Chapter 08: More Research on Techniques to Determine Physiology
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Description
Dr. Leeds explains that after his work on brain necrosis, he returned to studies focused on physiology. He talks about a book he published with Dr. Juan Tavares on identifying dynamic changes with cerebral angiographs. He notes that angiography created the foundation of his knowledge in the field.
He then turns to more recent work on physiological questions, including interpretation of data from stains. He notes the importance of distinguishing tumors from lesions created by stroke.
Next he talks about the fellowship program and his continued interest in passing on his valuable depth of knowledge to others.
Identifier
LeedsNE_02_20170620_C08
Publication Date
6-20-2017
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Researcher; The Researcher; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Discovery and Success; Overview; Definitions, Explanations, Translations; Education; On Education; Research; Technology and R&D
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T.A. Rosolowski, Ph.D.:
So tell me about how your research evolved after the necrosis project.
Norman Leeds, MD:
Hmm? T.A. Rosolowski, Ph.D. After you did the work on necrosis, how did your research evolve from there?
Norman Leeds, MD:
Then I did all that other physiological studies. I was always—I was always interested in the physiological factors of blood flow and changes, and actually wrote a seminal book, which came out at the wrong time, because it came out when CT [started], so it got lost. But it was written with Dr. Taveras on dynamic changes with cerebral angiography, in which we foresaw most of the current changes that are really being seen better, obviously, with CT, and then with MR. But we did come up with circulatory changes, and I guess that was the title of the book: Circulatory Changes in Neuroradiology. T.A. Rosolowski, Ph.D. So am I understanding correctly that the fact of doing the imaging changes circulation patterns in the brain, or that you were using imaging to—
Norman Leeds, MD:
No, no, no. No, we’re using the... No. (laughs) No, it doesn’t change. It gives physiological information. It’s a physiological feature. The circulation in the brain, understanding the normal, and then the abnormal, I mean, you know, many things came from that. We wrote about when just angiography, the shaggy vessel brought into focus. But that came from my understanding of that dynamics. We talked about all the circulatory changes, which helped us. What—we learned that the flow in children, the circulatory time in children is obviously shorter, and then reaches a normal, about 4.2 seconds, and then goes to six seconds. Anything over six seconds was pathological. That came out of our circulatory dynamic research. But we also pointed out the importance of the veins. I mean, I pointed out to the neurosurgeons prior to our work all they were interested in was shifts, midline shifts of veins and arteries, and stains, tumor stains. But we pointed out that the veins were critical because the veins around the lesion identified the exact location of the tumor, and was extremely helpful. So we identified many important things on physiological change. I wrote a paper subsequently based on that, on simulating brain tumors, circulatory changes. We had stains in infarcts, and we distinguished those stains from tumors, which I wrote. And then that was what we see in then CT and then MR. So it was an evolving. But it was the knowledge that learned from... I mean, angiography has never left. It was a lot of the knowledge of the flow that I learned that enabled me [to] call a meningioma [ ] a mother-in-law lesion. She came early and stayed late. (laughter) And that was the stain of a meningioma. Came early and stayed late. So we used those stains, which we still use to identify tumors. So we had done a lot of this early work, you know, with the angiography. And I think that gave me an advantage. We also did air studies, which were terrible, and I was happy to see them disappear. T.A. Rosolowski, Ph.D. Yeah, you were mentioning those last time, they didn’t like them.
Norman Leeds, MD:
Patients did not like them. T.A. Rosolowski, Ph.D. Yeah. Now, how did—you said that you returned to more physiologically-based work after you looked at the necrosis, so how did your focus shift in physiology? Because a lot of years had passed. What were you doing then?
Norman Leeds, MD:
Nothing. No, it’s just using the material to redefine the brain tumors to understand the various patterns, to be able to figure out what was what. To tell what the stain meant, to identify the various patterns to separate gliomas from meningiomas, and from other lesions. Also, it’s amazing how vascular lesions, meaning infarcts in the brain, can look like tumors. I said I wrote that paper that turned out to be mostly strokes that gave these unusual stains in the brain, which we identified and wrote about, which helped me to analyze. And it’s knowledge. You build up a knowledge base. And it’s critical that you understand stroke, because to separate a brain tumor, it is not always so easy. I mean, we’ve gotten cases referred both here and in New York that were called brain tumors that we’re able to analyze and say, “No, no, these are not brain tumors. These are strokes. Leave them alone, leave-me-alone lesions,” like an infarct. When we established the fellowship program in neurooncological neuroradiology, we wanted it to be someone who had had a neuroradiology training so that they would understand brain tumors, because if you don’t know about infarcts, and you don’t know about trauma, and these other things, you’re going to make significant errors. So we want people to have a knowledge base of neuroradiology so tumors can become more meaningful to them. So it all builds, and if I look at my material, it’s all there now. But understand—knowing the angio—we had the advantage of having looked at the early vein, and the significance of the early vein. How does it become an early vein? Which is seen in stroke and in tumors. But how to identify it, how to know it, how to avoid making those errors. You don’t want to treat a stroke as a tumor and a tumor— T.A. Rosolowski, Ph.D. And vice versa.
Norman Leeds, MD:
—as a stroke, which happens in a lot of places. So knowledge is critical. And basic knowledge is more so. So I had the advantage of starting with very little and growing it. And, you know, I tried to do that to teach others, because I’m not going to be here forever, and I’m trying to instill the search, the interest, and the knowledge in those that follow. T.A. Rosolowski, Ph.D. Yeah, I was just going to ask you how you communicate that depth of knowledge to trainees.
Norman Leeds, MD:
By training the residents, pointing out the various changes that will enable them to be better than I am. The more I can teach, the next generation will get better and better. Hopefully they will continue to improve. And there are always new things coming. I mean, I will not—we are not at the end. I mean, we are at the beginning. I mean, I think—you know, who would have—I mean, we just got CT, and we’re beginning to understand that, and along came MR, and changed the whole approach and visualization. I mean, looking—for the first time, we could look inside the brain, I mean, with CT, but really now with MR, you know, with the different pulse sequences, looking at the different changes, look at the dynamism and the contrast. And I think we’ll get different contrast, which we got. Look, myelography was terrible with the oil contrast. It became—then we had the nonionic contrast, which is safer, and we didn’t have to take out. We had to take out the oily contrast, which was painful to the patient, which led to a lot of problems. But it was the best we had.
Recommended Citation
Leeds, Norman MD and Rosolowski, Tacey A. PhD, "Chapter 08: More Research on Techniques to Determine Physiology" (2017). Interview Chapters. 1308.
https://openworks.mdanderson.org/mchv_interviewchapters/1308
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