Contrast-enhancing computed tomography ring in glioblastoma multiforme after intraoperative endocurietherapy.

The significance of the contrast-enhancing ring seen on serial follow-up postirradiation computed tomograms (CT) of the brain was evaluated in a group of 41 patients with glioblastoma multiforme (GM) who were treated in a phase I/II study by means of intraoperative remote afterloading endocurietherapy (ECT) with a high activity cobalt 60 probe (20.00 Gy) in one high-dose rate fraction), and conventional fractionated external-beam (EXRT) radiotherapy (60.00 Gy in 30 fractions in 7.5 weeks). All received minimum total tumor doses of 80.00 Gy. After completion of treatment, all patients were followed with serial CT scans of the brain. Two to 6 months after treatment, 27 of 41 patients developed the similar thin-walled, regular, contrast-enhancing CT rings with low-density attenuation inside and outside the ring. Postmortem study in two of these patients revealed that the thin-walled, regular, contrast-enhancing ring represented a continuous capsule of dilated cerebral vessels with inner low-density attenuation corresponding to necrosis, and outer low-density attenuation corresponding to edema. The CT appearance of the thin-walled, regular, contrast-enhancing ring produced after high-dose rate intraoperative ECT and EXRT is distinctly different from the CT ring characteristic of untreated or recurrent GM. After high-dose rate intracranial ECT and EXRT, the appearance of a post-ECT contrast-enhancing CT ring should not be automatically interpreted as recurrent disease as previously reported after conventional fractionated EXRT.

Pain-patient Minnesota Multiphasic Personality Inventory (MMPI) subgroups: evaluation of long-term treatment outcome.

Six hundred thirty-five chronic pain patients completed the Minnesota Multiphasic Personality Inventory (MMPI) prior to participation in a multidisciplinary inpatient pain treatment program. Three male and four female MMPI subgroups were identified by means of cluster analyses for each of two samples. Pretreatment and long-term follow-up differences were then examined among the MMPI subgroups. Results indicated that the subgroups identified in the present study closely resembled each other and those previously reported in the literature. However, at long-term follow-up only a few outcome differences were identified among male subgroups, while no differences were found among female subgroups. Possible explanations for no differential treatment outcomes among the MMPI subgroups are discussed.

Local control of recurrent clival and sacral chordoma after interstitial irradiation with iodine-125: new techniques for treatment of recurrent or unresectable chordomas.

Using new 125I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity 125I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity 125I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases.

Spinal metastases from pituitary hemangiopericytic meningioma.

A rare, previously irradiated, recurrent malignant angioblastic meningioma of the pituitary, hemangiopericytic type, was locally controlled by a new endocurietherapy technique that allows delivery of very high (10,000 cGy), sharply localized irradiation. Rather than succumbing to the local tumor recurrence, as would otherwise be expected, the patient developed distant spinal metastases several years later.

Endocurietherapy of glioblastoma multiforme with 125iodine: results of treatment.

We report our initial results of treatment of eight patients with newly diagnosed glioblastoma multiforme by means of a combination of surgical resection, 125Iodine endocurietherapy (4,000 rad), and external-beam radiotherapy (6,000 rad) for a total tumor bed dose of 10,000 rad.

Radiation-induced neoplasms of the brain.

The histopathology of two patients with radiation-induced neoplasms of the brain following therapeutic irradiation for intracranial malignancies is described. The second neoplasms were an atypical meningioma and a polymorphous cell sarcoma, respectively. They occurred 12 and 23 years after irradiation (4000 rad), within the original field of irradiation. In both cases, the radiation-induced tumors were histologically distinct from the initial medulloblastomas. Both patients were retreated with local irradiation using permanent implantation of radioactive iodine-125 seeds.

Retreatment of recurrent cystic craniopharyngioma with chromic phosphorus P 32.

A cystic craniopharyngioma in a two-year-old boy recurred six months after surgery and postoperative external-beam radiotherapy. Successful retreatment was accomplished with radioisotope injection of 0.5 mCi of chromic phosphorus P 32 into the intracranial cyst, which delivered approximately 300.00 Gy to the cyst wall. The patient's symptoms were relieved, and he is without evidence of disease or cystic fluid accumulation four years after intracavitary (32)P irradiation.

Intraoperative remote afterloading endocurietherapy with high-activity 60cobalt for treatment of glioblastoma multiforme.

An intraoperative remote afterloading endocurietherapy technique with high-activity 60Co for the treatment of glioblastoma multiforme is described. The technique can be used for initial management of the unresectable tumor or for retreatment of patients with recurrent tumor who have been treated previously with surgery and postoperative radiotherapy. Neither intraoperative nor postoperative complications were encountered in our treatment of 11 patients in this Phase I toxicity study.

Prediction of long-term outcome of multidisciplinary pain treatment.

Seventy-seven patients treated in a multidisciplinary pain program were assessed for treatment outcome according to Roberts' and Reinhardt's criteria, at a one to five-year follow-up. By these criteria, 47% were successes and 53% were not. Fourteen commonly collected demographic variables were then used in a discriminant analysis procedure to predict membership in the successful and unsuccessful groups. Age, compensation, education level, use of psychotropic medications, and number of pain surgeries formed a parsimonious set of predictor variables that correctly categorized more than 70% of the subjects.

Reversal of visual impairment after interstitial irradiation of pituitary tumor.

Bilateral blindness secondary to a recurrent hemangiopericytoma of the pituitary fossa in a 22-year-old man was corrected by the transsphenoidal implantation of a single high activity iodine-125 seed.

Spinal cord compression secondary to Gaucher's disease.

A case of compression of the spinal cord and cauda equina secondary to collapse of the T-12 and L-3 vertebral bodies in a patient with type 1 Gaucher's disease is presented. Decompressive laminectomies were done at both the T-12 and L-3 levels with moderate improvement of the patient's neurologic findings. Histologic examinations confirmed the presence of Gaucher's cells in the bone. Review of the literature revealed only one previous report.

The management of the chronic pain patient: clinical considerations.

Virtually everyone has experienced pain and it is reasonable to assume that individuals have sought out healers for pain since prehistoric times. There is an extensive literature about pain covering its definition, anatomy, physiology, psychology, and means of relieving it. However, it appears safe to say that the most significant advances have occurred during the last 25 to 30 years. Here, we will be concerned with the treatment of patients whose pain has been present six months or longer and which is not the result of a life-threatening or function-threatening disease process. Such pain is generally referred to as chronic benign, pain. At the present time, there are an increasing number of programs designed to deal with this problem, and health care providers are becoming more sophisticated in their understanding of chronic pain syndromes. In the material, which follows, the complexities of the problem are detailed from a multidisciplinary but integrated point of view.J Orthop Sports Phys Ther 194;5(6):305-307.

Cerebellopontine angle lipoma: a review.

Lipomas located in the cerebellopontine angle (CPA) have rarely been reported. With the advent of computed tomographic scanning and more sophisticated physiological diagnostic techniques, CPA lipomas are being reported more frequently. This paper reviews the world's literature on this lesion and summarizes the symptoms and signs, diagnostic studies, pathology, and surgical results. Recommendations regarding the therapy of this lesion are presented.