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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is important to remember that ESCC is a complication of systemic malignancy and usually denotes disseminated disease with poor survival rates. Early diagnosis is crucial. The initial symptom is almost always back pain, which is local, radicular, or both. Following neurologic examination and radiography, MRI scanning or myelography/CT is immediately indicated if radiculopathy or myelopathy is present or if the radiographs of the spine are abnormal. In cancer patients with local back pain and normal findings on neurologic examination and radiography of the spine, there is still a probability of 0.1 of significant ESCC. Therefore, urgent CT/MRI scanning is justified. At present, the best treatment for ESCC remains unknown. In the majority of patients, radiotherapy is the most readily available and appropriate option because it is equal in effect to posterior decompressive laminectomy in both radiosensitive and radioresistant tumors. In patients with posterior epidural disease without tissue diagnosis, laminectomy with or without stabilization should be performed. Posterior decompressive laminectomy alone is contraindicated in patients with vertebral collapse. In selected instances of anterior epidural compression without tissue diagnosis or after failure of radiotherapy, an anterior surgical approach or synchronous vertebral decompression with posterior stabilization may be indicated. In the future, after appropriate clinical trials, vertebral body resection may be the optimal approach in de novo selected patients with ESCC with radioresistant tumors and limited systemic spread of the disease.
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PMID:Metastatic epidural spinal cord compression. 175 28

Magnetic resonance imaging of the trachea was performed in 21 children with congenital or acquired narrowing of the trachea or main bronchi. Diagnosis included aortic arch anomalies, innominate artery compression, pulmonary artery compression and tracheomalacia. All patients were examined after bronchoscopy. The demonstration of the trachea and the surrounding tissue and vessels on MR images enables the cause of tracheal compression and the degree and location of collapse to be evaluated. MRI is a modality well suited to characterizing tracheal narrowing without employing ionizing radiation or intravenous contrast medium. All MRI examinations were carried out with the patient under general anaesthesia so as not to risk pulmonary deterioration during sedation. In the cases presented MRI is the diagnostic step of choice after tracheobronchoscopy and broadens the diagnostic potential in extrinsic tracheal or bronchial stenosis in paediatric patients.
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PMID:Magnetic resonance imaging as a new diagnostic criterion in paediatric airway obstruction. 190 84

Magnetic resonance (MR) imaging of the trachea was performed in twenty-one children with congenital or acquired narrowing of the trachea or main bronchi. The demonstration of the trachea and the surrounding tissue and vessels on MR images permitted the evaluation of the cause of trachea, compression and the degree and location of collapse. MRI is a well-suited modality for characterizing tracheal narrowing without employing ionizing irradiation or intravenous contrast medium. In the cases presented MRI should be the diagnostic step of choice after tracheo-bronchoscopy. It is an enrichment of the diagnostic possibilities for extrinsic tracheal or bronchial stenosis in pediatric patients.
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PMID:[Magnetic resonance tomography as a new diagnostic criterium in vascular-induced stenoses of the upper airways in childhood]. 198 66

Ninety-eight consecutive patients with 344 collapsed vertebrae underwent conventional and/or digital radiography and MRI. Vertebral collapse was due to osteopenia (16 cases), trauma (17 cases), and vertebral osteonecrosis (3 cases). Other causes were: spondylodiscitis (9 patients), primary neoplasm (4 patients), metastases (37 patients), and hemomyelopathies (7 patients); 5 patients bore vertebral angiomas. Sixty-three patients also underwent CT and 25 bone scintigraphy. As far as collapsed vertebral endplates are concerned, according to a previous classification, outcomes were divided into 4 groups. Type 1 (focal concave collapse) was observed in 10% of benign lesions and in 1% of malignant ones; type 2 (diffuse concave collapse) in 24% of benign and in 16% of malignant lesions; type 3 (focal collapse with an acute angle) in 11% of benign and malignant lesions, and type 4 (diffuse collapse with an acute angle) in 11% of benign and in 26% of malignant lesions. Neural arch involvement was observed in 3% of benign lesions and in 16% of malignant ones; paravertebral soft-tissue involvement in 6% of benign and in 29% of malignant lesions; vertebral canal involvement in 11% of benign lesions and in 20% of malignant ones. The intervertebral disk proximal to vertebral collapse was more involved in benign lesions (24%) than in malignant ones (8%). MR signal followed 4 main patterns: low signal on T1-weighted images and high signal on proton-density and T2-weighted images (2% of benign lesions, 49% of malignant ones), low signal on all sequences (7% of benign lesions and 25% of malignant ones), isointense signal on all sequences (50% of benign and 21% of malignant lesions), and high signal on all sequences (41% of benign lesions and 0% of malignant ones).
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PMID:[Vertebral collapse model: combined diagnostic imaging]. 201 21

Pediatric airway obstruction due to anomalies of the course of the innominate artery may produce respiratory distress. MR imaging of the trachea was performed after bronchoscopy on forty-one children with congenital tracheal stenosis. Bronchoscopy only allows the evaluation of the lumen of the trachea, and the degree and location of collapse, and it may be difficult to determine the etiology of the tracheal narrowing. In eighteen out of the forty-one patients MR imaging showed a compression of the trachea by the innominate artery. The MR imaging diagnoses were subsequently compared for accuracy with the diagnoses determined by direct surgical observations. MR imaging of the trachea, the surrounding tissue and vessels allows the evaluation of the cause of tracheal compression and the degree and location of collapse. For evaluation of the cause of airway obstruction. MRI is an ideal method depicting detailed anatomic structure without employing ionizing radiation or intravenous contrast medium.
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PMID:MRI in tracheal stenosis by innominate artery in children. 202 31

A case of cardiac paraganglioma is reported in a 30 year old man operated two years previously for bilateral carotid body paraganglioma. Due to the persistence of high catecholamine levels in the superior vena cava, a cardiac localization, suspected on echocardiography, was confirmed by coronary angiography. MRI identified the exact site of the tumour in contact with the posterior surface of the left atrium and the great vessels of the base of the heart. Complete resection was performed via sternotomy. The adhesions to the great vessels and atrium and the retrocardiac site of the tumour required continuation of the operation under CPB with transection of the superior vena cava, aorta and pulmonary artery in order to achieve complete resection despite the hypervascular nature of the tumour. Postoperative collapse of peripheral resistance requiring 48 hours of adrenaline infusion demonstrated the immediate efficacy of the surgical operation. After a follow-up of four months, the blood pressure and catecholamine levels remained normal. The authors emphasise: the value of MRI for the topographic diagnosis of thoracic lesions, the association of a double carotid body paraganglioma and a mediastinal tumour, especially cardiac, which has already been reported in the literature and the availability of CPB in order to perform complete resection of these tumours with complete security in view of their intimate relations with cardiac cavities and the vessels of the base of the heart.
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PMID:[Retrocardiac pheochromocytoma associated with a double carotid site. Diagnostic and therapeutic discussion]. 217 76

We are reporting our experience in 23 patients with tumors of the thoracic or lumbar vertebrae treated via surgical anterior decompression and stabilization. Seventeen patients had metastatic disease and were treated with vertebral body resection followed by stabilization with anterior polymethylmethacrylate and threaded Harrington rods with sacral distraction hooks. Six patients had primary tumors and, following tumor resection and partial vertebral body resection, had autogenous bone graft struts placed anteriorly as well as posterior instrumentation. Posterior instrumentation was transpedicular one level above and below in the lumbar spine, and segmental hooks and rods three levels above and below in the thoracic spine. Nineteen patients presented with severe unremitting pain, and 16 had neurologic deficits, including 7 who were unable to ambulate. Radiation therapy was used as an additional treatment and routinely begun 2 weeks postoperatively. All patients survived the surgery, and none had neurologic deterioration immediately postoperatively. Eight patients had died at the time of review. The mean survival was 14 months and ranged from 6 to 38 months. Of the surviving patients, follow-up ranged from 24 to 40 months with an average follow-up of 30 months. Pain relief was excellent in all but two patients (93%). Motor recovery occurred to some extent in all patients, and only one remained nonambulatory. Complications were minor in three patients (13%) and major in one (4%). Tumor recurrence with neurologic deterioration occurred in two patients. We are very encouraged by these results, and we recommend that patients with tumors of the vertebral body with neurologic deficit or severe unremitting pain be studied with MRI and/or myelography and CT. The patients with gross vertebral destruction and greater than 50% collapse of the vertebral body, those in need of a tissue diagnosis, or those with major neurologic deficit can be effectively treated by anterior decompression and stabilization.
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PMID:Tumors of the thoracic and lumbar spine: surgical treatment via the anterior approach. 252 70

Four patients with multi-cystic syringomyelia were treated by a single, non-valved syringoperitoneal shunt. In all the patients, the cavitations were separated by a segment of apparently normal cord. In two of the patients, the cavitations also contained multiple transverse septa. In three patients the shunt was inserted in the most caudal cavitation, causing the shunted compartment to collapse, usually within a few weeks. The width of the more cranial cavitations normalized on postoperative MRI scans over several months. This was the case also in one patient where the most cranial cavitation was shunted. No complications or side effects were observed that could be attributed to the use of a non-valved shunt.
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PMID:Multicystic syringomyelia treated with a single, non-valved syringoperitoneal shunt: fast and near-complete MRI normalization. 274 44

Magnetic resonance imaging and computed tomography were compared in a prospective study of 137 lung cancer patients proved by surgery or autopsy for determining the staging, evaluation of therapeutic effect and diagnosis of recurrent tumor. 1. Lung cancer staging In peripheral lung cancer, T1 and T2 relaxation times of the tumors before operation have some correlation with those of operated specimens. These relaxation times, however, are of limited nodule characterization. Hilar mass and adjacent pulmonary consolidation (obstructive pneumonia or collapse) can be distinguished on T2-weighted image (77%) and Gd-DTPA enhanced image (80%). Therefore these images help in distinguishing tumor from peripheral lung disease. In the diagnosis of tumor invasion to the heart and great vessels, MRI is superior to CT because MRI can be helpful in distinguishing true mass from heart and great vessels. As for the chest wall, MRI is more useful than CT in detecting tumor invasion especially to the thoracic inlet and superior regions. In the diagnosis of mediastinal and hilar lymphadenopathy, MRI is equivalent or slightly inferior to CT, but MRI can easily demonstrate the lymphadenopathy at subcarinal region on coronal image. 2. Evaluation of therapeutic effect in lung cancer patients treated by radiation and chemotherapy MRI patterns of therapeutic effect was divided into 3 types. It is suggested that there is some correlation between these patterns and histologic types. MRI can easily demonstrate necrotic area on T2-weighted and Gd-DTPA enhanced images. 3. Diagnosis of recurrent tumor in treated lung cancer Concerning detecting recurrent tumor after surgery or irradiation, and delineating tumor from radiation pneumonitis, T2-weighted and Gd-DTPA enhanced images are of clinical value.
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PMID:[MR imaging in the assessment of lung cancer patients: primary lung cancer staging, evaluation of therapeutic effect and diagnosis of recurrent tumor]. 279 69

A comparison between clinical and MRI findings in 20 patients with syringomyelia produced the following results: 1. The position and extent of the syrinx do not correspond with the clinical findings. 2. Successfully operated syringomyelia cavities collapse in their sagittal diameters. The resulting oval shape of the syrinx can be used to evaluate shunt insufficiency. 3. In almost half of the patients, the diameter of the spinal cord is within the 95th percentile of normal controls and would therefore not have been diagnosed by myelography. 4. Anomalies of the cranio-cervical junction were present in only one-third of the patients. This finding does not support the hypothesis that syringomyelia is caused by hydrodynamic factors only.
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PMID:[Syringomyelia: correlation of magnetic resonance tomographic and clinical findings before and after surgery]. 284 54


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