Biomedical subjects

M C Chamberlain

Publications and source records attributed to M C Chamberlain.

82 records · Page 5Linked to original sources

PubMed1988

Treatment of extraneural metastatic medulloblastoma with a combination of cyclophosphamide, adriamycin, and vincristine.

Seven patients with extraneural metastases from medulloblastoma were treated with a combination of cytoxan, adriamycin, and vincristine (CAV). None of the patients had evidence of active neural axis disease. All patients with bone metastases responded with a reduction in bone pain and improvement on the radionuclide bone scan. One patient presenting with lymph node metastases showed initial reduction in the size of the palpable nodes. In this group, the median time to the development of extraneural metastasis was 18 months from the time of original diagnosis of central nervous system medulloblastoma. The median duration of response to CAV, after extraneural metastasis, was 17 months (4-65 months). Four of seven patients died of disease-related causes, one patient presumed well was lost to follow-up, and two of seven are still without evidence of active disease at 37 and 65 months. The combination of CAV is well tolerated and provides reasonably good palliation for extraneural medulloblastoma.

Adolescent↗

PubMed1987

Phase I-II study of eflornithine and mitoguazone combined in the treatment of recurrent primary brain tumors.

Eflornithine (DFMO), an irreversible inhibitor of ornithine decarboxylase, and mitoguazone (MGBG), a competitive inhibitor of S-adenosylmethionine decarboxylase, were evaluated in a phase I-II study for patients with primary recurrent malignant brain tumors. All patients had failed prior radiation therapy and most had also failed prior chemotherapy. Two dose schedules were used, with the second schedule (Group II) a modification of the first schedule (Group I). The Group II schedule, with different dose levels, was better tolerated than the Group I schedule. Gastrointestinal and myelotoxicity were dose-limiting in most patients, and tinnitus was dose-limiting in two patients. Nineteen of 33 evaluable patients had anaplastic gliomas, in whom response was observed in 21%, stable disease in 53%, and immediate progression after one course of therapy in 26%. Of six patients with glioblastoma multiforme, two had brief stabilization of disease. An additional patient with brainstem glioma and ependymoma also had disease stabilization. Four patients with medulloblastoma, a spinal cord mixed glioma, and one with oligodendroglioma failed DFMO-MGBG. Based on this study, we believe that a combination of DFMO and MGBG is well-tolerated and deserves further evaluation for patients with anaplastic gliomas, particularly those that appear to be biologically slow growing.

Adolescent↗

PubMedDate not supplied

Neonatal schizencephaly: comparison of brain imaging.

Schizencephaly is a regional disturbance of cerebral hemisphere formation occurring at 3-5 months gestation; neonatal presentation is uncommon. Three neonates with schizencephaly were evaluated with cranial ultrasonography (US), unenhanced computed tomography (CT), and magnetic resonance imaging (MRI) examinations. Common findings in US, CT, and MRI include parasylvian and midline clefts, size asymmetries of the basal ganglia and thalamus, cerebral parenchymal volume loss, ventriculomegaly, ventricular diverticula, and absence of the septum pellucidum. MRI and CT were superior to US in detecting calcification, gyral and sulcal abnormalities, and parasylvian clefts. MRI alone demonstrated homolateral absence of the sylvian vasculature, small medullary pyramids, low position of the fornix, and the thinning of the corpus callosum. Although US appears adequate as a screening test, MRI best defines the precise pathoanatomic findings of neonatal schizencephaly and allows for the prediction of neurologic outcomes in affected newborns.

Brain↗

PubMedDate not supplied

Pediatric AIDS: comparative cranial MRI and CT scans.

Fourteen consecutive children (age range: 4 months to 11 years; median: 4 years) with acquired immunodeficiency syndrome (AIDS) were studied prospectively with cranial magnetic resonance imaging (MRI) and unenhanced computed tomography (CT). In 4 children, human immunodeficiency virus infection was transfusion-related, while in 10, transplacental transmission occurred. Twelve children had abnormal neurologic examinations; of these, 10 had developmental delay and 2 were normal by developmental history and neurologic examination. Standardized neuropsychologic tests were given to all children; 5 were in the normal range and 9 demonstrated significant delays in verbal or motor/perceptual development. All children with abnormal neuropsychologic results were developmentally delayed; however, in 2 infants with normal neuropsychologic assessments, developmental delay and abnormal neurologic examinations were documented. Brain parenchymal volume loss (8 patients) and cervical lymphatic hypertrophy (4 patients) were demonstrated equally well by MRI and CT. CT alone demonstrated striatal-thalamic calcification (1 patient), whereas MRI alone demonstrated delayed myelination (1 patient). The extent of focal white matter lesions in 1 patient was demonstrated better by MRI than by CT. No intracranial mass lesions were demonstrated; however, significant correlations were found between peripheral volume loss imaged by either MRI or CT and both verbal and performance scores. In our small series, MRI offered no apparent advantage over CT in evaluating children with AIDS. We suggest that CT alone is sufficiently sensitive in evaluating pediatric AIDS-related brain abnormalities.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Rhabdomyolysis in children: a 3-year retrospective study.

The case reports of 4 pediatric patients illustrate the complex clinical scenarios in which childhood rhabdomyolysis/myoglobinuria occurs. Children ranged in age from 8-18 years. Presumed etiologies of rhabdomyolysis/myoglobinuria included Neisseria sepsis, exertion-related episodes, dialysis disequilibrium, and diabetic ketoacidosis. No child developed respiratory or renal failure. all children were discharged with normal muscle power, indicating the benign nature of this disease and the importance of aggressive management.

Adolescent↗

PubMedDate not supplied

Osseous metastasis in medulloblastoma: MRI findings in an unusual case.

An 11-year-old boy with a history of medulloblastoma developed blastic osseous metastases. The metastases were detected by noting diffuse areas of low signal intensity within the calvarium on T1-weighted and T2-weighted magnetic resonance (MR) scans of the brain. The MR appearance of osseous metastases in medulloblastoma has not been reported previously. Extraneural metastases in medulloblastoma are relatively rare. The literature is briefly reviewed.

Bone Neoplasms↗

PubMedDate not supplied

Radioisotope CSF flow studies in leptomeningeal metastases.

BACKGROUND: Leptomeningeal metastases is a frequent neuro-oncologic complication in patients with cancer. OBJECTIVE: Radionuclide CSF flow studies provide a unique method of evaluating CSF compartments in patients with leptomeningeal metastases. METHODS: Radionuclide CSF flow studies are performed by injecting (111)Indium-DTPA into either the ventricular or lumbar CSF compartment. (111)Indium-DTPA is entrained by CSF and flows through CSF compartments based on normal CSF physiology. RESULTS: Normal times to appearance of (111)Indium-DTPA following intraventricular injection in either adults or children are as follows: ventricles (median 1 minute); cisterna magna/basal cisterns (5); cervical (15); thoracic (20); and lumbar (30) spinal subarachnoid spaces; and sylvian cisterns (50). Normal times to appearance of (111)Indium-DTPA following intralumbar injection are as follows: lumbar (1); thoracic (22.5); cervical (32.5) spinal subarachnoid spaces; cisterna magna/basal cisterns (37.5); sylvian cisterns (65); ventricles (1,440); and cerebral convexities (1,440). In 30 consecutive patients, 47% of patients had documented compartmentalization of CSF by (111)Indium-DTPA CSF flow studies. 13% had base of brain obstruction of whom 50% responded with re-establishment of normal CSF flow and 33% had spinal subarachnoid space block of whom 40% following therapy had re-establishment of normal CSF flow. In 61 consecutive patients, 33% of patients had abnormal spinal CSF flow studies which better demonstrated interruption of CSF flow when compared to CT myelography and spine MR. In 40 patients, all with CSF block, 20 of whom responded to therapy with re-establishment of normal CSF flow as compared to 20 with refractory CSF block, significant differences were seen in median survival and cause of death favoring patients with normal or restored CSF flow. CONCLUSIONS: Radioisotope CSF flow studies in patients with leptomeningeal metastasis appear to have two practical uses. First, radioisotope CSF flow studies by documenting normal CSF flow predict for homogeneous distribution of intra-CSF chemotherapy. Secondly, in patients with CSF flow obstruction refractory to site of obstruction therapy, limited survival, rapid leptomeningeal disease progression and death due to progressive CNS disease is predicted.

Adult↗

PubMedDate not supplied

Recurrent primary central nervous system lymphoma complicated by lymphomatous meningitis.

Primary central nervous system lymphomas (PCNSL) are chemosensitive primary brain tumors and are treated primarily with adjuvant chemotherapy. Nonetheless, therapy is palliative with the majority of tumors recurring in brain parenchyma. A common pattern of PCNSL recurrence is that of cerebrospinal fluid (CSF) dissemination manifested as lymphomatous meningitis (LM). Fourteen patients (8 men; 6 women) 34-76 years of age (median 56 years) with recurrent PCNSL manifested as either lymphomatous meningitis (8 patients) or combined parenchymal and CSF disseminated tumor (5) were retrospectively evaluated. All patients had received prior adjuvant therapy including surgery (gross total resection in 3; biopsy in 11), radiotherapy (whole brain in 11; craniospinal in 1; and orbital in 1) and chemotherapy (systemic in 13; intraventricular in 4). At recurrence, documented by either positive CSF cytology (14 patients) or neuroradiographic evidence of disease progression (6 patients), all patients were evaluated for extent of central nervous system disease. Two patients not previously irradiated were treated with whole brain radiotherapy. Eight patients received systemic chemotherapy including 7 patients (Brown University; Group A) treated with either high dose methotrexate (n=4) or cytosine arabinoside (n=3). Seven patients (UCSD: Group B) received intraventricular chemotherapy (methotrexate 5; cytosine arabinoside 4; thio-TEPA 4) without concomitant high dose systemic chemotherapy. Four of 14 patients (28.6%) are disease-free and have durable responses (median 36 months, range 22-56 months). Ten patients (71.4%) have died of disease progression (5 due to combined PCNSL and LM; 4 due to LM; and 1 due to PCNSL). Median survival was 5.5 months with a range of 3-12 months. Grade III/IV myelosuppression was seen in 5 patients, all as a result of systemic chemotherapy (Group A patients). Aseptic meningitis due to intraventricular chemotherapy was seen in 7 patients (Group B patients). No treatment-related deaths occurred. Four patients are disease-free and manifest leukoencephalopathy of whom 2 are symptomatic. Outcome was comparable in Group A and B patients. Recurrent PCNSL complicated by LM may be palliated by combined modality therapy and in this small series, approximately one-quarter of patients (two from each treatment group) are long-term survivors and disease-free. Outcome is similar in patients treated with intraventricular chemotherapy as compared to patients treated with high dose systemic methotrexate or cytosine arabinoside. Treatment-related toxicity was manageable however delayed neurotoxicity is seen in disease-free survivors.

Adult↗

PubMedDate not supplied

MR imaging and CT in three cases of Sturge-Weber syndrome: prospective comparison.

Three patients with Sturge-Weber syndrome (5 months, 6 years, and 17 years old) were studied prospectively with MR imaging and CT of the brain. Both techniques demonstrated parenchymal volume loss, choroid plexus enlargement, calvarial hemiatrophy, and proptosis. In regions of parenchymal volume loss, MR alone demonstrated thickened cortex with decreased convolutions and abnormal white matter. A focal thalamic lesion and prominent medullary and subependymal veins were also shown better by MR. However, CT definitively demonstrated the characteristic cortical calcification, while T2-weighted MR images detected only smaller, nonspecific foci of hypointense signal. MR and CT are complementary in the evaluation of Sturge-Weber syndrome.

Adolescent↗

PubMedDate not supplied

Primary health care in Canada: in praise of the nurse?

In Canada, as elsewhere, it has been agreed that primary health care (PHC) is needed, particularly for the underserved population. But the debate continues over which approach, what measures and who should be involved. To help find the answers, the Canadian Nurses Association presented a working paper already in 1980 to the Canadian Government recommending changes in the health system and proposing various roles that nurses could play in formulating and implementing its national primary health policy and in November this year organized a two-day PHC workshop involving representatives from provincial councils and government as well as nurses. Below, two nurses teaching at the University of Ottawa's School of Nursing give their view on what should and could be done in Canada.

Canada↗