bluuebunny/crossref_metadata_2025 huggingface dataset:
A noninvasive, reattachable skull fiducial marker system
Authors: Howard Matthew A. , Dobbs Matthew B. , Simonson Tereasa M. , LaVelle William E. , Granner Mark A.
Published: June 2009

✓ As computer-interactive technologies become more widely used in neurosurgery, radiology, and radiation therapy, the need for an optimum skull fiducial marker system increases. In the past, intracranial localization methods required precisely machined metal frames and rigid pin fixation to the skull. Recently, this function has been performed using “frameless” computer-based systems that calculate brain position relative to a series of external reference points, the most accurate of which are screwed directly into the skull. A penetrating fiducial marker system, however, is not well suited for applications requiring multiple volume registrations over an extended time period. We describe a new skull fiducial marker system that attaches to the maxillary teeth and can be used repeatedly on different occasions. A curved bar, known as a Banana Bar (BB) extends backward from a custom mouthpiece around the side of the patient's head; the bar contains sites of attachment for screw-in radiographic fiducial markers. Repositioning accuracy was quantitated using a photographic technique. A BB prototype was constructed and tested in three subjects. The BB weighs less than 100 g and can be comfortably held in position for up to 30 minutes. It takes less than 1 minute to screw in the mouthpiece and only seconds to secure the BB to the teeth. One hundred twenty photographic measurements were analyzed from 60 repositionings over a minimum 3-week period. Standard deviations for the measurement series ranged from 0.29 to 0.86 mm. Results suggest that the BB may be an inexpensive, efficient, and accurate method for providing the external reference points needed for a wide range of emerging computer-interactive applications.
Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients
Authors: Le Roux Peter D. , Elliott J. Paul , Downey Lois , Newell David W. , Grady M. Sean , Mayberg Marc R. , Eskridge Joseph M. , Winn H. Richard
Published: June 2009

✓ Several significant diagnostic and therapeutic advances in the management of subarachnoid hemorrhage have emerged during the last 10 years. The present study was undertaken to determine whether these advances have improved overall outcome in patients of low surgical risk and what factors predict outcome. The authors retrospectively reviewed the management of good-grade patients seen at the Harborview Medical Center at the University of Washington, who suffered ruptured anterior circulation aneurysms between 1983 and 1993. The results in this series demonstrate that favorable outcomes occurred in 96.8% of patients designated Hunt and Hess Grade I, 88.3% of those assigned Grade II, and 81.3% of those deemed Grade III after rupture of anterior circulation aneurysms. On the basis of clinical and radiographic factors present at admission, correct prediction can be made about all favorable, but only 17% of unfavorable outcomes. During the decade under investigation, the authors observed a significant (p = 0.002) increase in the number of favorable outcomes: 74.5% of patients treated during the first management period (1983–1987); 87% of patients treated during the second period (1987–1990); and 93.5% of patients treated during the third management period (1990–1993) experienced favorable outcomes. Improvements in critical-care techniques and the management of vasospasm may be associated with the improved outcome observed during this series.
The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children
Authors: Dailey Andrew T. , McKhann Guy M. , Berger Mitchel S.
Published: June 2009

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors.

To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients.

Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.
Effect of intermittent reperfusion and nitric oxide synthase inhibition on infarct volume during reversible focal cerebral ischemia
Authors: Iuliano Brian A. , Anderson Robert E. , Meyer Fredric B.
Published: June 2009

✓ The authors examined the effects of both intermittent reperfusion and nitric oxide synthase (NOS) inhibition, caused by NG-nitro-l-arginine methyl ester (l-NAME) during episodes of focal cerebral ischemia induced to simulate the neurosurgical setting. Seventy-eight Wistar rats underwent single (60 minutes of ischemia) or repetitive (four 15-minute periods of ischemia separated by 5 minutes of reperfusion) episodes of middle cerebral artery occlusion while under anesthesia (1.0% halothane). Twenty-four hours after the procedure, the animals were given neurological examinations and then sacrificed for histological preparation and examination. The intermittent reperfusion groups tended to have smaller mean cortical infarctions. There was also a trend showing a decrease in infarction size in groups givenl-NAME. The combination of intermittent reperfusion and preischemic administration ofl-NAME (10 mg/kg) resulted in a 65% reduction in infarction size (p < 0.05) when compared to that caused by 60 minutes of single occlusion withoutl-NAME. The use of NOS inhibition combined with intermittent reperfusion may be a technique to provide intraoperative cerebral protection during neurovascular procedures that require temporary vascular occlusion.
Prospective, randomized, double-blind trial of BQ-123 and bosentan for prevention of vasospasm following subarachnoid hemorrhage in monkeys
Authors: Hino Akihiko , Weir Bryce K. A. , Macdonald R. Loch , Thisted Ronald A. , Kim Chul-Jin , Johns Lydia M.
Published: June 2009

✓ Thirty-one monkeys were randomly divided into three groups to undergo baseline cerebral angiography followed by induction of subarachnoid hemorrhage by placement of autologous blood clot along the right-sided arteries of the anterior circle of Willis (Day 0). The monkeys were then given drug vehicle or one of two endothelin (ET) antagonists, BQ-123 (6 mg/kg/day) or bosentan (5 mg/kg/day) intracisternally. The BQ-123 was administered by continuous infusion from a subcutaneous pump and the bosentan was given by twice-daily injections into an Ommaya reservoir in the subcutaneous space with a catheter along the right middle cerebral artery (MCA). Seven days later (Day 7), angiography was repeated and the animals were killed. Comparison of arterial diameters shown on angiograms between Day 0 and Day 7 groups given placebo and bosentan showed significant reductions in the diameters of the right intradural internal carotid (28% ± 6% and 30% ± 6%, respectively, paired t-test, p < 0.05), anterior cerebral artery (29% ± 8% and 32%, ± 6% respectively ± 6%, respectively) and MCA (34% ± 6% and 46% ± 4%, respectively). Animals injected with BQ-123 had significant narrowing of the right extradural internal carotid artery (7% ± 6%) and the basilar artery (11% ± 3%), but not of the right MCA. Comparison of arterial diameters between groups at Day 7 showed significant variance in the right extradural internal carotid, both intradural internal carotid, right middle cerebral, and left anterior cerebral arteries; the animals injected with BQ-123 developed significantly less arterial narrowing these those receiving bosentan and placebo. Bosentan was not detected in the cerebrospinal fluid aspirated from the cisterna magna on Day 7, whereas BQ-123 was detected in two animals. We can infer from these results that BQ-123 prevents vasospasm following subarachnoid hemorrhage in monkeys, that further investigations of ET antagonists are warranted, and that ET may be an important pathophysiological mediator of vasospasm. The lack of efficacy of bosentan may be related to inadequate cerebrospinal fluid levels obtained by administration twice-daily through an Ommaya reservoir.
En bloc petrosectomy using a Gigli saw for petroclival lesions
Authors: Sasaki Tomio , Taniguchi Makoto , Suzuki Ichiro , Kirino Takaaki
Published: June 2009

✓ The authors report a new technique for en bloc petrosectomy using a Gigli saw as an alternative to drilling the petrous bone in the combined supra- and infratentorial approach or the transpetrosal—transtentorial approach. It is simple and easy and avoids postoperative cosmetic deformity. This technique has been performed in 11 petroclival lesions without injuring the semicircular canals, the cochlea, or the facial nerve.
Diagnosis of vascular compression in facial spasm by stereoscopic short-range magnetic resonance angiography
Authors: Shimizu Takashi , Kawasaki Hiroto , Kasuya Hidetoshi , Kurita Koki
Published: June 2009

✓ The authors describe the use of stereoscopic short-range magnetic resonance (MR) angiography to diagnose whether and by what means the brainstem is compressed in a case of facial spasm. The MR images were obtained on a 1.5-tesla imaging system with three-dimensional time-of-flight pulse sequence (repetition time 39 msec, echo time 9 msec). Six-source MR images, in which the internal acoustic meatuses were described, were processed using a maximum-intensity projection technique to reconstruct the MR angiograms. The internal acoustic meatuses, the posterior fossa, and the nearby arteries are shown on a single MR angiogram. When two MR angiograms with projection angles 10° apart are placed side by side and observed through polarized glasses, a stereoscopic view of the compressing artery can easily be seen.
Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results
Authors: Epstein Nancy E.
Published: June 2009

✓ This study was undertaken to determine and compare indications and relative benefits of various surgical approaches in 170 patients (average age 55 years) with far-lateral herniated lumbar discs, identified by magnetic resonance (MR) imaging and computerized tomography (CT) and operated on between 1984 and 1994. Essentially three surgical procedures were performed: complete facetectomy in 73 patients, laminotomy with medial facetectomy in 39 patients, and intertransverse discectomy (also known as ITT) in 58 patients. Follow-up periods averaged 5 years (range 0.5–10 years). Outcomes were scored as excellent (no deficit), good (mild radiculopathy), fair (moderate radiculopathy), and poor (unchanged or worse).

Overall, excellent and good results were achieved in 73 and 51 patients, respectively, and fair and poor results in 26 and 20, respectively. There was little difference among the results encountered for the three major surgical groups: 79% of the intertransverse (ITT) group had good-to-excellent outcomes, as compared with 70% of the facetectomy group, and 68% of the group who underwent at minimum laminotomy, and additional hemilaminectomy or laminectomy with medial facetectomy. Results were the same for the 121 patients followed for more than 2 years and for the 49 patients studied for under 2 years.

In the management of far-lateral discs, total facetectomy provides the best exposure, but increases the risk of instability. Laminotomy and medial facetectomy uncover the lateral and subarticular recess and preserve stability, but visualization of the far-lateral compartment is often inadequate. The intertransverse approach offers extensive far-lateral but not medial intraforaminal exposure, while also preserving stability.

Full facetectomy, laminotomy with medial facetectomy, and the intertransverse approaches yielded nearly comparable outcomes in far-lateral disc surgery. Only the full facetectomy exposes the entire course of the nerve root both medially and laterally, whereas the intertransverse procedure provides direct exposure of the far-lateral compartment alone.

It is important to select the correct approach or combination of approaches to address attendant complicating factors such as spinal stenosis, spondyloarthrosis, and degenerative spondylolisthesis identified on CT and MR studies.
Vascular endothelial growth/permeability factor expression in human glioma specimens: correlation with vasogenic brain edema and tumor-associated cysts
Authors: Strugar John G. , Criscuolo Gregory R. , Rothbart David , Harrington William N.
Published: June 2009

✓ Peritumoral vasogenic brain edema (PVBE) is a common accompaniment of malignant gliomas. It results from microvascular extravasation of plasma fluid and proteins through the interendothelial spaces. Tumor-associated cysts (TACs) are observed more commonly with benign gliomas that are not associated with PVBE. This study investigates the hypothesis that these morphologically distinct epiphenomena of microvascular extravasation are linked by a common pathophysiological mechanism involving vascular endothelial growth/permeability factor (VEG/PF), which has been implicated in vascular leak phenomena including ascites, malignant effusions, and brain edema. Furthermore, VEG/PF has been isolated from cultured glioma cells, and both VEG/PF protein and messenger RNA transcripts are expressed in brain tumor tissue. To further elucidate the relationship of VEG/PF to PVBE and TACs, the authors examined 34 pathological specimens for VEG/PF expression. Nineteen primary low-grade tumors, 11 primary high-grade tumors, and four gliosis controls were immunostained with a polyclonal anti-VEG/PF immunoglobulin G antibody. Magnetic resonance imaging was used to quantitate PVBE and to determine the presence of TACs and tumor enhancement. The study revealed that eight VEG/PF-negative specimens exhibited no significant edema, whereas 26 VEG/PF-positive tumors exhibited either significant PVBE or TACs. Notably, eight of nine benign TACs that were not associated with PVBE immunostained positive for VEG/PF. These data indicate a high degree of correlation between VEG/PF expression by gliomas and the occurrence of PVBE or TACs, irrespective of tumor grade, thus supporting VEG/PF's pivotal role as the common pathophysiological link between these processes.
Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery
Authors: Fox Mark W. , Piepgras David G. , Bartleson John D.
Published: June 2009

✓ A case of repeated vertebrobasilar ischemic attacks related to head rotation (bow hunter's stroke) is reported. With head rotation of 45° or more to the right, the patient would become lightheaded and feel as if she were going to lose consciousness. Angiography performed when head rotation was to the right revealed mechanical compression of the left vertebral artery at the foramen transversarium of the axis and an occluded right vertebral artery. Untethering of the vertebral artery as it passed through the foramen transversarium of the atlas in this case completely relieved the patient's symptoms. The authors conclude that contralateral vertebral artery occlusion predisposed this patient to symptomatic vertebrobasilar insufficiency secondary to ipsilateral vertebral artery mechanical stenosis induced by head turning.
Exclusively intracranial cranial fasciitis in a child
Authors: Pagenstecher Axel , Emmerich Beate , van Velthoven Vera , Korinthenberg Rudolf , Volk Benedikt
Published: June 2009

✓ The authors present a case of an intracranial tumor in a 7-year-old girl leading to increasing hemiparesis. The lesion arose from the dura and consisted of fibroblasts in a myxoid matrix. The diagnosis of cranial fasciitis was made. The histological, immunohistological, and ultrastructural features of the tumor are described and the differential diagnosis is discussed.
Case Western Reserve University and University Hospitals of Cleveland: a neurosurgical chronicle
Authors: Hlavin Mary Louise , Ratcheson Robert A.
Published: June 2009

✓ There is a strong tradition of neurosurgery in Cleveland. This article traces the origin of Case Western Reserve University School of Medicine and University Hospitals of Cleveland and examines the evolution of neurological surgery at these institutions. It looks at the strong Cushing influence on the process, by both Harvey Cushing and his family. The contributions of such luminaries as George Crile, Elliott Cutler, Claude Beck, and Frank Nulsen are described.
Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging
Authors: Meaney James F. M. , Eldridge Paul R. , Dunn Lawrence T. , Nixon Thomas E. , Whitehouse Graham H. , Miles John B.
Published: June 2009

✓ Until recently, the inability to demonstrate neurovascular compression of the trigeminal nerve preoperatively resulted in surgery being offered only in cases of severe trigeminal neuralgia (TGN), frequently after a prolonged trial of medical treatment and following less invasive procedures, despite the fact that posterior fossa microvascular decompression gives long-term pain relief in 80% to 90% of cases. To assess whether vascular compression of the nerve could be demonstrated preoperatively, high definition magnetic resonance tomographic angiography (MRTA) was performed in 50 consecutive patients, five of whom had bilateral TGN, prior to posterior fossa surgery. The imaging results were compared with the operative findings in all patients, including two patients who underwent bilateral exploration.

Vascular compression of the trigeminal nerve was identified in 42 of 45 patients with unilateral symptoms and on both sides in four patients with bilateral TGN. In the last patient with bilateral TGN, neurovascular compression was identified on one side, and on the other side the compressing superior cerebellar artery was separated from the nerve by a sponge placed during previous surgery. There was full agreement regarding the presence or absence of neurovascular compression demonstrated by MRTA in 50 of 52 explorations, but MRTA misclassified four vessels compressing the trigeminal nerve as arteries rather than veins. In two cases, there was disagreement between the surgical and MRTA findings. In the first of these cases, surgery revealed distortion of the nerve at the pons by a vein that MRTA had predicted to lie 6 mm remote from this point. In the second patient, venous compression was missed; however, this patient was investigated early in the series and did not have gadolinium-enhanced imaging.

In nine cases, MRTA correctly identified neurovascular compression of the trigeminal nerve by two arteries. Moreover, MRTA successfully guided surgical reexploration in one patient in whom a compressing vessel was missed during earlier surgery and also prompted exploration of the posterior fossa in two patients with multiple sclerosis and one patient with Charcot-Marie-Tooth syndrome, in whom neurovascular compression was identified preoperatively.

It is concluded that MRTA is an extremely sensitive and specific method for demonstrating vascular compression in TGN. As a result, open surgical procedures can be recommended with confidence, and microvascular decompression is now the treatment of choice for TGN at the authors' unit. They propose MRTA as the definitive investigation in such patients in whom surgery is contemplated.
Functional MR and PET imaging of rolandic and visual cortices for neurosurgical planning
Authors: Fried Itzhak , Nenov Valeriy I. , Ojemann Steven G. , Woods Roger P.
Published: June 2009

✓ Magnetic resonance (MR) imaging has recently been used to demonstrate physiological activation of the human brain. This development is of considerable interest to the neurosurgeon planning procedures near brain regions involving specific functions. In the present study, rolandic and visual cortices were imaged with a conventional 1.5-tesla clinical MR imager using a spoiled gradient-recalled acquisition in the steady state sequence. Two patients, one with a right frontal astrocytoma and the other with a left parietal meningioma, underwent MR imaging of rolandic cortex while performing a repetitive finger apposition task. Two patients with complex partial seizures referable to the temporal and occipital regions underwent MR imaging of visual cortex while exposed to repetitive photic stimulation (8.3 Hz). Significant signal intensity changes up to 15% between the activation and rest conditions were observed near the surgical targets at the expected anatomical location of the rolandic and visual cortices. In two of these cases activation measured by MR was compared and found similar to the activation measured at the same plane by H215O positron emission tomography (PET). These results suggest that functional MR and PET techniques can be used to obtain preoperative brain mapping in individual patients considered for neurosurgical procedures.
Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage
Authors: Mayer Stephan A. , Limandri Giuseppe , Sherman David , Lennihan Laura , Fink Matthew E. , Solomon Robert A. , Ditullio Marco , Klebanoff Louise M. , Beckford Avis R. , Homma Shunichi
Published: June 2009

✓ A reversible and presumably neurogenic form of myocardial dysfunction may occur following subarachnoid hemorrhage (SAH), but the relationship of this finding to electrocardiographic abnormalities remains unclear. To clarify this issue, serial electrocardiograms (ECGs, mean 6.2 per patient) and echocardiograms (mean 3.4 days after SAH) were obtained in 57 SAH patients without preexisting cardiac disease. The goal was to determine which specific electrocardiographic changes, if any, reflect abnormal left ventricular wall motion in acute SAH.

Wall motion abnormalities were identified in five (8%) of 57 patients. Four of these affected patients experienced hypotension (systolic blood pressure < 100 mm Hg) and three exhibited pulmonary edema within 6 hours of SAH, compared to none of the 52 patients with normal wall motion (p < 0.0001). Patients with abnormal wall motion were more likely than patients with normal echocardiograms to have symmetrical T wave inversion (five of five vs. seven of 52, p < 0.001) and severe (≥ 500 msec) QTc segment prolongation (five of five vs. three of 52, p < 0.001) on serial ECGs. These associations maintained their significance with analysis limited to single ECGs performed on or near the day of echocardiography. Abnormal wall motion was also associated with borderline (2% to 5%) creatine kinase MB elevation (five of five vs. three of 52, p < 0.001) and poor neurological grade (p < 0.0001). Although no combination of findings on a single ECG resulted in 100% sensitivity for abnormal wall motion, the presence of either inverted T waves or severe QTc segment prolongation on serial ECGs was associated with 100% sensitivity and 81% specificity.

These results demonstrate an association between reduced left ventricular systolic function, mild creatine kinase MB elevation, and electrocardiographic repolarization abnormalities in acute SAH. Symmetrical T wave inversion and severe QTc segment prolongation best identified patients at risk for myocardial dysfunction and may serve as useful criteria for echocardiographic screening following SAH.
The microsurgical anatomy of the jugular foramen
Authors: Ayeni S. Adetokunboh , Ohata Kenji , Tanaka Kiyoaki , Hakuba Akira
Published: June 2009

✓ The microsurgical anatomy of the jugular foramen was studied in 10 fixed cadavers, each cadaver consisting of the whole head and neck. Five of the cadavers were injected with latex. The jugular foraminal region was exposed using the infratemporal fossa type A approach of Fisch and Pillsbury in five cadavers (10 sides) and the combined cervical dissection—mastoidectomy—suboccipital craniectomy approach in five cadavers (10 sides). The right foramen was larger than the left in seven cases (70%), equal in two cases (20%), and smaller in one case (10%). The dura covering the intracranial portal of the foramen had two perforations, a smaller anteromedial perforation through which passed the ninth cranial nerve (CN IX), and a larger posterolateral perforation, through which passed the 10th and 11th cranial nerves (CNs X and XI) and the distal sigmoid sinus. The perforations were separated by a fibrous septum in 16 specimens (80%). After exiting the posterior fossa, CNs IX, X, and XI all lay anteromedial to the superior jugular bulb (SJB) within the jugular foramen. The inferior petrosal sinus (IPS) entered the foramen between CNs IX and X in most cases; however, in 10% of our cases it entered the foramen between CNs X and XI, and in 10% it entered the foramen caudal to CN XI. The IPS terminated in the SJB in 90% of our cases; in 40%, the IPS termination consisted of multiple channels draining into both the SJB and internal jugular vein. This study shows that the arrangement of the neurovascular structures within the jugular foramen does not conform to the hitherto widely accepted notion of discrete compartmentalization into an anteromedial pars nervosa containing CN IX and the IPS and a posterolateral pars venosa containing the SJB, CNs X and XI, and the posterior meningeal artery.
Intracranial facial nerve rhabdomyoma
Authors: Vandewalle Giovani , Brucher Jean-Marie , Michotte Alex
Published: June 2009

✓ Nerve rhabdomyomas are exceedingly rare benign tumors of the peripheral nerves consisting of well-differentiated striated muscle fibers admixed with parental nerve fibers. Only one case of intracranial nerve rhabdomyoma has been described, which affected the trigeminal nerve. This report presents the detailed neuropathological description of a nerve rhabdomyoma arising in the schwannian portion of the facial nerve root in a 41-year-old Caucasian man. The nerve fibers were arranged chaotically as in a traumatic neuroma. Because of the intimate intermingling of this slowg-rowing tumor with the parental nerve fibers, complete excision should be avoided.
The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience
Authors: Stillerman Charles B. , Chen Thomas C. , Day J. Diaz , Couldwell William T. , Weiss Martin H.
Published: June 2009

✓ A number of operative techniques have been described for the treatment of herniated thoracic discs. The transfacet pedicle-sparing approach allows for complete disc removal with limited spinal column disruption and soft-tissue dissection. Fifteen cadaveric spinal columns were used for evaluation of exposure, development of thoracic microdiscectomy instrumentation, and establishment of morphometric measurements. This approach was used to remove eight thoracic discs in six patients. Levels of herniation ranged from T-7 through T-11. Preoperatively, all patients had moderate to severe axial pain, and three (50%) of the six had radicular pain. Myelopathy was present in four (67%) of the six patients. Through a 4-cm opening, the ipsilateral paraspinal muscles were reflected, and a partial facetectomy was performed. The disc was then removed using specially designed microscopic instrumentation. Postoperatively, the radiculopathy resolved in all patients. Axial pain and myelopathy were completely resolved or significantly improved in all patients.

The minimal amount of bone resection and muscle dissection involved in the operation allows for: 1) decreased operative time and blood loss; 2) diminished perioperative pain; 3) shorter hospitalization time and faster return to premorbid activity; 4) avoidance of closed chest tube drainage; and 5) preservation of the integrity of the facet—pedicle complex, with potential for improvement in outcome related to axial pain. This technique appears best suited for the removal of all centrolateral discs, although it has been used successfully for treating a disc occupying nearly the entire ventral canal. The initial experience suggests that this approach may be used to safely remove appropriately selected thoracic disc herniations with good results.
Age-related multifactorial causes of neurological deterioration after early surgery for aneurysmal subarachnoid hemorrhage
Authors: Yoshimoto Yuhei , Kwak Suyong
Published: June 2009

✓ The factors contributing to neurological deterioration after early surgery for aneurysmal subarachnoid hemorrhage (SAH) were investigated. One hundred forty-two patients who underwent surgery within 3 days after SAH and recovered consciousness were divided into three age groups: 49 years of age or younger (Group A), 50 to 64 years old (Group B), and 65 years of age or older (Group C). Among these, 40 patients (28%) overall showed neurological deterioration; these cases were analyzed in detail. Although the highest incidence of deterioration was noted in patients in Group C (42%), angiographic vasospasm, quantified by measuring the change in the ratio of the diameters of the intracranial arteries to the extracranial internal carotid artery, was negatively correlated with age. In elderly patients, the severity of angiographic vasospasm was not related to the reversibility of symptoms or the outcome. At the time of aggravation, associated systemic complications such as cardiac decompensation, hypoxia, and electrolyte imbalance were noted in two (18%) of 11 patients in Group A, five (38%) of 13 in Group B, and eight (50%) of 16 in Group C, and these complications were significantly correlated with poor outcome in Group C. Although arterial narrowing is a leading cause of neurological deterioration after early aneurysmal surgery, the etiology is often multifactorial, especially in elderly patients, suggesting that hypervolemic therapy, which might provoke various complications, should be performed carefully under intensive monitoring.
Magnetic resonance axonography of the rat spinal cord: postmortem effects
Authors: Matsuzawa Hitoshi , Kwee Ingrid L. , Nakada Tsutomu
Published: June 2009

✓ The recent development of magnetic resonance (MR) axonography, which uses three-dimensional anisotropy contrast (3DAC), a new algorithm for the treatment of an apparent diffusion tensor, has provided an unprecedented opportunity for visualizing the anatomical details of the spinal cord in live animals. In this study, the authors investigated the sensitivity of the 3DAC method in detecting pathological conditions by obtaining chronological MR axonography of the rat spinal cord immediately after induction of cardiac arrest. The results clearly demonstrated that 3DAC is highly sensitive to any perturbation of physiological conditions. Trichromatic coefficient analyses indicated postmortem changes observed pictorially are indeed due to loss of anisotropy. The study further indicated the presence of at least two independent factors responsible for observed physiological anisotropy. Considering its rather simple implementational process and high anatomical resolution as well as its sensitivity to pathological alteration, MR axonography based on the 3DAC method appears to be the ideal noninvasive imaging technique for assessment of the spinal cord in biomedicine.
Lymphoplasmacyte-rich meningioma in a child
Authors: Loiseau Hugues , Pedespan Jean-Michel , Vital Anne , Marchal Cécile , Vital Claude , Cohadon François
Published: June 2009

✓ A rare case of lymphoplasmacyte-rich meningioma observed in a young girl is reported. The first clinical manifestations of the disease were seizures. Neuroradiological images favored the existence of a meningioma. Abnormalities in the patient's blood chemistry, principally including hypergammaglobulinemia and inflammatory syndrome, were associated with the disease. The tumor was histologically confirmed as meningioma with massive infiltrates of type B lymphocytes. The pathophysiology of the conspicuous lymphoplasmacyte infiltrates, responsible for peripheral blood abnormalities, has remained poorly understood. Alternative diagnostic hypotheses of masses that mimic this type of meningioma are discussed.
Association Study between BDNF Gene Polymorphisms and Autism by Three-Dimensional Gel-Based Microarray
Authors: Cheng Lu , Ge Qinyu , Xiao Pengfeng , Sun Beili , Ke Xiaoyan , Bai Yunfei , Lu Zuhong
Published: June 2009

Single nucleotide polymorphisms (SNPs) are important markers which can be used in association studies searching for susceptible genes of complex diseases. High-throughput methods are needed for SNP genotyping in a large number of samples. In this study, we applied polyacrylamide gel-based microarray combined with dual-color hybridization for association study of four BDNF polymorphisms with autism. All the SNPs in both patients and controls could be analyzed quickly and correctly. Among four SNPs, only C270T polymorphism showed significant differences in the frequency of the allele (χ2 = 7.809, p = 0.005) and genotype (χ2 = 7.800, p = 0.020). In the haplotype association analysis, there was significant difference in global haplotype distribution between the groups (χ2 = 28.19，p = 3.44e-005). We suggest that BDNF has a possible role in the pathogenesis of autism. The study also show that the polyacrylamide gel-based microarray combined with dual-color hybridization is a rapid, simple and high-throughput method for SNPs genotyping, and can be used for association study of susceptible gene with disorders in large samples.
Polymers Comprising Cholesterol: Synthesis, Self-Assembly, and Applications
Authors: Zhou Yuxiang , Briand Victoria  A. , Sharma Nitin , Ahn Suk-kyun , Kasi Rajeswari  M.
Published: June 2009

This article reviews the current status of self-assembling liquid crystalline polymers comprising cholesterol. This article will focus on synthesis, structure-property relationships and strategies to direct ordering and packing of meso- and nanostructures of cholesterol polymers in the neat- or melt state and in solution. The applications of these self-assembled structures will be presented.
The Complete Sequence of a Human Parainfluenzavirus 4 Genome
Authors: Yea Carmen , Cheung Rose , Collins Carol , Adachi Dena , Nishikawa John , Tellier Raymond
Published: June 2009

Although the human parainfluenza virus 4 (HPIV4) has been known for a long time, its genome, alone among the human paramyxoviruses, has not been completely sequenced to date. In this study we obtained the first complete genomic sequence of HPIV4 from a clinical isolate named SKPIV4 obtained at the Hospital for Sick Children in Toronto (Ontario, Canada). The coding regions for the N, P/V, M, F and HN proteins show very high identities (95% to 97%) with previously available partial sequences for HPIV4B. The sequence for the L protein and the non-coding regions represent new information. A surprising feature of the genome is its length, more than 17 kb, making it the longest genome within the genus Rubulavirus, although the length is well within the known range of 15 kb to 19 kb for the subfamily Paramyxovirinae. The availability of a complete genomic sequence will facilitate investigations on a respiratory virus that is still not completely characterized.
Monitoring system for isolated limb perfusion based on a portable gamma camera
Authors: Orero A. , Roé N. , Muxí A. , Rubí S. , Duch J. , Rull R. , Pavón N. , Pons F. , Pavía J. , Vidal-Sicart S.
Published: June 2009

Background: The treatment of malignant melanoma or sarcomas on a limb using extremity perfusion with tumour necrosis factor (TNF-α) and melphalan can result in a high degree of systemic toxicity if there is any leakage from the isolated blood territory of the limb into the systemic vascular territory. Leakage is currently controlled by using radiotracers and heavy external probes in a procedure that requires continuous manual calculations. The aim of this work was to develop a light, easily transportable system to monitor limb perfusion leakage by controlling systemic blood pool radioactivity with a portable gamma camera adapted for intraoperative use as an external probe, and to initiate its application in the treatment of MM patients. Methods: A special collimator was built for maximal sensitivity. Software for acquisition and data processing in real time was developed. After testing the adequacy of the system, it was used to monitor limb perfusion leakage in 16 patients with malignant melanoma to be treated with perfusion of TNF-α and melphalan. Results: The field of view of the detector system was 13.8 cm, which is appropriate for the monitoring, since the area to be controlled was the precordial zone. The sensitivity of the system was 257 cps/MBq. When the percentage of leakage reaches 10% the associated absolute error is ± 1%. After a mean follow-up period of 12 months, no patients have shown any significant or lasting side-effects. Partial or complete remission of lesions was seen in 9 out of 16 patients (56%) after HILP with TNF-α and melphalan. Conclusion: The detector system together with specially developed software provides a suitable automatic continuous monitoring system of any leakage that may occur during limb perfusion. This technique has been successfully implemented in patients for whom perfusion with TNF-α and melphalan has been indicated.
Association of Severe Inflammatory Polyarthritis in Primary Sjögren’s Syndrome: Clinical, Serologic, and HLA Analysis
Authors: MOHAMMED KHULOOD , POPE JANET , LE RICHE NICOLE , BRINTNELL WILLIAM , CAIRNS EWA , COLES ROBERT , BELL DAVID A.
Published: June 2009

Objective.

To evaluate the clinical, serologic, and MHC class II antigen characteristics of a group of patients with primary Sjögren’s syndrome (SS) and severe arthritis.

Methods.

A case-control study comparing 35 patients with primary SS: 17 with inflammatory arthritis, 18 without arthritis.

Results.

All patients fulfilled criteria for primary SS. There were no demographic or clinical features other than inflammatory arthritis, often erosive, that distinguished patients with arthritis from those without. All patients had anti-Ro/SSA autoantibodies, most had anti-La/SSB autoantibodies, and a high percentage of these patients had anti-citrullinated peptide antibodies absent in those without inflammatory arthritis. HLA typing revealed that most patients with anti-citrulline antibodies expressed MHC class II molecules with the shared epitope (SE). The presence of DRB1*0301 linked to the expression of anti-Ro/SSA autoantibodies did not influence the level or frequency of anti-citrulline antibodies in these patients.

Conclusion.

Severe arthritis with features resembling rheumatoid arthritis including erosive disease can occur in primary SS, particularly among those with anti-citrulline antibodies and the SE.
Diagnostic Value of Salivary Gland Ultrasonographic Scoring System in Primary Sjögren’s Syndrome: A Comparison with Scintigraphy and Biopsy
Authors: MILIC VERA D. , PETROVIC RADMILA R. , BORICIC IVAN V. , MARINKOVIC-ERIC JELENA , RADUNOVIC GORAN L. , JEREMIC PREDRAG D. , PEJNOVIC NADA N. , DAMJANOV NEMANJA S.
Published: June 2009

Objective.

To compare an ultrasonographic (US) scoring system of salivary glands with scintigraphy and salivary gland biopsy, in order to evaluate its diagnostic value in primary Sjögren’s syndrome (SS).

Methods.

In 135 patients with suspected SS, the grades of 5 US measures of both parotid and submandibular salivary glands were scored (0–48 scale). Diagnosis of primary SS was established following the American-European Consensus Group criteria of 2002. The patients’ total scintigraphic score (0–12 scale) was determined and the histopathological changes of minor salivary glands graded. Area under the receiver-operating characteristic (ROC) curve was employed to evaluate the diagnostic value of the US scoring system.

Results.

Primary SS was diagnosed in 107 (79.2%) patients and the remaining 28 subjects (20.8%) constituted the control group. US changes of salivary glands were established in 98/107 patients with SS and in 14/28 controls. Mean US score was 26 in SS patients and 6 in controls. Through ROC curves, US arose as the best performer (0.95 ± 0.01), followed by scintigraphy (0.86 ± 0.31). Setting the cutoff score for US at 19 resulted in the best ratio of specificity (90.8%) to sensitivity (87.1%), while setting the cutoff scintigraphic score at 6 resulted in specificity of 86.1% and sensitivity of 67.1%. Among 70 patients with US score ≥ 19, a scintigraphic score > 6 was recorded in 54/70 (77.1%) and positive biopsy findings in 62/70 (88.5%) patients.

Conclusion.

We show high diagnostic accuracy of a novel US scoring system of salivary glands (0–48) in patients with primary SS comparable to invasive methods, i.e., scintigraphy and salivary gland biopsy.
Variable morphology of the sacrum in a Chinese population
Authors: Wu Li‐Ping , Li Yi‐Kai , Li Yu‐Ming , Zhang Ying‐Qi , Zhong Shi‐Zhen
Published: May 2009

Although several morphological variations of sacrum have been reported in western populations, little attention has been paid to this anatomic issue in eastern people, and classification of sacral variability in particular. In this research of sacral morphology in Chinese people, we investigated and measured thoroughly and systematically 203 specimens of intact dry Chinese adult sacra. Morphological features of sacral variations were observed by visual inspection, and correlation parameters of variability were measured with a vernier caliper. The incidence of sacral variations was calculated. We found that the overall rate of sacral variations was 58.1% (male: 57.4%; female: 59.5%). The anatomical variants that we observed fell into the following five categories: accessory auricular surface (25 specimens, 12.3%); sacral skewness (48 specimens, 23.6%); transitional vertebra (34 specimens, 16.7%); sacral spina bifida occulta (57 specimens, 28.1%), Degrees I, II, and III of which were 36, 14, and 7 specimens, respectively; multiple variations (42 specimens, 20.7%), the types of which were diversified. This study reveals that sacral variations are common in Chinese population. The sacral variants in anatomic morphology should be taken into consideration when diagnosing and treating sacrum‐related diseases. Clin. Anat. 22:619–626, 2009. © 2009 Wiley‐Liss, Inc.
Intersegmental origin of the axillary artery and accompanying variation in the brachial plexus
Authors: Yang Hee‐Jun , Gil Young‐Chun , Lee Hye‐Yeon
Published: May 2009

The wide anatomical variation of the brachial plexus and the axillary artery has been thoroughly explored in previous studies. However, there has been little information reported on the variation in the relationship between the brachial plexus and the axillary artery. The principal feature of this relationship is the passage of the axillary artery through the loop of the median nerve, which occurs in normal arteries derived from the seventh intersegmental artery. In this study, we analyzed the abnormal position and course of the axillary artery related to the brachial plexus in 607 axillae of 306 cadavers. We found 12 unusual axillary arteries that did not pass through the median loop. Eleven arteries were determined to be ninth intersegmental arteries and one as the sixth intersegmental artery. All ninth intersegmental arteries ran caudally to the brachial plexus. In six cases of this type, abnormal connections interfering with the normal arterial position were observed in the brachial plexus. In another five cases of this type, the lateral and medial cords merged and the axillary artery passed anteromedial to the plexus. The sixth intersegmental axillary artery pierced the musculocutaneous nerve which is from the unified lateral and medial cords. This study discussed the how the anomalous structure of the brachial plexus could involve the deterioration of the course of the axillary artery. Clin. Anat. 22:586–594, 2009. © 2009 Wiley‐Liss, Inc.
Rate coefficients for the reaction of the acetyl radical, CH3CO, with Cl2 between 253 and 384 K
Authors: Gierczak T. , Rajakumar B. , Flad Jonathan E. , Burkholder James B.
Published: May 2009

Rate coefficients, k, for the gas‐phase reaction CH3CO + Cl2 → products (2) were measured between 253 and 384 K at 55–200 Torr (He). Rate coefficients were measured under pseudo‐first‐order conditions in CH3CO with CH3CO produced by the 248‐nm pulsed‐laser photolysis of acetone, CH3C(O)CH3, or 2,3‐butadione, CH3C(O)C(O)CH3. The loss of CH3CO was monitored by cavity ring‐down spectroscopy (CRDS) at 532 nm. Rate coefficients were determined by first‐order kinetic analysis of the CH3CO temporal profiles for [Cl2] < 1 × 1014 molecule cm−3 and the analysis of the CRDS profiles by the simultaneous kinetics and ring‐down method for experiments performed with [Cl2] > 1 × 1014 molecule cm−3. k2(T) was found to be independent of pressure, with k2(296 K) = (3.0 ± 0.5) × 10−11 cm3 molecule−1 s−1. k2(T) showed a weak negative temperature dependence that is well reproduced by the Arrhenius expression k2(T) = (2.2 ± 0.8) × 10−11 exp[(85 ± 120)/T] cm3 molecule−1 s−1. The quoted uncertainties in k2(T) are at the 2σ level (95% confidence interval) and include estimated systematic errors. A comparison of the present work with previously reported rate coefficients for the CH3CO + Cl2 reaction is presented. © 2009 Wiley Periodicals, Inc. Int J Chem Kinet 41: 543–553, 2009
Interactions Between an Anionic Fluorosurfactant and a PEO‐PPO‐PEO Triblock Copolymer in Aqueous Solutions
Authors: Wang Zhongni
Published: May 2009

Surface tensions were determined for a mixture of an anionic fluorinated surfactant and a PEO‐PPO‐PEO triblock copolymer. The interactions between the two surfactant molecules in the mixed monolayer and the mixed micelle were studied through molecular interaction parameters (βσ, βM) and the molecule exchange energy (ε, εm). It was noted that synergism and strong attractive interactions took place between the anionic fluorinated surfactant and the triblock copolymer molecules in both mixed micelles and mixed monolayers, reflected by the interaction parameter values of between −10 and −18 for all mixtures investigated. Moreover, it can be seen from the value of (ε − εm) that when the mixture has a small amount of triblock copolymer, the formation of mixed micelle results in a greater decrease in energy than does the formation of a mixed monolayer. With an increase in the mole fraction of the triblock copolymer in the mixture, in order to obtain the lowest surface energy, surfactants tend to form mixed monolayers first, and then form mixed micelles.