Brian Tress - Academia.edu (original) (raw)

Papers by Brian Tress

Medical Journal of Australia, 1983

ANZ Journal of Surgery, 1986

Medical Journal of Australia, 1979

SINCE July, 1975, 8580 computed tomography (CT) examinations have been performed at the Royal Mel... more SINCE July, 1975, 8580 computed tomography (CT) examinations have been performed at the Royal Melbourne Hospital. The indications for examination fell into seven main groups: (i) clinical suspicion of intracranial focal lesion, based on focal symptoms and signs; (ii) head trauma; (iii) follow-up scans after craniotomy; (iv) cerebrovascular accident; (v) dementia; (vi) epilepsy; (vii) non-specific symptoms without neurological signs (headache, blackouts and vertigo). It is accepted that CT should be the initial examination for patients in the first three categories. The role of CT in the investigation of cerebrovascular disease lies principally in distinguishing between haemorrhage' and infarction when they enter into the differential diagnosis.' The justification for performing CT as the initial examination upon patients in the latter three categories is less certain. Therefore, the results of CT in the latter three categories were examined over a 12-month period (the year of 1976), during which a total of 2492 examinations were per.formed.

Medical Journal of Australia, 1983

Five patients with caroticocavernous fistula were treated by new, interventional angiographic tec... more Five patients with caroticocavernous fistula were treated by new, interventional angiographic techniques. In four patients, latex balloons filled with a silicone polymer were introduced into the cavernous sinus via the transfemoral route and detached; this resulted in complete obliteration of the caroticocavernous fistula and preservation of the internal carotid artery flow in two of the four patients. In the fifth patient, stainless steel coils were introduced into the cavernous sinus via the superior ophthalmic vein which had previously been surgically exposed. These percutaneous, angiographic techniques of intervention should be considered the initial treatment of choice for caroticocavernous fistulae.

Radiology, 1983

One thousand patients had both CT of the head and a conventional skull series of radiographs. Rad... more One thousand patients had both CT of the head and a conventional skull series of radiographs. Radiographic findings were abnormal in 250 patients (25%), but only 64 patients (6.4%) had diagnostically significant abnormalities at radiography that were not detected by CT. If the 163 patients who presented after acute trauma were excluded from the series, only 39 (4.7%) of the remaining patients had radiographically significant abnormal findings that were not seen at CT, and only two (0.2%) of these abnormalities could not be diagnosed by a lateral skull radiograph alone. In only five patients (0.5%) was the management actively changed because an abnormality that was detected at skull radiography was not detected at CT. Thus, in nontrauma patients who have stroke, epilepsy, dementia, or nonspecific symptoms without focal signs, or have recently undergone craniotomy, and who have been referred for CT, skull radiographs are not justified. In the patient with a history and findings that are strongly suggestive of a pathological disorder anywhere other than in the sella turcica, cerebello-pontine angle, and paranasal sinuses, only the lateral skull radiograph should be obtained after CT, and only if CT is equivocal.

Diagnostic imaging, 1979

An elderly female being treated for an unrelated medical condition was found to have an arteriove... more An elderly female being treated for an unrelated medical condition was found to have an arteriovenous malformation involving the vein of Galen. The florid radiological features are described, including the computed tomogram (CT) appearances. The pathology and usual modes of clinical presentation are reviewed. This patient is the oldest yet described with an arteriovenous malformation involving the Galenic system. It is suggested that the condition is more common in adults than previously thought.

Australian and New Zealand journal of medicine, 1985

To evaluate the place of intravenous digital subtraction angiography (IV-DSA) in the investigatio... more To evaluate the place of intravenous digital subtraction angiography (IV-DSA) in the investigation of patients with carotid territory ischemia, we have compared the IV-DSA and conventional angiographic (CA) findings in 40 patients in a prospective study. Arterial disease was assessed by grading stenosis from zero (normal artery) to six (complete occlusion) and recording any luminal ulceration. In 59 of 66 bifurcations imaged by both techniques, the IV-DSA evaluation of any internal carotid artery origin disease was within one grade of the CA assessment, with three false negatives and four false positives. Luminal ulceration was less reliably predicted, and two clinically important middle cerebral artery lesions were missed by IV-DSA. In 11 patients who had carotid endarterectomy, there was a good correlation between surgical, CA, and IV-DSA findings, although some ulcerations were not detected by either angiographic technique. These results suggest that IV-DSA is a sensitive techniq...

Stroke, 2010

Background and Purpose— The Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a pros... more Background and Purpose— The Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a prospective, randomized, double-blinded, placebo-controlled, phase II trial of alteplase between 3 and 6 hours after stroke onset. The primary outcome of infarct growth attenuation on MRI with alteplase in mismatch patients was negative when mismatch volumes were assessed volumetrically, without coregistration, which underestimates mismatch volumes. We hypothesized that assessing the extent of mismatch by coregistration of perfusion and diffusion MRI maps may more accurately allow the effects of alteplase vs placebo to be evaluated. Methods— Patients were classified as having mismatch if perfusion-weighted imaging divided by coregistered diffusion-weighted imaging volume ratio was >1.2 and total coregistered mismatch volume was ≥10 mL. The primary outcome was a comparison of infarct growth in alteplase vs placebo patients with coregistered mismatch. Results— Of 99 patients with baseline d...

Neurology, 1998

Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffus... more Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffusion-weighted imaging (DWI) in predicting stroke evolution and outcome in 18 patients with acute hemispheric infarction.Methods: Patients were studied within 24 hours (mean, 12.2 hours), subacutely(mean, 4.7 days), and at outcome (mean, 84 days). Comparisons were made between infarction volumes as measured on perfusion imaging (PI) and isotropic DWI maps, clinical assessment scales (Canadian Neurological Scale, Barthel Index, and Rankin Scale), and final infarct volume (T2-weighted MRI).Results: Acute PI lesion volumes correlated with acute neurologic state, clinical outcome, and final infarct volume. Acute DWI lesions correlated less robustly with acute neurologic state, but correlated well with clinical outcome and final infarct volume. Three of six possible patterns of abnormalities were seen: PI lesion larger than DWI lesion (65%), PI lesion smaller than DWI lesion (12%), and DWI lesi...

Investigative Radiology, 1998

Magnetic resonance contrast enhancement depends on the timing of image acquisition. Human trials ... more Magnetic resonance contrast enhancement depends on the timing of image acquisition. Human trials have demonstrated efficacy of renal artery stents on salvage of renal function. This study assessed the ability of dynamic gadolinium (Gd)-DTPA administration to demonstrate renal and iliac artery stent patency compared to conventional angiography as the gold standard. Seven subjects with eight stents referred for angiography underwent dynamic magnetic resonance studies, all with renal artery stenting. All were examined with conventional angiography and after dynamic Gd-DTPA infusion. Coronal magnetic resonance images were acquired using a GE Signa 1.5 T magnet (fast spoiled gradient echo; echo time = 4.2 ms; repetition time = 68-150 ms; flip angle = 75 degrees) 0 to 600 seconds after 0.1 mmol/Kg Gd-DTPA intravenous bolus injection during sequential breath-hold acquisitions 13 to 32 seconds each. All eight stents were visualized with 100% accurate patency documentation. Fast spoiled gradient echo magnetic resonance imaging with bolus Gd-DTPA administration can provide adequate time and spatial resolution to demonstrate arterial stent patency.

The British Journal of Radiology, 1977

Archives of Neurology, 1990

We evaluated prospectively the incidence of early seizures in 1000 consecutive patients with stro... more We evaluated prospectively the incidence of early seizures in 1000 consecutive patients with stroke and transient ischemic attacks to determine whether seizure occurrence correlates with stroke type, pathogenesis, or outcome. Seizures occurred in 44 patients (4.4%; SE, 0.7%), including 10 (15.4%) of 65 (SE, 4.5%) with lobar or extensive hemorrhage, 6 (8.5%) of 71 (SE, 3.3%) with subarachnoid hemorrhage, 24 (6.5%) of 370 (SE, 1.3%) with cortical infarction, and 4 (3.7%) of 109 (SE, 1.8%) with hemispheric transient ischemic attacks. Lacunar infarcts and deep hemorrhages were not associated with seizures. Arteriovenous malformation was a common cause of lobar hemorrhage with early seizures, but in cortical infarcts there was no association between seizure occurrence and pathogenesis. Seizures generally occurred within 48 hours of stroke onset, were usually single, partial, and readily controlled. Seizures were not associated with a higher mortality or worse functional outcome.

Archives of Neurology, 1995

To compare the acute Allen's Prognostic Score, Canadian Neurological Scor... more To compare the acute Allen's Prognostic Score, Canadian Neurological Score, and subacute Barthel Index as predictors of outcome functional status and infarct size at 3 months in patients with acute cortical infarction. A prospective study of acute stroke predictors and outcome measurements in a cohort of sequential hospitalized patients. Fifty-one patients with acute cortical infarction and without previous disability assessed 24 hours after onset with Allen's Prognostic Score and the Canadian Neurological Score and at 7 days with the Barthel Index. Mortality, Barthel Index, and volumetric measurement of infarct size on computed tomography 3 months after stroke. There were seven deaths. The outcome Barthel Index was measured in all 44 survivors, of whom 29 had computed tomography at the time outcome was determined. In a multivariate analysis, functional outcome was best predicted by Allen's Prognostic Score, a score of less than -15 having a sensitivity of 82% and specificity of 97% in predicting a poor outcome (Barthel Index, < or = 12 or death). Volumetric tissue loss was predicted only by Allen's Prognostic Score (r = .62, P < .001). Allen's Prognostic Score is a robust predictor of both functional outcome and tissue loss in acute cortical infarction and has a potentially important role in the analysis of the results of acute stroke intervention trials.

Neuroradiology, 1987

Dynamic cerebral CT scanning (DCT) was used to quantitatively analyse the haemodynamic effects of... more Dynamic cerebral CT scanning (DCT) was used to quantitatively analyse the haemodynamic effects of extracranial and intracranial arterial occlusive lesions in 17 patients with TIA's or minor cerebral infarcts. Using DCT and gamma variate curve fitting, mean transit times were determined for the terminal internal carotid arteries, middle cerebral arteries and middle cerebral-supplied Sylvian cortex at the level of the Circle of Willis. Six patients were studied sequentially, four before and after transcranial bypass surgery. No arterial or tissue delays were found in patients without haemodynamic arterial lesions or cortical infarcts. Seven of nine patients with haemodynamic, extracranial carotid lesions showed ipsilateral delays in arterial or tissue transit times. Tissue delays usually correlated with CT or clinical evidence of infarction. Improved haemodynamics in patients re-studied correlated with the effects of surgery or clinical recovery. DCT has several important limitations but has the potential to provide additional haemodynamic information about the cerebral circulation in selected patients with cerebral arterial occlusive disease.

Journal of Medical Imaging and Radiation Oncology, Mar 1, 1981

SUMMARYAmongst the many recognized complications of cerebral angiography are those due to the int... more SUMMARYAmongst the many recognized complications of cerebral angiography are those due to the introduction of emboli into the cerebral circulation. This report documents a previously undescribed iatrogenic embolic material, pubic hair, together with the simple measures necessary to prevent this potential hazard.

Medical Journal of Australia, 1983

ANZ Journal of Surgery, 1986

Medical Journal of Australia, 1979

SINCE July, 1975, 8580 computed tomography (CT) examinations have been performed at the Royal Mel... more SINCE July, 1975, 8580 computed tomography (CT) examinations have been performed at the Royal Melbourne Hospital. The indications for examination fell into seven main groups: (i) clinical suspicion of intracranial focal lesion, based on focal symptoms and signs; (ii) head trauma; (iii) follow-up scans after craniotomy; (iv) cerebrovascular accident; (v) dementia; (vi) epilepsy; (vii) non-specific symptoms without neurological signs (headache, blackouts and vertigo). It is accepted that CT should be the initial examination for patients in the first three categories. The role of CT in the investigation of cerebrovascular disease lies principally in distinguishing between haemorrhage' and infarction when they enter into the differential diagnosis.' The justification for performing CT as the initial examination upon patients in the latter three categories is less certain. Therefore, the results of CT in the latter three categories were examined over a 12-month period (the year of 1976), during which a total of 2492 examinations were per.formed.

Medical Journal of Australia, 1983

Five patients with caroticocavernous fistula were treated by new, interventional angiographic tec... more Five patients with caroticocavernous fistula were treated by new, interventional angiographic techniques. In four patients, latex balloons filled with a silicone polymer were introduced into the cavernous sinus via the transfemoral route and detached; this resulted in complete obliteration of the caroticocavernous fistula and preservation of the internal carotid artery flow in two of the four patients. In the fifth patient, stainless steel coils were introduced into the cavernous sinus via the superior ophthalmic vein which had previously been surgically exposed. These percutaneous, angiographic techniques of intervention should be considered the initial treatment of choice for caroticocavernous fistulae.

Radiology, 1983

One thousand patients had both CT of the head and a conventional skull series of radiographs. Rad... more One thousand patients had both CT of the head and a conventional skull series of radiographs. Radiographic findings were abnormal in 250 patients (25%), but only 64 patients (6.4%) had diagnostically significant abnormalities at radiography that were not detected by CT. If the 163 patients who presented after acute trauma were excluded from the series, only 39 (4.7%) of the remaining patients had radiographically significant abnormal findings that were not seen at CT, and only two (0.2%) of these abnormalities could not be diagnosed by a lateral skull radiograph alone. In only five patients (0.5%) was the management actively changed because an abnormality that was detected at skull radiography was not detected at CT. Thus, in nontrauma patients who have stroke, epilepsy, dementia, or nonspecific symptoms without focal signs, or have recently undergone craniotomy, and who have been referred for CT, skull radiographs are not justified. In the patient with a history and findings that are strongly suggestive of a pathological disorder anywhere other than in the sella turcica, cerebello-pontine angle, and paranasal sinuses, only the lateral skull radiograph should be obtained after CT, and only if CT is equivocal.

Diagnostic imaging, 1979

An elderly female being treated for an unrelated medical condition was found to have an arteriove... more An elderly female being treated for an unrelated medical condition was found to have an arteriovenous malformation involving the vein of Galen. The florid radiological features are described, including the computed tomogram (CT) appearances. The pathology and usual modes of clinical presentation are reviewed. This patient is the oldest yet described with an arteriovenous malformation involving the Galenic system. It is suggested that the condition is more common in adults than previously thought.

Australian and New Zealand journal of medicine, 1985

To evaluate the place of intravenous digital subtraction angiography (IV-DSA) in the investigatio... more To evaluate the place of intravenous digital subtraction angiography (IV-DSA) in the investigation of patients with carotid territory ischemia, we have compared the IV-DSA and conventional angiographic (CA) findings in 40 patients in a prospective study. Arterial disease was assessed by grading stenosis from zero (normal artery) to six (complete occlusion) and recording any luminal ulceration. In 59 of 66 bifurcations imaged by both techniques, the IV-DSA evaluation of any internal carotid artery origin disease was within one grade of the CA assessment, with three false negatives and four false positives. Luminal ulceration was less reliably predicted, and two clinically important middle cerebral artery lesions were missed by IV-DSA. In 11 patients who had carotid endarterectomy, there was a good correlation between surgical, CA, and IV-DSA findings, although some ulcerations were not detected by either angiographic technique. These results suggest that IV-DSA is a sensitive techniq...

Stroke, 2010

Background and Purpose— The Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a pros... more Background and Purpose— The Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a prospective, randomized, double-blinded, placebo-controlled, phase II trial of alteplase between 3 and 6 hours after stroke onset. The primary outcome of infarct growth attenuation on MRI with alteplase in mismatch patients was negative when mismatch volumes were assessed volumetrically, without coregistration, which underestimates mismatch volumes. We hypothesized that assessing the extent of mismatch by coregistration of perfusion and diffusion MRI maps may more accurately allow the effects of alteplase vs placebo to be evaluated. Methods— Patients were classified as having mismatch if perfusion-weighted imaging divided by coregistered diffusion-weighted imaging volume ratio was >1.2 and total coregistered mismatch volume was ≥10 mL. The primary outcome was a comparison of infarct growth in alteplase vs placebo patients with coregistered mismatch. Results— Of 99 patients with baseline d...

Neurology, 1998

Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffus... more Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffusion-weighted imaging (DWI) in predicting stroke evolution and outcome in 18 patients with acute hemispheric infarction.Methods: Patients were studied within 24 hours (mean, 12.2 hours), subacutely(mean, 4.7 days), and at outcome (mean, 84 days). Comparisons were made between infarction volumes as measured on perfusion imaging (PI) and isotropic DWI maps, clinical assessment scales (Canadian Neurological Scale, Barthel Index, and Rankin Scale), and final infarct volume (T2-weighted MRI).Results: Acute PI lesion volumes correlated with acute neurologic state, clinical outcome, and final infarct volume. Acute DWI lesions correlated less robustly with acute neurologic state, but correlated well with clinical outcome and final infarct volume. Three of six possible patterns of abnormalities were seen: PI lesion larger than DWI lesion (65%), PI lesion smaller than DWI lesion (12%), and DWI lesi...

Investigative Radiology, 1998

Magnetic resonance contrast enhancement depends on the timing of image acquisition. Human trials ... more Magnetic resonance contrast enhancement depends on the timing of image acquisition. Human trials have demonstrated efficacy of renal artery stents on salvage of renal function. This study assessed the ability of dynamic gadolinium (Gd)-DTPA administration to demonstrate renal and iliac artery stent patency compared to conventional angiography as the gold standard. Seven subjects with eight stents referred for angiography underwent dynamic magnetic resonance studies, all with renal artery stenting. All were examined with conventional angiography and after dynamic Gd-DTPA infusion. Coronal magnetic resonance images were acquired using a GE Signa 1.5 T magnet (fast spoiled gradient echo; echo time = 4.2 ms; repetition time = 68-150 ms; flip angle = 75 degrees) 0 to 600 seconds after 0.1 mmol/Kg Gd-DTPA intravenous bolus injection during sequential breath-hold acquisitions 13 to 32 seconds each. All eight stents were visualized with 100% accurate patency documentation. Fast spoiled gradient echo magnetic resonance imaging with bolus Gd-DTPA administration can provide adequate time and spatial resolution to demonstrate arterial stent patency.

The British Journal of Radiology, 1977

Archives of Neurology, 1990

We evaluated prospectively the incidence of early seizures in 1000 consecutive patients with stro... more We evaluated prospectively the incidence of early seizures in 1000 consecutive patients with stroke and transient ischemic attacks to determine whether seizure occurrence correlates with stroke type, pathogenesis, or outcome. Seizures occurred in 44 patients (4.4%; SE, 0.7%), including 10 (15.4%) of 65 (SE, 4.5%) with lobar or extensive hemorrhage, 6 (8.5%) of 71 (SE, 3.3%) with subarachnoid hemorrhage, 24 (6.5%) of 370 (SE, 1.3%) with cortical infarction, and 4 (3.7%) of 109 (SE, 1.8%) with hemispheric transient ischemic attacks. Lacunar infarcts and deep hemorrhages were not associated with seizures. Arteriovenous malformation was a common cause of lobar hemorrhage with early seizures, but in cortical infarcts there was no association between seizure occurrence and pathogenesis. Seizures generally occurred within 48 hours of stroke onset, were usually single, partial, and readily controlled. Seizures were not associated with a higher mortality or worse functional outcome.

Archives of Neurology, 1995

To compare the acute Allen's Prognostic Score, Canadian Neurological Scor... more To compare the acute Allen's Prognostic Score, Canadian Neurological Score, and subacute Barthel Index as predictors of outcome functional status and infarct size at 3 months in patients with acute cortical infarction. A prospective study of acute stroke predictors and outcome measurements in a cohort of sequential hospitalized patients. Fifty-one patients with acute cortical infarction and without previous disability assessed 24 hours after onset with Allen's Prognostic Score and the Canadian Neurological Score and at 7 days with the Barthel Index. Mortality, Barthel Index, and volumetric measurement of infarct size on computed tomography 3 months after stroke. There were seven deaths. The outcome Barthel Index was measured in all 44 survivors, of whom 29 had computed tomography at the time outcome was determined. In a multivariate analysis, functional outcome was best predicted by Allen's Prognostic Score, a score of less than -15 having a sensitivity of 82% and specificity of 97% in predicting a poor outcome (Barthel Index, < or = 12 or death). Volumetric tissue loss was predicted only by Allen's Prognostic Score (r = .62, P < .001). Allen's Prognostic Score is a robust predictor of both functional outcome and tissue loss in acute cortical infarction and has a potentially important role in the analysis of the results of acute stroke intervention trials.

Neuroradiology, 1987

Dynamic cerebral CT scanning (DCT) was used to quantitatively analyse the haemodynamic effects of... more Dynamic cerebral CT scanning (DCT) was used to quantitatively analyse the haemodynamic effects of extracranial and intracranial arterial occlusive lesions in 17 patients with TIA's or minor cerebral infarcts. Using DCT and gamma variate curve fitting, mean transit times were determined for the terminal internal carotid arteries, middle cerebral arteries and middle cerebral-supplied Sylvian cortex at the level of the Circle of Willis. Six patients were studied sequentially, four before and after transcranial bypass surgery. No arterial or tissue delays were found in patients without haemodynamic arterial lesions or cortical infarcts. Seven of nine patients with haemodynamic, extracranial carotid lesions showed ipsilateral delays in arterial or tissue transit times. Tissue delays usually correlated with CT or clinical evidence of infarction. Improved haemodynamics in patients re-studied correlated with the effects of surgery or clinical recovery. DCT has several important limitations but has the potential to provide additional haemodynamic information about the cerebral circulation in selected patients with cerebral arterial occlusive disease.

Journal of Medical Imaging and Radiation Oncology, Mar 1, 1981

SUMMARYAmongst the many recognized complications of cerebral angiography are those due to the int... more SUMMARYAmongst the many recognized complications of cerebral angiography are those due to the introduction of emboli into the cerebral circulation. This report documents a previously undescribed iatrogenic embolic material, pubic hair, together with the simple measures necessary to prevent this potential hazard.