Wednesday, December 19, 2007
Monday, December 17, 2007
Wednesday, December 05, 2007
Saturday, December 01, 2007
Wednesday, November 28, 2007
Are you an addict Stacie is. Take the Internet test to see if you are addicted.
Do you wake up early to check your blog stats, stay up till all hours typing away at you keyboard. Is google sending you money every month? I wish........ !! You will enjoy what Stacie has to say about everything. Check out Stacie's Blog
Tuesday, November 27, 2007
Sunday, November 18, 2007
Best buy ad
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Wal-mart also is putting out there Black Friday e-Circular at Walmart.com with great deals on toys, electronics and other fun stuff.
For you adults out there there is the PlayboyStore.com or the
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Monday, November 05, 2007
Lie detectors have been around for a long time, and have not always been acurate. We are at a technological turning point where we have the tools to look into the brain and tell conclusively if someone is lying. At Vanderbilt University neuroscientists are using FMRI to probe the inerworkings of the human brain, delving into reserch that will tell when you are lying or when you are in love.
The way FMRI works is by Measuring the flow of Oxygenated blood into areas of the brain showing the most activity, (neural activity). As blood flow to these areas increase the MRI machine can detect tiny differences in the magnetic properties of hemoglobin, (blood). All the data is reconstructed and the Radiologist can determine the area’s of the brain that are in use during the scan.
Darpa, the pentagon’s high-tech reserch department has been developing uses for FMRI. A recent article in the Cornell Law Review noted, “have developed technologies that may render the ‘dark art’ of interogation unneccessary”. This could lead to FMRI become a new Gold Standard for lie detecting . One company called NO-lie MRI is offering its FRMI based lie detecting services for $10,000 a scan. they have more than 100 potential clients that have expressed interest.
MRI may or may not be the solution, but as technology continues to progress we will see so many changes. MRI is like a new telescope into the mind and we are just starting to explore.We have so far to go.
Saturday, November 03, 2007
Saturday, October 27, 2007
One small hospital in the US, currently without an MRI, has a chance to win the system by producing a short video on why they want the scanner, and entering it in the contest held over at WinAnMRI.com. The video with the most votes wins. So, whether you want to watch a bunch of amusing videos, or you want to side with your local hospital, head on to the website and vote.
(hat tip: WSJ Health Blog)
More about this MRI: ESSENZA 1.5 Tesla
Magnetom Essenza is a powerful and low-cost system that supports the clinical and financial success of its users. In addition to the low initial investment, savings of up to 25% can also be attained on installation costs for space, power requirements and construction. In part this is due to the light-weight 3.5 ton magnet, which even makes it possible to install the Magnetom Essenza on higher floors. If the system is replacing an existing MR system, it can reduce energy consumption up to 50% thanks to its high-performance electronics. Since the state-of-the-art magnet has zero helium boil-off, there is no need to regularly refill this expensive substance, and the system is always ready for operation.
Thanks to its powerful gradients (30mT/m), the new member of the Magnetom family delivers superior image quality for all clinical applications. Using Tim technology with Magnetom Essenza, the area of the patient to be examined can be covered with up to 25 seamlessly integrated coil elements that are read by 8 independent radiofrequency channels. Tim allows for flexibly combining up to four different coils, which make patient and coil repositioning virtually unnecessary. Tim also enables Parallel Imaging for reduced acquisition times. All of these benefits translate into workflow improvements as well as increased patient throughput, not to mention improving the profit situation. As an example, a complete examination of the entire central nervous system can be performed in less than ten minutes.
Another powerful new innovation is the IsoCenter Matrix coil. It is permanently positioned at the isocenter of the magnet and therefore always in position, ready to scan. The advantage: the user does not need to carry large, heavy spine coils any more and the patient preparation time is shortened. Additionally, by ensuring the correct positioning of the coil excellent image quality is also guarantied. The IsoCenter Matrix can be used in flexible combinations with other coils and works as a virtual 140 cm coil without patient repositioning in multi-step examinations.
Another new feature is the Focus Shoulder Array for optimum imaging of the shoulder. The coil's shim wing shifts the examination area of the magnet from the middle of the system to the shoulder, which would lie at the edge of the measuring volume without this technology.
Magnetom Essenza has a shorter system length than many conventional 1.5 Tesla MR systems. This means that the head and feet of the patient remain outside of the system in many cases, making the examination much more pleasant for the person in the bore.
Thursday, October 25, 2007
these are great MRI's of this Syndrome
Here is another good caseThanks mypacsnet
Hemangioma-Thrombocytopenia Syndrome (also known as Kasabach-Merritt Syndrome) is a rare disorder characterized by an abnormal blood condition in which the low number of blood platelets causes bleeding (thrombocytopenia). The thrombocytopenia is found in association with a benign tumor consisting of large, blood-filled spaces (cavernous hemangioma). The exact cause of this disorder is not known.
Hemangioma-Thrombocytopenia Syndrome is a rare disorder that is typically characterized by a benign (non-cancerous) tumor consisting of large, blood- filled spaces (cavernous hemangioma). This tumor occurs along with a blood condition (thrombocytopenia) characterized by an abnormally low number of blood platelets which can cause excessive bleeding.Excessive bleeding (hemorrhaging) beneath the skin (purpura) typically develops within the first six weeks of life, but may appear later in childhood as the hemangioma increases in size. Usually there is only one hemangioma which is found on the neck, arms, legs, or trunk of the body. Less common are tumors of the internal organs which may be found on the tongue, thorax, spleen, liver, gastrointestinal tract or bones. Hemangiomas are rarely found internally and on the skin of the same patient.Thrombocytopenia may occur within the first month of life in association with a hemangioma of the outer layer of the placenta (placental chorioangioma) or large hemangiomas of the skin.Hemangiomas may become filled with blood (engorged) before a bleeding spell occurs. The cause of the bleeding is not certain, but it can be triggered by trauma.A decrease in the level of the oxygen carrying component of blood cells (hemoglobin), red blood cells (erythrocytes), and/or proteins in the blood that are part of the clotting process (prothrombin and fibrinogen) may also occur. However, fibrinogen deficiency usually affects older children and adults.CausesThe exact cause of Hemangioma-Thrombocytopenia Syndrome is not known. It is thought that the thrombocytopenia may be a result of platelet destruction which occurs in relationship to growth of the hemangioma. There is no evidence that the syndrome is hereditary.Affected PopulationsHemangioma-Thrombocytopenia Syndrome is a very rare disorder that affects males and females in equal numbers. Approximately one in every five hundred cases of people with hemangiomas have associated thrombocytopenia.Courtesy of NORD website: http://rarediseases.org/
11 month 22 day old male: 11-month-old with history of Kasabach-Merritt syndrome and left shoulder/arm hemangioma, presenting with thrombocytopenia. The patient is a full term spontaneous vaginal delivery with no complications during pregnancy. At six weeks of age at a well baby checkup, the patient was noted to have two small bruises on the left arm and deltoid region. At three months the patient's mother noticed increased area of bruising as well as two more bruises on the left shoulder area. Diagnosis was hemangioma which would resolve with time. A left shoulder incisional biopsy was consistent with hemangioma. In September of 1994 he was placed on Prednisone, 4 milligrams per kilograms per day. Prednisone initially resulted in improvement but then the hemangioma increased in size. The patient was first given platelets in September of 1994 for a platelet count of 22K. Mother estimates some 30 platelet transfusions since then, the last one being in December of 1994. The patient underwent three sessions of radiation treatment in December of 1994, and on December 22, 1994 the patient was admitted with the diagnosis of rectal prolapse, which was reduced. Cultures grew out Klebsiella and the patient was treated with Tobramycin and Timentin. The patient improved and was discharged. Interferon was begun in October of 1994, present dose is 0.3 milliliters subcutaneously q.d. Two urine samples of FgF showed on January 30, 1995 44,000, and on February 27th 32,000. Three days prior to admission the patient showed increased agitation. Hemangioma became darker and harder, and most recent complete blood count as of April 3, 1995 was a red blood cells of 4.53, hematocrit of 23.2, and platelet count of 5. The white blood cell count had a differential of 15 polys, 7 bands, 61 lymphs, 5 monos, 2 eosinophils. There has been no history of significant bleeding.
Case study of IAC involvement.
Sunday, October 21, 2007
Dean Kamen has been working on robotic arms for injured soldiers who have lost limbs. The technology is like nothing we have ever seen before. He is being funded by a goverment agency (DARPA) and making great progress. The robotic arms will be able to have sensory perception along with motor control.
Wednesday, October 17, 2007
Continue reading Sony cranks out artsy new audio gear, VAIO laptops
Tuesday, October 16, 2007
To remind our readers, here's how the technology works:
TopSpin Medical has developed a self contained "inside-out" miniature MRI probe in a tip of an intravascular catheter that allows for local high-resolution imaging of blood vessels without the need for external magnets or coils. The advantages of this technique range from the very practical aspect of a low-cost system (since no expensive external setup is required), accessibility to the patient during the procedure, compatibility with existing interventional tools, and finally resolution and diffusion contrast capabilities that are unattainable by conventional clinical MRI, due to the strong local gradients created by the probe and its proximity to the examined tissue.
The intravascular probe serves as a first example for a wide range of applications for this method, which in the near future may revolutionize the field of clinical MRI. It opens the door for the application of MRI in cases where high-resolution local images are required and when the transformation into an MRI environment is both mentally and economically difficult for the hospital. The medical applications for this technology include detection and staging of prostate cancer, imaging tumors in the colon, lung and breast and intravascular imaging of the peripheral vasculature...
A static magnetic field of about 0.2 Tesla is generated by strong permanent magnets located at the tip of the catheter. The gradients that result from such a small configuration are in the range of 100-300 T/m, and may be controlled to some extent by changing the angle of the magnetization and the dimensions of the gap between the two magnet pieces. Due to volume constraints, a single coil is used both for transmission and for reception. The magnetic field profile created by this "inside-out" probe within the imaged volume is significantly different from that created by conventional NMR or MRI setups.
The IVMRI catheter is used for measuring the apparent water diffusion coefficient of the various components of the atherosclerotic vascular wall. It shows decreased and isotropic water diffusion within the atherosclerotic plaque compared with the fibrous cap and medial layer. Hence, the heterogeneous water diffusion properties within the atherosclerotic arterial wall can be exploited, by the IVMRI catheter, to develop an index of arterial wall lipid infiltration and help determine the structure of the arterial wall with regard to lipid content. The extent and location of increased vascular lipid infiltration can then be used to determine the presence of an atherosclerotic lesion with an increased likelihood of subsequent clinical instability. The IVMRI catheter was designed to obtain high-resolution imaging, thereby revealing the depth and size of the necrotic core and assess fibrous cap thickness.
Globes: Topspin Medical applies to FDA for catheter approval ...
TopSpin Medical ...
Flashback: IntraVascular MRI (IVMRI) Catheter
Saturday, October 06, 2007
The directive is set to be implemented across Europe by April next year and was drawn up to limit medical workers' exposure to electromagnetic fields.
But Professor Dag Rune Olsen, a specialist in experimental radiation therapy at the Norwegian Radiation Hospital in Oslo, told the European Cancer Conference in Barcelona that the directive could put at risk some eight million annual MRI scans, hampering patient treatment.
"These are likely to have to stop, since the directive sets limits to occupational radiation exposure which will mean that anyone working or moving near MRI equipment will breach them, thus making it possible for them to sue their employers," he said.
"Even those maintaining or servicing the equipment may be affected," said Olsen, who is also chairman of the physics committee of the European Society for Therapeutic Radiology and Oncology (ESTRO).
Britain's Health and Safety Executive published a study in June, undertaken by Professor Stuart Crozier of Brisbane University, Australia, which found that anyone standing within about one metre (yard) of an MRI scanner in use would breach the exposure limits laid down in the EU directive.
EU authorities are now considering amendments to the directive.
According to Professor Olsen, "Slovakia has already implemented the directive, on the grounds that it was based on the assumption that the limits which it sets would have no effect. This would appear to mean that it is now illegal to carry out MRI scanning in the country."
In a statement, conference organisers said the directive "will also stop the use of MRI for interventional and surgical procedures, and will curtail cutting edge research."
"The added value that MRI represents to medical diagnostics has been tremendous," Olsen insisted.
He said he hoped there could be a delay in the directive's implementation, while also warning against "hasty decisions without scientific support".
Professor John Smyth, president of the Federation of European Cancer Societies (FECS), meanwhile warned that political decisions were harming cancer treatment in Europe.
He cited the MRI directive as an example and said that "(it) looks as though it may stop all MRI scanning in Europe".
"We simply cannot continue to bury our heads in the sand on these issues, which affect doctors and patients alike," he said.
Earlier, the conference heard that the number of elderly cancer patients would likely double from 2000 to 2030, creating "huge challenges" to healthcare systems worldwide
We imagine that a system like this might be useful in reverse, where a physician uploads information for the rest of the family to see, as in cases like a child away at camp or parents that live at a distance who visit a clinic.
Currently in beta, Microsoft's HealthVault plans to stay free and to pay for itself through advertising on the built-in search engine.
HEALTH SEARCH: The new way to search for healthcare articles, Web links, and mini-applications.
DIRECT INPUT: Enter your personal information, upload health documents, and create records for members of your family. It's time to digitize the doctor's office "clipboard".
FAX INPUT: Have your health records faxed directly into your HealthVault account. Collect all your paper-based health records into your digital store.
YOUR DOCTORS: Your whole healthcare provider team — from MDs to Chiropractors — are generating information about your health. You should have a copy of that information so that you can share it with all of them.
PRESCRIPTIONS: Medications need to be managed and renewed and, if your MD is e-prescribes, HealthVault can collect and store your medication history.
IMAGING & LAB RESULTS: Your images (X-Rays, MRIs, CAT Scans) and lab results may also be a part of your health record, and HealthVault helps you keep copies of them in your account.
Thursday, October 04, 2007
Cerebellar astrocytoma is the most common posterior fossa neoplasm in the child. Occasionally, these tumors present in young adults. Eighty-five percent are of the pilocytic type, which appear relatively well-circumscribed, are partially cystic and often contain a mural nodule of enhancing solid tissue. Pilocytic cerebellar astrocytomas uncommonly calcify (20%) and rarely hemorrhage. Hydrocephalus is often present, leading to patients' common presenting symptoms of nausea, vomiting, headache, or ataxia. There is an increased frequency of occurrence with neurofibromatosis type I. Pilocytic astrocytomas are associated with a 90-95% 25-year survival rate, the highest of all primary brain gliomas. The less common fibrillary astrocytoma comprises 15% of cerebellar astrocytomas. This subtype carries a worse prognosis and tends to be infiltrative.
Medulloblastoma is primarily a neoplasm of children but occurs in adults 30% of the time. Peak incidence is in the latter half of the first decade although a smaller second peak occurs in the early third decade. In young adults, medulloblastomas usually arise in the dorsal aspect of the lateral cerebellar hemispheres, as opposed to the characteristic origin from the cerebellar vermis in children. Medulloblastoma typically has a high CT density before intravenous contrast with dense enhancement after injection. On MRI, the long TR images usually demonstrate an isointense mass, rather than the hyperintensity seen in this case. Like other primitive neuroectodermal tumors (PNET), medulloblastomas have the propensity to disseminate into the subarachnoid space via cerebrospinal fluid (CSF) pathways. The occurrence of medulloblastomas has been associated with such heritable diseases as Gorlin's basal cell nevus syndrome, Turcot's glioma-polyposis syndrome, and ataxia-telangiectasia.
Ependymomas account for about 5% of all intracranial gliomas. They are most common in children under 5 years of age, but a smaller peak occurs at age 30 to 40 years. The fourth ventricle is the most common site, often leading to dilatation and extrusion of tumor through the various ventricular foramina. However, CSF seeding occurs less frequently compared to PNET tumors. Ependymomas appear heterogeneous on CT and MRI and often contain hemorrhagic foci. Calcification is present in about 40-50% of patients.
Hemangioblastomas of the posterior fossa usually occur spontaneously but are associated with von Hippel Lindau disease (vHL) in 4-20% of patients. With vHL, 20% of tumors are multiple and can occur anywhere in the cerebellum, brainstem, or spinal cord. Hemangioblastomas classically are cystic-appearing with an enhancing mural nodule, but they are entirely solid in 30-40% of patients. The tumors often have associated large vessels leading to the mass, best seen on gradient echo MRI.
By Patrick J. Kelly, M.D., FACS, Professor and Chairman of Neurosurgery
Glial Neoplasms comprise the majority of primary intracranial tumors. These affect about 14,000 Americans annually. Glial tumors are divided into a classification scheme based on cell type-usually based on the supposed cell of origin. Thus, astrocytomas are derived from astrocytes, Oligodendrogliomas derived from oligodendroglial cells and mixed gliomas or oligoastrocytomas are derived from both astrocytes and oligodendroglial elements. The following discussion concerns astrocytomas only and is presented in hopes that it will provide some insight into the classification and treatment of these tumors.
In general astrocytic tumors are classified according to histologic grade. There is some confusion among pathologists on the proper system for tumor grading. This can result in confusion for physicians, research protocols and especially for patients. Below I will try to clarify the classification issue as this is extremely important for understanding the tumor and its prognosis.
The astrocytoma is derived from a normal supporting cell in the brain called the astrocyte. In a patient with one of these tumors, the cells in the astrocytoma tumor are no longer normal; and the degree of this abnormality is used to determine the tumor's grade. The tumor's grade determines the prognosis of the tumor. Astrocytomas are graded from 1 to 4, with grade 1 being the slowest growing and grade 4 being the most rapidly growing and malignant lesions. The following descriptions refer to the appearance of the tumor under the pathologist's microscope.
Grade 1: In these tumors astrocytic tumor cells are usually normal in appearance except that there are more of them than normally seen in microscopic examinations of brain tissue. Usually grade 1 astrocytomas produce epileptic seizures as their only symptom since their presence is irritating to surrounding brain tissue. They can also become quite large since they are well tolerated by the brain. However, when the mass effect of the tumor and the mass of the brain combine within the non-yielding skull cavity; a rise in pressure inside the skull results. This can cause headaches, paralysis, personality change, coma and death. The prognosis for grade 1 astrocytomas is generally good. Sometimes surgery to reduce mass effect is required, however. Patients with grade 1 astrocytomas have been known to live 30 years or more following diagnosis. Radiation therapy is probably not appropriate in these tumors.
Pilocytic astrocytomas: These benign astrocytomas tend to occur in children and young adults, are histologically circumscribed . Despite the fact that many are located in the thalamus and other important subcortical locations, they can be completely resected by computer assisted stereotactic technique with excellent postoperative results. These lesions exhibit prominent enhancementon CT or on MR imaging with gadolinium
Grade 2: In grade 2 tumors, tumor cells are slightly abnormal in appearance as well as increased in number. The variations in appearance of these cells is referred to as pleomorphism. There should be no mitotic figures (indications that the cells are dividing) and no necrosis (dead tissue). In general, these tumors are made up of isolated tumor cells within functioning brain tissue. On imaging studies these lesions show hypodensity on CT and prolongation of T1 and T2 on MRI, They only very rarely exhibit contrast enhancement.Removal of the tumor is, in fact, removal of this "sick" brain tissue. These tumors are, therefore, usually biopsied only; unless they are located in unimportant brain tissue- in which case they can be removed
There remains some debate on the place for radiation therapy and chemotherapy in these tumors. However, recent studies have shown that 5 year survival in grade 2 astrocytomas without treatment is about 34%; and with treatment (radiation therapy): about 70%. Therefore most centers recommend radiation therapy after a grade 2 astrocytoma is diagnosed by biopsy or some other surgical procedure.
Grade 3: These and Grade 4 astrocytomas are frequently referred to as malignant astrocytomas. They exhibit contrast enhancement on imaging studies. Frequently, the contrast enhancing mass is surrounded by a zone of hypodensity on CT and prolonged T1 and T2 on MRI as shown in Figure 4. This zone is frequently called "edema" and it is edematous brain parenchyma infiltrated by isolated tumor cells.
In another classification scheme these are referred to as anaplastic astrocytomas. In grade 3 tumors, cells are not only abnormal in appearance but some show evidence of mitosis. Mitosis is the cellular process by which cells divide; where one cell becomes two. Mitoses are apparent to the pathologist as the surgical specimen is reviewed under the microscope. Some of the cells in the tumor infiltrate into brain tissue- similar to the picture seen with grade 1 and grade 2 astrocytomas; other cells stay put and continue to divide and destroy the brain parenchyma in which they reside as the joined cells for a mass of solid tumor tissue. When the tumor tissue is formed in important brain areas, neurological deficits corresponding to that area result because the brain tissue in that area is destroyed by the evolving tumor tissue mass. For example, a grade 3 astrocytoma forming in the central area of the brain, with formation of solid tumor tissue in the motor area will produceweakness and paralysis on the opposite side of the patient's body ( remember that the left side of the brain controls the right side of the body and vice versa).
Treatment for grade 3 astrocytomas involves establishing the diagnosis by surgery or stereotactic biopsy and follow-up with radiation therapy and chemotherapy. The average survival of patients with grade 3 astrocytomas is 18 months with treatment.
Grade 4: Grade 4 astrocytomas ( frequently referred to as glioblastomas or glioblastoma multiforme) are the most malignant variety of these tumors. They are made up of cells which infiltrate brain tissue with a region (and in some cases regions) of solid tumor tissue within the zone of infiltrated brain tissue. Mitoses are frequently noted by the pathologist as the surgical specimen is examined. In addition, regions of necrosis (dead tissue) are also noted- where the tumor has grown so fast that parts of it has outpaced itsblood supply. These tumors induce the formation of new but abnormal blood vessels which when identified are also important in establishing the diagnosis. The CT and MRI demonstrate a contrast enhancing mass with a hypodense center (which corresponds to necrosis) surrounded by a zone of hypodensity on CT and prolonged T1 and T2 on MRI which corresponds to infiltrated parenchyma as shown in Figure 5.
The grade 4 astrocytoma has the worst prognosis of all: 17 weeks average (mean) survival after diagnosis without treatment; 30 weeks average survival with biopsy followed by radiation therapy; 37 weeks average survival following surgical removal of most of the tumor tissue component of the tumor and radiation therapy and 51 weeks average survival following stereotactic volumetric resection of the tumor tissue component and radiation therapy. The prognosis for any patient with a malignant astrocytoma (grade 3 or 4) is also very dependent upon age (older people do not live as long as young patients) and performance status ( patients who are neurologically normal and independent live longer than patients who have a neurological deficit). Chemotherapy has been shown to add several weeks on to the survival. Radiation implants (brachytherapy) have also been shown to increase survival but more than half of these patients require another operation to remove dead tissue resulting from the radiation.
Therapy for Astrocytomas
With only a few exceptions (notably, pilocytic astrocytomas) astrocytomas are not curable tumors with any of the treatment methods available to us today. These treatment modalities consist of surgery which establishes the diagnosis and in some cases can remove a significant part of the tumor, radiation therapy, usually given in daily "fractions" of about 200 rads per day (5 days a week) over a 6 week course and chemotherapy ( many agents are available and being evaluated in many clinical "trials" around North America).
Conventional Craniotomy with internal decompression
Here the patient's skull is opened and a surgeon guided by his own hand-eye coordination, knowledge of anatomy, qualitative interpretation of the CT and/or MRI and the appearance of the lesion from normal brain attempts to remove as much of the tumor as possible.The goals are to reduce intracranial pressure and reduce tumor burden.
A probe is inserted by means of a stereotactic frame into the CT and/or MRI defined tumor target in an attempt to obtain a specimen of the lesion for histologic diagnosis.
Stereotactic Volumetric Resection
This is a less invasive procedure than a conventional craniotomy. A virtual tumor volume (determined by the CT and MRI defined boundaries of the lesion) is established in a computer. The surgical procedure is simulated on the computer beforehand to determine the safest and most effective surgical approach. At surgery an opening in the skull is much smaller than with other types of neurosurgery and the removal of the tumor is guided by computer generated images, usually transmitted into a heads-up display unit mounted on the operating microscope. These computer generated images are superimposed over the surgical field and indicate to the surgeon where tumor stops and normal brain tissue begins. This helps the surgeon establish a plane between tumor and brain tissue for a more complete (and safer) removal of the lesion.
Conventional External Beam: Modern radiation therapy for astrocytomas is delivered in multiple fractions by means of a linear accelerator (LINAC) . A planning CT or MRI scan is done to assist in targeting the radiation beams from the LINAC to encompass tumor plus a 2-3cm margin. Although there are variations in protocols between institutions, most patients receive between 6000 and 6500 rads delivered over a six week period of time (5 days per week).
Stereotactic Interstitial Irradiation: Radiation is delivered to a CT and/or MRI defined tumor volume by means of multiple stereotactically implanted radiation seeds (Iridium 192, Iodine 125, Palladium 103). Acting together these radionuclide sources produce a radiation dose field which is fitted to the volume of the tumor so that the tumor gets a lethal dose of radiation while the surrounding brain tissue receives much less because of the dose fall-off away from the sources. Radiation is delivered in a lower dose rate (typically 40 to 50 rads per hour) than in conventional external beam irradiation (200 rads per minute) which is theoretically safer for normal brain tissue surrounding the tumor. However, this form of radiation requires a surgical procedure to place the sources and they are frequently removed after the desired dose of radiation has been delivered. Commonly, interstitial irradiation is used as a "boost" to the radiation doses delivered by external beam radiation therapy.
Stereotactic Radiation Therapy: This type of external beam radiation therapy is delivered by a LINAC in multiple fractions but with the patient's head secured in a relocatable stereotactic frame which increases the accuracy.
There are many chemotherapy protocols under investigation in Phase II and Phase III clinical trials. Chemotherapy is usually considered in patients who have tolerated surgery and radiation therapy. Standard chemotherapeutic agents include BCNU, Procarbazine and Cisplatin. These will be discussed in further installments.
There are many experimental therapies- none of which have been shown to be curative yet. These include brachytherapy (stereotactic interstitial irradiation), stereotactic radiosurgery (focused one shot high dose irradiation to the tumor), immunotherapy (where lymphocytes conditioned to attack brain tumor cells are injected into the tumor or cavity made by surgical removal of part of the tumor) and most recently gene therapy ( where the brain is infected by a genetically engineered virus which attacks tumor cells). Clinical trials are underway for the evaluation of all of these.
Sunday, September 23, 2007
NeuroRAZ Looking inside people mind
Brain blogger The GNIF Brain Blogger covers topics from multidimensional biopsychosocial perspectives. It reviews the latest news and stories related to neuroscience, psychiatry, and neurology. It serves as a focal point for attracting new minds beyond the science of the mind-and-brain and into the biopsychosocial model.
radswiki blogNot only is radiology one of the coolest job out there…Some of us are just not cut out for interacting with patients.Here is a true story
The Nurse Practitioner's PlaceMarried, proud mother of four. I am a newly graduated Family Nurse Practitioner somewhere in Florida.
On The WardsOn The Wards (OTW) is a medical blog devoted to diverse topics related to medicine, medical education, and health care. The motivation of this project primarily stems from a professional interest in academic medicine
scan man's notes
This is my personal blog. Everything that you read here is my personal opinion with the exception of statements that are clearly attributed to someone else.
I may occasionally write something related to radiology or medicine in general. These again are my personal opinions, supported by references where available. Nothing in my blog is intended as medical advice
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MSK Radiology 2This Blog contains practically relevant MSK Radiology with relevant references, links and images. Images are not taken from other websites and are from my collection. Feel free to use for teaching and learning. Some institutional websites may block viewing of the images.
Neurology Minutiae Arcane items of medical obscurity are the neurologist's lifeblood. We can figure stuff out. This blogger is interested in diseases that affect people-- go somewhere else for results of rat research. Information is meant to be advanced but clinically relevant esoterica
On Line Sports Auction
Several Premiership and Championship Football Clubs as well as Derbyshire Cricket Club donated memorabilia – signed shirts, photos, a cricket bat, stadium tour, match tickets and a signed pennant were sold online and raised just over £100. Many thanks to Derbyshire Cricket Club, Middlesbrough FC and Leicester City FC.
Sunday 16th September 2007 – Watercolour Exhibition/Sale
The exhibition held by the twins Grandma (Pat Wilson) raised just under £800. The day was a great success with Pat selling 39 of her 51 paintings. Money was also raised from the sale of postcards, greetings cards and prints as well as a raffle. Thank you to everyone who came and spent!!!
Monday 17th September 2007 – Evening of Mediumship
Tamworth Spiritualist Church held a special evening to raise funds for Sam and Alex and raised nearly £350. Many thanks to all those who attended as well as the special guests who gave their time free of charge. Particular thanks to Sonia Cherrington and Cindy Heath.
Sarah’s friend Charlotte Hunter and her sister Zoe Crosby are taking part in a parachute jump in October (exact date to be confirmed) to raise funds for the boys. If you would like to sponsor either Charlotte or Zoe please email us to sponsor. Two brave ladies!!!!!
What is spinal muscular atrophy?
Spinal Muscular Atrophy (SMA) is a neuromuscular condition causing weakness of the muscles.
Is SMA Hereditary?
The gene for SMA is passed from parents to their children, but SMA can only affect a child if both parents carry a defective gene (this is called an autosomal recessive pattern). Genes come in pairs, one from each parent. If a person has one normal and one affected gene they do not show the symptoms of SMA but are carriers. If both genes are affected they will have SMA.
How Spinal Muscular Atrophy is Inherited.
Each child of carrier parents has a 1 in 4 chance of being affected by SMA, a 2 in 4 chance of being a carrier themselves, and a 1 in 4 chance of being completely clear of SMA. Boys and girls are affected equally.
Is There More Than One Type SMA?
There are several types of SMA. These differ in the age at which they have an obvious effect, how severe this effect is, and which muscles are most affected. The intermediate form described here starts in infancy. However, it does not have such a severe effect as Werdnig-Hoffmann Syndrome with which it is sometimes confused.
Types of SMA
All ages of onset are approximate
Type 1 (Severe) Also known as Werdnig-Hoffman Syndrome. Onset before or shortly after birth. Unable to sit. Do not usually survive past 2 years old.
Type II (Intermediate) Onset between 3 months and 2 years. Able to sit, but not stand without aid. Survival into adulthood possible.
Type III (Mild) Also known as Kugelberg-Welander Disease. Onset usually around 2 years. Able to walk. Normal lifespan. Adult Onset SMA Number of forms differing in age of onset. Degree of weakness is variable.
How do Normal Muscles Work?
Muscles contract, moving parts of the body, when signals from the brain pass down the spinal cord through the anterior horn cells. Each anterior horn cell is responsible for passing a signal down another nerve to a muscle. The group of structures made up by one anterior horn cell, the nerve fibre and the muscle it supplies, is known as a motor unit.
What Happens in SMA?
In SMA, it is the anterior horn cell, which is abnormal. Not all nerve impulses can be passed from the brain to the muscles. This results in some of the muscles becoming weak and wasted (atrophied).
All of the above details have been taken with permission from the Jennifer Trust website, the UK’s only existing website driven towards Spinal Muscular Atrophy.
For more information, why not visit the Twins with SMA website?
Saturday, September 22, 2007
... the Las Vegas incident intrigued enough teams in the NFL that two -- the Oakland Raiders and Indianapolis Colts -- have agreed to use the CereTom in their home stadiums. The hope, Bailey said, is that teams can use the CereTom to immediately examine players for serious underlying conditions that might not register in regular screenings.
Thursday, September 20, 2007
From the official announcement by the Lasker Foundation:
The Lasker Award for Basic Medical Research honors Ralph M. Steinman, 64, of the Rockefeller University, New York City, who discovered dendritic cells. These immune cells trigger other components of the immune system to thwart microbial invaders. Steinman's work has opened up novel therapeutic avenues for combating cancer and pathogens.
The Lasker Award for Clinical Medical Research honors Alain Carpentier, 74, of Hôpital Europeen Georges Pompidou, Paris, and Albert Starr, 81, of the Providence Health System, Portland (OR), who developed prosthetic mitral and aortic valves. These devices have prolonged and enhanced the lives of millions of people with heart disease, providing treatment where none existed before.
The Mary Woodard Lasker Award for Public Service, awarded bi-annually, honors Anthony S. Fauci, 66, Director of the National Institute of Allergy and Infectious Diseases, a component of the National Institutes of Health, for engineering two major U.S. governmental programs, one aimed at AIDS and the other at biodefense.
The fun part for us, of course, is about the development of artificial heart valves:
The 2007 Albert Lasker Award for Clinical Medical Research honors two surgeon-scientists who revolutionized the treatment of heart disease. Albert Starr and his engineer partner, the late Lowell Edwards, invented the world's first successful artificial heart valve. This device has transformed life for people with serious valve disease, providing a remedy where none previously existed. Alain Carpentier then circumvented the predominant limitation of mechanical valves--a propensity to clot within blood vessels and the associated need to take blood thinners--by adapting animal valves for use in humans. In the embryonic days of open-heart surgery, Starr and Carpentier opened up the entire field of valve replacement. Their work has restored health and longevity to millions of individuals with heart disease.
Starr's and Carpentier's contributions extend beyond these landmark innovations. In an era before the Food and Drug Administration (FDA) regulated medical devices, Starr set up the infrastructure for conducting clinical trials on his valves, including an informed-consent procedure and long-term patient tracking. This practice allowed him to evaluate valve replacement outcomes and seek solutions to clinical problems. Furthermore, his surgical patients required a new type of postoperative care. To deliver it, he assembled a multidisciplinary healthcare team, creating what corresponds to today's cardiac intensive care unit. Carpentier, in turn, augmented his own initial discovery by formulating techniques to repair rather than replace valves--a venture that was aided by the availability of prosthetic valves as a backup. He continues to probe the suboptimal areas of heart-valve surgery,relentlessly pursuing superior strategies.
Prior to the introduction of the Starr-Edwards valve, no human with a valve replacement had survived longer than three months. As of 2004, four live patients had replacement valves that had been implanted at least 40 years earlier. Currently, more than 90,000 people in the United States and approximately 300,000 people worldwide receive new valves annually; the procedure is the second most common heart surgery in the United States, exceeded only by coronary bypass operations.
Heart valve prostheses and annuloplasty rings.—Numerous heart valve prostheses and annuloplasty rings have undergone testing for MR safety. Of these, the majority showed measurable but relatively minor translational attraction and/or torque in association with exposure to the MR systems used for testing. Since the magnetic field–related forces exerted on heart valves and annuloplasty rings are deemed minimal compared with the force exerted by the beating heart (ie, approximately 7.2 N) , an MR procedure is considered to be safe for a patient with any of the heart valve prostheses or annuloplasty rings that have undergone testing to date . This includes the Starr-Edwards model Pre-6000 heart valve prosthesis, which had previously been suggested to be potentially hazardous for a patient in the MR environment. Heart valve prostheses and annuloplasty rings tested at 3 T.—Many heart valve prostheses and annuloplasty rings have now been evaluated for MR safety by using 3-T units . Findings indicate that one annuloplasty ring (Carpentier-Edwards Physio Annuloplasty Ring, Mitral model 4450; Edwards Lifesciences, Irvine, Calif) showed relatively minor magnetic field interactions. Therefore, similar to heart valve prostheses and annuloplasty rings tested at 1.5 T, because the actual attractive forces exerted on these implants are deemed minimal compared to the force exerted by the beating heart, MR procedures at 3 T are not considered to be hazardous for individuals with these implants (5,128). Additional heart valves and annuloplasty rings from the Medtronic Heart Valve Division (Minneapolis, Minn) have undergone MR safety testing at 3 T. These implants were tested for magnetic field interactions and artifacts by using a shielded 3-T MR system. According to information provided by Medtronic (Bayer KM, personal communication, 2002), these specific implants are safe for patients undergoing procedures with MR systems operating up to 3 T.
(Frank G. Shellock, PhD
John V. Crues, MD)
Sunday, September 16, 2007
SanDisk Takes Action against Alzheimer’s Disease with Special SanDisk Ultra II SD Card and Cruzer Micro USB Flash Drive
SanDisk will contribute $1 to the Alzheimer’s Association, the leading volunteer organization for Alzheimer’s research and family support, for each specially-branded product purchased through August 2008, up to a maximum of $1 million. The two products, which carry the same manufacturer’s suggested retail price as SanDisk’s regular 2GB SanDisk Ultra II SD card and 2GB Cruzer Micro drive, stand apart from the SanDisk line because they are purple – the signature color of the Alzheimer’s Association.
“SanDisk as a company is dedicated to preserving digital memories, so it’s appropriate for us to do what we can to help stop a disease that attacks human memory,” said Greg Rhine, senior vice president and general manager of the Consumer Products Division at SanDisk. “Alzheimer’s is a terrible disease – it is the seventh leading cause of death in the United States and, according to surveys, nearly half of all Americans know someone who has Alzheimer’s. We are pleased to support the important work of The Alzheimer’s Association.”
Alzheimer’s is a progressive disease that kills brain cells, ultimately destroying both mental and physical functions. It is not a normal part of the aging process and there is no known cause or cure. Although most prevalent after age 65, the disease can strike people as young as age 30.
Alzheimer’s also puts huge emotional and financial burdens on family members of those suffering from the disease, because around-the-clock care is almost always required in later stages.
“Our new alliance with SanDisk, a well-known name in the field of consumer electronics, will help increase awareness of Alzheimer’s,” said Angela Geiger, vice president at the Alzheimer’s Association. “In addition, SanDisk will be raising much-needed funds for our education, care and support, and research programs.”
There is currently no cure or widely effective treatment for Alzheimer’s disease, but there is hope. The Alzheimer’s Association has raised more than $200 million for research since 1982, and scientists are now exploring possible treatments that would slow or stop the disease.
Susan Park, senior product marketing manger for SanDisk Ultra II cards and leader of the Alzheimer’s initiative at SanDisk, said: “By choosing SanDisk’s Take Action Against Alzheimer’s cards and flash drives, consumers get the same quality at the same price as our regular cards and drives, while making a contribution to the Alzheimer’s Association. Our goal in launching this program is not only to raise funds, but to help increase awareness of Alzheimer’s. We’re very appreciative of our retail partners who are showing their support by displaying these products on their store shelves.”
The Alzheimer's Association is the leading voluntary health organization in Alzheimer’s care, support and research. The association’s mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. For more information about the Association’s mission, visit http://www.alz.org/.
Pricing and availability
SanDisk’s two Take Action Against Alzheimer’s products are available now at select Best Buy stores in the United States. Other U.S. retailers are expected to begin carrying the products in October. The 2GB SanDisk Ultra II SD card has a manufacturer’s suggested retail price of $44.99, and the 2GB Cruzer Micro USB flash drive has an MSRP of $39.99. More information on the products is available at www.sandisk.com/alz.
SanDisk is the original inventor of flash storage cards and is the world’s largest supplier of flash data storage card products, using its patented, high-density flash memory and controller technology. SanDisk is headquartered in Milpitas, California, and has operations worldwide, with more than half its sales outside the U.S.
1 1 gigabyte (GB) = 1 billion bytes.
SanDisk’s product and executive images can be downloaded from www.sandisk.com/corporate/media.asp
SanDisk’s web site/home page address: http://www.sandisk.com/
The Alzheimer’s Association is a not-for-profit 501(c)(3) organization. However, this contribution is not tax deductible. SanDisk is conducting this promotion as a commercial co-venturer/paid fund-raiser and has paid for the use of the Alzheimer’s Association’s name and logo. Alzheimer’s Association has not endorsed any SanDisk products. SanDisk will not receive any compensation from the Alzheimer’s Association for or relating to this promotion.
For more information, write to: SanDisk Takes Action Against Alzheimer’s Disease, attn: Susan Park, 601 McCarthy Corporation, Milpitas, CA 95035-7932. You may obtain a copy of the Alzheimer's Association’s most recent financial report by writing to it at 225 N. Michigan Ave., Fl. 17, Chicago, IL 60601-7633 or by calling toll-free at 800-272-3900. All contracts and reports regarding the Alzheimer's Association are on file with the IL Attorney General
Friday, September 14, 2007
In magnetic resonance imaging (MRI), a magnetic field generated by a large magnet sends protons in the brain spinning. Specially constructed coils of wire in the machine detect changes in the spin, which differ in different tissue types, as the magnetic field changes. Computer algorithms then use measurements from different parts of the brain to create the anatomical picture.
MRI machines in medical centers typically have up to 12 coils, but the new devices under development have up to 96 coils arrayed in a dense field over the scalp. "A small detector up close is more efficient," says Lawrence Wald, a biophysicist at Boston's Massachusetts General Hospital (MGH), whose team has developed the devices in collaboration with Siemens. "But it only captures a small part of the brain, so you need lots of small detectors spread out over the scalp." Each coil measures a small but highly accurate spin signal from the chunk of brain tissue beneath it. The images are then computationally stitched together to create a high-resolution picture of the brain.
These multichannel devices have already helped some epilepsy patients. In a study using an early prototype, neurologists found abnormalities in about two-thirds of epileptic patients whose previous brain scans had been declared normal, making these patients better candidates for neurosurgery.
Scientists are now using a newer prototype to study Alzheimer's patients. "In diseases like Alzheimer's, where there is not a basic diagnosis based on imaging, we hope that being able to look at smaller alternations in the brain would yield some additional diagnostic information and perhaps allow you to monitor medication," says Wald.
Patients suspected of having Alzheimer's may get an MRI to rule out other neurological causes for their symptoms. But recent studies suggest that subtle neurological changes increase risk for the disease; these changes can include shrinkage of the hippocampus, a crucial memory area, and of parts of the cortex important for memory and higher cognitive function. Detecting these changes requires lengthy scanning sessions to generate high-quality data, making such scans unfeasible in routine clinical practice. "This technology has the potential to change that," says Brad Dickerson, a neurologist at Harvard Medical School, in Boston. While he cautions that routine clinical use is still years off, he says that "we are rapidly moving into a new era where we can use this kind of data to identify abnormalities that are consistent with Alzheimer's."
Siemens is now working on a commercial version of the 32-channel array developed at MGH, which is expected to be on the market later this year. The imaging device, now being tested by some of Siemens's customers, "increases spatial or temporal resolution," says Jeffrey Bundy, vice president of the MR division at Siemens Medical Solutions, headquartered in Malvern, PA.
The device is likely to have important applications in functional magnetic resonance imaging (fMRI), a variation of standard MRI that tracks blood flow in the brain as an indirect measure of activity. The technique is often used to locate the parts of the brain that control specific functions, such as speech and movement. The first clinical application for the device will likely be fMRI for neurosurgery planning, says Bundy. "Surgeons want to know where speech and motor areas are when they take a tumor out--the more precise, the better."
The instrument could also impact our basic understanding of the brain. "The spatial resolution of fMRI is somewhat limited," says Gabrieli. "We've hit the wall on a lot of scientific questions." With higher-resolution images, scientists could try to determine neurological basis of various aspects of cognitive function. Gabrieli, for example, says that he'd like to figure out if different parts of the amygdala--a small structure deep in the brain that plays a key role in emotion--regulate different emotions, such as fear and joy.
While Siemens is putting the finishing touches on the 32-channel array, Wald and his colleague Graham Wiggins, also at MGH, are already developing new scanners with even more channels, including 96-channel and 128-channel arrays. "These are the highest-resolution brain images being taken today," says Wald. (source) By Emily Singer.
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