disease. In 123 consecutive patients with psychiatric diseases in three institutions, 105 CT scans (85.4%) interpreted as normal or normal except for atrophy did not influence management, only reassured clinicians and patients. Incidental and false positive findings were more numerous than true positive findings. All six true positive findings occurred in patients with focal findings on neurologic examination; four led to management changes. The lower 954% confidence limit of the cost of case finding by CT only was estimated to be $2931 for all patients; $603 for patients with focal findings; and at least $7083 for patients without focal findings. Computed tomography is a sensitive diagnostic method that may detect more false and incidental positive findings when used somewhat unselectively to "rule-out" disease. In these patients, a examination suggesting structural intracranial abnormalities would have been less expensive and more effective.

Adolescent↗
PubMed1980

Computed tomography in the evaluation of congenital cerebral toxoplasmosis.

This report deals with the contribution of computed tomography (CT) to the diagnosis of congenital toxoplasmosis in two infants. Computed tomography revealed diffuse hydrocephalus and confirmed the periventricular nature of the brain calcifications. The clinical, radiographic, and CT findings are discussed.

Brain Diseases↗
PubMed1980

An asymmetric screen pair for angiography.

Commercially available rare-earth screens are mechanically softer and less abrasion resistant than calcium tungstate screens. This leads to problems in radiography without the use of cassettes in areas where particulate matter appears. The benefits of an asymmetric screen pair in Schonander changers in which the movable front screen is calcium tungstate and the back screen is a Du Pont Quanta III are investigated. The image is sharper, the quantum mottle is less apparent, the speed remains high, and the physical durability of the system is improved in comparison to a pair of Quanta III screens.

Angiography↗
PubMed1980

Treatment of cerebral arteriovenous malformations: a combined neurosurgical and neuroradiological approach.

It is believed that surgical excision of arteriovenous malformations is the best treatment when technically feasible without causing significant damage to adjacent brain. The introduction of polymers or particulate emboli by catheter has been used either alone or as an adjunct in attempts to reduce the size of these lesions prior to surgery; however, it is seldom possible to embolize the entire malformation. The authors have used direct injection of a 50% mixture of bucrylate and iophendylate into the feeding arteries supplying the area at craniotomy, with success in three cases. The cases are described to illustrate the method.

Adult↗
PubMed1979

Cyanoacrylate occlusion of carotid-cavernous fistula with preservation of carotid artery flow.

We report a new treatment for carotid-cavernous fistula. Using a flow-guided, balloon-tipped microcatheter, we catheterize the fistula itself, verify balloon entry into the fistula with fluoroscopy and x-ray films, and then infuse the tissue adhesive isobutyl-2-cyanoacrylate with careful fluoroscopic control. Three patients have had their fistulas occluded, with preservation of flow through the internal carotid artery. This balloon microcatheter allows the radiologist to perform a reversible test occlusion. All three patients had neurological changes during or after the procedure, and in one we inadvertently occluded several distal middle cerebral artery branches without permanent neurological deficit. No patient became blind or developed 3rd, 4th, or 6th nerve palsy from the treatment. This technique seems to have promise as another method for the obliteration of carotid-cavernous fistula.

Arteriovenous Fistula↗
PubMed1979

Calibrated leak balloon microcatheter: a device for arterial exploration and occlusive therapy.

In quest of an endarterial treatment for intracranial arteriovenous malformations and fistulas, a microcatheter which can be flow-guided into third- and fourth-order branches of the intracranial arteries was developed. This permits controlled deposition of a vascular occlusive polymer (isobutyl-2 cyanoacrylate). Goals and experimental techniques are reviewed and clinical experience on the first 25 patients is presented. Complications included one stroke and three catheters glued in place, but refinements in technique have permitted avoidance of complications over the 14 months before this report.

Animals↗
PubMed1979

Computed tomography of intracerebral leukemic masses.

Five patients with differing types of leukemia had clinical symptoms of a localized intracerebral leukemic mass. Computed tomography (CT) demonstrated a mass of equal or increased density relative to normal brain; a zone of surrounding edema was variable. In each case, the mass showed evidence of relatively uniform contrast enhancement. CT appearance of leukemic masses is consistent and quite different from the findings in other central nervous system complications of leukemia and its aggressive treatment.

Acute Disease↗
PubMed1979

Modification of cyanoacrylate for therapeutic embolization: preliminary experience.

Cyanoacrylate is a satisfactory material for therapeutic embolization, but it has the disadvantage of not being radiopaque and polymerizing within 1 sec after contact with ionic materials. Its behavior was modified with varying concentrations of iophendylate and were able to satisfactorily control its polymerization from 1 to 30 sec. This control should allow penetration of arteriovenous malformations, which is necessary if cure is to result. The iophendylate adds radiopacity and seems to enhance the suspension of tentalum, another opacifying agent. Preliminary experience in dogs is encouraging, but too few humans have been treated with this method to recommend it as more than an experimental procedure at this time.

Bucrylate↗
PubMed1978

Intraarterial cyanoacrylate: an adjunct in the treatment of spinal/paraspinal arteriovenous malformations.

Arteriovenous malformations are difficult lesions to treat whether surgical or catheter occlusive therapy is used. If the major feeders are ligated or blocked, other arteries open quickly to supply the malformation. Isobutyl 2-cyanoacrylate, deposited with a calibrated leak balloon microcatheter, has given satisfactory short term improvement in both the signs and symptoms of two patients with spinal arteriovenous malformations. Superselective placement of the catheter system, a provocative test perfusion of the arteriovenous malformation and its supplying vessels before the acutal occlusion, and high quality fluoroscopy and angiographic equipment added to the safety of the procedure. No long term results are available, but this system may prove itself another tool in the catheter therapist's armamentarium.

Adult↗
PubMed1978

Cerebral ischemia. I. Current angiographic techniques, complications, and safety.

The angiographic evaluation of the transient ischemic attack has been technically difficult, time consuming, and complication prone because of underlying arteriosclerosis and other medical diseases. The examination described depends upon small soft catheters, dynamic fluoroscopy for positioning, and selective magnified views of the arteries needed for surgical planning. Five basic views are exposed. On the side of clinical interest, a lateral view of the head and neck, a frontal view of the head, and a fluoroscopically positioned view of the carotid bifurcation are obtained; on the other side the frontal view is omitted. A total of 662 consecutive studies were performed on 603 patients without death or permanent strokes. The only permanent complication was a partial radial nerve palsy.

Cerebral Angiography↗
PubMed1978

Remote effects of neuroblastoma.

Neuroblastoma, which is primarily an extracranial disease, has remote manifestations which can be confusing. Neurologic signs and symptoms such as opsoclonus (dancing eyes), ataxia, blindness, and cord paralysis may precede by several months the manifestations of the primary tumor in a distant site such as the abdomen. Descriptions of nine cases demonstrate the various modes of presentation and some of the unusual aspects of this disease. The recent advent of computed tomography requires a reevaluation of the neuroradiologic approach to the evaluation of neuroblastoma.

Bone Neoplasms↗