Biomedical subjects
Publications and source records attributed to L Steiner.
A stereotactic guide for microsurgery is presented. The guide consists of a weak helium neon laser projecting a red beam towards the target when the arc carrying the beam has been set on the Leksell frame according to the stereotactic co-ordinates of the target calculated on the pre-operative imaging studies. The device allows free manoeuverability of the operating microscope.
The ability to perform accurate and precise testing in sites outside the main clinical laboratory is more dependent on the quality of the individual performing the alternate-site testing (AST) than on any other factor. Most of these individuals have little or no laboratory training or experience. The central laboratory must take responsibility for training AST analysts, monitoring their performance (testing, QC, PT, and QA), and certifying their competence. Regular retraining and recertification must be performed.
The time of emergence of immunoglobulin kappa and lambda light (L) chains in evolution is unknown. An L chain cDNA clone was isolated from the nurse shark (Ginglymostoma cirratum), a cartilaginous fish, whose predicted variable (V) region amino acid sequence has up to 60% sequence identity to mammalian V kappa domains. Genomic analyses suggest a cluster-type gene organization for this L chain locus, similar to the shark lambda-like immunoglobulin L chain loci rather than mammalian kappa loci. We propose that divergence of the ancestral L chain into isotypes likely occurred before the emergence of elasmobranchs 400-450 million years ago. Similarities in gene organization between the two isotypes in sharks may reflect the gene organization utilized by the ancestral L chain.
PURPOSE: To investigate the temporal sequence of post radiosurgery magnetic resonance imaging changes in cerebral arteriovenous malformations. METHODS AND MATERIALS: Eighteen patients were regularly followed up after gamma knife surgery. The follow-up intervals ranged from one day to 44 months. High signal lesion in or around arteriovenous malformations on T2-weighted magnetic resonance images corresponding to the treatment volume and developing after radiosurgery were defined as the adverse reaction of the irradiation. This high signal and the regression of arteriovenous malformations nidus after radiosurgery were evaluated. RESULTS: Adverse reaction of irradiation was observed in nine cases. Seven of them were symptomatic. The reactions presented as focal high signal in three cases and focal high signal with extension along the neural tracts in six cases. The reactions were seen either immediately after treatment (one case), between 3 and 14 months (seven cases), and 40 months after treatment (one case). The regression of the adverse reaction was observed to start 5 +/- 3 months after its appearance. Regression of the arteriovenous malformations' nidus was found in 16 cases. In two cases the AVMs became invisible on magnetic resonance images but the angiogram still demonstrated abnormal shunts. In another one case with angiogram showing total obliteration, the nidus was erroneously interpreted as incomplete obliteration on magnetic resonance images. CONCLUSION: It is concluded that magnetic resonance imaging is a sensitive in vivo method for detecting cerebral radiation injury. Magnetic resonance imaging offers a method for evaluating the regression of arteriovenous malformations' nidus, but the diagnosis of complete obliteration of the nidus after radiosurgery still relies on the angiogram.
A rat stereotactic device was designed for use in Gamma Knife radiosurgery. Experimental radiosurgical lesions were made in superficial and deep cerebral structures to verify the accuracy of the coordinate system, which is based on a standard rat stereotactic atlas. Calculated dosages were shown to be accurate utilizing thermoluminescence dosimetry. Two additional features of the device permit the surgical positioning and placement of electrodes, and postmortem slicing of the brain according to the same coordinate system. This new apparatus allows precise and repeatable gamma irradiation of the rat brain without the need for expensive and time-consuming imaging techniques. Studies of this type will provide a rapid means for examining the effects of radiosurgery on the central nervous system.
Postradiation changes in angiographically determined nidus volume were quantitatively studied in 22 arteriovenous malformation (AVM) cases treated by gamma unit radiosurgery. The postradiosurgical decrease was statistically significant by post-treatment year 2 (p < .05). In children, AVMs tended to be obliterated more quickly than in adults. Volume reduction was more rapid in nidi receiving 25 Gy or more than in those receiving less than 25 Gy (p < .01). However, there were no significant differences in nidus volume decrease between these two dose groups at the second or third postradiosurgical year. Dose response curves were obtained 1, 2, and 3 years following treatment.
We describe our experience with stereotactic microsurgical resection of 27 lesions using the Leksell frame in 23 patients; 7 had cerebral metastases, 6 had gliomas, 6 had vascular malformations, 3 had meningiomas and 1 had radiation necrosis. Gross total removal of the lesion was accomplished in every case. All lesions were between 1.0 and 3.5 cm in greatest diameter and located either deep within the cerebral (n = 7) or superficially in areas of functional cortex (n = 20). There was no operative mortality and only minimal morbidity. Average length of operating time including frame application, imaging and resection was 4.4 h and most patients were discharged on the second postoperative day. The indications, advantages and limitations of stereotactic craniotomy are discussed and technical modifications that extend the usefulness and safety of this technique are described.
One handicap in achieving ideal dosimetry with the Gamma Knife is the limited number of standard collimator sizes (4, 8, 14 and 18 mm). We report an approach that makes possible the creation of 50% or higher isodose lines, corresponding to collimator sizes from 4 to 18 mm. This technique, which uses the same icocenter, but with different sized and weighted collimators, improves matching for given isodose lines to the diameter of the lesion in a defined plane. However, when combination fields, designed to reproduce the 50% isodose diameter of the 8- and 14-mm collimators, are compared to the standard sizes, there are significant differences in the three-dimensional dosimetry.
Radiosurgery is used with increasing frequency, not only for the treatment of cerebral arteriovenous malformations (AVMs), but also for the treatment of other well-defined lesions including acoustic neuromas, meningiomas, pituitary adenomas as well as solitary metastases. Although investigators have addressed dosimetric aspects of stereotactic radiosurgery in terms of target volume, little if any attention has been focused on the absorbed doses received at extracranial sites. Therefore, absorbed doses to the eye, thyroid, sternum and gonads were measured in 111 patients (100 adults and 11 children) using thermoluminescent dosimetry (TLDs). For the 100 adults, the average maximum target absorbed dose was 35 +/- 8 Gy. The measured absorbed dose in selected organs of adults from Gamma Knife radiosurgery using one or more isocenters was 9 +/- 8 cGy for the eye, 15 +/- 7 cGy for the thyroid, 20 +/- 10 cGy for the sternum and 3 +/- 2 cGy for the gonads. The absorbed doses received by the children (13 years and younger) was similar with the exception of a marked increase in gonadal dose. The use of multiple isocenters is associated with higher absorbed doses to extracranial sites.
Radiosurgical treatment with the gamma knife for venous angiomas was used as an alternative to microsurgical removal in order to avoid abrupt cessation of venous drainage, which may be shared by the venous angioma and important parts of the brain. Thirteen cases of venous angioma were treated between 1977 and 1991. In two cases cavernous angiomas were also present and in one case a distant arteriovenous malformation (AVM) was also found. In two cases the angioma shared the venous drainage with an adjoining AVM; this is the first description of such pathology. For venous angiomas irradiation was prescribed to cover at least the convergence of the medullary veins. For AVM's close to a venous angioma the treatment was exclusively prescribed to the AVM nidus. After treatment, complete obliteration of the venous angioma was observed in one case, partial obliteration was observed in three cases, and five venous angiomas were unaffected by the treatment. Undue effects of radiation occurred in four cases: one focal edema and three radionecroses. Extirpation of the radionecrotic tissue 6 months after radiosurgery was necessary in one case. In the other three cases, the venous angioma was observed to be completely or partially obliterated, or unaffected by the treatment (one case each). In two cases of combined AVM and venous angioma, complete obliteration of the treatment AVM nidus was obtained. It is concluded that radiosurgery for venous angioma, although conceptually attractive, still does not fulfill the rigid criteria of minimal risk which must be set for the treatment of a lesion with a benign natural history.
Explore the source record for details and available documents.
Long-term follow-up results of nine children treated for cerebral arteriovenous malformation with a gamma unit are presented. Complete nidus obliteration was angiographically confirmed in six cases and significant decreases in arteriovenous malformation size were observed in the other three. There were no radiation-related deteriorations in physical or mental development. In seven patients who underwent endocrinological examination more than 3 years after irradiation, five were normal and the other two showed only low serum adrenocorticotropic hormone levels, which, however, did not necessitate replacement therapy. Neurodiagnostic imaging follow-up studies revealed no radiation-induced lesions in any of the nine cases.
Detailed follow-up results for 25 patients treated for cerebral arteriovenous malformation (AVM) with a gamma unit are presented. Complete nidus obliteration was angiographically confirmed in 16 (73%) of 22 cases receiving full-dose irradiation. There were no radiation- or AVM-related mortalities. However, we did experience one case of radiation-related morbidity and one of angiography-related mortality, the autopsy findings of which are discussed. Computed tomography scan and magnetic resonance imaging follow-up studies of radiosurgically treated AVMs indicated that increased enhancement of the nidus after contrast or gadolinium administration could persist even after obliteration of the AVM was angiographically confirmed.
The clinical outcomes are described for 247 consecutive cases of arteriovenous malformation (AVM) treated with the gamma knife between April, 1970, and December 31, 1983. Headache resolved in 65 (66.3%) of the 98 patients presenting with this symptom and improved in an additional nine (9.2%). Of 59 patients admitted with seizures, 11 (18.6%) became seizure-free without anticonvulsant medication and an additional 30 patients (50.8%) became seizure-free with anticonvulsant medication. Pre-existing neurological deficits improved or totally disappeared following radiosurgery in 56.7% of affected cases. This improvement presumably occurred within the frame of the natural history. The protective effect of the ionizing beams against hemorrhage in incompletely obliterated AVM's is analyzed. To assess the rate of rebleeding, probability estimates were calculated using both the person-year method and the Kaplan-Meier life table. With the person-year method the actual rebleed rate is not too different from the values observed in the natural history of the disease (2% to 3%/yr). Analysis by Kaplan-Meier life-table estimates demonstrated a risk of nearly 3.7%/yr until 60 months after radiosurgery. Five years following treatment, the life table ends in a plateau which could be interpreted as an indication of decrease in the risk of hemorrhage. However, long flat regions at the right end of the life table do not imply that the real risk of rebleeding is negligible unless a large number of patients have been followed well into or beyond the flat region.
Explore the source record for details and available documents.
The double logistic product formula is proposed as a method for predicting the probability of developing brain necrosis after high dose irradiation of small target volumes as used in stereotactic radiosurgery. Dose-response data observed for the production of localized radiation necrosis for treating intractable pain with the original Leksell gamma unit were used to choose the best fitting parameters for the double logistic product formula. This model can be used with either exponential or linear quadratic formulas to account for the effects of dose, fractionation and time in addition to volume. Dose-response predictions for stereotactic radiosurgery with different sized collimators are presented.
The interaction between SCH28080 and omeprazole, two specific inhibitors of gastric H+/K+-ATPase, was investigated using gastric glands and isolated gastric membranes. For gastric glands, inhibition of acid formation by SCH28080 was not reversed by washing whereas inhibition by omeprazole was partially reversed after washing. These features are opposite to what is found with isolated membranes. However, if gastric glands were permeabilized with digitonin after exposure to the inhibitors and recovery measured as ATP-dependent acid formation or H+/K+-ATPase activity, inhibition by SCH28080 was completely reversed while inhibition by omeprazole was non-reversible. Using a procedure of pretreatment with inhibitors followed by permeabilization and assay of recovered activity, it was found that a combined treatment with SCH28080 plus omeprazole prevented the irreversible inhibition by omeprazole, i.e. acid forming capability and ATPase activity were fully recovered. In order to test the possibility that SCH28080 prevented activation of omeprazole by dissipating an acid environment, control experiments were performed with SCN, which gave equivalent dissipation of the acid gradient but did not prevent the irreversible inhibition by omeprazole. These results were confirmed in isolated gastric membranes where residual p-nitrophenylphosphatase activity was assayed following exposure of acid transporting vesicles to omeprazole. Compared to control conditions, omeprazole inhibited 48% of the phosphatase activity whereas simultaneous addition of SCH28080 reduced the inhibition to 14%. The results therefore suggest that SCH28080 selectively blocks irreversible inhibition by omeprazole and thus that these two agents interact at a common region of the luminal aspect of the gastric H+/K+-ATPase.