Chapter 03: A Detailed Understanding of Brain Circulation
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Description
In this chapter, Dr. Leeds talks about his early research contributions to neuroradiology. He began his work with a focus on understanding the circulatory system of the brain in detail and he achieved expertise in brain angiography and brain circulation time, which led to other discoveries. He notes that he was the first to do a magnification angiograph and the first pediatric radiologist. He also notes his work on genetic abnormalities and pattern in neuroradiology.
Identifier
LeedsNE_01_20170530_C03
Publication Date
5-30-2017
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; Overview; The Researcher; Discovery and Success; Definitions, Explanations, Translations; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; 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.:
Tell me a little bit about the research that you were doing, how it was evolving over these years.
Norman Leeds, MD:
Well, most of it was, really—is research that I did, that I accomplished, was first in angiography, and I was the first one to do magnification cerebral angiography, which I wrote [about]. T.A. Rosolowski, Ph.D. What does that mean?
Norman Leeds, MD:
Making things bigger. In other words, we would separate the head from the film and from the X-ray machine, so that caused enlargement. Well, it was also—because it was done that way, it was bigger and sharper [ ]. We saw things we couldn’t see any other way. And we did that. I did angiotomography, because that was very critical. So I did a lot of understanding of—and I understood because I wrote that original—you know, sometimes you’ve got to do a lot of the work from which comes many things. I understood circulation time, and, after all, what’s critical with the vessels is the circulation. And so I learned that, and that was—I’ve written, what, two books, and that’s when I stopped writing books, because you don’t make enough money to warrant the amount of effort that goes into writing a book. I mean, it really is a challenge to collect the cases, to make the cases, to write it, to put it all together. And you have to read a lot. T.A. Rosolowski, Ph.D. So this was not books that you edited where other people were contributing; this was your effort start to finish.
Norman Leeds, MD:
These are—this was a book Dr. Burrows and I did. Burrows was in—he was [in] Southampton in England, and we wrote this book. Oh, by the way, how long are we going to work today? T.A. Rosolowski, Ph.D. Until 11:30. Is that OK?
Norman Leeds, MD:
OK. T.A. Rosolowski, Ph.D. OK. I mean, I’m fine if you need—
Norman Leeds, MD:
Yes. T.A. Rosolowski, Ph.D. OK, good, good.
Norman Leeds, MD:
That’s what I was planned for, so that’s— T.A. Rosolowski, Ph.D. No problem.
Norman Leeds, MD:
Yes, ma’am. T.A. Rosolowski, Ph.D. OK, good, good. So tell me, you know, the circulation studies... Well, let me just observe, you know, it’s something that I’ve had conversations with other people about where they—you know, they talk about being in at the beginning of a field. They have to do a lot of basic stuff. Sometimes they have to build equipment. They have to do everything from scratch. And they talk about the value of that, because it enables you to understand a system in such detail. And that’s kind of what you’re telling me here.
Norman Leeds, MD:
That’s... Yes, but I didn’t build it. I mean, but you have to— T.A. Rosolowski, Ph.D. No, no, no, of course, not, but that... Yeah.
Norman Leeds, MD:
I review... Look, anything you do a lot of, you learn. You should—let’s put it this way: you should learn. You don’t necess... But by [ ] reviewing the hundred normal angiograms, which I did to develop circulation time, I began to understand what circulation time meant. We studied the arterial phase, the intermediate phase, which includes the capillaries, and then the venous phase. So there are really three phases. And we timed it, and we wrote what the—I think it was 4.27 [seconds]. See, I never forgot that—is the normal circulation time. T.A. Rosolowski, Ph.D. So what is the significance of circulation time, when we start coming to—
Norman Leeds, MD:
Well, if it’s too long it’s not good, and if it’s too short... But it’s what happens... Children have a shorter circulation time than adults: 4.27 is normal. After six seconds, it’s bad. Your circulation time is longer than 6 seconds, not good. T.A. Rosolowski, Ph.D. And so this is something—is it a diagnostic thing, that if cancer can—
Norman Leeds, MD:
No, it’s just learning. It’s just— T.A. Rosolowski, Ph.D. It’s just learning.
Norman Leeds, MD:
It has... It has... But in doing that, I learned when things occur. So we described the early veins, early filling veins. I mean, the things I described in that book with Taveras were all new, literally, that the veins were the things that allowed us to localize the tumor. T.A. Rosolowski, Ph.D. Interesting.
Norman Leeds, MD:
No one... Well, I got up and I said the neurosurgeons used two things: stains—means abnormal circulation—and shifts, vessels being displaced. But we added the more important thing, which was the localization, which the veins did for you [defining the tumor localization]. T.A. Rosolowski, Ph.D. Interesting.
Norman Leeds, MD:
Which no one had described until we did all that. So it’s all—most neuroradiologists don’t understand it. I mean, I had to go through writing that book and learning to do it. Do you follow? [ ] T.A. Rosolowski, Ph.D. I do, absolutely.
Norman Leeds, MD:
I mean, it was—that was my—instead of building, that was my structure was the [ ]... And that stood me... I mean, we described it in angiography. I had described it in MR. So the newest things in MR are all interrelated. I mean, none of these things are wasted. In fact, they—you begin to understand critical things that no one else can do. Because I didn’t depend on other people. These were... Well, the circulation time was not mine; it was Torgny Greitz, who was a great neuroradiologist from Sweden. And believe it or not, we became friends, because I went to learn how to use a catheter. We didn’t use catheters. We used to use very [direct sticks]. Everybody today uses catheters for angiography. We did direct sticks of the carotid. That was what—it was [how I] started, and that’s what I learned at Columbia. And then I realized I had [to learn to use a catheter]. So I told Dr. Jacobson, [ ] “I want to go to a place that does the catheter angiography.” I mean, I didn’t have to learn how to do it. I wanted to see how they did it. Come on, I stuck arteries all the time. I would know how to do it once I saw what they did. I didn’t... You know, you don’t need the experience if you understand. So I went to UCSF [to work with Dr. Hans Newton.] T.A. Rosolowski, Ph.D. What was the advantage of the catheter over the direct stick?
Norman Leeds, MD:
Because you go into four different arteries. And, you know, one was sticking in the groin, and the other was going in somebody’s neck. So it was easier to do—use a catheter. So I watched the way Newton did it at UCSF, and I learned. It took me a week, and I was lucky. You know, again, luck. Torgny Greitz was in UCSF that week that I was there, so we spent a week together. I mean, I didn’t know him from the man in the moon, but he was one of the greats of neuroradiology from Sweden, and we spent that week together. We used to have dinner every night, so he knew me and I knew him. You know, I knew... And I learned a great deal. And [we have remained friends]. T.A. Rosolowski, Ph.D. What were some of the things you learned from him?
Norman Leeds, MD:
Well, I didn’t learn... I... Well, I learned a lot about his life and things, but I—I mean, he had written the first paper about circulation time. It had actually been published in Acta Radiologica, and I had read it, because that’s where I developed... [ ] you know, I’m reviewing it, and I learned it, and then it was great to meet him, because he was considered one of the greatest, and we became very close friends from then on. You know, you get to know somebody in a week, eating dinner with them [and sharing ideas]. T.A. Rosolowski, Ph.D. Absolutely.
Norman Leeds, MD:
—every night. T.A. Rosolowski, Ph.D. Well, and with huge areas of commonality like that.
Norman Leeds, MD:
Yeah, we became very good friends, Torgny and I. T.A. Rosolowski, Ph.D. Now, tell me: how did you build on this understanding of circulation? What other research did it lead to?
Norman Leeds, MD:
Well, it led to... You know, it’s—you’re doing all those angiograms. All of them have circulation time. And then I looked at all the changes that occurred. Remember, I—and I was also the first pediatric neuroradiologist, because I was at CHOP, and we did angiograms. In fact, I gave a talk at Yale [on infectious disease of the brain demonstrating varying forms of meningiomas]. T.A. Rosolowski, Ph.D. And CHOP is...?
Norman Leeds, MD:
Children’s Hospital of Philadelphia. T.A. Rosolowski, Ph.D. Of Philadelphia, OK.
Norman Leeds, MD:
It is—which is still one of the preeminent... In fact, I’m going to send them some money. I was so impressed with what new things they’re doing for kids and things— T.A. Rosolowski, Ph.D. Oh, really?
Norman Leeds, MD:
—that... Yeah, they—I’m still on the list. I get their paper, I guess, because I was there for years. And, I mean, I saw things in pediatrics that were totally different—you know, the circulation time, etc.—which I described in many... So I did all the stuff on inflammatory diseases of the brain, which are totally different, and I think my first—one of my first talks was an invitation to Yale Medical School to talk about inflammatory diseases of the brain. (laughs) And someone foolishly asked me if this was the way to [diagnose] inflammatory disease. What a question! You know, it shows naiveté. I said, “No, no, the lumbar puncture and the history is still more [useful].” I mean, the angiography is helpful, but I pointed out why it’s helpful. You can distinguish some of the [meningitis cases] with the—but the angiography was just interesting, and I did it, because you’re at a children’s hospital, and those are... You know, each thing has its own [diseases]. We have tumors. Children’s Hospital, inflammatory diseases were more important and things. So... And I think I did the genetic work on the—what was it? Was... The genetic [chromosome] was 13/15 genes, and what abnormalities. I wrote this with one of the scientists from University... We noticed they had narrow interorbital distances as a hallmark of [these entities]. [ ] T.A. Rosolowski, Ph.D. Seeing the...
Norman Leeds, MD:
Let me—it’s identification. It’s—your brain is o... I was there at the beginning, so I did a lot of the new stuff, because I knew what the old stuff was. And I think most of the vascular changes, I’m the father of. I don’t get the credit for all of it, but a lot of it is based on the observations that we made very early on [in neuroradiology, since I was there early on]-- T.A. Rosolowski, Ph.D. Interesting.
Norman Leeds, MD:
—in this. I mean, I’m ahead not because I’m smarter, [ but] I was there first, and if you don’t make ’em, you don’t make ’em, so... T.A. Rosolowski, Ph.D. How was the field evolving in general at the time? You know, technologically, I mean, all these different ways.
Norman Leeds, MD:
It was evolving. Angiograph— T.A. Rosolowski, Ph.D. Fast, or...?
Norman Leeds, MD:
No, it just... It’s just time, and it’s... I think we had high-quality people, were interested in neuro, and, you know, it became a choice. I don’t think it’s a choice anymore. I think a lot of people like interventional radiology more, but in that—in those days it was everything. We stuck needles in people. We did air studies, which I’m glad [are no longer being performed since CT]. T.A. Rosolowski, Ph.D. What’s an air study?
Norman Leeds, MD:
Pneumoencephalography. T.A. Rosolowski, Ph.D. Yeah. I mean, that’s—I read about injecting air into the brain. What was the reason for that, and why? What were the pros and cons?
Norman Leeds, MD:
Pff... (laughter) No, people didn’t like it. Patients usually said, “I’d rather commit suicide.” They did not like... But, you see, that’s what show—your statement shows a lack of understanding. It’s good because what is the brain? It has ventricles. So with an air study, you see the ventricles. You fill the subarachnoid spaces with air. So you learn a great deal with an air study, but it has—it makes sense when you think about it in terms of angiography, because you have a lot of the same things which we use on angiograms, which told us how big the ventricles were. We didn’t need to do an [PEG]. I mean, if I had to choose, I’d rather do an angiogram. T.A. Rosolowski, Ph.D. What—was it painful? I mean, why didn’t the patients like the process?
Norman Leeds, MD:
They did complain. They got headaches. They vomited. It was not a pleasant study. I had patients tell me they would rather commit suicide than have an air study. The one thing it did do is it told you about dementia. I once got a judge for dementia to study in Philadelphia, and when we injected the air he didn’t feel a thing. They don’t feel it. They don’t know that... I mean, it was just interesting that they have a total lack. But everything has a value. Air studies have a value. But you have to understand them. I mean, they can kill... We used to—we did what we called fractional pneumoencephalography. We took out the fluid, subarachnoid fluid, and injected air. Neurosur—when I wasn’t at Children’s, sometimes they did an air study without me. And they would just [remove] fluid and inject air. You know, we did it positionally, because you want the air to go someplace, you have to keep it there. Otherwise, it... (laughs) You know, air moves! T.A. Rosolowski, Ph.D. What’s the point? Yeah.
Norman Leeds, MD:
So, I mean, it was just a joke. The neurosurgeons didn’t understand. They all—they damaged children. Oh, another thing I learned was you don’t do an air study in children under three months. The first—I first had one, and we had to revive him. I almost lost three kids, and then I realized you can’t do an air study below three months [of age]. Well, it took me... You know, when you’re founding, (laughs) you’ll find out what you shouldn’t do, as well as what you should do.
Recommended Citation
Leeds, Norman MD and Rosolowski, Tacey A. PhD, "Chapter 03: A Detailed Understanding of Brain Circulation" (2017). Interview Chapters. 1303.
https://openworks.mdanderson.org/mchv_interviewchapters/1303
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