Stanley F. Handel

Intracarotid infusion of cis‐diamminedichloroplatinum in the treatment of recurrent malignant brain tumors

Thirty‐five patients with malignant brain tumors (23 with primary brain tumors and 12 with brain metastases) progressing after cranial irradiation chemotherapy received cisplatin, 60 to 120 mg/m2, into the internal carotid artery by a transfemoral approach. Courses of therapy were repeated every 4 weeks. Therapeutic evaluation was performed monthly using the CT scan of the brain and clinical neurologic examination. Thirty patients were evaluable for response. Of 20 evaluable patients with primary malignant brain tumors, 6 responded to therapy and 5 had stable disease. The median time to tumor progression for responding patients was 33 weeks, for stable patients 16 weeks, and 13 weeks for all patients. Five of 10 evaluable patients with brain metastases responded to intracarotid cisplatin, and 2 patients had stable disease. The estimated median time to progression for responding patients was 30+ weeks and 12+ weeks for patients with stable disease. Side effects included seizures in 5 courses, mental agitation and motor restlessness in 1, and transient hemiparesis in 7. One patient may have had a drug‐related death, and one patient appeared to develop encephalopathy after treatment. Five patients had clinical deterioration in vision; in two patients it was bilateral. Intracarotid cisplatin has definite activity in patients with malignant primary brain tumors and in patients with brain metastases. The recommended starting dose for intracarotid cisplatin is 60 to 75 mg/m2. At this dose level side effects are uncommon, but includes the risk of neurologic and retinal toxicity.

Arterial occlusion in the management of pain from metastatic renal carcinoma.

Arterial embolization was performed in nine patients with metastases from renal carcinoma who had severe pain resistant to conventional therapy. Patients with metastases in the ilium (four), the lumbosacral spine (one), and the base of the skull (one) experienced pain relief lasting from one to six months. The other three patients, who had metastases in the proximal femur, underwent preoperative embolization to facilitate tumor curettage and internal hip fixation. No significant complications were seen with this therapeutic approach.

Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients.

A preliminary retrospective correlation between computed tomographic scans and intracranial pressure (ICP) monitored was performed for 21 patients. No patient with a normal CT scan had elevated ICP. The lowest correlation was noted with slit ventricles; the highest, with dilatation of the contralateral temporal horn.

Digital radiography using a computed tomographic instrument

A prototype computed radiography (CR) system was evaluated for its efficacy as an independent diagnostic modality. Preliminary measurements of high contrast resolution, low contrast perceptibility, and dose were obtained. Clinical examinations including skull, abdomen, liver, gallbladder, biliary system, spine, and extremities were performed as an adjunct to either computed tomography or CR. The data suggest that CR can be an effective diagnostic imaging modality by itself. Advantages over conventional radiography include high scatter rejection, low patient dose, wide dynamic range, and good low contrast sensitivity for large objects; disadvantages, its long exposure time and relatively poor high contrast spatial resolution.

The sella turcica in primary end organ failure.

Pituitary hyperplasia, or adenoma, may result from end or target organ failure as seen in primary hypothyroidism and hypogonadism. Associated enlargement of the sella turcica and contour alterations without significant increase in volume may be seen. A review was made of 12 patients with end organ failure demonstrating the spectrum of radiologic changes within the sella turcica. Recognition of pituitary enlargement resulting from end organ failure may eliminate unnecessary surgery.

Posterior lumbar apophyseal fractures

The radiographic findings in 4 patients with fractures of the lumbar vertebral ring apophysis are reported. All patients had a bony ridge or fragment projecting into the spinal canal, usually from the lower border of L4; a defect in the postero-inferior aspect of the vertebral body; and either an anterior extradural impression or complete blockage on the myelogram. Computed tomography was performed on one patient and appears to be helpful in demonstrating bone within the spinal canal. Preoperative diagnosis can facilitate selection of the appropriate surgical approach.

Inability to Sneeze as a manifestation of medullary neoplasm

A young man with headache was unable to sneeze despite a strong sensory urge to do so. Magnetic resonance imaging revealed a cystic neoplasm in the medulla oblongata that presumably interrupted the efferent arc of the sneezing reflex.