Faculty Bibliography

BACKGROUND. Multicystic benign lymphoepithelial lesions of the parotid gland (BLL) seen in patients with human immunodeficiency virus (HIV) can produce considerable cosmetic deformity as well as physical discomfort. We previously reported our preliminary results with low-dose radiotherapy in this disease, and all 8 patients were satisfied with the initial improvement in their appearance. We now report the long-term follow-up of those patients and additional patients. METHODS. Twelve HIV-positive patients with BLL were treated with 8-10 Gy of external radiation using 2-Gy daily fractions. Objective responses and subjective duration of patient-defined cosmetic control were recorded. RESULTS. All 12 patients (100%) had at least a 50% decrease in the size of their parotid masses. Five of 12 (42%) had a complete response and 7 (58%) had a partial response. Persisting complete response was achieved in only 1 patient, however, with relapse in the other 11 patients. Cosmetic palliation, as judged by the patients, was achieved for a median of 9.5 months. Eight patients were subsequently retreated with doses of 6-16 Gy (median and mode: 10 Gy). None (0%) of the 8 patients retreated achieved local control. CONCLUSIONS. Very low-dose radiation (8-10 Gy) provides reliable but temporary cosmetic palliation for BLL. Retreatment was unsatisfactory, and we are now investigating higher initial doses of radiation to prolong palliation and eliminate recurrences

OBJECTIVE: To compare the amount of scatter produced by titanium plates versus Vitallium (Howmedica, Rutherford, NJ) plates. Software was also evaluated to determine its effectiveness in removing the scatter and clarifying the underlying anatomy. MATERIALS AND METHODS: Miniplating and microplating systems composed of Vitallium or titanium were placed on the nasal and frontal bones of three adult pig heads. A computerized axial tomography (CAT) scan was then performed and a three-dimensional CAT scan was reconstructed using MediCad software (MediCad Inc, Cedar Knolls, NJ). The amount of scatter for each plating system was quantitated using the MediCad software measuring tool. The scatter was removed and the three-dimensional CAT scan was reconstructed to assess the clarification of the underlying anatomy. RESULTS: No scatter was found with either the miniplating or the microplating system composed of titanium. The Vitallium plates did show significant amount of scatter with the mini, micro, and micromesh system. Removal of the scatter resulted in slight improvement in the anatomic detail. CONCLUSION: Titanium plating systems do not cause any radiation scatter. The MediCad software system allows removal of the scatter found with the Vitallium plates, which helps clarify the underlying anatomy.

Magnetic resonance imaging of the brain in 11 consecutively referred patients with velo-cardiofacial syndrome (VCF) showed anomalies in nine cases including small vermis, cysts adjacent to the frontal horns, and small posterior fossa. Focal signal hyperintensities in the white matter on long TR images were also noted. The nine patients showed a variety of behavioral abnormalities including mild developmental delay, learning disabilities, and characteristic personality traits typical of this common multiple anomaly syndrome which has been related to a microdeletion at 22q11. Analysis of the behavioral findings showed no specific pattern related to the brain anomalies, and the patients with VCF who did not have detectable brain lesions also had behavioral abnormalities consistent with VCF. The significance of the lesions is not yet known, but the high prevalence of anomalies in this sample suggests that structural brain abnormalities are probably common in VCF

BACKGROUND. Anatomic barriers to the spread of laryngeal cancer include the conus elasticus, the quadrangular membrane, and the thyroid cartilage. It has been speculated that an elastic barrier surrounds and protects the ventricle. METHODS. The authors studied the microanatomic patterns of spread of 17 cases of patients who had laryngeal cancer with paraglottic disease and confirmed their findings by examining normal autopsy specimens. RESULTS. Five patients of the seventeen cases showed no ventricular mucosal involvement despite extensive paraglottic disease. Both an inner, central, subepithelial periventricular elastic membrane barrier were identified; the latter was in continuity with the conus elasticus and quadrangular membrane. CONCLUSIONS. Two weak fibroelastic barriers surround the ventricle. The outer, peripheral, fibroelastic membrane is contiguous with the conus elasticus and the quadrangular membrane. Therefore, ventricular involvement is not a sensitive indicator of paraglottic spread. Squamous cell cancer may grow around the periventricular barriers to involve both the true and false cords but may spare the ventricle. The prognostic significance of the violation or preservation of the periventricular elastic barriers is unknown

From the records of The Mount Sinai Hospital, seven cases which met established criteria for radiation-induced meningiomas were identified. This represents the largest series of radiogenic meningiomas documented in North America and includes both intracranial and intraspinal tumors. The records and pathological specimens were reviewed and these data analyzed with other cases retrieved from the world literature. This study reveals that radiation-induced meningiomas can be categorized into three groups based on the amount of radiation administered: 1) low dose; 2) moderate dose and miscellaneous; and 3) high dose. The overwhelming majority of cases had received low-dose irradiation (800 rad) to the scalp for tinea capitis and the second largest group resulted from high-dose irradiation for primary brain tumors (greater than 2000 rad). The unique features distinguishing radiation-induced meningiomas from other meningiomas are reviewed. Although histologically atypical tumors were common in this series, overt malignancy was not encountered. The preoperative management of these lesions should include angiography to evaluate for large-vessel occlusive vasculopathy, a known association of meningiomas induced by high-dose irradiation. Given the propensity these tumors possess for recurrence, a wide bony and dural margin is recommended at surgical resection

Leptomyelolipoma (lumbosacral lipoma) is a common form of spinal dysraphism. The deficits produced include sensory, motor, bowel, and bladder dysfunction, and vary in incidence between the pediatric and adult populations. Twenty patients treated surgically at the Mount Sinai Hospital between 1972 and 1988 are reviewed. Fifty percent were 12 years of age or less and 50% were older than 18 years of age. The surgical approach was designed to accomplish untethering of the conus medullaris, debulking of the lipomatous mass compressing the cord, reconstruction of the dural canal, and reapproximation of the paraspinal muscles and lumbosacral fascia to prevent future trauma. Postoperatively, no patient experienced deterioration of neurological function. Of the symptomatic patients. 67% displayed dramatic improvement or became asymptomatic and 33% experienced stabilization of their deficits. The symptoms most resistant to surgical correction were orthopedic foot deformities and bowel dysfunction, whereas bladder dysfunction, motor weakness, and radiculopathies were most amenable to surgical therapy. Early surgical repair is recommended in these cases to forestall irreversible neurological damage

The 29th patient with a lingual osteoma is presented. This is the first case, to our knowledge, with preoperative radiographic and computed tomographic documentation. This rare, benign tumor almost always occurs as a pedunculated solitary mass that arises from the posterior tongue near the foramen cecum. The patients are usually young women who complain wf dysphagia or fullness in the base of the tongue. The imaging findings and theories of the origin of this tumor are described

A special 30 degree slant-hole collimator has been developed for rotating camera single photon emission computerized tomography (SPECT) that allows the camera to remain close to the patient's head throughout a standard 360 degrees circular rotation. Compared with SPECT using parallel-hole collimation, angled-collimator SPECT (A-SPECT) yielded approximately a 30% increase in resolution without significant losses in sensitivity. The full width at half maximum in reconstructed transaxial images of Tc-99m line sources was 1.2 cm for the A-SPECT system compared with 1.6 cm for conventional SPECT, and A-SPECT yielded substantial improvements in modulation transfer function for the line source. A-SPECT images of phantoms and of patients with paranasal sinus disease were consistently superior in resolution to those of conventional SPECT. The findings suggest that A-SPECT will improve the quality of cranial images obtained with rotating camera SPECT systems