Richard H. Britt

Radiation-induced carotid artery disease

Nine patients with atherosclerotic carotid artery disease associated with neck radiation were compared to 40 control patients. The data suggest that significant differences in age, incidence of coronary and peripheral vascular disease, elevated lipids and serum cholesterol, and the angiographic incidence of disseminated atherosclerosis justify the description of radiation‐induced carotid disease as a clinical entity. Elevated serum cholesterol and hyperlipidemia may contribute to the development of radiation‐induced vascular disease. Successful surgical reconstruction does not appear to be influenced by the prior radiotherapy, although periarterial fibrosis and increased difficulty in separating the plaques from the vascular media was encountered.

Localized Hyperthermia in the Treatment of Malignant Brain Tumors Using an Interstitial Microwave Antenna Array

An interstitial microwave antenna array hyperthermia (IMAAH) system was evaluated in a series of acute experiments for its ability to generate localized hyperthermic fields in the normal adult and developing dog brain. Using a single microwave antenna, the maximum diameter of heating greater than or equal to 42°C was 1.3 cm. Using four microwave antennas, temperatures greater than or equal to 42°C were obtained over a 2.5 cm cross-sectional diameter. Normal gray matter cannot be heated above 42.2°C for 60 min without causing acute damage to cortical neurons. Edema formation can occur at temperatures as low as 42°C in both gray and white matter. Disruption of myelin tracts in white matter is apparent at temperatures of 43.0-43.5°C. The IMAAH system generates significantly higher and more variable temperature distributions in virally induced experimental brain tumors than in the developing dog brain at the same power levels.

Experimental Brain Abscess Evolution: Computed Tomographic and Neuropathologic Correlation

Brain abscess evolution was studied in dogs by correlating the CT appearance with the neuropathologic findings. The abscess, produced by direct inoculation, progressed from an area of cerebritis to a well encapsulated abscess over 14 days. Ring enhancement was seen in the cerebritis stage prior to capsule formation. The ring reached its maximum size at this stage and correlated best with the area of cerebritis surrounding the developing necrotic center; the rim of this ring increased in thickness, resulting in progressive diminution of the central lucent area on scans delayed up to 60 min. The diameter of the ring decreased as cerebritis receded. Once the capsule had formed, the central lucent area was similar and no longer filled in on delayed scans.

Chronic histological effects of ultrasonic hyperthermia on normal feline brain tissue.

The histopathological changes associated with ultrasonic heating of normal cat brain have been correlated with thermal distributions. Ultrasound energy was applied for 50 min at different intensities to generate tissue temperatures from 42 to 48 degrees C. Animals were sacrificed at various intervals from 1 to 56 days. The organization and resolution of thermal damage was characterized by three stages of histopathological changes within the nervous tissue. The acute stage (Days 1-3) was defined by (1) extensive coagulation necrosis, (2) pyknosis of neuronal elements in the gray matter, (3) edema and vacuolation in the white matter, and (4) polymorphonuclear leukocytes. The subacute stage (Days 3-21) was characterized by (1) the appearance of lipid-laden macrophages, (2) liquefaction of the necrotic regions, (3) fibroblastic proliferation, and (4) vascular proliferation with some perivascular inflammatory infiltration (lymphocytes). Lastly, the chronic stage (Days 21-56) was defined by (1) fibrosis (reticulin and collagen formation) and (2) gliosis (reactive astrocytic proliferation) occurring around the fluid-filled necrotic center. Analysis of these data has also included a study of the lesion size versus the dose (temperature for 50 min) of heating. The results demonstrate a significant linear dose-response correlation. The results of this study indicate that the histological appearance and time course of repair of thermal injury in the normal brain tissue are analogous to acute brain necrosis resulting from cerebral infarction, except the thermal damage does not result in significant hemorrhage.

Temperature measurements in high thermal gradients: II. Analysis of conduction effects.

Measurement errors associated with thermal conduction along a temperature probe in regions of high thermal gradients are examined. An analysis of a conducting probe inserted into an insulating catheter for the purpose of temperature mapping gives a means for estimating the effects of thermal smearing on the measured distribution. A comparison is made between the theory and an experimental test case (flow cell-thermal step gradient). Also, an iterative algorithm is developed to correct thermally smeared temperature distributions in order to reconstruct the desired unsmeared distributions. The algorithm is checked for self consistency in the flow cell experiment and is applied to in vivo data obtained during interstitial microwave heating in normal dog brain. Data from flow cell measurements are used to make relative comparisons of the probe conduction artifact for several different temperature probes (2 thermocouple needle probes, a thermistor needle probe and an optical probe) and assorted teflon catheters (16, 18 and 20 ga).

Temperature measurements in high thermal gradients: I. The effects of conduction

Two temperature probes (a fluoroptic sensor and a metallic thermistor), which are both suitable for stereotaxic implantation, were used in comparative thermometry studies during interstitial microwave heating of the brain in vivo. Thermal distributions having large temperature gradients (5-10 degrees C/cm) were routinely observed. The temperature differentials (delta T) between the 2 probes were position dependent within the thermal field. The maximum difference in temperatures measured, using the 2 probes along identical tracks without a catheter, ranged between 0.5 degree C and 1.8 degree C. Near the brain/air surface, the thermistor measured lower temperatures than the optical probe; however, medial to the antenna, the thermistor temperatures were higher than the optic sensor. The measured temperature discrepancies are the result of smearing due to thermal conduction along the axial length of the metallic thermistor probe. These effects are significantly accentuated when the temperature probes are tracked in catheters. Experiments performed in a nonperfused phantom, heated with the interstitial microwave antenna, demonstrated similar conductive effects. Studies in a nonelectromagnetic environment (flow cell-thermal step gradient) additionally confirmed that thermal conductive artifacts were the major source of temperature error.

Effect of radiation therapy on hemangioblastoma: a case report and review of the literature.

A case of medullary hemangioblastoma treated with radiation and operation is presented. After radiation a 55% decrease in the volume of the vascular portion of the tumor was documented by angiograms. Also, there were planes of dissection between the tumor and the dorsal medulla that had not been appreciated at exploratory operation before radiation. Total resection of the tumor was accomplished using hypothermia and cardiac standstill. The literature detailing the effects of radiation on hemangioblastoma is reviewed. (Neurosurgery, 6: 82--86, 1980)

Analysis of the frequency following response in the cat

The generators of the frequency following response (FFR) were characterized for three frequency ranges by studying changes in FFR response after lesioning the nuclei within the central brainstem auditory pathway. Responses to low frequency (200-500 Hz) stimulation demonstrated changes in the complexity of the FFR waveform in both time and frequency domains following lesions in the brainstem auditory pathway. The results indicate that the complexity of the low frequency FFR is due to activity from multiple sites within the auditory pathway. The intermediate frequency (700-1500 Hz) responses showed unpredictable amplitude changes following similar lesions and no conclusion could be drawn about the generators of the FFR in this frequency range. The responses to high frequency (3-8 Hz) stimulation showed no reduction in amplitude following serial lesioning. These results, combined with other experimental evidence presented, indicate that the high frequency FFR response originates from the cochlear microphonic. Different electrode configurations were used to evaluate the low frequency FFR. In contrast to multiple generator sources recorded with the standard vertex-mastoid electrode configuration, we were able to record a response contributed primarily by the inferior colliculi with a less peripherally sensitive electrode configuration (vertex-linked-pinnae) at low intensity stimulation. The fact that auditory brainstem nuclei contribute to the FFR in varying amounts depending on the electrode configuration may explain some of the conflicting characterizations of this response in the literature. Despite this difficulty, the FFR neural generators were identified and characterized in the low frequency range using our most sensitive electrode configuration (vertex-mastoid) and in the high frequency range where the single generator is the cochlear microphonic.

Intracellular study of synaptic events related to phase-locking responses of cat cochlear nucleus cells to low frequency tones.

In this study intracellular recording techniques were used to study the synaptic events related to phase-locking of cochlear nucleus cells to low frequency stimuli. A variable degree of phase-locking was noted even with units of the same low characteristic frequency. With low frequency phase-locking units an excitatory postsynaptic potential (EPSP) occurred in response to each period of the frequency stimulus, but the probability of an action potential occurring decreased as the frequency of the stimulus was raised. Complex units were described which phase-locked at lower frequencies of stimulation but did not at higher frequencies where the temporal pattern of firing to tone burst stimulation changed as well. Results are discussed as they relate to the frequency following response recorded with gross electrodes in the lower auditory pathway and the relationship to frequency coding in the auditory pathway.

Short term, high dose corticosteroids in computed tomographic staging of experimental brain abscess

SummaryA short term, high dose corticosteroid treatment protocol was investigated to determine its clinical utility in staging an experimental brain abscess. Corticosteroids were shown to decrease the degree of contrast enhancement of brain abscess 12 h after administration but the magnitude of the effect was not consistent enough to be clinically useful in staging. The corticosteroid effect progressively diminished as the inflammatory lesion encapsulated over time. This effect emphasized that a decreasing ring diameter and not diminished contrast enhancement should be the CT criterion for brain abscess resolution.