bluuebunny/crossref_metadata_2025 huggingface dataset:
In Long-Term Smokers and Former Smokers the Bronchodilator Response Is Not Related to the Fall in FEV1
Authors: Stănescu Dan , Veriter Claude , Sanna Antonio
Published: April 2003

Background: Cigarette smoking is the cardinal cause of chronic obstructive pulmonary disease (COPD), but only a relatively small percentage of smokers are developing clinically overt disease, suggesting, therefore, that other risk factors than smoking are involved. Several studies have shown that the bronchodilator response (BR) is related to the progress of COPD, as assessed by the fall in forced expiratory volume in 1 s (FEV1). However, the relationship between BR and fall in FEV1, is a disputed one. Objective: To assess the relationship between BR and fall in FEV1 in a group of long-term smokers and ex-smokers who were 60 years old on the average. Methods: Questionnaire, spirographic tests and BR were assessed in 56 smokers and ex-smokers of mean age 62.5 ± (SD) 2.7 years at the end of a 13-year follow-up period. BR was expressed as a percentage change of the prebronchodilator value (‘% initial’) and as a percentage change of predicted value (‘% predicted’). Results: The FEV1/VC vital capacity was 68.9 ± 7.6% at the start and 64.5 ± 11.3% at the end of the study. The average fall in FEV1 over 13 years was 26 ± 25 ml/year. The FEV1 increased after albuterol on the average with 5.9 ± 6.6%, 4.5 ± 3.9% of predicted, and the vital capacity with 2.5 ± 6.5%, 2.3 ± 6.4% of predicted. BR and fall in FEV1 were correlated: the greater the BR, the more rapid the fall in FEV1 (r = 0.4 and p < 0.01 for FEV1% and r = 0.3 and p < 0.05 for FEV1 predicted). However, when adjusting for prebronchodilator FEV1, the BR was no more related to the fall in FEV1 (r = 0.15, p > 0.05). Conclusions: In long-term smokers and ex-smokers, the BR measured at the end of the follow-up period was correlated with the fall in FEV1. However, after adjusting for prebronchodilator FEV1 values, BR was no more related to the decline in FEV1. The BR appears not to be associated with the development of COPD.
Detecting Alveolar Epithelial Injury following Volatile Anesthetics by 99mTc DTPA Radioaerosol Inhalation Lung Scan
Authors: ChangLai S.P. , Hung W.T. , Liao K.K.
Published: April 2003

Background: Many volatile anesthetics have long been thought to affect alveolar epithelial permeability. Objective: The purpose of this study was to examine the acute effects of volatile anesthetics on the permeability of the alveolocapillary barrier to 99mTc DTPA. Methods: Twenty-seven patients (24 females, 3 males, age 29–73 years) undergoing operation were enrolled in this study and grouped according to the type of anesthesia received. Group 1 patients were administered 1% halothane. Group 2 patients were given 1.5% isoflurane. Intravenous anesthesia without volatile anesthetics were used for group 3 patients. Before and after anesthesia, 99mTc DTPA radioaerosol inhalation lung scans were performed to detect alveolar epithelial injury due to volatile anesthetics. The negative slope of the regression line was designated as the 99mTc DTPA pulmonary clearance rate and was expressed in terms of percentage decrease in radioactivity per minute. Results: In group 1, the 99mTc DTPA clearance rates were 1.26 ± 0.34 and 1.29 ± 0.38 before and after anesthesia, respectively. The difference was not significant (p > 0.05). In group 2, the rates were 0.76 ± 0.20 and 1.10 ± 0.37, before and after anesthesia, respectively. The difference was significant (p < 0.05). In group 3, the clearance rates were 1.07 ± 0.38 and 1.21 ± 0.48, before and after anesthesia, respectively. The difference was not significant. Conclusions: Following isoflurane administration, the more rapid pulmonary clearance of 99mTc DTPA indicates that isoflurane increases the permeability of the alveolo-capillary barrier.
Serum Concentrations of Lignocaine before, during and after Fiberoptic Bronchoscopy
Authors: Loukides S. , Katsoulis K. , Tsarpalis K. , Panagou P. , Kalogeropoulos N.
Published: April 2003

Background: Lignocaine is commonly used for local anesthesia during fiberoptic bronchoscopy (FOB). Several studies have reported the peak serum concentration of lignocaine in relation to time, but most of them did not specify the administered dose of lignocaine gel and its possible correlation with peak serum concentration. Objective: The aim of our study was to record the plasma concentrations of lignocaine before, during and after FOB and to evaluate whether the doses for nasal and tracheobronchial anesthesia have any correlation with the peak serum concentrations of the drug. Methods: Twelve patients with no comorbid conditions undergoing FOB were studied. Lignocaine was administered as a 2% solution using a larynx syringe, 2% gel (mean dose 182.5 ± 15 mg) and finally 2% solution through the bronchoscope (mean dose 339 ± 12 mg). Total dose was 622 ± 20 mg. Venous blood samples were taken before the beginning of local anesthesia and then at 5, 10, 20, 60, 90 and 120 min thereafter. Results: Our results showed that peak plasma concentrations of lignocaine were observed in 8 patients 20 min after the beginning of local anesthesia, in 3 patients 30 min afterwards and in 1 patient 60 min afterwards (2.15 ± 0.4 μg/ml, 1.9 ± 0.3 μg/ml, 1.81 μg/ml, respectively). None of our patients exceeded the critical level of toxicity (5 μg/ml). Both the total and tracheobronchial doses of lignocaine were significantly correlated with peak serum concentration (r = 0.63, p = 0.05 and r = 0.64, p = 0.02, respectively). No correlation was found between the dose for nasal anesthesia and peak serum concentration. No adverse reactions were observed. Conclusions: In conclusion our data show that although the amount of lignocaine used in this study exceeded the recommended highest dose (400 mg) in all patients, no toxic levels were observed. Peak plasma concentrations were found within 20–30 min from the beginning of local anesthesia. The dose for the anesthesia of nasal mucosa represented a significant percentage of the total dose, but did not correlate with the peak serum concentration of the drug.
Significance of Alpha-2-Macroglobulin, Alpha-1-Acid Glycoprotein, and C-Reactive Protein in Pleural Effusion Differentiation
Authors: Alexandrakis M.G. , Coulocheri S.A. , Bouros D. , Vlachonikolis I.G. , Eliopoulos G.D.
Published: April 2003

Background: The differentiation between exudates and transudates is fundamental when investigating the cause of pleural effusions. Acute-phase proteins could be potentially useful markers in this discrimination. Objective: The present study was designed to evaluate whether the acute-phase proteins: α2-macroglobulin (AMG), α1-acid glycoprotein (AAG) and C-reactive protein (CRP) are useful in investigating the pleural effusions. Methods: We prospectively measured the concentrations of the above proteins in the serum and pleural fluid of 84 consecutive patients with various diseases using a nephelometric assay. Results: Pleural effusion AMG, AAG and CRP were all significantly elevated in the group of patients with exudates compared to patients with transudates (p < 0.001, p < 0.001 and p < 0.01, respectively). An AAG value >63 mg/dl in a pleural effusion is predictive of an exudate with a sensitivity of 90% and a specificity 85%. Similarly, an AMG value >44 mg/dl in a pleural effusion is predictive of an exudate with a sensitivity and a specificity of 90% and 60%, respectively. Moreover, pleural AAG was significantly higher in cancerous exudates than in exudates and transudates of all other cause taken together (p < 0.001). Finally, to differentiate the same pleural effusion, the cut-off value of 1.0 mg/dl of pleural CRP has a sensitivity and a specificity of 74% and 74%, respectively. Conclusions: We conclude that both AAG and AMG concentrations in pleural effusions have a high sensitivity and are therefore useful parameters in distinguishing exudates from transudates, but the latter is inferior due to its unacceptably low specificity.
Concurrence of Sarcoidosis and Lung Cancer
Authors: Yamasawa Hideaki , Ishii Yoshiki , Kitamura Satoshi
Published: April 2003

Although sarcoidosis and lung cancer are both frequently encountered conditions, their simultaneous occurrence in the same patient is unusual. In this report, we describe 4 cases of their concurrence and discuss the possible pathogenic mechanisms of their concurrent appearance. In particular, in 2 of the cases, both diseases had coexisted for a long period (more than 6 and 4 years, respectively), showing a surprisingly slow growth of cancers. Although the chest computed tomography showed hilar and mediastinal lymphadenopathy, the histopathological findings of the excised lymph nodes of both cases revealed no metastasis. The causal relationship between sarcoidosis and lung cancer remains uncertain, but cases such as these may be helpful in elucidating its precise nature.
Transient Mediastinal Enlargement: An Unusual Computed Tomographic Manifestation of Pulmonary Venous Hypertension and Congestive Heart Failure
Authors: Miller Jeffrey A. , Contractor Sohail , Maldjian Pierre , Wolansky Leo
Published: April 2003

We describe a case of diffuse superior and middle mediastinal enlargement of soft tissue attenuation noted on helical computed tomography (CT) of a patient with clinical and radiographic findings of congestive heart failure (CHF). Upon treatment and improvement of his pulmonary venous hypertension, a repeat CT scan revealed resolution of the mediastinal abnormalities. We, therefore, advocate a search for primary CT signs of CHF in patients with findings of widespread mediastinal distension. If present, repeat CT scanning after resolution of the cardiac condition should be performed before further intervention for the mediastinal abnormality is attempted.
Sleep Apnea Syndrome in Patients with Cardiac Pacemaker
Authors: Fietze Ingo , Röttig Jens , Quispe-Bravo Sabine , Riedel Frank , Witte Joachim , Baumann Gerd , Witt Christian
Published: April 2003

Background: Heart rhythm disturbances are cardiac side effects in patients with sleep-disordered breathing (SDB), which in itself is considered to be a risk factor for bradycardic rhythm disturbances. Objective: We analyzed the prevalence and degree of SDB in patients who received a cardiac pacemaker due to bradycardic rhythm disturbances and investigated the relationship between the severity of an underlying SDB and the type of heart rhythm disturbance. Methods and Results: 192 patients (100 males, 92 females, mean age 62.2 ± 12.2 years) were studied using the portable screening device MESAM IV. The respiratory disturbance index (RDI) was calculated visually. The mean RDI in all patients was 9.13 ± 11.09/h, 11.7 ± 13.15/h in males and 6.33 ± 7.42/h in females. The prevalence ratio of SDB between men and women was 1.7:1, with significant differences in the respective severity (p < 0.05). The screening showed a prevalence of SDB (RDI > 10/h) of 32.3%. The highest prevalence was found in the group of patients with atrial fibrillation and bradycardia. However, there were no significant differences compared to other types of rhythm disturbances. The RDI in the population studied depended on age and body mass index, but not on the existence or type of rhythm disturbance and not on concomitant diseases. Conclusion: The prevalence of SDB in cardiac pacemaker patients is similar to that in patients of comparable age without a pacemaker. A heart rhythm disturbance does not seem to be an independent risk factor for development of SDB. Nevertheless, the differential diagnosis of bradycardic rhythm disturbances in this age group should include a screening for sleep apnea.
Soot-Exposed Mononuclear Cells Increase Inflammatory Cytokine mRNA Expression and Protein Secretion in Cocultured Bronchial Epithelial Cells
Authors: Drumm K. , Attia D.I. , Kannt S. , Micke P. , Buhl R. , Kienast K.
Published: April 2003

Background: Soot particles are air pollutants capable of inducing airway and lung parenchymal injury. Mononuclear and bronchial epithelial cells are central to the maintenance of homeostasis and inflammation in the airways. Objectives: The aim of this study was to evaluate the contribution of mononuclear cells to the release of inflammatory mediators by bronchial epithelial cells. Methods: To model the in vivo situation, an in vitro system of cocultured blood monocytes and BEAS-2B cells was established in a transwell system. Blood monocytes were exposed to soot particles (FR 101) at concentrations of up to 100 μg/106 cells. Inflammatory cytokine mRNA and protein concentrations were quantified in BEAS-2B mono- and BEAS-2B-BM cocultures by RT-PCR and ELISA following exposure to soot for 1 and 8 h. Results: No inflammatory cytokine mRNA expression was observed in unstimulated BEAS-2B cells. IL-6 and IL-8 mRNA and protein levels showed a dose-dependent elevation in FR 101-exposed blood monocytes. In addition, both IL-6 and IL-8 mRNA expression was upregulated in cocultured BEAS-2B cells while cytokine concentrations in the blood monocyte-BEAS-2B coculture medium were significantly increased. This upregulation was likely due to a synergism of two cell populations. Conclusions: Exposure to soot particles induces an autocrine stimulation of inflammatory cytokine release by blood monocytes and BEAS-2B cells. Since IL-6 and IL-8 play a major role in the pathogenesis and persistence of bronchial inflammation, these findings may serve as a partial explanation for the aggravation of asthmatic and bronchitic symptoms after exposure to soot.
Respimat® (a New Soft Mist Inhaler) Delivering Fenoterol plus Ipratropium Bromide Provides Equivalent Bronchodilation at Half the Cumulative Dose Compared with a Conventional Metered Dose Inhaler in Asthmatic Patients
Authors: Kunkel G. , Magnussen H. , Bergmann K.-C. , Juergens U.R. , de Mey C. , Freund E. , Hinzmann R. , Beckers B.
Published: April 2003

Background: Respimat®, a possible alternative to the conventional metered dose inhaler (MDI), is a novel, reusable, propellant-free, multidose soft mist inhaler. Respimat slowly releases a metered dose of active substance as a soft mist with a high proportion of the dose in the fine particle fraction, leading to improved lung deposition following inhalation when compared with the conventional MDI. Objectives and Methods: The equipotent bronchodilating efficacy and safety of a combination of fenoterol hydrobromide and ipratropium bromide (F/I) in cumulative doses delivered by either Respimat or pressurised MDI was assessed in a randomised, controlled, double-blind (within device) 4-way crossover study. Forty-three patients with stable asthma (mean FEV1 62% predicted) responsive to F/I inhaled cumulatively 16 puffs on each of 4 test days (1 + 1 + 2 + 4 + 8 puffs at 50-min intervals) via Respimat delivering 50/20, 25/20 or 25/10 µg F/I per puff or via MDI delivering 50/20 µg F/I per puff. Results: Cumulative doses of 400/160 and 400/320 µg F/I via Respimat produced bronchodilation (evaluated by average increase in FEV1 45–245 min after first inhalation) equivalent to that achieved with a cumulative 800/320 µg F/I via MDI (mean increase in FEV1 above baseline 0.76, 0.73 and 0.71 litres, respectively). The tolerability of the F/I combination via Respimat was also comparable to that of twice the dose delivered via MDI. Conclusion: Therefore, a fenoterol hydrobromide/ipratropium bromide combination delivered by Respimat is as safe and effective as the MDI at half the cumulative dose, on acute administration to patients with asthma.
Malignant Transient Pleural Transudate: A Sign of Early Lymphatic Tumoral Obstruction
Authors: Fernandez Cleofe , Martín Concepción , Aranda Ignacio , Romero Santiago
Published: April 2003

In the absence of a responsible comorbid condition, the transudative character of a pleural effusion in patients with malignancy does not imply a favorable outcome. We report a case of colon carcinoma metastatic to lung and pleura presenting as a bilateral transudative pleural effusion. Tumoral diffuse lymphatic permeation was identified as the cause of lymphatic obstruction on pleural and transbronchial biopsies. The transudative character of the pleural effusion was transient denoting its obstructive origin.
Effect of Thoracic Sympathectomy on Arm and Leg Exercise Capacity and on Lung Function
Authors: Ben-Dov Issahar , Chorney Natacha , Gaides Mark , Shachor Dov
Published: April 2003

Background: Thoracic T2–4 sympathectomy (TS) relieves palmar hyperhidrosis. These same roots innervate the heart and the lung. Thoracoscopic TS minimizes damage to the chest wall so that the effect of sympathectomy itself on these organs can be studied. We attempted to determine whether attenuated sympathetic output affects arm or leg exercise tolerance and lung function in young adults who underwent this operation. Methods: Seven subjects, aged 17–30 years, had lung function tests (water spirometer, Godart, Holland), and leg and arm maximal exercise (CPX, MedGraphics, USA), before and 3–6 months after TS. Results: After TS, resting and exercise heart rate and blood pressure were reduced. Baseline leg and arm peak O2 uptake, 2.08 (0.6) and 1.44 (0.5) liters/min, respectively, were not different from the post-TS values, 2.06 (0.7) and 1.54 (0.5) liters/min (nonsignificant). Post-TS lung functions were not significantly reduced. Conclusion: Thoracoscopic T2–4 sympathectomy does not lead to a clinically important fall in lung function and does not compromise arm or leg exercise capacity. Therefore, TS can be done safely in young subjects with palmar hyperhidrosis.
Spontaneous Pneumomediastinum in 33 Patients: Yield of Chest Computed Tomography for the Diagnosis of the Mild Type
Authors: Kaneki Toshimichi , Kubo Keishi , Kawashima Akira , Koizumi Tomonobu , Sekiguchi Morie , Sone Shusuke
Published: April 2003

Background: Spontaneous pneumomediastinum (SPM) usually occurs in young people without an apparent precipitating factor or disease. Although there have been many studies focused on the clinical features and standard chest X-ray (CXR) findings of SPM, few have reviewed the chest computed-tomographic (CT) findings. Objectives: We assessed SPM using CXR and CT, and the relation between them. Methods: We evaluated 33 patients (26 males) diagnosed with SPM on the basis of symptoms and chest radiological findings. Results: Three patients showed normal CXR but a diagnostic CT scan. Seven showed mild pneumomediastinum on CXR. In these 10 patients, pneumomediastinum was easily detected by chest CT. Moderate and severe SPM were easily detected by both CXR and CT. Conclusions: These findings suggested that CXR alone poorly detected approximately 30% of SPM and that chest CT scan was needed to make the diagnosis in these cases. It seems likely that SPM is underdiagnosed by 30% or more in clinical practice.
Diagnostic Accuracy of Pleural Fluid Polymorphonuclear Elastase in the Differentiation between Pyogenic Bacterial Infectious and Non-Infectious Pleural Effusions
Authors: Alegre José , Suriñach José Maria , Varela Encarna , Armadans Lluis , Marti Ramón , Segura Rosa , Aleman Carmen , Falcó Vicente , Fernandez de Sevilla Tomás
Published: April 2003

Background and Objectives: To establish the diagnostic accuracy of the markers of neutrophil activity (elastase and lysozyme) determined in pleural fluid, for differentiating between pyogenic bacterial infectious and non-infectious pleural effusions. Patients and Methods: At our tertiary referral teaching hospital, 160 patients over 14 years with pleural effusion (PE), classified as pyogenic bacterial infectious (41 parapneumonic complicated, 32 parapneumonic non-complicated) and non-infectious (32 neoplasm and 55 undiagnosed pleural exudates) were examined in a prospective study. Polymorphonuclear elastase (PMN-E) was determined by an immunoactivation method and lysozyme by a turbidimetric method. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: Pleural fluid PMN-E was the biochemical marker that best differentiated between pyogenic bacterial infectious and non-infectious PE. The ROC area under the curve (AUC) for PMN-E was 0.8276. A PMN-E value over 230 µg/l diagnosed infectious PE with a specificity of 0.81 and a sensitivity of 0.74. The ROC AUC for proteins plus lactate dehydrogenase was 0.7430. Differences between the two ROC curves were significant (p = 0.032). After excluding purulent parapneumonic complicated PE, the sensitivity of a pleural fluid PMN-E value equal to or greater than 230 µg/l was 0.64 and the specificity 0.81. Conclusions: Pleural fluid PMN-E was the marker that best differentiated infectious from non-infectious PE, and PMN-E values lower than 230 µg/l suggest non-infectious PE.
Effect of the Airway Epithelium on the Contraction of Rat Isolated Trachea under Conditions of Low Temperature
Authors: González O. , Santacana G.E.
Published: April 2003

Background: The exposure of the airways to low temperature (LT) is a well-known trigger of bronchoconstriction and asthma. However, the mechanisms involved in this response are not well understood. In particular, the specific role of the airway epithelium in the response to LT has not been well established. Objective: The purpose of this work is to study the regulatory role of the airway epithelium in the contractile response of the rat trachea under conditions of LT. Methods: Isolated rat tracheas were stimulated with acetylcholine (ACH) at 37 and 18°C, and dose-response curves were generated in epithelium-intact or epithelium-denuded conditions. EC50 and Emax were determined under these conditions. Results: Epithelium denudation at 37°C, increases the tracheal sensitivity to ACH, (EC50 from 5.9 to 2.6 µM, p = 0.003). The effects of denudation were even more pronounced at 18°C. Emax was significantly decreased under these conditions. Exposure of intact tracheas to 18°C also produced a significant increase in tracheal sensitivity (EC50 from 5.9 to 1.5 µM, p = 0.0004), although no changes in Emax were noted. Conclusions: These results strongly suggest that the airway epithelium diminishes the sensitivity of the airway smooth muscle to ACH at 37 and 18°C, and that it is also needed to observe the maximal contractile response under LT conditions. Therefore, the spasmogenic effect of low temperature is significantly potentiated by the absence of airway epithelium.
Systemic to Pulmonary Fistulas in Hodgkin’s Disease
Authors: Sabadell C. , Ruiz-Manzano J. , Muchart J. , Pereandreu J. , Batlle M. , Morera J.
Published: April 2003

Systemic to pulmonary fistula is an unusual entity and its association with hematological diseases like Hodgkin’s is extremely rare. We present a case of a 26-year-old woman with a thoracic mass and large arteriovenous fistula. The diagnosis of Hodgkin’s disease, nodular sclerosis, was obtained by a biopsy of the supraclavicular lymph node. We achieved an excellent response after combined treatment with chemotherapy, radiotherapy and arterial embolization with complete disappearance of the mass.
Allergic Granulomatous Angiitis (Churg-Strauss Syndrome) Associated with Allergic Bronchopulmonary Candidiasis
Authors: Matsumoto Hisako , Niimi Akio , Suzuki Katsuhiro , Kawai Mitsuru , Matsui Yasunori , Amitani Ryoichi
Published: April 2003

We describe a case of Churg-Strauss syndrome (CSS) associated with allergic bronchopulmonary candidiasis (ABPC). A 61-year-old man who had been given a diagnosis of ABPC based on serologic and radiographic findings experienced pain and purpuric rash on the left leg accompanied with motor weakness. The diagnosis of CSS was made from skin, nerve and muscle biopsies. Although immunosuppressant and prednisolone were administered and resulted in transient improvement, candidal pneumonia was suspected to have developed 60 days after the administration and the patient finally died of respiratory failure. To our knowledge, this is the first case of CSS associated with ABPC.
Immediate Motor Effects of Stimulation through Electrodes Implanted in the Human Globus Pallidus
Authors: Ashby P. , Strafella A. , Dostrovsky J.O. , Lozano A. , Lang A.E.
Published: April 2003

The immediate motor effects of stimulation through electrodes chronically implanted in the globus pallidus internus (GPI) were studied in 9 subjects with Parkinson’s disease. Single stimuli (at ≫0.4 Hz) produced short latency facilitation of voluntarily activated contralateral muscles in all subjects. The latency and distribution of the facilitation, its probably monosynaptic nature, and the short chronaxie and refractory period of the activated neural elements suggest that the facilitation results from the direct excitation of the fast conducting corticospinal pathway. The facilitation of motoneurons followed high frequency (e.g. 200 Hz) stimulation without decrement and occurred at stimulus intensities well below those required to produce a visible muscle contraction. We conclude that, while there may be other effects, GPI stimulation through electrodes may activate the corticospinal tract, even when the stimuli are below the threshold for a visible muscle contraction, and that continuous stimulation may do so continuously. This may be an unwanted side effect, but possible therapeutic actions are considered. The reproducible short latency facilitation enabled us to estimate current spread from the quadripolar electrodes used for deep brain stimulation. When the current is sufficient to excite large myelinated fibers near one of the quadripolar electrodes, an additional 1-mA current will activate similar fibers at an additional distance of 1.8 mm with bipolar stimulation and at a distance of 5.7 mm with monopolar stimulation.
Topographic Analysis of the Gyral Patterns of the Central Area
Authors: Lee Uhn , Bastos A.C. , Alonso-Vanegas M.A. , Morris R. , Olivier A.
Published: April 2003

Great advances in imaging technology allows the surgeon to visualize the entire brain surface during surgery. However, the cerebral convolutions are extremely complex, so that it is often difficult to define the central area precisely. Using the curvilinear reconstruction technique (Gyroview) and MRI, we have analyzed the gyral anatomy of the central area in 20 normal brans and have recognized several patterns of topographic organization and have classified them into several categories. We divided the central area into anterior and posterior subregions with the central sulcus as the main landmark. More specifically, we studied how the pre- and postcentral gyri merge into the frontal and parietal lobe proper by anatomical bridges (roots). We describe three anterior and two main posterior roots which originate from the precentral and the postcentral gyrus, respectively. We found four different types of pattern for the anterior roots and as many as 10 different patterns for the posterior roots. The arterior roots are relatively constant, compared to the posterior ones. The most frequent pattern (type 1) was found in 33 hemispheres among the 40 analyzed (82.5%). Four main posterior root patterns were recognized in 32 hemispheres of the 40 analyzed (80%). Thus, although gyral variability was encountered for the posterior roots, a very constant global pattern was seen for the central area. One of the most important steps of frameless stereotactic-guided epilepsy surgery is the precise localization of the central area. Therefore, a knowledge of gyral patterns of the central area is essential not only for the resective epilepsy surgery, but also for the successful removal of a variety of lesions in the central area.
Stereotactic Treatment of Central Pain
Authors: Ohye Chihir o
Published: April 2003

In the present study, the effect of stereotactic treatment on central pain is briefly reviewed. Studies have shown that the spinothalamic tract projects to the shell zone of the principal sensory nucleus (Vc) and its rostral part (Vim), where it forms clusters. Recent anatomophysiological studies have revealed specific nociceptive neurons in the thalamic submedius and VMpo nucleus, from which fibers project to the insular and cingulate cortex. In the abnormal state of central pain, these structures may be subjected to excess excitation. Thalamic recording during the course of stereotactic thalamotomy strongly supports this hypothesis. Thus, Vim-Vcpc thalamotomy ameliorates the so-called deep pain after stroke.
Surgical Palliation of Dyskinesiae in Parkinson’s Disease
Authors: Brophy Brian P.
Published: April 2003

The history of surgical management of Parkinson’s disease is outlined. Current practice of thalamotomy and pallidotomy is discussed. Surgical management has re-established its role in the management of Parkinson’s disease.
The Effect of LINAC Stereotactic Radiosurgery on Epilepsy Associated with Arteriovenous Malformations
Authors: Eisenschenk Stephan , Gilmore RobinL. , Friedman WilliamA. , Henchey RuthA.
Published: April 2003

Reduction of seizures associated with arteriovenous malformations (AVMs) following radiosurgery has been reported. This investigation assessed the effect of LINAC radiosurgical treatment of AVMs on the associated epilepsies correlated to AVM location, size, seizure type, and postradiosurgical thrombosis. Of 100 patients with AVMs, 33 presented with seizures (11 generalized tonic-clonic seizures, 8 simple partial seizures, and 14 complex partial seizures with or without secondary generalization). Patients with AVMs ≥25.0 mm were more likely to have seizures. Patients with frontal lobe AVMs were the most likely to have associated epilepsy (72.7%). Following radiosurgery, 59% were seizure-free and 19% had marked reduction of seizure frequency. Seizure remission was most frequent for AVMs of the centrum (83.3%). Of 14 patients with 2-year follow-up angiography, 9 had complete thrombosis and 6 became seizure-free. Four of 5 patients without thrombosis also became seizure-free. We conclude that LINAC radiosurgery is effective for epilepsies associated with AVMs. Radiosurgery was most effective for generalized tonic-clonic and complex partial seizures. There was no statistically significant correlation between reduction in epilepsy and original AVM size. Four of 5 patients without thrombosis became seizure-free, suggesting that structural or biochemical alterations of epileptogenic neurons following radiosurgery may reduce epileptogenicity.
Comparison between Stereotactic CT and MRI Coordinates of Pallidal and Thalamic Targets using the Laitinen Noninvasive Stereoadapter
Authors: Hirabayashi Hidehiro , Hariz Marwan I. , Fagerlund Markku
Published: April 2003

The coordinates of one and the same target were compared between stereotactic CT and MRI studies, using the original Laitinen noninvasive Stereoadapter, and a slightly modified stereoadapter in 34 patients scheduled for pallidotomy or thalamotomy. The differences between CT and MRI coordinates were significant for the anteroposterior y (p < 0.001) and the vertical z (p < 0.01) coordinates. When the targets were analyzed separately for the coordinates in the right and left hemispheres, only those of the left-sided targets were significantly different between CT and MRI measurements. In patients where a vertex support was added to the Stereoadapter, there were no differences between CT and MRI target coordinates, regardless of the side of the target. However, in all patient groups, the three-dimensional vectorial difference between CT and MRI coordinates showed that the MRI-defined targets lay anterior and dorsal, that is, rostral, to the CT-defined targets, with a 95% confidence interval of the differences ranging from 1.8 to 2.4 mm. This rostral shift in target coordinates on MRI versus CT happens to coincide with the usual approach of the probe towards the target during surgery. It is concluded that the differences in target coordinates in our study are due partly to MRI distortion and partly to repositioning error of the Stereoadapter on the head. The relatively low magnitude of these differences does not preclude the use of the Stereoadapter for MRI-guided functional stereotactic surgery, provided careful impedance monitoring and macrostimulation of the target area prior to lesioning.
Brain Targets for Pain Control
Authors: Davis Karen D. , Lozano Andres M. , Tasker Ronald R. , Dostrovsky Jonathan O.
Published: April 2003

A variety of brain sites have been targeted for surgical treatment of intractable pain. Both ablative and chronic stimulation procedures have been reported to attenuate such pain. These targets include the thalamus and its projections, the periventricular gray, the cingulate cortex and the motor cortex. An overview of these procedures and their efficacy is provided.
Effects of a Stereotactic Headframe Assembly on Proton Magnetic Resonance Spectroscopy
Authors: Campeau Norbert G. , Wood Christopher P. , Erickson Bradley J. , Jack Jr. Clifford R. , Felmlee Joel P.
Published: April 2003

The effects of a magnetic resonance-compatible stereotactic headframe assembly on single voxel proton magnetic resonance spectroscopy (MRS) were investigated. Multiple stimulated echo acquisition mode (STEAM) spectra were obtained within a commercially available brain metabolite phantom placed within the headframe assembly (Leksell, Model G). All acquisition parameters were kept constant, except voxel location. Maximal distortion occurred for voxels acquired in the immediate vicinity of a headframe fixation pin, manifested by spectral broadening, changes in peak area and height and distortion of the baseline, rendering these acquisitions nondiagnostic. The range of this interaction was short, and a voxel acquired with nearest edge located 2.0 cm or greater from the fixation pin tip produced NAA/Cr, Cho/Cr and mI/Cr ratios differing by less than 7.5% from a spectrum obtained at the phantom center. The feasibility of performing single voxel MRS with a stereotactic headframe in place is demonstrated.
Utilization of Impedance Measurements in Pallidotomy Using a Monopolar Electrode
Authors: Limonadi Farhad M. , Roberts David W. , Darcey Terrance M. , Holtzheimer III Paul E. , Ip Justin T.
Published: April 2003

Object: This study was performed to evaluate the reliability and utility of using monopolar impedance monitoring for estimation of the location of the thermocouple electrode during a pallidotomy procedure. Methods: In 26 patients, impedance profiles were measured at 2-mm intervals and anatomical boundaries were marked on postoperative MRI studies in 19 patients. The pattern of change in impedance as the electrode was towards the target coordinates in the globus pallidus was studied empirically in relation to MRI-defined anatomy and by electrical stimulations. The pattern of impedance change was of greater reliability than absolute impedance values. A drop in impedance was noted in 10 cases where the electrode entered the putamen or globus pallidus upon exiting the internal capsule, and in 9 of these this drop was measured before or at the distal boundary of the internal capsule. A variable pattern in the region of the base of the globus pallidus was observed, with 10 of 19 cases demonstrating a decrease and 8 cases an increase, consistent with the proximity of a CSF cistern in the former and the ansa lenticularis and optic tract in the latter. Simulations showed that the monopolar electrode was more sensitive to the approach of a boundary than the bipolar electrode. Conclusion: Our measurements and simulations suggest that a monopolar electrode could predict a nearby region of high or low impedance before penetrating it and a trend of decreasing impedance as the distal edge of the globus pallidus is approached.
Interventional MRI-Guided Stereotactic Aspiration of Acute/Subacute Intracerebral Hematomas
Authors: Tyler Donnie , Mandybur George
Published: April 2003

Surgical interventions for hypertensive intracerebral hematomas are still controversial. Many believe only hyperacute intervention is of any real utility. The majority of present interventions require a formal craniotomy with standard neurosurgical techniques. There are, however, a few reports on CT-guided stereotactic aspiration of these hematomas with favorable results. We report 10 patients treated with frameless fiduciless stereotactic means using an intraoperative MRI scanner (GE 0.5 T Signa SP). These patients were initially diagnosed as having hypertensive intracerebral hematoma and operated on within 1–34 days after hemorrhage. The actual operating time averaged less than 120 min, including intraoperative imaging. Clot volumes ranged from 2.5 to 75 cm3 with a mean of 31 cm3. There were 2 thalamic hematomas and 8 basal gangliar hematomas. Three patients had intraventricular hematoma extension and all 3, as well as an additional patient, required extraventricular drainage. However, no patients required permanent posthemorrhage ventriculoperitoneal shunting. Aspiration was successful in all cases to 70–90% of clot removal. Two cases utilized intrahematoma t-PA infusion with subsequent 80–90% clot removal.
There were no complications or rehemorrhages. All patients showed some form of improvement that included either improved blood pressure control, speech or cognitive abilities. We conclude that using an intraoperative MRI scanner to perform frameless, fiduciless stereotactic aspiration of acute/subacute intracerebral hematoma is a safe and potentially effective means of treating intracerebral hematomas.
Stereotactic Ventral Intermedial Thalamotomy for the Treatment of Essential Tremor:Results of a Series of 37 Patients
Authors: Akbostanci M. Cenk , Slavin Konstantin V. , Burchiel Kim J.
Published: April 2003

We have analyzed 43 ventral intermediate thalamotomies performed in our center for treatment of medically intractable essential tremor (ET) in 37 patients. The mean age of patients was 70.9 years (range 42–84), duration of symptoms 33.3 years (1–65). The surgery in all cases was performed with stereotactic technique using MRI or CT localization. Intraoperative neurophysiological confirmation of the target location was obtained using a macrostimulation technique. All patients experienced either complete abolition of the contralateral tremor or significant improvement in tremor intensity immediately after the surgery. At follow-up examination 1–13 months after the operation, 60.5% of patients had no tremor, and 13.9% had mild residual tremor without interference with daily life. Tremor recurrence was observed in 5 patients, all of whom underwent repeat ventral intermedial (VIM) thalamotomy with excellent results. Transient problems with speech and motor functions were observed after 15 thalamotomies, permanent hemiparesis and speech difficulties were seen in 6 patients. We conclude that VIM thalamotomy is a highly effective procedure for medically intractable ET and may be performed with no mortality and low morbidity rate.
Comparison of Three Techniques for Calculation of Target Coordinates in Functional Stereotactic Procedures
Authors: Slavin Konstantin V. , Anderson Gregory J. , Burchiel Kim J.
Published: April 2003

We compared three techniques of target coordinate determination for various functional stereotactic procedures. All procedures were based on preoperative MRI with contiguous 3-mm cuts. The first technique involved determination of anatomical landmarks and fiducial markers of the stereotactic frame on the monitor screen of an MRI scanner and calculation of the target point using a series of formulas; the second technique used a Leksell tabletop localizer, and the third technique is a part of ‘Stealth’ stereotactic navigation software. Final coordinates for the procedure were derived from all three techniques and subsequently adjusted using intraoperative electrical macrostimulation. We found that difference between techniques was on average 0.9 ± 0.4 mm in each of three directions, and 1.8 ± 0.9 mm in absolute distance. There were 7 cases in which one of the techniques had a discrepancy of more than 3 mm (more than 1 MRI slice thickness) compared with the other two, indicating a potential error in coordinate determination. This difference could potentially result in inappropriate placement of the electrode, thus affecting the procedure outcome. In 6 cases, such an error apparently occurred with the first or second technique of calculation. The average number of mapping trajectories decreased from 1.8 to 1.4 since this stereotactic software became a part of operative planning. We conclude that use of computerized planning software increases the precision of target
coordinate calculation and improves the accuracy of functional stereotactic procedures.
Thalamic Stimulation in Patients with Multiple Sclerosis
Authors: Schulder Michael , Sernas Thomas , Mahalick David , Adler Roberta , Cook Stuart
Published: April 2003

Objective: To assess tremor control and side effects in patients with multiple sclerosis (MS) treated with chronic thalamic stimulation for relief of upper extremity tremor. Methods: Five patients were studied before and after thalamic placement of a deep brain stimulation (DBS) system. Preoperative and postoperative evaluation included magnetic resonance imaging, Extended Disability Status Scale (EDSS), the Bain-Finchley visual analog scale for tremor, video recording and neuropsychological testing. Stereotactic targeting of the Vim nucleus was done using computed tomography; intraoperative testing was done under local anesthesia before permanent implantation. Results: Functionally useful tremor suppression was obtained in 3/5 patients. Neuropsychological deficits of higher cortical function, memory and visuospatial coordination were observed in all patients before surgery; in 1 patient with improved postoperative visuospatial coordination, worsened memory was found. New brainstem plaque formation was seen several weeks after surgery in 1 patient who had an acute worsening of MS which improved after high-dose intravenous steroids. Conclusions: Chronic thalamic stimulation may help selected patients with MS-induced tremor. Given the complexity of their underlying illness, patients must be selected carefully, and long-term follow-up is vital to evaluate the true utility of DBS.
Stereotactic Posterioventral Pallidotomy Improves Balance Control as Assessed by Computerized Posturography
Authors: Mandybur George , King W. Michael , Moore Kenneth
Published: April 2003

Postural instability is arguably the most debilitating symptom of Parkinson’s disease (PD). Recently, posterioventral pallidotomy/pallidoansotomy (PVP) has been advocated to improve a multitude of symptoms associated with PD. Dyskinesias, rigidity and bradykinesia are the most talked about improved symptoms, but posture and gait are also affected after PVP. To analyze the effect of PVP on postural control, 14 patients with PD were prospectively studied using a computerized dynamic posturography machine. Seven males and 7 females underwent a total of 18 procedures, 6 left PVP, 6 right PVP, 2 bilateral and 2 had Vim thalamotomies in addition to PVP. Data were collected pre- and postoperatively after a 12-hour drug-free interval (‘off’ period) and 1–2 h after medications (‘on’ period). Postoperative analyses were performed between 1 and 3 months postoperatively. As a group, patients’ balance, in the off period, improved after surgery in a dynamic setting. Prior to surgery, patients’ anterior-posterior sway exceeded their stability limits (patient fell) on 31% of the trials. After surgery, the fall rate
decreased to 23%. Anterior-posterior sway decreased significantly (p < 0.05) postoperatively when the platform was sway referenced. In comparing the effect of surgery in decreasing sway with that of medication preoperatively, improvement after surgery (off period) was better than the preoperative on period (p < 0.05). Patients also improved in ostoperative off state when compared to preoperative off state with the platform sway referenced (p < 0.05), controlling for improvement in dyskinesia-induced imbalance. In conclusion, PVP improves standing balance performance better than that achieved with medications preoperatively. Since central input parameters were improved, the mechanism of PVP may be centralized.
Analysis of Brain Tumours Suitable for Curability via Gene Therapy in North East Malaysia
Authors: Abdullah J. , Isa M.N.
Published: April 2003

Two hundred primary brain tumours in both adults and children from the year 1990 to 1998 presenting for treatment to the Neurosurgical Division of the Hospital of the University of Sciences Malaysia were studied retrospectively. Volumes of tumours were taken from CT scans with contrast using two formulas and divided into 4 groups: (1) less than 20 cm3, (2) 20–50 cm3, (3) 50–100 cm3 (4) larger than 100 cm3. The majority of the brain tumours were in the volume range of 50–100 cm3, and are thus potentially curable with retroviral gene therapy.
Adjuvant Stereotactic Radiosurgery for Anaplastic Ependymoma
Authors: Jawahar Ajay , Kondziolka Douglas , Flickinger John C. , Lunsford L. Dade
Published: April 2003

Object: The purpose of this retrospective study is to evaluate the role of stereotactic radiosurgery using the Gamma Knife as an adjuvant to other modalities used in the treatment of malignant ependymomas of both children and adults and to assess its efficacy in terms of tumor control and overall survival. Method: Between 1987 and 1998, 22 patients in the age range of 1.5–65 years (mean age 22.3) with progressive anaplastic ependymoma were treated by stereotactic radiosurgery using the 201 source Co-60 Leksell Gamma Knife at the University of Pittsburgh. The irradiated tumor volume varied from 0.84 to 36.8 cm3 (mean 13.7). The median dose delivered to the tumor margin was 16.1 Gy (range 10–20), and the mean maximal dose was 32.2 Gy (range 20–40). The disease-free survival, the tumor control rate and the overall survival were recorded to evaluate the efficacy of radiosurgery. The median follow-up from radiosurgery was 21 months (range 4–84). Results: Median survival after radiosurgery was 2.2 years (46.6 ± 12.1% 5-year actuarial). Median survival from the initial diagnosis was 10.1 years (50.3 ± 12.5% at 5 years, 37.7 ± 14.4% at 10 years). Reduction or stabilization of the treated tumor was seen in 16 out of 22 (68%) patients. Forty-one percent of the patients eventually developed delayed distant cerebral recurrence outside the treated volume. The 5-year actuarial rates for local control and cranial control at any location were 62.3 ± 13.6% and 32.4 ± 10.8%, respectively. No complication occurred as a side effect of radiosurgery. Conclusion: For patients with locally recurrent or progressive anaplastic ependymomas, Gamma Knife stereotactic radiosurgery proved to be safe and effective as a salvage adjuvant therapy to achieve local tumor control and improve survival.
Stereotactic Radiosurgery in the Treatment of Metastatic Disease to the Brain
Authors: Chen Joseph C.T. , O’Day Steven , Morton Donald , Essner Richard , Cohen-Gadol Aron , MacPherson Dana , Giannotta Steven L. , Petrovich Zbigniew , Yu Cheng , Apuzzo Michael L.J.
Published: April 2003

We review 190 consecutive patients with 434 metastatic tumors treated by gamma knife stereotactic radiosurgery, from August 1994 to February 1999. Median actuarial survival for all patients was 34 weeks. Factors correlated with significantly improved survival included controlled systemic disease and nonmelanoma histology. We found that no significant survival benefit could be discerned from adjuvant whole brain radiotherapy in this patient group. Survival was not statistically different for patients initially presenting with 1–4 metastases at initial treatment.