|C. Joon Choi, MD, PhD of the UCSD Cardiovascular Center discusses the importance of coronary artery wall imaging in heart disease by MRI and current advances in interventional cardiovascular MRI. Series: "UCSD Cardiovascular Center: Cardiovascular Update" [Health and Medicine] [Professional Medical Education]|
Tuesday, December 19, 2006
Friday, December 08, 2006
Defibrillators: In Vitro Magnetic Resonance Imaging
Evaluation at 1.5-Tesla
Thursday, December 07, 2006
|Presented by Thomas Steineke, MD, Phd at the "Diagnosis Brain Tumor- You Are Not Alone" conference at the Neuroscience Institute at JFK Medical Center, Edison, NJ Oct 15,2005.|
The Brain Tumor Society
Central NJ Brain Tumor Support Group
Monmouth & Ocean Brain Tumor Support Group
Available on DVD along with many other brain tumor lectures from this and other conferences at virtualtrials.com/video.cfm
Wednesday, December 06, 2006
Wednesday, November 22, 2006
Monday, November 20, 2006
This is the future, FoxHollow Technologies Inc.'s SilverHawk catheter is one of the hottest selling new medical devices on the market and has sent the company's stock surging since it went public in October 2005.
Since March 2006, Radiologist Joseph Flynn, D.O., and the Interventional Radiology department at Parrish Medical Center have been successfully performing this procedure. Dr. Flynn is continually advancing his knowledge to bring cutting-edge technology to the North Brevard community through advanced classes and seminar training. Other Interventional Radiology care partners are Tammy Flannery RT(R)(CT)(CV), Jennifer Rice RT(R), Julie Cook R.N. and Cherie Clark R.N. The SilverHawk is inserted into the patient's groin through a small puncture site and moved through the artery to the site of the blockage. The tiny rotating blade is activated and the doctor advances the SilverHawk through the vessel, shaving plaque from the artery walls as it moves forward. The plaque is collected in the tip of the device and completely removed from the patient's body. Plaque excision typically is performed as a stand alone therapy without requiring additional procedures such as stent placement. Multiple lesions and multiple arteries can be treated with a single device. A number of multi-center and single center studies have demonstrated promising early clinical results in a range of patients from those with mild leg pain to those with critical limb ischemia.
Sunday, November 05, 2006
Melanocyte-Stimulating Hormone (MSH)
Gonadotropins: Luteinizing and Follicle Stimulating Hormones
Adrenocorticotropic Hormone (ACTH, corticotropin)
Growth Hormone (Somatotropin)
Empty sella syndrome occurs in patients when spinal fluid is found within the space created for the pituitary. The most common cause is a large openening a membrane which sits on top of the pituitary. When this opening is large, the spinal fluid pressure is forcred down onto the pituitary and flattens it out within the sella. In most cases, the pituitary functions normally as evidenced by normal thyroid functions, normal tests of adrenal function, normal somatomedin-C levels, and regular menses. Some patients have empty sella syndrome as a result of other processes such as neurosarcoidosis pituitary tumors that have degenerated, etc. Rare patients have a congenital empty sella and a coexisting pituitary tumor.
Pituitary tumors are associated by function.Usually by what hormone they release.Pituitary adenomas are the fourth most common intracranial tumor after gliomas, meningiomas and schwannomas. The large majority of pituitary adenomas are benign (not malignant) and are fairly slow growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are by far the most common disease affecting the pituitary. They more commonly affect people in their 30s or 40s, although they are diagnosed in children as well. Most of these tumors can be successfully treated. Pituitary tumors can vary in size and behavior. Tumors that produce hormones are called functioning tumors, while those that do not produce hormones are called nonfunctioning tumors.
Pituitarary Apoplexy Can occur When An Aneurysm near the pituitary ruptures. This can cause bleeding or hemorage in the pituitary . Pituitary aneurysms can be enough to cause symptoms and they often include headache, nausea, visual loss, double vision and altered mental status. Most patients also have undiagnosed hormone insufficiency prior to the apoplectic event. In patients with such symptoms, the diagnosis of pituitary apoplexy is best confirmed with an MRI of the brain with special attention to the pituitary. Conditions to consider when trying to establish the diagnosis of pituitary apoplexy include ruptured intracranial aneurysm, meningitis, brain stem stroke, cavernous sinus thrombosis, intracerebral hemorrhage, temporal arteritis and ophthalmoplegic migraine headache, but typicaly pituitary apoplexy is a condition that develops over hours to several days, typically resulting from hemorrhage and/or infarction of a pituitary macroadenoma.Treatment for pituiray tumors
Wednesday, November 01, 2006
Monday, October 30, 2006
There has been new research done into the area of these mirror cells and Autism. Ever since autism was identified It has been a struggle to find out what causes it. We know It can be inherited, but the enviroment may also play some part. In people with autism their main signs are lack of eye contact and absence of empathy. They may also have problems understanding metaphors, sometimes taking them literally. Another very unusual behavior is an extreme dislike or complete aversion to certain sounds or noises that sets off bells in their heads. This Is A GREAT article by
Vilayanur S. Ramachandran and Lindsay M. Oberman in Scientific American
about Autistic children and the reserch done on the mirror cells. I could not stop reading.
I hope Every one likes it.
Monday, October 16, 2006
****Since I first posted this article I have witnessed this first hand sevral times now. The patients have been on ventilators with high levels of oxygen and the Rads have refered back to this article when reading the brain scan.**** Thanks again to the contributors of the article
Yoshimi Anzai, Makiko Ishikawa, Dennis W. W. Shaw, Alan Artru,
Vasily Yarnykh, and Kenneth R. Maravilla.
Wednesday, October 11, 2006
When the Bone Flap Hits the Floor. Neurosurgery. 59(3):585-590, September 2006.Brian T. Jankowitz, M.D.; Douglas S. Kondziolka, M.D.
Links: Abstract HTML PDF (447 K)
Abstract: OBJECTIVE: There is no published data in the neurosurgical literature describing the incidence, treatment, or outcome of contaminating a bone flap. We reviewed our departmental experience to determine methods of prevention and assess our treatment strategies.
METHODS: We retrospectively reviewed all incidents of dropped bone flaps during a craniotomy at a single medical center during a 16-year period. In addition, a questionnaire was mailed to neurosurgeons in the United States and abroad asking their own experience and method of management.
RESULTS: Fourteen incidents of dropped bone flaps occurred during a 16-year period. Follow-up varied from 2 to 176 months. The bone flap was dropped while elevating the bone (n = 4), when handing the bone off the field (n = 4), and during plating (n = 4). The context was unknown in two cases. Management included soaking the flap in betadine and/or antibiotic solution (n = 8), autoclaving (n = 2), or discarding the bone flap and replacing with a mesh cranioplasty (n = 3). The treatment remains unknown in one case. No instances of infection were noted in follow-up. In response to the survey, 66% (33 out of 50) of the polled neurosurgeons had experienced this complication during their practice, and 83% would replace the bone flap after disinfection.
CONCLUSION: Dropping a bone flap during neurosurgery remains an uncommon but preventable complication. Treatment options include discarding the bone followed by cranioplasty versus replacing the bone after treatment with antibiotic irrigation, betadine, and/or autoclaving. Replacement after disinfection is an appropriate option for contaminated bone flaps that avoids the expense and time of cranioplasty.
Copyright (C) by the Congress of Neurological Surgeons
Children's intraoperative MRI system is the 1st and only system of its kind in a pediatric hospital
October 25, 2006 at 1:00 PM EDT (17:00 UTC)
From Children's Hospital Boston
Neurosurgery Webcast: Neurosurgeons at Children's Hospital Boston to perform MRI- guided brain tumor removal with cortical mapping on a 13-year-old during live Webcast
On Wednesday, Oct. 25, at 1:00 p.m. EDT, neurosurgeons at Children's Hospital Boston will remove a brain tumor employing functional mapping of the cortex on a 13-year-old pediatric patient during a live Webcast. Children's hosts three to four Webcasts annually to showcase its pioneering care and technology to specialists and referring physicians around the world, and to educate consumers on the latest and MORE...
Neurosurgery Webcast: Neurosurgeons at Children's Hospital Boston to perform MRI- guided brain tumor removal with cortical mapping on a 13-year-old during live Webcast
On Wednesday, Oct. 25, at 1:00 p.m. EDT, neurosurgeons at Children's Hospital Boston will remove a brain tumor employing functional mapping of the cortex on a 13-year-old pediatric patient during a live Webcast. Children's hosts three to four Webcasts annually to showcase its pioneering care and technology to specialists and referring physicians around the world, and to educate consumers on the latest and most innovative medical treatments available.
The Webcast will feature Children's intraoperative MRI system, known as the MR-OR, the first and only system of its kind at a pediatric hospital in the country. Developed by IMRIS, the iSPACE surgical imaging suite captures digital images through a unique, ceiling-mounted, movable MRI scanner that can be used to take high-resolution, real-time patient scans before, during and after a surgical procedure. This advanced technology allows surgeons to determine the extent of a tumor while the patient is undergoing surgery to ensure its accurate removal.
"Unlike other intraoperative MR machines, the mobile MRI lets surgeons use their usual metal surgical tools because the unit is moved into the shielded garage when surgeons are operating," says Joseph R. Madsen, MD, a neurosurgeon in the Department of Neurosurgery at Children's Hospital Boston and associate professor of Surgery at Harvard Medical School.
Dr. Madsen will operate on a patient with oligodendroglioma, a low-grade tumor arising from glial cells in the central nervous system. The tumor lies near motor and sensory areas of the brain, which will require electrocorticography and physiological tests to map the normal brain around the tumor before the surgery. Once the mapping has been completed, Dr. Madsen will then perform a microsurgical resection of the tumor.
Brain tumors are the most common solid tumors in children—approximately 1,800 are diagnosed in the United States each year. Today, more than half of all children diagnosed with a brain tumor will be cured of the disease. The most effective form of treatment is the surgical removal of all or part of the tumor without jeopardizing any of the brain's critical functions. In order to decide which areas of the tumor can safely be removed, neurosurgeons use the technique of brain mapping.
"The cutting edge of neurosurgery is to identify and remove as much of the undesirable pathologically damaging brain tissue without disturbing the functioning areas of the brain," says Dr. Madsen. "Through the use of physiological mapping and the MR-OR, we are able to achieve this and assure our patients the best possible surgical outcomes."
Dr. Madsen will be assisted by neurologist Frank H. Duffy, MD, radiologist Carolyn Robson, MB, ChB, and associate anesthesiologist-in-chief Mark A. Rockoff, MD. They will also serve as Webcast commentators, providing additional information about the procedure throughout the surgery.
Moderating the live broadcast will be neurosurgeon Mark R. Proctor, MD. Neurosurgeon-in-chief R. Michael Scott, MD, will introduce the Webcast and offer insight into pediatric brain tumors. Liliana C. Goumnerova, MD, and Mark Kieran, MD, PhD, the surgical and medical directors of the Brain Tumor Clinic, a collaborative program with Dana-Farber Cancer Institute, will also be on-hand to discuss the neuro-oncological aspects of the procedure, while Craig D. McClain, MD, and Keith Ligon, MD, will comment on the anesthesia and neuropathology, respectively. An 11-year-old brain tumor patient, who recently underwent a similar procedure in the MR-OR, and his family will also answer questions during the Webcast.
View CBS4 Boston news story with Dr. Goumnerova regarding a successful brain surgery on a 13 year old girl. Click Here
Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 11 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: http://www.childrenshospital.org/newsroom
IMRIS Inc. designs and manufactures advanced surgical imaging systems for use in cranial, spinal and general surgery applications. IMRIS is focused exclusively on providing fully integrated surgical imaging solutions that support the effectiveness of the surgical team. For more information about the IMRIS iSPACE™ solution visit: www.imris.com
Friday, September 29, 2006
Recently, I had a patient come in for a Brain MRI. She had Erdheim-Chester disease. It is a type of histiocytosis. This disease is a rare non-Langerhans cells histiocytosis affecting multiple organ systems . Symmetric sclerosis of the long bones is usually reported, but the central nervous system and sinus can also be affected. Among patients with central nervous system involvement, the most frequent manifestations are diabetes insipidus, cerebellar syndromes, orbital lesions, and extra-axial masses involving the dura . The patient is coming in to be scanned about every 6 months. She is on cobalt and it seems to be helping. Her chemotherapy looks like it is making her very weak, but seems to be helping the disease. I was supprised at how little information there was about this disease on the web when I started looking. I did find one source of information that recomended doing a T2 flair cor in addition to the T2 flair ax. I am glad I did because the lesions in her brain show up better on the flairs than anything else.The lesions enhanced post gad but in a fuzzy sort of way. The flairs offer the best images in the study. Just my $.02.
Erdheim-Chester disease (ECD) is a rare multisystem disorder of adulthood. It is characterized by excessive production and accumulation of histiocytes within multiple tissues and organs. Histiocytes are large phagocytic cells (macrophages) that normally play a role in responding to infection and injury. (A phagocytic cell is any "scavenger cell" that engulfs and destroys invading microorganisms or cellular debris.) In those with ECD, sites of involvement may include the long bones, skin, tissues behind the eyeballs, lungs, brain, pituitary gland, and/or additional tissues and organs. Associated symptoms and findings and disease course depend on the specific location and extent of such involvement. The specific underlying cause of ECD is unknown.
68-year-old woman with Erdheim-Chester disease involving both lower extremities. Coronal T1-weighted MR image (TR/TE, 520/25) of both lower extremities shows diffusely invasive bone marrow masses destroying cortical bones in both tibias.
Erdheim-Chester disease, or ECD, is a potentially fatal disorder caused by the overproduction of histiocytes, which are large cells that help the body respond to infection or injury. These rogue histiocytes accumulate in the loose connective tissue, causing it to become thickened and dense. ECD can affect many areas of the body, including the eye cavity (orbit), skin, brain, long bones of the arm and leg and the lungs.
Numerous treatments have been attempted for this disease [2,6,13,14].
Corticosteroids are the traditional first-line treatment and are used to control
symptoms, but generally are either ineffective or only transiently effective [2,6].
Bisphosphonates are efficient in treating osteolytic lesions in Langerhans cell
histiocytosis but have only partial or temporary success in the management of bone
involvement in Erdheim-Chester disease . Chemotherapy can induce transient
partial responses, but is often ineffective [2,16]. Cladribine has been used
successfully in adult Langerhans histiocytosis, but its application in Erdheim-Chester
disease is limited to two patients, one of whom responded [16,17]. Radiation,
methotrexate, cyclosporine and azathioprine have not yielded sustained clinical
We describe the successful treatment of three patients suffering from Erdheim-
Chester disease with interferon-. The initial therapeutic dose of 3 to 6x106 units s.c.
three times per week, was reduced to 1x106 units three times per week because of
fatigue. This low dose was well tolerated and response was observed within one
month with dramatic reduction in the exophthalmos and recovery of vision in two
patients (case #1 and #3) whose vision was threatened by progressive disease while
on high-dose chemotherapy and/or steroids. Response was also manifested by
- 7 -
gradual improvement in diabetes insipidus (cases #1 and #2) and in bone lesions
(case #2) (Figure 2).
The mechanism(s) underlying the salutary effects of interferon- in Erdheim-
Chester are unclear but could be due to several of the diverse biological effects of this
agent: maturation and activation of dendritic cells [9,10]; immune-mediated (e.g. via
natural killer cells) destruction of Histiocytes; or direct antiproliferative effects .
There is also anecdotal evidence of clinical therapeutic benefits for interferon-alpha in
other histiocytic disorders (Langerhans cell histiocytosis  and Rosai-Dorfaman
Erdheim-Chester disease is a rare and difficult-to-treat disease. All three of our
patients with this disorder achieved a long-lasting response (3+, 3.5 and 4.5+ years)
while receiving interferon-. Our observations suggest that this well-tolerated
treatment warrants further application and investigation in this disorder.(source)
Wednesday, September 20, 2006
Saturday, September 02, 2006
HERE IS A GREAT BOOK THAT HAS HELPED ALONG THE WAY.
THIS WEBSITE IS AN ONLINE TUTOR THAT IS VER GOOD I ALSO RECOMEND IT.
WILLIAM FAULKNER ALSO HAS A COURSE FOR REGISTRY REVIEW.
Here are a few good sites good luck!
Phillips Learning Center
Friday, September 01, 2006
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