bluuebunny/crossref_metadata_2025 huggingface dataset:
Why Is Wallerian Degeneration in the CNS So Slow?
Authors: Vargas Mauricio E. , Barres Ben A.
Published: March 2007

Wallerian degeneration (WD) is the set of molecular and cellular events by which degenerating axons and myelin are cleared after injury. Why WD is rapid and robust in the PNS but slow and incomplete in the CNS is a longstanding mystery. Here we review current work on the mechanisms of WD with an emphasis on deciphering this mystery and on understanding whether slow WD in the CNS could account for the failure of CNS axons to regenerate.
Preservation of coronary reserve by ivabradine-induced reduction in heart rate in infarcted rats is associated with decrease in perivascular collagen
Authors: Dedkov Eduard I. , Zheng Wei , Christensen Lance P. , Weiss Robert M. , Mahlberg-Gaudin Florence , Tomanek Robert J.
Published: March 2007

We tested the hypothesis that chronically reducing the heart rate in infarcted middle-aged rats using ivabradine (IVA) would induce arteriolar growth and attenuate perivascular collagen and, thereby, improve maximal perfusion and coronary reserve in the surviving myocardium. Myocardial infarction (MI) was induced in 12-mo-old male Sprague-Dawley rats, which were then treated with either IVA (10.5 mg·kg−1·day−1; MI + IVA) or placebo (MI) via intraperitoneal osmotic pumps for 4 wk. Four weeks of IVA treatment limited the increase in left ventricular end-diastolic pressure and the decrease in ejection fraction but did not affect the size of the infarct, the magnitude of myocyte hypertrophy, or the degree of arteriolar and capillary growth. However, treatment reduced interstitial and periarteriolar collagen in the surviving myocardium of MI + IVA rats. The reduced periarteriolar collagen content was associated with improvement in maximal myocardial perfusion and coronary reserve. Although the rates of proliferation of periarteriolar fibroblasts were similar in the MI and MI + IVA groups, the expression levels of the AT1 receptor and transforming growth factor (TGF)-β1 in the myocardium, as well as the plasma level of the ANG II peptide, were lower in treated rats 14 days after MI. Therefore, our data reveal that improved maximal myocardial perfusion and coronary reserve in MI + IVA rats are most likely the result of reduced periarteriolar collagen rather than enhanced arteriolar growth.
Matrix metalloprotease-9 dysregulation in lower airway secretions of cystic fibrosis patients
Authors: Gaggar Amit , Li Yao , Weathington Nathaniel , Winkler Margaret , Kong Michele , Jackson Patricia , Blalock J. E. , Clancy J. P.
Published: March 2007

Matrix metalloproteases (MMPs) are proteolytic enzymes that regulate extracellular matrix turnover and aid in restoring tissue architecture following injury. There is an emerging role for extracellular matrix destruction in the pathogenesis of chronic neutrophilic lung diseases. In this study, we examined the expression and activity profiles of MMPs in lower airway secretions from cystic fibrosis (CF) patients, patients with acute respiratory failure (ARF), and normal controls. A discrete repertoire of MMP isoforms was found in the CF samples, with robust MMP-9 expression compared with normal controls and ARF. CF samples possessed increased levels of active MMP-9, as well as decreased amounts of tissue inhibitor of metalloprotease-1 (TIMP-1), a natural inhibitor of MMP-9. The CF inpatient samples demonstrated fully active MMP-9 activity compared with CF outpatients, ARF, and normal controls. CF samples also demonstrated increased human neutrophil elastase (HNE) levels compared with ARF and normal controls. To examine potential mechanisms for the protease dysregulation seen in the CF clinical samples, in vitro studies demonstrated that HNE could activate pro-MMP-9 and also degrade TIMP-1; this HNE-based activation, however, was not seen with MMP-8. A strong correlation was seen between HNE and MMP-9 activity in CF inpatient samples. Finally, the dysregulated MMP-9 activity seen in CF inpatient sputum samples could be significantly reduced by the use of MMP-9 inhibitors. Collectively, these findings further emphasize the proposed protease/antiprotease imbalance in chronic neutrophilic lung disease, providing a potential mechanism contributing to this proteolytic dysregulation.
Tissue-specific changes in protein synthesis associated with seasonal metabolic depression and recovery in the north temperate labrid,Tautogolabrus adspersus
Authors: Lewis Johanne M. , Driedzic William R.
Published: March 2007

The tissue-specific changes in protein synthesis were tracked in relation to the seasonal metabolic depression in cunner ( Tautogolabrus adsperus). In vivo protein synthesis rate and total RNA content were determined in liver, white muscle, brain, heart, and gill during periods of normal activity before metabolic depression, entrance into and during winter dormancy, and during the recovery period. The decrease in water temperature from 8°C to 4°C was accompanied by a 55% depression of protein synthesis in liver, brain, and heart and a 66% depression in gill. Protein synthesis in white muscle fell below detectable levels at this temperature. The depression of protein synthesis is an active process (Q10= 6–21 between 8°C and 4°C) that occurs in advance of the behavioral and physiological depression at the whole animal level. Protein synthesis was maintained at these depressed levels in white muscle, brain, heart, and gill until water temperature returned to 4°C in the spring. Liver underwent a hyperactivation in the synthesis of proteins at 0°C, which may be linked to antifreeze production. During the recovery period, a hyperactivation of protein synthesis occurred in white muscle, which is suggestive of compensatory growth, as well as in heart and liver, which is considered to be linked to increased activity and feeding. Seasonal changes in total RNA content demonstrate the depression of protein synthesis with decreasing temperature to be closely associated with translational capacity, but the stimulation of protein synthesis during recovery appears to be associated with increased translational efficiency.
Modulation of HSP25 and TNF-α during the early stages of functional overload of a rat slow and fast muscle
Authors: Huey Kimberly A. , McCall Gary E. , Zhong Hui , Roy Roland R.
Published: March 2007

Early events in response to abrupt increases in activation and loading with muscle functional overload (FO) are associated with increased damage and inflammation. Heat shock protein 25 (HSP25) may protect against these stressors, and its expression can be regulated by muscle loading and activation. The purpose of this study was to investigate the responses of HSP25, phosphorylated HSP25 (pHSP25), and tumor necrosis factor-α (TNF-α) during FO of the slow soleus and fast plantaris. We compared the HSP25 mRNA, HSP25 protein, pHSP25, and TNF-α responses in the soleus and plantaris after 0.5, 1, 2, 3, and 7 days of FO. HSP25 and pHSP25 were quantified in soluble and insoluble fractions. HSP25 mRNA increased immediately in both muscles and decreased with continued FO. However, HSP25 mRNA levels were consistently higher in the muscles of FO than control rats. In the soluble fraction, HSP25 increased in the plantaris after 2–7 days of FO with the greatest response at 3 and 7 days. The pHSP25 response to FO was greater in the plantaris than soleus at all points in the soluble fraction and at 0.5 days in the insoluble fraction. TNF-α levels in the plantaris, but not soleus, were higher than control at 0.5–2 days of FO. This may have contributed to the greater FO response in pHSP25 in the plantaris than soleus as TNF-α increased pHSP25 in C2C12myotubes. These results suggest that the initial responses of pHSP25 and TNF-α to mechanical stress and inflammation associated with FO are greater in a fast than slow extensor muscle.
Mechanisms initiating integrin-stimulated flow recruitment in arteriolar networks
Authors: Frame Mary D. , Rivers Richard J. , Altland Owen , Cameron Scott
Published: March 2007

Our purpose was to investigate the local mechanisms involved in network-wide flow and diameter changes observed with localized downstream vitronectin receptor ligation; we tested specific K or Cl channels known to be involved in either dilation or elevated permeability following vitronectin receptor activation and tested integrin-linked pathway elements of tyrosine phosphorylation and protein kinase C (PKC). Arteriolar networks were observed in the cheek pouch tissue of anesthetized (pentobarbital sodium, 70 mg/kg) hamsters ( n = 86) using intravital microscopy. Terminal arteriolar branches of the networks were stimulated with micropipette LM609 (0.5–10 μg/ml, 60 s) alone or with inhibitors (separate micropipette). Hemodynamic changes (diameter, red blood cell flux, velocity) were observed at the upstream entrance to the network. LM609 alone stimulated first an increase in wall shear stress (WSS), followed by a dilation that recovered WSS to baseline or below. K channel inhibition (glybenclamide, 4-AP) had no effect on the initial peak in WSS, but decreased remote vasodilation. Cl channel inhibition (DIDS, IAA-94, niflumic acid) or inhibition of PKC (chelerythrine) prevented the initial peak in WSS and decreased remote vasodilation. Inhibition of tyrosine phosphorylation (genistein) prevented both. With the use of nitro-arginine at the observation site, the initial peak in WSS was not affected, but remote vasodilation was decreased. We conclude the remote response consists of an initial peak in WSS that relies on both PKC activity and depolarization downstream, leading to an upstream flow mediated dilation and a secondary remote dilation that relies on hyperpolarization downstream at the stimulus site; both components require tyrosine phosphorylation downstream.
Pathogenesis and Classification of Proliferative Diabetic Vitreoretinopathy
Authors: Kroll Peter , Büchele Rodrigues Eduardo , Hoerle Steffen
Published: March 2007

Purpose: To review the current knowledge regarding the pathogenesis of proliferative diabetic vitreoretinopathy (PDVR) and to present recommendations for its clinical staging. Design: Focused literature review and authors’ clinical experience. Results: Although several biochemical mediators may be responsible for the pathogenesis of PDVR, no common biochemical pathway exists. Of those mediators, vascular endothelial growth factor is the one most studied so far. However, since in proliferative diabetic retinopathy (PDR) the thickened posterior vitreous cortex is one of the main factors in the development of proliferations, a consequent shrinkage of the posterior vitreous cortex leads to hemorrhages and tractive retinal detachments. Therefore, PDR should be called PDVR. In consequence, the authors present a new morphological classification of PDVR. Conclusions: There is no consensus about the biochemical pathway responsible for the progression of PDVR. Although several classifications are described in the literature, the classification suggested here is important in the judgment of, the communication about and the therapy of diabetic retinopathy. Furthermore, it is the only reliable classification for predicting the surgical outcome in diabetics.
Surgery for Diabetic Retinopathy
Authors: Helbig Horst
Published: March 2007

Surgery for diabetic retinopathy addresses late secondary complications of a primary microvascular disease. Since surgery is not a causative therapy, the functional outcome of surgery depends on the degree of retinal ischemia and may be disappointing even in technically and anatomically successfully operated eyes. Typical indications for vitrectomy are vitreous hemorrhage, tractional retinal detachment, combined tractional rhegmatogenous retinal detachment and tractive macular edema. More recently diffuse diabetic macular edema has been shown to improve after removal of an attached vitreous in several cases. Neovascular glaucoma requires aggressive surgical intervention to salvage the eye. Cataract surgery is commonly performed in eyes with diabetic retinopathy. It may however deteriorate diabetic eye disease. Vitreous surgery also has a potential for severe complications in diabetic eyes which can be ameliorated but not eliminated by proper surgical strategies and techniques. The decision for an intervention in diabetic eyes always requires a careful weighing of risks and benefits of surgery.
Pharmacological Treatment of Diabetic Retinopathy
Authors: Lang Gabriele E.
Published: March 2007

Despite the better options of controlling diabetes mellitus and although the prognosis of diabetic retinopathy has markedly improved by laser treatment and vitreoretinal surgery, diabetic retinopathy still is the leading cause of blindness in working age people in industrialized countries. Little has changed in the last decades regarding the prognosis of ocular complications in diabetes mellitus. We therefore need better tools and new therapeutic approaches for the prevention and treatment of diabetic ocular complications. Newer therapeutic options are directed at the causative mechanisms of diabetic retinopathy. Experimental and clinical evidence suggests that pharmacological compounds like somatostatin analogues and protein kinase C (PKC) inhibitors may be effective in the treatment of diabetic retinopathy. Chronic overproduction of growth hormone and insulin-like growth factor 1 play an important role in the pathogenesis of diabetic retinopathy. In the treatment of diabetic retinopathy somatostatin receptors are the targets of somatostatin analogues like octreotide. Octreotide has shown to be a promising treatment of diabetic retinopathy and diabetic macular edema. One important pathomechanism in the development of diabetic retinopathy is the activation of PKC induced by high glucose due to an increased diacylglycerol level. The selective PKC-β inhibitor ruboxistaurin mesylate enables a new therapeutical approach for the treatment of diabetic retinopathy. Ongoing prospective clinical trials investigate whether the treatment with the specific PKC-β inhibitor can prevent the progression of diabetic retinopathy and diabetic macular edema.
Current Treatment Approaches in Diabetic Macular Edema
Authors: Meyer Carsten H.
Published: March 2007

Purpose: To review current treatment approaches in diabetic macular edema (DME). Methods: The underlying pathopathology, classifications and diagnostic examination techniques including fluorescein angiography, optical coherence tomography and stereoscopic biomicroscopy. Treatment modalities with focal or grid argon laser photocoagulation, pars plana vitrectomy with and without peeling of the inner limiting membrane (ILM), as well as intravitreal injections using triamcinolone acetonide or novel vascular endothelial growth factor (VEGF) inhibitors are described. Results: DME results from a series of biochemical and cellular changes, causing progressive leakage and exudation. Focal and grid photocoagulation remains the standard care for diabetic maculopathy. However, the availability of new agents raises the possibility of improvements if significant benefits can be validated in randomized clinical trials. Posterior vitreous attachments play a critical role through several mechanical or physiological mechanisms. Vitrectomy without ILM removal seems to be effective in reducing the retinal thickness and improving visual acuity. Conclusion: A proper evaluation of the vitreous and retina is fundamental to select the most appropriate treatment approach in DME. While small microaneurysms with focal DME may be treated by conventional focal photocoagulation, diffuse DME which do not respond to grid photocoagulation may benefit from intravitreal injections using triamcinolone acetonide or novel VEGF inhibitors. Eyes with DME and additional vitreous traction may benefit from pars plana vitrectomy without ILM peeling. A combination of laser, pharmacological and surgical treatment modalities may be necessary to maintain central vision in eyes with DME.
Perceptions of Genetic Testing for Cancer Predisposition among Ashkenazi Jewish Women
Authors: Lewis M. Jane , Peterson Susan K.
Published: March 2007

Background: Clinical genetic testing can help identify individuals who are predisposed to a variety of diseases and conditions; thus, it is important to understand attitudes and perceptions of individuals who may consider or who may be offered such testing. Methods: We examined knowledge and attitudes about cancer genetic testing among 59 women of Ashkenazi Jewish descent (age 25–80 years) through six focus group discussions. Participants were asked about their knowledge and experience with hereditary conditions and genetic testing, and attitudes regarding risk management options, genetic privacy, and potential discrimination issues. Results: Although 54% reported having a personal and/or some family history of breast, ovarian, or colorectal cancer, none had undergone cancer genetic counseling or testing and few expressed an interest or intention in doing so. While most endorsed benefits of genetic testing for those with a significant cancer family history, women also expressed concerns over the possible distress of learning that one carried a cancer-predisposing mutation and suggested that increasing cancer screening practices may be preferable to having genetic testing. Participants doubted the ability of state genetic privacy legislation to protect against insurance or employment discrimination. Conclusion: Findings underscore the need for public education on the broad range of benefits and limitations associated with genetic testing, in order to help consumers to appropriately interpret complex information and make decisions about these services.
Definition of Total Mesorectal Excision, Including the Perineal Phase: Technical Considerations
Authors: Havenga Klaas , Grossmann Irene , DeRuiter Marco , Wiggers Theo
Published: March 2007

Background: Total mesorectal excision (TME) has contributed to a decline in local recurrence. The operation is difficult because of the complicated anatomy of the pelvis and the narrow spaces in the pelvis. We review the anatomy related to TME and we present our surgical technique. Anatomy: The pelvis can be divided into a parietal compartment and a visceral compartment. Both compartments are covered by a fascial layer: the parietal and the visceral fascia. A space between these fascial layers can be opened by dividing loose areolar tissue. The pelvic autonomic nerves consist of the sympathetic hypogastric nerve and the parasympathetic sacral splanchnic nerve. At the pelvic sidewall these nerves join in the inferior hypogastric plexus. Surgery: We present our surgical technique based on careful dissection under direct vision and describe our approach to abdominoperineal resection in the knee-chest position. This position enables en bloc resection of the levator ani muscle with the mesorectum, preventing positive circumferential margins in distal rectal tumor. Conclusion: TME is a difficult and challenging operation. Continuous attention to surgical technique and anatomy is important to keep up the high standards of contemporary rectal surgery.
Adjuvant Chemotherapy for Colon Cancer: Evidence on Improvement in Survival
Authors: Samantas E. , Dervenis C. , Rigatos S.K.
Published: March 2007

Clear progress has been made in the adjuvant treatment of colon cancer. Until very recently, the absolute benefit for survival obtained with the administration of 6 months’ FU/LV compared with control was about 6%. Fluoropyrimidines have been shown to be at least as active and can replace intravenous FU/LV in stage III colon cancer. Based on the results of the MOSAIC and NSABP C-07 trials, the addition of oxaliplatin to FU/LV improves disease-free survival and FOLFOX for 6 months can be recommended as adjuvant treatment for patients with stage III colon cancer. The benefit of adjuvant chemotherapy in stage II disease is limited and it should be proposed in patients with high-risk features. Adjuvant treatment of colon cancer improving and the use of genetic/molecular markers with the new targeted therapies may further improve survival.
Early Rectal Cancer: Definition and Management
Authors: Lezoche Emanuele , Baldarelli Maddalena , De Sanctis Angelo , Lezoche Giovanni , Guerrieri Mario
Published: March 2007

Background: Local excision of rectal cancer is an alternative to radical resection but today its role surrounding the management of patients with early stage rectal cancer (T1-T2-N0) represents an important surgical issue. Aim: To analyze the results of 135 patients with early stage low rectal cancer treated with local excision by transanal endoscopic microsurgery and in the case of T2 also by neoadjuvant therapy. Study Design:135 patients with T1-T2-N0-M0 rectal cancer were enrolled in the study. Staging according to the definitive histological findings was as follows: pT0 in 24 patients (17.8%), pT1 in 66 patients (48.8%) and pT2 in 45 patients (33.4%). Results: Minor complications were observed in 12 patients (8.8%) whereas major complications were seen only in 2 patients (1.5%). At a median follow-up of 78 (36–125) months, local recurrences occurred in 4 patients and distal metastasis in 2 patients (all patients were staged preoperatively T2). Disease-free survival rates in T1 and T2 patients were 100 and 93% respectively at the end of follow-up. Conclusions: With respect to local recurrence and survival rate, the long-term results of early stage rectal cancer in patients treated with transanal endoscopic microsurgery were similar to those reported in the literature after conventional surgery (total mesorectal excision).
Lymph Node Clearance after Total Mesorectal Excision for Rectal Cancer: Laparoscopic versus Open Approach
Authors: Pechlivanides George , Gouvas Nikolaos , Tsiaoussis John , Tzortzinis Anastasios , Tzardi Maria , Moutafidis M. , Dervenis Christos , Xynos Evaghelos
Published: March 2007

Background: Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clearance. Aim: To assess lymph node yield after laparoscopic total mesorectal excision (TME) for rectal cancer as compared to the open approach. Methods: 74 patients with middle and low rectal cancer were prospectively randomized in two groups. Group A included 39 patients who had an open TME (35 with low anterior resection of the rectum (LARR) and 4 with abdominoperineal resection of the rectum (APR)). In group B, there were 34 patients who had a laparoscopic TME (27 with LARR and 7 with APR). 10 of the LARR patients in group A and 14 of the LARR patients in group B had a defunctioning ileostomy. All operations were performed by one surgeon or under his supervision. Results: Gender and age distribution were similar for both groups (group A: 23 males; mean age 69 (41–85); group B: 20 males; mean age 72 (31–84)). The mean distance of the tumor from the dentate line was 7.6 cm (1–12 cm) for group A and 6.1 cm (1–12 cm) for group B. Anastomosis was formed at a mean distance of 5.5 cm (1.5–8.5 cm) from the dentate line in group A and 3.5 cm (1–4.5 cm) in group B. At histology, in group A there were 5 T4 tumors, 9 T3, 10 T3+ (<1 mm distance from the circumferential resection margin), 13 T2 and 2 T1. In group B, there were 3 T4 tumors, 14 T3, 8 T3+, 7 T2 and 2 T1. Differences between groups were not significant.The mean number of lymph nodes retrieved in group A specimens was 19.2 (5–45) and in group B 19.2 (8–41) (p = 0.2). In group A, 3.9 (1–9) regional, 13.9 (3–34) intermediate and 1.5 (1–3) apical lymph nodes were retrieved. The respective values in group B were 3.7 (3–7), 14.4 (4–33) and 1.3 (1–3). Differences between groups were not significant. Also, the incidence of lymph node involvement by the tumor was not significantly different between groups (group A: 23; group B: 19). Conclusions: Laparoscopic resection of the rectum can achieve similar lymph node clearance to the open approach. Also, distribution of the lymph nodes along the resected specimens is similar between the two approaches.
Erythropoietin Reduces Ischemia-Reperfusion Injury in the Rat Liver
Authors: Schmeding M. , Neumann U.P. , Boas-Knoop S. , Spinelli A. , Neuhaus P.
Published: March 2007

Background: Human recombinant erythropoietin (Epo) has recently been shown to be a potent protector of ischemic damage in various organ systems. A significant reduction of stroke injury following cerebral ischemia has been postulated as well as improved cardiomyocyte function after myocardial infarction in tissue pretreated with Epo. It was the aim of this study to evaluate the effects of Epo in liver ischemia. Material and Methods: Rats were subjected to 45 min of warm hepatic ischemia. Animals were either pretreated with 1,000 IU of Epo in three doses or received 1,000 IU into the portal vein 30 min before ischemia. Control animals received saline at the same time points before ischemia. Animals were than sacrificed 6, 12, 24, 48 h and 7 days after surgery and transaminases were measured. Liver specimens were evaluated regarding apoptosis, necrosis and regeneration capacity. Results: Apoptosis rates were dramatically reduced in animals pretreated with Epo while mRNA of tumor necrosis factor-α and STAT-3 were upregulated in all groups. Intraportal venous injection displayed superiority to subcutaneous preconditioning. Transaminases were significantly reduced among the Epo-treated animals after 6 and 12 h. Conclusion: Our data suggests a protective effect of Epo in warm hepatic ischemia and reperfusion injury in the rat.
Progressive Reduction of Relative Height in Childhood Predicts Adult Stature below Target Height in Boys with Constitutional Delay of Growth and Puberty
Authors: Wehkalampi Karoliina , Vangonen Katarina , Laine Tiina , Dunkel Leo
Published: March 2007

Background/Aims: In some adolescents with constitutional delay of growth and puberty (CDGP), the reduction in relative height (height SDs) starts already in childhood, before puberty. Some subjects with CDGP do not reach their target height (TH). We investigated whether early height SD reduction or testosterone treatment in low doses (1–2 mg/kg/month) influence final height (FH). Methods: The growth of 70 adult men with a history of CDGP was investigated. 31 subjects (13 treated with testosterone) had progressive height SD reduction between 3 and 9 years, and in 39 (17 treated with testosterone) no such reduction was seen. Results: In untreated subjects without early height SD reduction, FH was closer to TH than in those with such reduction (FH – TH 0.05 ± 0.94 vs. –0.63 ± 0.50 SD, p = 0.009). FH – TH did not differ between the testosterone-treated and untreated subjects in the group with early height SD reduction (FH – TH –0.36 ± 0.48 vs. –0.63 ± 0.50 SD, p = 0.15), nor in the group without such reduction (FH – TH –0.08 ± 0.70 vs. 0.05 ± 0.94 SD, p = 0.64). Conclusion: Subjects with early height SD reduction do not attain FH consistent with their genetic height potential, whereas those without such reduction do. Treatment with low doses of testosterone does not adversely affect FH.
Necrotizing Sarcoid Granulomatosis in a Family of Patients with Sarcoidosis Reinforces the Association between Both Entities
Authors: Lazzarini Luiz Claudio Oliveira , de Fatima do Amparo Teixeira Maria , Souza Rodrigues Rosana , Marcos Nunes Valiante Paulo
Published: March 2007

Necrotizing sarcoid granulomatosis (NSG) is a rare entity mainly characterized by a prominent granulomatous vasculitis affecting middle-aged or old individuals and with a favorable prognosis. Although many believe it is a variant of sarcoidosis, the proper classification is still a matter of debate as some of its features are found in sarcoidosis but also in Churg-Strauss syndrome, Wegener’s disease and hypersensitivity pneumonitis. In this paper, we described for the first time a case of NSG in a family with several cases of sarcoidosis, reinforcing the relationship between NSG and sarcoidosis. Additional interesting findings were the young age of the patient (15 years old), the symptoms limited to the respiratory tract (uncommon when NSG affects youngsters) and the increase in serologic markers of autoimmune disease. Though complete criteria for autoimmune disease were not present, systemic lupus erythematosus and Sjögren’s syndrome are possible candidates. As sarcoidosis is described to be associated with several autoimmune diseases, this finding is an additional suggestion of the relationship between both entities.
New CT-Guided Stereotactic Apparatus and Clinical Experience with Intracerebral Hematomas
Authors: Tanizaki Yoshio , Sugita Kenichiro , Toriyama Toshihide , Hokama Masanobu
Published: March 2007

The conventional Sugita stereotactic frame has been improved to perform CT-guided stereotactic surgery both in the CT and operating rooms. The development of our instrument and the software of the scanners’ computer are presented. Newly designed equipment produced almost no artifacts on the CT image. Using the improved stereotactic frame, we have operated upon 44 intracerebral hematomas in the CT room. More than 80% of the cases had satisfactory results. Two complications were encountered, and 1 patient died from pneumonia. Our initial experience of the pre- and postoperative cerebral blood flow measurement with 133Xe inhalation method and single photon emission CT is described.
CT-Guided Ablative Stereotaxis without Ventriculography
Authors: Laitinen Lauri V.
Published: March 2007

A new technique is described which permits all types of stereotactic surgery to be done without ventriculography, with CT guidance only. The present series consists of 42 patients who underwent thalamotomy, posteromedial hypothalamotomy, dentatotomy or anterior capsulotomy for movement disorders, chronic pain, spasmodic torticollis or psychiatrie illness. Postoperative lesion control with repeated CT showed that the method was accurate. The clinical results were considered to be better than those after previous ventriculography-guided surgery. It is concluded that ventriculography is no longer needed for stereotactic neurosurgery.
Digital Image Processing to Handle Neuroanatomical Information and Neurophysiological Data
Authors: Giorgi C. , Cerchiari U. , Broggi G. , Birk P. , Struppeler A.
Published: March 2007

An application of computer graphics technology to functional stereotactic neurosurgery is presented. Neuroanatomical images derived from a stereotactic atlas and information retrieved from a neurophysiological data base are drawn on a graphic monitor. The pictures are oriented and scaled according to appropriate landmarks. The aim of this work ist to add confidence in the surgeon’s selection of the probe trajectory and to improve the knowledge of sensory and motor organization within the thalamus.
A New Stereotactic Instrument for Use with Computerized Tomography and Magnetic Resonance Imaging
Authors: de A. Montagno E. , Nashold Jr. B.S.
Published: March 2007

The new stereotactic instrument has the advantages of (1) use with computerized tomography (CT) or magnetic resonance imaging (MRI) without special adaptations of instruments, (2) brain targets transferred directly from CT or MRI to apparatus, and (3) use with conventional stereotactic techniques. The apparatus is designed to meet present demands of neurosurgical facilities of good standards and capabilities, encompassing present and future developments towards more efficient and less invasive brain operations.
Experience in the First 100 Patients Undergoing Computerized Tomography-Guided Stereotactic Procedures Utilizing the Brown-Roberts-Wells Guidance System
Authors: Levin Allan B.
Published: March 2007

A series of 100 patients undergoing CT-guided stereotactic procedures for biopsy and/or drainage (n = 87), deep brain electrode placement (n = 9), endoscopy (n = 1), and functional lesioning (n = 3) was reviewed. Only 1 patient required general anesthesia. There were 4 procedural related hematomas, only 1 of which was sympto-matic. No other complications were encountered.
A New Apparatus for CT-Guided Stereotactic Surgery
Authors: Iseki H. , Amano K. , Kawamura H. , Tanikawa T. , Kawabatake H. , Notani M. , Shiwaku T. , Iwata Y. , Taira T. , Nagao H. , Umezawa Y. , Shimizu T. , Kitamura K.
Published: March 2007

Combining whole-body CT scan with a stereotactic system, the authors have developed and applied clinically an apparatus which readily provides intraoperative CT images, making it possible to confirm the location of the target point and ascertain the intraoperative environment. It takes about 9 s to obtain a CT image. Our purpose is to make stereotactic surgery, a kind of blind surgery, as safe and reliable as a visualized procedure by intraoperative CT scanning. By the method, in which there is very little invasion under local anesthesia, evacuation of deep-seated intracerebral hematomas as well as brain abscesses and also biopsy or brachytherapy of brain tumors in the brain can be done with safety and reliability.
Bioengineering Changes in Spastic Cerebral Palsy Groups following Cerebellar Stimulation
Authors: Davis Ross , Gray Edward , Ryan Thomas , Schulman Joseph
Published: March 2007

Quantitative bioengineering tests were performed on 30 spastic cerebral palsy (CP) patients who underwent chronic cerebellar stimulation (CCS) using the fully implantable pulse generator (Neurolith 601, 1.1–1.8 µC/cm2/phase). Using respiratory inductive plethysmography to measure 8 patients with paroxysmal and/or ataxic breathing patterns, 5 were shown to revert to normal with 3 others markedly improved within 5 months of CCS. Compliance testing of the ankle was performed on 4 patients who showed improvement in 9 of the 16 tests performed. Motor performance ability was evaluated with 9 comprehensive tests in 17 patients. Following 1–2 weeks of CCS, 52% showed performance increases greater than 10%, increasing to 62% during the first year.
Stereotactic Interstitial Brachytherapy - Current Concepts and Concerns in Twenty Patients
Authors: Lunsford L. Dade , Deutsch Melvin , Yoder Virgil
Published: March 2007

Recent advances in imaging and stereotactic techniques have resulted in wider application of interstitial brachytherapy (IBT) for brain tumors. The advantages of brachytherapy alone or in combination with teletherapy have been detailed, and may be responsible for increasing survival time. We report the preliminary results of 20 patients who underwent CT stereotactic IBT for malignant brain tumors. Despite both old and recent evidence about the effïcacy of IBT, concerns remain about the proper grade neoplasm, the target, the dose, and the timing for treatment. Current usage of IBT should be limited to centers with both stereotactic and radiotherapeutic expertise, and where the risks and benefïts are being investigated.
Treatment of Low Malignancy Brain Neoplasms by Means of Stereotactic Interstitial Radiotherapy
Authors: Frank F. , Fabrizi A.P. , Frank-Ricci R. , Sturiale C. , Nuzzo G.
Published: March 2007

The authors report their results of 37 patients with low malignancy brain tumors seated in deep or highly functional areas not amenable to traditional surgery, nor to conventional radiochemotherapy. In the past 5 years these patients were treated by means of stereotactic interstitial radiotherapy. The isotope employed in all cases was 125I. Stereotactic radioisotope implants were always preceded by multiple stereotactic biopsies affording precise histological diagnoses. A 6-month to 5-year follow-up shows a survival rate of 72.6% (29 patients), and of these patients, 80.9% (26 out of 29) had complete social reentry.
Epileptogenic Cerebral Low-Grade Tumors: Effect of Interstitial Stereotactic Irradiation on Seizures
Authors: Rossi G.F. , Scerrati M. , Roselli R.
Published: March 2007

15 patients with various types of surgically inaccessible epileptogenic cerebral neuroepithelial tumors were treated with stereotactic interstitial irradiation. Epilepsy was improved in all cases, being abolished in 6 and markedly reduced in another 7. The effects which became apparent soon after the radioisotope implant persisted. Possible mechanisms of the phenomenon are discussed.
Central Nervous System Mechanisms for Pain Modulation
Authors: Willis Jr. W.D.
Published: March 2007

Although a great deal has been learned about the neural basis for stimulation-produced analgesia, it is evident that the ‘analgesia systems’ are much more complex than was initially thought. Part of the complexity derives from the fact that a number of different pathways, using several different neurotransmitters, can affect nociceptive transmission. Further complexity sterns from evidence that nociceptive transmission can be modulated both at a spinal cord level and at higher levels of the nociceptive projection system, such as the thalamus. Hopefully, a greater understanding of the ‘analgesia system’ will lead to explanations for a number of puzzling aspects of pain and perhaps to improved therapy.
Possible Neurohumoral Mechanisms in CNS Stimulation for Pain Suppression
Authors: Meyerson B.A. , Brodin E. , Linderoth B.
Published: March 2007

Improved knowledge about biochemical mechanisms underlying pain suppression by CNS electric stimulation is one condition for the further advancement of this form of treatment. In 6 patients treated with PVG stimulation and in 14 with spinal cord stimulation the concentration of substance P-like immunoreactivity in lumbar CSF increased significantly following stimulation. However, these changes may be unspecific and not directly related to the suppression of pain. Measurements of somatostatin, cholecystokinin, vasoactive intestinal polypeptide, neurotensin and monoamine metabolites in CSF showed no changes related to stimulation and the ensuing pain relief. Possible reasons for these negative findings are discussed.
Enhancement of Memory with Human Ventrolateral Thalamic Stimulation: Effect Evident on a Dichotic Listening Task
Authors: Ojemann George A.
Published: March 2007

Previous experience with left ventrolateral thalamic (VL) stimulation during visually presented language and verbal memory tasks has shown that stimulation at the time information enters memory increases the accuracy of subsequent recall. The present study investigated the effects of VL stimulation on an auditory dichotic listening task. A similar effect was identified with significantly more words presented during left VL stimulation subsequently correctly reported, compared to words presented in the absence of stimulation, or with right VL stimulation. No significant effects on the ratios of correct responses from opposite ears were observed.
Spinal versus Intraventricular Chronic Opiate Administration with Implantable Drug Delivery Devices for Cancer Pain
Authors: Lazorthes Y. , Verdie J.C. , Bastide R. , Lavados A. , Descouens D.
Published: March 2007

Early publications have separately reported the efficacy, specificity and conservative character of direct spinal and intraventricular morphine analgesia in the treatment of intractable cancer pain. The objectives of this study are to compare efficacy and safety of these sites of local administration in order to determine the indication for each, the clinical effects of different opiates and the choice of various drug administration devices.
Further Experience in Stereotactic Pontine Tractotomy
Authors: Hitchcock Edward , Kim M.C. , Sotelo M.
Published: March 2007

The problem with percutaneous and even stereotactic cordotomy is the difficulty in obtaining sufficiently high analgesic levels without autonomie complications, although the problem seemed to apply to relatively few patients since percutaneous and stereotactic spinal procedures achieved sufficiently high analgesic levels to encompass most patients’ pain. There is a group of patients, however, with high pain in the shoulder and neck where conventional percutaneous and stereotactic spinal procedure are dangerous. From the standpoint of achieving high levels of analgesia with a low incidence of dysaesthesia, pontomedullary lesions appear to have advantages.
Therapeutic Approach to the Pancoast Pain Syndrome
Authors: Esposito S. , Bruni P. , Delitala A. , Canova A. , Hernandez R. , Callovini G.M.
Published: March 2007

The incidence of the Pancoast syndrome ranges from 2 to 5% of patients with lung cancer. We treated 20 cases between 1979 and 1984 with 29 procedures including percutaneous cordotomy, selective posterior radiculotomy, decompressive laminectomy, central administration of opiates, and TENS. Selective posterior radiculotomy gave the best pain relief.
Stereotactic Mesencephalic Tractotomy in the Treatment of Pancoast Syndrome
Authors: Frank F. , Sturiale C. , Gaist G. , Fabrizi A.P. , Frank-Ricci R.
Published: March 2007

A series of 38 patients with Pancoast syndrome treated by means of stereotactic mesencephalic tractotomy (SMT) is presented. The immediate postoperative results were good in all patients with complete pain relief, and without any impairment of respiratory function (in contrast to percutaneous cervical cordotomy). After 1–7 months’ follow-up the analgesic effect was unchanged in 33 (86.8%) out of 38 patients. Six patients (15.7%) showed recurrence of pain on the same side, while 4 patients (10.5%) presented contralateral pain. Immediate postoperative side effects of oculomotor palsy (18.4%) and dysesthesias (28%) remained unchanged at follow-up in 6 patients (16%). The intervention was well tolerated by all patients, and there was no mortality.
Plastic Change of Thalamic Organization in Patients with Tremor after Stroke
Authors: Ohye C. , Shibazaki T. , Hirai T. , Kawashima Y. , Hirato M. , Matsumura M.
Published: March 2007

Thirteen patients with tremor after stroke were treated by stereotactic thalamotomy. Prior to making therapeutic lesions, microrecordings were tried and the findings were compared with our own results obtained in Parkinson’s disease. Several characteristic features were revealed in terms of changes in electrical activity in and around the thalamic Vim nucleus. These findings support the idea that reorganization of the thalamic sensory nuclei might take place.
Cross-Correlation Analysis of Thalamic Neurons and EMG Activity in Parkinsonian Tremor
Authors: Lenz F.A. , Tasker R.R. , Kwan H.C. , Schnider S. , Kwong R. , Murphy J.T.
Published: March 2007

Bursting activity in cells cross-correlated with electromyographic (EMG) activity during parkinsonian tremor. Statistically significant evidence of cross-correlation was found for 49% of cells located at the lesion target for relief of tremor. Statistically significant correlation was found for 90% of cells having tremor frequency power greater than twice ‘average power’ at nontremor frequencies. This population of cells may be involved in the generation of parkinsonian tremor.
Spasmodic Head Movements Produced by Destruction of Unilateral Ventromedial Tegmentum in Cats
Authors: Mori Kazuo , Shimabukuro Haruhiro , Yamashiro Katsumi , Miyake Hitoshi , Kawano Teruaki
Published: March 2007

In cats, unilateral electrolytic destruction in the dorsomedial parts of the ventral tegmental area (VTA) (Tsai) led to the appearance of torticollic rotatory head postures associated with a marked drop of the corresponding caudate serotonin. Results obtained from fluorescence histochemistry and brain dialysis also revealed that decrease in serotonin shared the leading role. However, since a chemical lesion produced by neurotoxic agents failed to induce such abnormal postures, concomitant interruption of nonaminergic fibers at VMT might also be the essential factor. Among them the interstitial nucleus (Cajal) and its descending tract were the most suspicious.
Phrenic Nerve Stimulation (Diaphragm Pacing) in Respiratory Paralysis
Authors: Fodstad H. , Andersson G. , Blom S. , Linderholm H.
Published: March 2007

Phrenic nerve stimulators (diaphragm pacers) were implanted in 16 pa-tients with partial or total respiratory insufficiency due to high cervical medullary lesions and brain stem lesions (14 cases) or central hypoventilation syndrome (2 cases). At 5–72 months'' follow-up (M=35) 12 patients are entirely independent of conventional respirator, 2 of them after 8 years of total respirator dependency. Two patients are dead and the fïnal 2 cases had limited help from diaphragm pacing.
Management of Non-Malignant Chronic Pain Using Stimulators
Authors: Vijaya G. , Balasubramaniam C. , Kanaka T.S.
Published: March 2007

A transcutaneous nerve stimulator was used for the management of 220 patients with chronic non-malignant pain and has a defïnite role in the management.
Dynamic EEG Topography and Analysis of Epileptic Spikes and Evoked Potentials following Thalamic Stimulation
Authors: Takahashi Hiroshi , Yasue Masaharu , Ishijima Buichi
Published: March 2007

Dynamic EEG topography is used to study evoked potentials following thalamic stimulation as well as epileptic spikes and spike-wave complexes during stereotactic operations. Dynamic EEG topography is an effective method for displaying the distribution pattern of evoked potentials following thalamic stimulation. This technique makes it possible to observe successive increases in augmenting responses and to define the localization of epileptic foci.
CT-Guided Stereotactic Aspiration of Intracerebral Hematoma – Result of a Hematoma-Lysis Method Using Urokinase
Authors: Niizuma Hiroshi , Otsuki Taisuke , Johkura Hidefumi , Nakazato Nobukazu , Suzuki Jiro
Published: March 2007

CT-guided stereotactic aspiration was performed in the CT room on 97 patients with hypertensive intracerebral hematomas, using a Standard ventricular cannula. Residual hematomas were liquefïed by urokinase and aspirated through the drainage tube. Major and minor rebleeding were seen in 7 cases. Two out of the 4 major rebleeding cases were followed by craniotomy, while the other cases were treated conservatively. More than 80% of the hematomas were aspirated in 68 cases, 50–70% in 19 cases and 30–40% in 6 cases. Operation in the CT room and hematoma lysis with urokinase is very useful for the aspiration of intracerebral hematomas.
CT-Guided Stereotactic Surgery for Evacuation of Hypertensive Intracerebral Hematoma
Authors: Tanikawa T. , Amano K. , Kawamura H. , Kawabatake H. , Notani M. , Iseki H. , Shiwaku T. , Nagao T. , Iwata Y. , Taira T. , Umezawa Y. , Shimizu T. , Kitamura K.
Published: March 2007

During the last 3 years, 46 cases of hypertensive intracerebral hemorrhage were treated by CT-guided stereotactic surgery. Our present report is concerned with the evaluation of this procedure in the treatment of hypertensive intracerebral hematoma, in terms of the rate of aspirated hematoma and follow-up study of patients. It is difficult to draw any definite conclusion about the operative indications. CT-guided stereotactic aspiration, however, can be evaluated as a less invasive and more definitive treatment of intracerebral hematoma in the basal ganglia and thalamus.
Physiological Monitoring of Stereotactic Biopsy
Authors: Tasker R.R.
Published: March 2007

It is helpful to have direct confirmation during a CT-guided stereotactic procedure that the intended target has been reached without operating under imaging. This can be simply accomplished with readily available equipment by serial monitoring of electrical impedance as a probe is directed to the target because the impedance of hematomas, cysts, and most neoplasms is conspicuously below that of normal brain.
Diagnosis and Treatment of Brainstem Mass Lesions by CT-Guided Stereotactic Surgery
Authors: Coffey R.J. , Lunsford L.D.
Published: March 2007

Current neuroradiographic techniques including computed tomographic scanning (CT) and magnetic resonance imaging (MRI) when added to the clinical neurologie examination can localize precisely even small lesions within the brainstem. While the clinical-radiographic diagnosis is accurate with respect to locale, it is often in error with respect to the pathologic nature of the solitary brainstem lesion. Therefore, empiric treatment without the benefit of a tissue diagnosis will often be inappropriate. CT-guided stereotactic surgery can safely and reliably provide a tissue diagnosis in such cases. Furthermore, in selected cases, therapeutic interventions can be of substantial and lasting benefit to the patient.