Intraoperative dynamic MRI: localization of sites of brain tumor recurrence after high-dose radiotherapy.

In patients with malignant astrocytomas or metastatic brain disease treated with high-dose radiotherapy, conventional imaging methods may not adequately distinguish recurrent tumor from radiation change. We used a fast spoiled gradient refocusing technique in the open-configuration intraoperative MR system to assess the rate of regional enhancement of the treated tumor bed and to localize specific sites for pathologic sampling to determine whether gadolinium uptake correlated with histologic data. Twenty-four patients were studied. Fourteen of 15 patients with areas of early enhancement had recurrent tumor present in histologic samples, and 8 of the remaining 9 patients had only reactive changes. Dynamic MRI was predictive of recurrent tumor (P < .0005, Fisher exact test and P < .002, Student t test). We conclude that dynamic MRI in the open-bore magnet is a promising method for localizing potential sites of active tumor growth in patients treated for malignant astrocytomas and metastatic brain lesions.

Evaluation of intracranial cysts by intraoperative MR.

Eleven patients with intracranial cystic collections were evaluated in the open-bore intraoperative MR system. In each case, the cystic collection or the surrounding cerebrospinal fluid (CSF) space was injected with .02 to .5 cc of .5 mol/l gadopentetate dimeglumine. Serial imaging was performed using T1-weighted imaging. In seven patients, free communication was demonstrated between the cystic collection and the surrounding CSF spaces. In four cases, the cyst did not communicate with the CSF; two of these were drained in the intraoperative MR system with reduction in symptoms. One patient developed an aseptic meningitis 10 days after the study, which was successfully treated with steroids; no other complications were noted. We conclude that the communication of intracranial cystic collections with the cisterns and ventricles can be safely and effectively elucidated with gadolinium injection in the intraoperative MR system.

Inpatient management of violent behavior: nursing prevention and intervention.

Psychiatric nurses in inpatient settings play a critical role in the management of potentially violent patients. One of their primary objectives is to ensure the safety of patients and staff 24 hours a day. This requires skillful observation of patients' motor behavior, verbal clues, and change in mental status, which may indicate an increase in agitation or possible aggressive behavior. It requires experience in prevention strategies and skill in acute crisis intervention techniques. To effectively intervene with potentially violent patients, psychiatric nurses must be able to work well under stress and be able to organize and execute a plan of immediate action. After the acute stage of the patient's illness, nurses should focus their work on assisting patients to manage their own behavior and supporting their newly acquired skills.