bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological function in NASCIS 2
Authors: Bracken Michael B. , Holford Theodore R.
Published: May 2009

✓ Previous analyses of the National Acute Spinal Cord Injury Study (NASCIS) have not distinguished recovery of segmental function at the injury level from recovery of the long spinal tracts. Recovery at the injury level could be of considerable clinical significance, but long-tract recovery is the ultimate therapeutic goal.

This analysis demonstrates that the greatest proportion of all neurological recovery and of recovery due to treatment with very high doses of methylprednisolone within 8 hours of injury occurs below the lesion. Methylprednisolone treatment administered early following injury has been found to improve recovery below the lesion in patients initially diagnosed as having complete or incomplete injuries; it also leads to greater (but still relatively small) improvement in the injury level. The analysis indicates that delayed treatment with methylprednisolone is associated with decreased neurological recovery. Naloxone administration also improved neurological function below the lesion in patients with incomplete injuries; these results support further experimental work with this drug.

This observation of differential neurological response within a narrow treatment window has important implications for both experimental studies and clinical management. Early clinical management with highdose methylprednisolone is supported by this analysis.
The petrosal approach with hearing preservation
Authors: King Wesley A. , Black Keith L. , Martin Neil A. , Canalis Rinaldo F. , Becker Donald P.
Published: May 2009

✓ Twenty-six patients with petroclival lesions were operated on via a petrosal approach designed to preserve hearing. The surgical pathology included 14 meningiomas, three chordomas, three epidermoid cysts, four vertebrobasilar aneurysms, and two pontine cavernous malformations. The approach allowed complete resection of 14 of 20 tumors and definitive treatment of all six vascular lesions. Complications included cerebrospinal fluid leakage in three patients, high-frequency sensorineural hearing loss in three, meningitis in one, and cranial nerve palsies (which were usually transient). This approach allows a wide exposure of the petroclival region with decreased operating distance. Cerebellar and temporal lobe retraction are minimized, dural sinus patency is maintained, and the inner ear structures are not sacrificed. The approach is suitable for neoplastic or vascular lesions involving the petroclival region, the ventral pons, or the basilar artery trunk. The surgical technique, indications, and neuro-otological considerations are discussed.
Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma
Authors: Kondziolka Douglas , Lunsford L. Dade , Martinez A. Julio
Published: May 2009

✓ Many physicians rely upon neuroimaging studies alone to select therapy for adult patients suspected of having a glial neoplasm, in the belief that certain imaging features accurately characterize the histological diagnosis of low-grade astrocytoma. During a 4-year interval when both computerized tomography and magnetic resonance imaging was available, the authors performed stereotactic biopsies on 20 consecutive adult patients who were suspected of having an astrocytoma. The patients were generally young (mean age 37 years), had seizures (17 cases), and had lobar lesions. An accurate histological diagnosis was obtained, without morbidity, in all 20 patients. Only 10 (50%) in fact had low-grade astrocytomas, whereas nine (45%) had anaplastic astrocytomas and one (5%) had encephalitis. The results of this study indicate that modern high-resolution neuroimaging alone cannot be used as a reliable tool to predict the histological diagnosis of astrocytoma (50% false-positive rate). All patients with supratentorial mass lesions that exhibit the “typical” imaging features of astrocytoma should undergo stereotactic biopsy for confirmation in order that appropriate management may be planned.
Microsurgery for 67 intracranial arteriovenous malformations less than 3 cm in diameter
Authors: Sisti Michael B. , Kader Abraham , Stein Bennett M.
Published: May 2009

✓ The surgical outcome in a series of small arteriovenous malformations (AVM's) that might have been considered optimal for radiosurgery is reviewed. In a total microsurgical series of 360 patients, 67 (19%) underwent resection of AVM's less than 3 cm in largest diameter, regardless of location. Many of these lesions (45%) were in locations that might be considered surgically inaccessible such as the thalamus, brain stem, medial hemisphere, and paraventricular regions. Complete angiographic obliteration of the AVM by microsurgical technique was accomplished in 63 patients (94%) with a surgical morbidity of 1.5% and no operative mortality. Patients with hemispheric AVM's had a cure rate of 100% and no neurological morbidity. Stereotactically guided craniotomy was used in 14 patients (21%) to locate and resect deep or concealed malformations. The results from five major radiosurgery centers treating similar-sized AVM's are analyzed. The authors' surgical results compare favorably with those from radiosurgery centers which, in their opinion, supports the conclusion that microneurosurgery is superior to radiosurgery, except for a small percentage of lesions that are truly inoperable on the basis of inaccessibility.
Stereotactic radiosurgery for cerebral metastatic melanoma
Authors: Somaza Salvador , Kondziolka Douglas , Lunsford L. Dade , Kirkwood John M. , Flickinger John C.
Published: May 2009

✓ To determine local tumor control rates and survival of patients with melanoma metastases to the brain, the authors reviewed the results of 23 consecutive patients with a total of 32 tumors (19 patients had a solitary tumor and four had multiple tumors) who underwent adjuvant stereotactic radiosurgery. Tumor locations included the cerebral hemisphere (24 cases), brain stem (four cases), basal ganglia (two cases), and cerebellum (two cases). Fifteen patients had associated cranial symptomatology and eight had incidental metastases. All patients had tumors of 3 cm or less in diameter (mean tumor volume 2.5 cu cm), and all received fractionated whole-brain radiation therapy (30 Gy) in addition to radiosurgery (mean tumor margin dose 16 Gy). Nineteen patients were managed with both modalities at the time of diagnosis; four underwent radiosurgery 3 to 12 months after fractionated whole-brain radiotherapy. The mean patient follow-up period was 12 months (range 3 to 38 months).

After radiosurgery, eight patients improved, 13 remained stable, and two deteriorated. One patient subsequently required craniotomy because of intratumoral hemorrhage; this patient and three others are living 13 to 38 months after radiosurgery. Nineteen patients died, 18 from progression of their systemic disease and one from another hemorrhage into a new brain metastasis. The local tumor control rate was 97%. Only two patients subsequently developed new intracranial metastases. The median survival period after diagnosis was 9 months (range 3 to 38 months). The authors believe that stereotactic radiosurgery coupled with fractionated whole-brain irradiation is an effective management strategy for cerebral metastases from a melanoma. Multi-institutional trials are warranted to confirm that stereotactic radiosurgery results equal or surpass the outcome achieved with craniotomy and tumor resection.
Thymidine kinase-mediated killing of rat brain tumors
Authors: Barba David , Hardin Joseph , Ray Jasodhara , Gage Fred H.
Published: May 2009

✓ Gene therapy has many potential applications in central nervous system (CNS) disorders, including the selective killing of tumor cells in the brain. A rat brain tumor model was used to test the herpes simplex virus (HSV)-thymidine kinase (TK) gene for its ability to selectively kill C6 and 9L tumor cells in the brain following systemic administration of the nucleoside analog ganciclovir. The HSV-TK gene was introduced in vitro into tumor cells (C6-TK and 9L-TK), then these modified tumor cells were evaluated for their sensitivity to cell killing by ganciclovir. In a dose-response assay, both C6-TK and 9L-TK cells were 100 times more sensitive to killing by ganciclovir (median lethal dose: C6-TK, 0.1 µg ganciclovir/ml; C6, 5.0 µg ganciclovir/ml) than unmodified wild-type tumor cells or cultured fibroblasts.

In vivo studies confirmed the ability of intraperitoneal ganciclovir administration to kill established brain tumors in rats as quantified by both stereological assessment of brain tumor volumes and studies of animal survival over 90 days. Rats with brain tumors established by intracerebral injection of wild-type or HSV-TK modified tumor cells or by a combination of wild-type and HSV-TK-modified cells were studied with and without ganciclovir treatments. Stereological methods determined that ganciclovir treatment eliminated tumors composed of HSV-TK-modified cells while control tumors grew as expected (p < 0.001). In survival studies, all 10 rats with 9L-TK tumors treated with ganciclovir survived 90 days while all untreated rats died within 25 days. Curiously, tumors composed of combinations of 9L and 9L-TK cells could be eliminated by ganciclovir treatments even when only one-half of the tumor cells carried the HSV-TK gene. While not completely understood, this additional tumor cell killing appears to be both tumor selective and local in nature. It is concluded that HSV-TK gene therapy with ganciclovir treatment does selectively kill tumor cells in the brain and has many potential applications in CNS disorders, including the treatment of cancer.
New transducers for intraoperative spinal sonography
Authors: Kawakami Noriaki , Mimatsu Kentaro , Kato Fumihiko , Kondo Yuji , Itoh Hisao , Matsunaka Toshiyuki
Published: May 2009

✓ Although ultrasonography during spinal cord surgery has been widely accepted, it still has limitations in clinical application because of the size of the transducers needed and the immersion method. The authors report on newly designed microprobe transducers used to evaluate intramedullary spinal cord lesions and to monitor surgical procedures. This microprobe system permitted the microscopic use of intraoperative ultra-sonography without requiring saline immersion.
Role of angiography following aneurysm surgery
Authors: Macdonald R. Loch , Wallace M. Christopher , Kestle John R. W.
Published: May 2009

✓ The postoperative angiograms in 66 patients who underwent craniotomy for clipping of 78 cerebral aneurysms were reviewed. Indications for urgent postoperative angiography included neurological deficit or repeat subarachnoid hemorrhage. Routine postoperative angiograms were carried out in the remaining patients. Postoperative angiograms were reviewed to determine the incidence of unexpected findings such as unclipped aneurysms, residual aneurysms, and unforeseen major vessel occlusions. Logistic regression analysis was used to test if the following were factors that predicted an unexpected finding on postoperative angiography: aneurysm site or size; the intraoperative impression that residual aneurysm was left or a major vessel was occluded; intraoperative aneurysm rupture; opening or needle aspiration of the aneurysm after clipping; or development of a new neurological deficit after surgery. Kappa values were calculated to assess the agreement between some of these clinical factors and unexpected angiographic findings.

Unexpected residual aneurysms were seen in three (4%) of the 78 occlusions. In addition, three aneurysms were completely unclipped (4%); these three patients were returned to the operating room and had their aneurysms successfully obliterated. There were nine unexpected major vessel occlusions (12%); six of these resulted in disabling stroke and two patients died. Of six major arteries considered to be occluded intraoperatively and shown to be occluded by postoperative angiography, two were associated with cerebral infarction. Logistic regression analysis showed that a new postoperative neurological deficit predicted an unforeseen vessel occlusion on postoperative angiography. Factors could not be identified that predicted unexpected residual aneurysm or unclipped aneurysm.

The inability to predict accurately the presence of residual or unclipped aneurysm suggests that all patients should undergo postoperative angiography. Since a new postoperative neurological deficit is one factor predicting unexpected arterial occlusion, intraoperative angiography may be necessary to help reduce the incidence of stroke after aneurysm surgery. With study of more patients or of factors not examined in this series, it may be possible to select cases more accurately for intraoperative or postoperative angiography.
Spinal cord injury without radiographic abnormality and Chiari malformation
Authors: Bondurant Charles P. , Oró John J.
Published: May 2009

✓ Spinal cord injury without radiographic abnormality and asymptomatic Chiari I malformation have an unusual coincidence. A young boy who had recently fallen from his porch was transferred to the neurosurgery service with a high cervical central cord syndrome. Careful study demonstrated no radiographic abnormality and, although the patient was previously quite well, magnetic resonance imaging revealed Chiari I malformation. Although expectedly uncommon, reports of three other similar cases support a less than independent relationship between these two processes. All four children, each aged 2 years, were premorbidly asymptomatic and were playing when they fell from low elevations; two were on a couch. All were evaluated by primary authorities 12 to 48 hours before definitive admission, and all had normal plain film examinations. Three of the four children suffered injuries in flexion, the fourth in extension. Three realized a 5-minute to 3-hour delay before the onset of symptoms, and three suffered gradual progression of deficit. Magnetic resonance imaging was the most commonly applied and productive diagnostic medium, demonstrating cerebellar ectopia in three of three cases. Two children were surgically treated, and all achieved at least a functional outcome. Similarities among these cases support a common mechanism of injury, and indicate careful counseling in children with asymptomatic Chiari I malformation and consideration of operative decompression in those children with progressive neurological injury and deficit.
Nondiagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience
Authors: Ranjan Alok , Rajshekhar Vedantam , Joseph Thomas , Chandy Mathew J. , Chandi Sushil M.
Published: May 2009

Nondiagnostic biopsies were analyzed in a consecutive series of 407 patients undergoing computerized tomography (CT)-guided stereotactic biopsies. These were categorized as either negative biopsies, when normal tissue or nonspecific pathology was found, or inconclusive, when a definitive diagnosis could not be made although representative tissue was obtained. Nineteen biopsies (4.7%) were negative and 10 (2.4%) were inconclusive, giving an overall nondiagnostic biopsy rate of 7.1% (29 of the 407 cases).

Suspected neoplastic masses (390 cases) were classified on the basis of their CT morphology into four groups: Group 1 included purely hypodense nonenhancing masses; Group 2 included isodense nonenhancing masses; Group 3 included ring-enhancing masses; and Group 4 included mixed-density enhancing masses. Although a higher proportion of hypodense nonenhancing masses (six of 56, or 10.7%) yielded a negative result, there was no statistically significant difference in the negative biopsy rates for the different CT categories (p = 0.06). The negative biopsy rates for the 6 years of the study, 1987 to 1992 (1987 being an incomplete year) were as follows: 13.3%, 6%, 3.2%, 3%, 5.8%, and 2.7%. There was no significant decrease in the negative biopsy rate as experience with this procedure increased (p = 0.20). A total of eight surgeons independently performed the biopsies. There was no significant difference (p = 0.24) in the negative biopsy rate of the surgeon with the most experience (124 biopsies, 2.4% negative biopsy rate) compared with that of the seven other surgeons combined (283 biopsies; 5.7% negative biopsy rate).

These findings suggest that the yield in a stereotactic biopsy is independent of the CT appearance of the mass. Adherence to certain basic principles in patient and target selection will ensure a reasonable percentage of positive yield with stereotactic biopsy procedures even if the surgeon is relatively inexperienced. There does not appear to be a learning curve in the performance of CT-guided stereotactic biopsies. The management of patients with nondiagnostic biopsies is discussed.
Correlation of glucose consumption and tumor cell density in astrocytomas
Authors: Herholz Karl , Pietrzyk Uwe , Voges Jürgen , Schröder Roland , Halber Marco , Treuer Harald , Sturm Volker , Heiss Wolf-Dieter
Published: May 2009

✓ To determine histological correlates of the variability of glucose consumption in astrocytomas, the authors performed positron emission tomography (PET) with 18F-2-fluoro-2-deoxy-D-glucose (FDG) and matched the PET scans three-dimensionally with computerized tomography scans obtained in a stereotactic frame before biopsy. Ten patients with astrocytomas of World Health Organization Grade 2 or 3 were studied; patients with glioblastomas, oligodendrogliomas, or oligoastrocytomas were excluded from the study to avoid any confounding effects of different cell types and necroses. In samples of pure tumor, glucose consumption correlated significantly with cell density, but not with nuclear polymorphism. It is concluded that tumor cell density is a major determinant of glucose consumption in astrocytomas. The use of PET with FDG may help to locate the highest cell density and thus improve the diagnostic yield of stereotactic biopsy.
Central nervous system gangliogliomas
Authors: Lang Frederick F. , Epstein Fred J. , Ransohoff Joseph , Allen Jeffrey C. , Wisoff Jeffrey , Abbott I. Richmond , Miller Douglas C.
Published: May 2009

The records of 58 patients with gangliogliomas surgically treated between January 1, 1980, and June 30, 1990, were retrospectively reviewed in order to determine long-term survival, event-free survival, and functional outcome resulting after radical resection and to assess the impact of histological grading on outcome. Tumors were located in the cerebral hemisphere in 19 cases, the spinal cord in 30, and the brain stem in nine. Forty-four patients had gross total resection and 14 had radical subtotal resection. Only six patients underwent postoperative irradiation or chemotherapy and, therefore, the outcome was generally related to surgery alone. Of the 58 gangliogliomas, 40 were classified as histological grade I, 16 were grade II, and two were grade III. The median follow-up period was 56 months. There were no operative deaths, and the operative morbidity rate was 5%, 37%, and 33% for cerebral hemisphere, spinal cord, and brain-stem gangliogliomas, respectively. The 5-year actuarial survival rates for cerebral hemisphere, spinal cord, and brain-stem gangliogliomas were 93%, 84%, and 73%, respectively (p = 0.7). The event-free survival rate at 5 years was 95% for cerebral hemisphere gangliogliomas and 36% for spinal cord gangliogliomas (p < 0.05); for brain-stem gangliogliomas the event-free survival rate at 3 years was 53% (p < 0.05). Neurological function at recent follow-up evaluation was stable or improved in 81% of patients. Multivariate analysis (Cox linear regression) revealed tumor location to be the only variable predictive of outcome, with spinal cord and brain-stem gangliogliomas having a 3.5- and 5-fold increased relative risk of recurrence, respectively, compared to cerebral hemisphere gangliogliomas. Histological grade was not predictive of outcome, although in each location there was a trend for higher-grade tumors to have a shorter time to recurrence. It is concluded that radical surgery leads to long-term survival of patients with gangliogliomas, regardless of location, and adjuvant therapy can probably be reserved for special cases.
Ganglioglioma presenting as a vascular lesion in a 10-year-old boy
Authors: Baltuch Gordon H. , Farmer Jean-Pierre , Meagher-Villemure Kathleen , O'Gorman Augustin M. , Montes José L.
Published: May 2009

✓ The authors present the case of a 10-year-old boy admitted for evaluation of a generalized seizure and a history of headaches. Computerized tomography (CT) and gadolinium-enhanced magnetic resonance (MR) imaging demonstrated a large nonhomogeneous contrast-enhancing mass of the left frontal lobe, with a large cystic component. Cerebral angiography revealed the lesion to be highly vascular and fed entirely by the internal carotid artery system. The patient underwent craniotomy and the lesion was completely removed. Neuropathological study revealed that the tumor was a ganglioglioma. On review of the literature, it was found that gangliogliomas often present in the second and third decade, are known to have cystic components, and are contrast-enhancing on CT and MR imaging; however, they are classically known to be avascular on angiography. This case of a markedly vascular ganglioglioma emphasizes that these tumors should be included in the differential diagnosis of vascular supratentorial lesions.
Inflammatory pseudotumor of the choroid plexus
Authors: Pimentel José , Costa Adília , Távora Luís
Published: May 2009

✓ The case of an 18-year-old man with a tumor of the left lateral ventricle is reported. The mass was observed to be contiguous with the choroid plexus but could be totally removed. Pathological examination disclosed an inflammatory pseudotumor. The authors review the literature on this lesion and related disorders involving the central nervous system and stress the need for a morphological differential diagnosis. Inflammatory pseudotumor should be considered in any case of intraventricular tumor.
Postoperative irradiation for subtotally resected meningiomas
Authors: Goldsmith Brian J. , Wara William M. , Wilson Charles B. , Larson David A.
Published: May 2009

✓ The authors retrospectively analyzed 140 patients treated at the University of California, San Francisco, from 1967 to 1990 to evaluate the results of radiation therapy (median 5400 cGy) given as an adjuvant to subtotal resection of intracranial meningioma. Of the 140 meningiomas, 117 were benign and 23 were malignant. The median follow-up period was 40 months. The overall survival rate at 5 years was 85% for the benign and 58% for the malignant tumor groups (p = 0.02); the 5-year progression-free survival rates were 89% and 48%, respectively (p = 0.001). For patients with benign meningioma, the 10-year overall and progression-free survival rates were 77%. An improved progression-free survival rate in that group was not related to tumor size but was associated with a younger age (p = 0.01) and treatment after 1980 with innovative technologies (p = 0.002); none of those variables affected the progression-free survival rate in the patients with malignant meningioma. Increased progression-free survival in the benign tumor group was also significantly associated with increasing the minimum radiation dose (p = 0.04). The 5-year progression-free survival rate for patients with benign meningioma treated after 1980 (when computerized tomography or magnetic resonance imaging was used for planning therapy) was 98%, as compared with 77% for patients treated before 1980 (p = 0.002). There were no second central nervous system tumors. Morbidity (3.6%) included sudden blindness or cerebral necrosis and death. When total resection of benign meningioma is not feasible, subtotal resection combined with precise treatment planning techniques and adjuvant radiation therapy can achieve results comparable to those of total resection.
Recurrent spheno-orbital meningioma
Authors: Maroon Joseph C. , Kennerdell John S. , Vidovich Danko V. , Abla Adnan , Sternau Linda
Published: May 2009

✓ A series of 15 patients who underwent neurosurgical procedures for recurrent spheno-orbital meningioma is reported. There were 11 women and four men, with a mean age of 46 years. The mean duration between the first and second operations was 46 months. Progressive proptosis without neurological deficit was the most common symptom. All tumors were large at the time of reoperation and involved the greater and lesser wings of the sphenoid bone and the orbit. Aggressive resection in all patients resulted in no deaths and only slight morbidity, with the exception of one patient who developed blindness 24 hours after surgery due to central retinal artery occlusion. Fourteen patients were improved cosmetically and one patient, treated early in the series, had persistent proptosis due to inadequate bone removal. No attempt was made to remove tumor within the cavernous sinus in patients who were neurologically normal. Although postoperative imaging demonstrated complete gross excision of tumor in nine patients, 10 underwent conventional radiation therapy for residual tumor visualized at the time of surgery in the dura of the superior orbital fissure, the cavernous sinus, or the basal optic canal.

Although this study is inconclusive and requires further long-term documentation, no recurrences have been seen to date in the follow-up period, ranging from 16 to 95 months. The following important points are discussed: 1) the failure by experienced surgeons to radically excise bone, tumor, and involved dura at the first operation; 2) the importance of early aggressive therapy, depending upon the patient's age and medical condition; 3) the almost invariable intracranial dural involvement, which at times was seen only by gadolinium-enhanced magnetic resonance imaging and not visualized on computerized tomography; 4) an illustrated stepwise surgical technique for complete resection through a small craniotomy without the need for complicated reconstruction of the orbit or temporal fossa; 5) the role of radiation therapy when removal is incomplete or deemed hazardous because of cavernous sinus involvement; and 6) the excellent cosmetic results possible with minimal morbidity and no mortality.
Pituitary adenomas in childhood and adolescence
Authors: Partington Michael D. , Davis Dudley H. , Laws Edward R. , Scheithauer Bernd W.
Published: May 2009

✓ Pituitary adenomas are uncommon in childhood. Between 1975 and 1988, 36 patients underwent trans-sphenoidal resection at the Mayo Clinic before their 17th birthday. Fifteen (41.7%) had prolactin (PRL)-secreting tumors, 16 (44.4%) had adrenocorticotropic hormone (ACTH)-secreting tumors (including two patients with Nelson-Salassa syndrome), and three (8.3%) had tumors secreting growth hormone (GH); two patients (5.6%) had clinically nonfunctioning tumors. Of the 36 patients, 21 (58.3%) were girls, and girls predominated in every group except that with ACTH-secreting tumors, where they accounted for only 37.5% of the patients. The average age at the time of surgery was 14.7 ± 2.2 years, the youngest patient being 7.3 years old. The ACTH-secreting tumors were associated with an earlier onset of symptoms than the other tumor types: six (37.5%) of 16 patients became symptomatic before 10 years of age, compared with two (10.0%) of the 20 other patients. Presenting symptoms primarily reflected endocrine dysfunction, with neurological presentation (visual field deficits) occurring in only two patients.

There were no deaths in this patient group. Significant operative morbidity included steroid-induced psychosis in one patient and diabetes insipidus in three, which resolved in two. Plurihormonal tumors, broadly defined as tumors producing more than one hormone, were common, comprising five (36%) of 14 PRL-secreting tumors, all three GH-secreting tumors, and one of two clinically nonfunctioning tumors, or 25.7% overall. Macroadenomas accounted for 89% of plurihormonal tumors. Long-term follow-up review (median > 5 years) revealed good control of PRL-secreting tumors (although five of 15 patients had received postoperative radiotherapy), contrasted with a 25% late recurrence rate for ACTH-secreting tumors, which had an 80% initial remission rate. The majority of patients had good endocrine function, including reproductive function. It is concluded that: 1) although pediatric pituitary adenomas occur primarily in adolescence, Cushing's disease is found at any age; 2) transsphenoidal surgery is feasible and safe in this age group; 3) plurihormonal tumors occur more frequently in the pediatric age group than in adults; and 4) long-term control rates in PRL- and ACTH-secreting tumors are probably similar to those seen in adults.
The incidence and treatment of asymptomatic, unruptured cerebral aneurysms
Authors: Nakagawa Toshio , Hashi Kazuo
Published: May 2009

✓ The importance of early detection by various radiological techniques of asymptomatic, unruptured aneurysms as a means of preventing subarachnoid hemorrhage (SAH) is discussed in this report. Four hundred volunteers underwent clinical and radiological evaluations between March, 1988, and September, 1992. Studies included a neurological examination as well as digital subtraction cerebral angiography via a femoral arterial catheter, computerized tomography, T1- and T2-weighted magnetic resonance (MR) imaging of the whole brain, and MR angiography. The evaluation revealed 27 asymptomatic, unruptured intracranial aneurysms in 26 volunteers, for an incidence of 6.5%. The subjects ranged in age from 39 to 71 years, with an average of 55 years. The aneurysms were located on the internal carotid artery in 13 cases (48%), the anterior communicating artery in six (22%), the middle cerebral artery in six (22%), and the basilar artery in two (7%). Aneurysms ranged in size from 5 mm or less in 16 cases, 6 to 10 mm in nine, and 11 to 15 mm in one; one aneurysm was more than 15 mm, with a maximum diameter of 2 cm. Volunteers with a family history of SAH within the second degree of consanguinity showed a higher incidence of aneurysms (17.9%). Aneurysm clipping was performed on 20 of the 26 cases with no significant morbidity or mortality. These findings support the contention that aggressive early detection of unruptured aneurysms may improve the outcome in patients harboring cerebral aneurysms by preventing the devastating effects of SAH.
Direct clipping of basilar trunk aneurysms using temporary balloon occlusion
Authors: Mizoi Kazuo , Yoshimoto Takashi , Takahashi Akira , Ogawa Akira
Published: May 2009

✓ In the surgical treatment of basilar trunk aneurysms, there is still considerable technical difficulty in gaining both proximal artery control and a sufficient operative field. The authors describe their experience in five patients with basilar trunk aneurysms treated using temporary balloon occlusion and intraoperative digital subtraction angiography. With the patient under general anesthesia, a heparinized angiography catheter was guided into the dominant vertebral artery by means of the Seldinger technique. A silicone balloon catheter was introduced coaxially through the angiography catheter to the basilar artery just proximal to the aneurysm. The balloon was inflated tentatively to evaluate the appropriate inflation volume, then the balloon catheter was withdrawn back into the angiography catheter to prevent thrombus formation. After exposure of the aneurysm, the occlusion balloon was advanced again and inflated temporarily within the basilar artery to prevent premature rupture and to facilitate dissection of the aneurysm. The mean duration of temporary balloon occlusion was 22 minutes. There were no patients with postoperative deficits attributable to the temporary occlusion. The results of aneurysm clip placement were confirmed by intraoperative digital subtraction angiography immediately after clipping. No patient suffered from distal embolism or other complications related to vessel catheterization. From this experience, it is concluded that this intraoperative endovascular technique can contribute to the success of surgery for complex cerebral aneurysms, particularly for basilar trunk aneurysms in which proximal vascular control is difficult.
Changes in Ca++-ATPase activity in smooth-muscle cell membranes of the canine basilar artery with experimental subarachnoid hemorrhage
Authors: Wang Jinze , Ohta Shinsuke , Sakaki Saburo , Araki Nobukazu , Matsuda Seiji , Sakanaka Masahiro
Published: May 2009

✓ Changes in Ca++-adenosine triphosphatase (ATPase) activity in the plasma membrane of smooth-muscle cells in the basilar arteries of dogs with experimental subarachnoid hemorrhage (SAH) were examined. The study methods included electron microscopic histochemistry and bioassay of the enzyme that exports cytoplasmic Ca++ to extracellular spaces. The Ca++-ATPase activity in the basilar artery increased significantly in response to the application of vasoconstrictive agents (prostaglandin F2α and a phorbol ester), but decreased significantly 24 hours after experimental SAH, inversely with basilar artery contraction. Dogs that had undergone two arterial blood injections (double SAH) exhibited a further decrease in Ca++-ATPase activity as well as persistent contraction of the basilar artery for a longer period (at least 7 days) than was seen in animals with a single arterial blood injection. Bioassay of the enzyme also demonstrated a decrease in vascular Ca++-ATPase activity in dogs subjected to double SAH. These findings suggest that the early occurrence of and long-lasting decrease in Ca++-ATPase activity in dogs with experimental SAH induces a persistent disturbance of Ca++ homeostasis and indicates that damage to the plasma membrane in the cerebral arterial smooth-muscle cells proceeds to myonecrosis after SAH.
A new model of diffuse brain injury in rats
Authors: Abd-Elfattah Foda Montasser A. , Marmarou Anthony
Published: May 2009

✓ A new model producing diffuse brain injury, without focal brain lesions, has been developed in rats. This has been achieved by allowing a weight of 450 gm to fall onto a metallic disc fixed to the intact skull of the animal which is supported by a foam bed. Two levels of injury were examined by adjusting the height of the falling weight to either 1 m or 2 m. Two groups of animals were studied. Group 1 animals were separated into three subgroups: 10 received a 1-m weight drop, 58 received a 2-m weight drop, and 13 served as controls; all were allowed to breathe spontaneously. Group 2 animals were separated into the same subgroups: four received a 1-m weight drop, six received a 2-m weight drop, and four served as controls; all of these were mechanically ventilated during the procedure. In Group 1, morphological studies using light and electron microscopy were performed at 1, 6, 24, or 72 hours, or 10 days after insult; all Group 2 rats were studied at 24 hours after injury.

Results from Group 1 animals showed that no mortality occurred with the 1-m level injury, while 59% mortality was seen with the 2-m level injury. On the other hand, no mortality occurred in Group 2 animals regardless of the level of trauma induced. However, the morphological changes observed in both groups were similar. Gross pathological examination did not reveal any supratentorial focal brain lesion regardless of the severity of the trauma. Petechial hemorrhages were noticed in the brain stem at the 2-m level injury. Microscopically, the model produced a graded widespread injury of the neurons, axons, and microvasculature. Neuronal injury was mainly observed bilaterally in the cerebral cortex. Brain edema, in the form of pericapillary astrocytic swelling, was also noted in these areas of the cerebral cortex and in the brain stem. Most importantly, the trauma resulted in a massive diffuse axonal injury that primarily involved the corpus callosum, internal capsule, optic tracts, cerebral and cerebellar peduncles, and the long tracts in the brain stem. It is concluded that this model would be suitable for studying neuronal, axonal, and vascular changes associated with diffuse brain injury.
Hydrocephalus due to villous hypertrophy of the choroid plexus in the lateral ventricles
Authors: Hirano Hirofumi , Hirahara Kazuho , Asakura Tetsuhiko , Shimozuru Tetsuro , Kadota Koki , Kasamo Shizuya , Shimohonji Masaru , Kimotsuki Kanetaka , Goto Masamichi
Published: May 2009

✓ A case is reported of hydrocephalus due to overproduction of cerebrospinal fluid (CSF) caused by villous hypertrophy of the choroid plexus in the lateral ventricles. A 7-year-old girl with mental retardation developed gait disturbance; hydrocephalus and a Dandy-Walker cyst were detected on computerized tomography. She was initially treated with a ventriculoperitoneal shunt; however, shunting failed to control the hydrocephalus. The excessive outflow of CSF suggested choroid plexus abnormality, and magnetic resonance (MR) imaging revealed enlargement of the choroid plexus in both lateral ventricles. The patient was therefore diagnosed as having hydrocephalus induced by overproduction of CSF, which was controlled by resection of the choroid plexus. Histological examination showed the structure typical of normal choroid plexus. This is a rare case of villous hypertrophy of the choroid plexus in which MR imaging assisted in the diagnosis.
“Trap door” exposure of the cervicothoracic junction
Authors: Nazzaro Jules M. , Arbit Ehud , Burt Michael
Published: May 2009

✓ This report describes a “trap door” exposure of the cervicothoracic junction. The method combines a standard anterior approach to the spine along the medial border of the sternocleidomastoid muscle with both a partial median sternotomy and an anterolateral thoracotomy. Transection of the clavicle is not required and the sternoclavicular joint is preserved. With this method, all important ventral paravertebral vessels, nerves, and associated soft tissue are fully identified and readily mobilized as needed. The method provides full bilateral anterior exposure from the C-4 through at least the T-3 vertebral levels, as well as unilateral anterolateral access to the upper thoracic spine.
Ertragskundliche Leistung in den Plenterwald-Versuchsflächen der Schweiz | Yield performance in the plenter forest research plots in Switzerland
Authors: Zingg Andreas , Frutig Fritz , Bürgi Anton , Lemm Renato , Erni Vinzenz , Bachofen Hansheinrich
Published: May 2009

22 plenter forest research plots, some of which are under long-term observation, allow the assessment of the performance of these stands and to a certain extent these performances can also be compared with the perfor mances of other management systems. The performance descriptions presented here are in a broad sense of the term growth and yield: the pure growth parameters for four selected areas are complemented by a modelling of the economic results by determination of the timber harvesting costs and the revenues. Young forest surveys were also made in four areas and thus allow us a glimpse into the future development. Most of the areas presented here lie in the silver fir - beech belt, some in the upper montane and in the subalpine zone and only one in a stand rich of broad-leaved trees. An equilibrium model can be calculated for most of these stands. The high altitude areas, two stands with high volume retention and conversion stands were exceptions. These areas showed high fluctuations in the growing stock. In contrast the increment remains the same over a large range of the growing stock. Utilization and increment are on the average in a similar magnitude. Standing volume and heavy timber proportions are lower in higher altitudes due to site conditions. The modelled revenues after deducting harvesting costs can be partly correlated with the diameter of the mean basal area tree of the harvested logs. Based on the stem number distribution from the one year old plant to the thickest tree, the sustainability of the forest effects – timber extraction or protection – for four areas is assured in the future. It can be shown with this data that the big advantage of selection forests lays in the regularity of these performances and this also on small areas.
A Distributed Geo-Routing Algorithm for Wireless Sensor Networks
Authors: Joshi Gyanendra Prasad , Kim Sung Won
Published: May 2009

Geographic wireless sensor networks use position information for greedy routing. Greedy routing works well in dense networks, whereas in sparse networks it may fail and require a recovery algorithm. Recovery algorithms help the packet to get out of the communication void. However, these algorithms are generally costly for resource constrained position-based wireless sensor networks (WSNs). In this paper, we propose a void avoidance algorithm (VAA), a novel idea based on upgrading virtual distance. VAA allows wireless sensor nodes to remove all stuck nodes by transforming the routing graph and forwarding packets using only greedy routing. In VAA, the stuck node upgrades distance unless it finds a next hop node that is closer to the destination than it is. VAA guarantees packet delivery if there is a topologically valid path. Further, it is completely distributed, immediately responds to node failure or topology changes and does not require planarization of the network. NS-2 is used to evaluate the performance and correctness of VAA and we compare its performance to other protocols. Simulations show our proposed algorithm consumes less energy, has an efficient path and substantially less control overheads.
A Portable and Autonomous Magnetic Detection Platform for Biosensing
Authors: Germano José , Martins Verónica  C. , Cardoso Filipe  A. , Almeida Teresa  M. , Sousa Leonel , Freitas Paulo  P. , Piedade Moisés  S.
Published: May 2009

This paper presents a prototype of a platform for biomolecular recognition detection. The system is based on a magnetoresistive biochip that performs biorecognition assays by detecting magnetically tagged targets. All the electronic circuitry for addressing, driving and reading out signals from spin-valve or magnetic tunnel junctions sensors is implemented using off-the-shelf components. Taking advantage of digital signal processing techniques, the acquired signals are processed in real time and transmitted to a digital analyzer that enables the user to control and follow the experiment through a graphical user interface. The developed platform is portable and capable of operating autonomously for nearly eight hours. Experimental results show that the noise level of the described platform is one order of magnitude lower than the one presented by the previously used measurement set-up. Experimental results also show that this device is able to detect magnetic nanoparticles with a diameter of 250 nm at a concentration of about 40 fM. Finally, the biomolecular recognition detection capabilities of the platform are demonstrated by performing a hybridization assay using complementary and non-complementary probes and a magnetically tagged 20mer single stranded DNA target.
Study of Understanding Pharmacists' Perspectives on Remuneration and Transition toward Chronic Disease Management (SUPPORT-CDM): Results of an Alberta-Wide Survey of Community Pharmacists
Authors: Mah Ellen , Rosenthal Meagen , Tsuyuki Ross T.
Published: May 2009

Background:

Strong evidence supports the benefits of pharmacist intervention and chronic disease management (CDM) for patients, yet most pharmacists are not providing such services. The purpose of this study was to better understand pharmacists' perceptions of CDM and potential remuneration models.

Methods:

We developed and tested a web-based survey based on the issues identified in a series of focus groups involving pharmacists: current practice setting, education, remuneration models, current practice environment and implementation. An invitation to complete the survey was e-mailed to registered pharmacists and was included in a weekly newsletter to Alberta pharmacists in January 2008, with 3 subsequent reminders to complete the survey.

Results:

Responses from 140 pharmacists were included. Pharmacists were most interested in providing CDM for diabetes (79%), although only 49% were presently comfortable with managing diabetes. The top enablers for provision of CDM included pharmacists' desire to change their scope of practice, a supportive work environment and patient demand. The top barriers included a lack of time to engage in CDM, lack of remuneration and staffing issues. Interestingly, relatively few identified pharmacists' resistance to change and difficulty finding eligible patients (38% and 25%, respectively) as important barriers. The majority of pharmacists agreed that payment should be shared between the pharmacy and the pharmacist as a fee-for-service. The average amount pharmacists expected for this model was $44.23/service.

Conclusions:

Pharmacists showed interest but may lack the confidence to provide CDM services to patients. Many of the facilitators and barriers point toward the need for a sustainable remuneration model for pharmacists' clinical care. We plan to use these results to help develop such a model.
Rheumatoid Atlantoaxial Subluxation Can Be Prevented by Intensive Use of Traditional Disease Modifying Antirheumatic Drugs
Authors: KAUPPI MARKKU J. , NEVA MARKO H. , LAIHO KARI , KAUTIAINEN HANNU , LUUKKAINEN REIJO , KARJALAINEN ANNA , HANNONEN PEKKA J. , LEIRISALO-REPO MARJATTA , KORPELA MARKKU , ILVA KIRSTI , MÖTTÖNEN TIMO ,   for the FIN-RACo Trial Group
Published: May 2009

Objective.

To evaluate the 5-year incidence of cervical spine disorders in patients with early rheumatoid arthritis (RA) treated by 2 different disease modifying antirheumatic drug (DMARD) strategies.

Methods.

In a national, multicenter, prospective FIN-RACo-trial, a cohort of 199 patients with early, clinically active RA was randomly assigned to treatment with a combination of 3 DMARD and prednisolone (Combi group) or with a single DMARD (Single group) with or without prednisolone, aiming to induce remission. After 2 years, the DMARD therapy was unrestricted. Lateral view cervical spine radiographs during full flexion and extension were taken at the 5-year followup visits. The presence of anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI), and subaxial subluxation (SAS) was assessed in the 149 patients with radiographs available (80 Single and 69 Combi).

Results.

At the 5-year visits, aAAS, AAI, and SAS were found in 13 (9%), 6 (4%), and 9 (6%) patients, respectively. The corresponding Single/Combi group ratios were 11/2, 5/1, and 5/4. Of the baseline data, only poor physical function [Health Assessment Questionnaire (HAQ); p = 0.024] and Single treatment strategy (p = 0.019) were significantly associated with aAAS. Worse HAQ scores and Disease Activity Score 28 values were found in patients who developed aAAS during the 5-year followup.

Conclusion.

RA patients with sustained clinical disease activity and poor HAQ are at increased risk of developing aAAS. The development of aAAS during the first 5 years of RA was rare among the patients treated with a combination of DMARD for at least 2 years from the diagnosis. Intensive treatment with traditional DMARD prevents or retards the development of aAAS in patients with recentonset RA.