bluuebunny/crossref_metadata_2025 huggingface dataset:
A new portable monitor for measuring odorous compounds in oral, exhaled and nasal air
Authors: Tamaki Naofumi , Kasuyama Kenta , Esaki Mitsue , Toshikawa Takara , Honda Shun-Ichi , Ekuni Daisuke , Tomofuji Takaaki , Morita Manabu
Published: April 2011

Background

The B/B Checker®, a new portable device for detecting odorous compounds in oral, exhaled, and nasal air, is now available. As a single unit, this device is capable of detecting several kinds of gases mixed with volatile sulfur compounds (VSC) in addition to other odorous gasses. The purpose of the present study was to evaluate the effectiveness of the B/B Checker® for detecting the malodor level of oral, exhaled, and nasal air.

Methods

A total of 30 healthy, non-smoking volunteers (16 males and 14 females) participated in this study. The malodor levels in oral, exhaled, and nasal air were measured using the B/B Checker® and by organoleptic test (OT) scores. The VSCs in each air were also measured by gas chromatography (GC). Associations among B/B Checker® measurements, OT scores and VSC levels were analyzed using Spearman correlation coefficients. In order to determine the appropriate B/B Checker® level for screening subjects with malodor, sensitivity and specificity were calculated using OT scores as an identifier for diagnosing oral malodor.

Results

In oral and nasal air, the total VSC levels measured by GC significantly correlated to that measured by the B/B Checker®. Significant correlation was observed between the results of OT scores and the B/B Checker® measurements in oral (r = 0.892, p < 0.001), exhaled (r = 0.748, p < 0.001) and nasal air (r = 0.534, p < 0.001). The correlation between the OT scores and VSC levels was significant only for oral air (r = 0.790, p < 0.001) and nasal air (r = 0.431, p = 0.002); not for exhaled air (r = 0.310, p = 0.096). When the screening level of the B/B Checker® was set to 50.0 for oral air, the sensitivity and specificity were 1.00 and 0.90, respectively. On the other hand, the screening level of the B/B Checker® was set to 60.0 for exhaled air, the sensitivity and specificity were 0.82 and 1.00, respectively.

Conclusion

The B/B Checker® is useful for objective evaluation of malodor in oral, exhaled and nasal air and for screening subjects with halitosis.

Trial registration

ClinicalTrials.gov: NCT01139073
Periostin identified as a potential biomarker of prostate cancer by iTRAQ-proteomics analysis of prostate biopsy
Authors: Sun Chuanyu , Song Chao , Ma Zhicheng , Xu Ke , Zhang Yang , Jin Hong , Tong Shijun , Ding Weihong , Xia Guowei , Ding Qiang
Published: April 2011

Background

Proteomics may help us better understand the changes of multiple proteins involved in oncogenesis and progression of prostate cancer(PCa) and identify more diagnostic and prognostic biomarkers. The aim of this study was to screen biomarkers of PCa by the proteomics analysis using isobaric tags for relative and absolute quantification(iTRAQ).

Methods

The patients undergoing prostate biopsies were classified into 3 groups according to pathological results: benign prostate hyperplasia (BPH, n = 20), PCa(n = 20) and BPH with local prostatic intraepithelial neoplasm(PIN, n = 10). Then, all the specimens from these patients were analyzed by iTRAQ and two-dimensional liquid chromatography-tandem mass spectrometry (2DLC-MS/MS). The Gene Ontology(GO) function and the transcription regulation networks of the differentially expressed were analyzed by MetaCore software. Western blotting and Immunohistochemical staining were used to analyze the interesting proteins.

Result

A total of 760 proteins were identified from 13787 distinct peptides, including two common proteins that enjoy clinical application: prostate specific antigen (PSA) and prostatic acid phosphatase(PAP). Proteins that expressed differentially between PCa and BPH group were further analyzed. Compared with BPH, 20 proteins were significantly differentially up-regulated (>1.5-fold) while 26 were significantly down-regulated in PCa(<0.66-fold). In term of GO database, the differentially expressed proteins were divided into 3 categories: cellular component(CC), molecular function (MF) and biological process(BP). The top 5 transcription regulation networks of the differentially expressed proteins were initiated through activation of SP1, p53, YY1, androgen receptor(AR) and c-Myc The overexpression of periostin in PCa was verified by western blotting and immunohistochemical staining.

Conclusion

Our study indicates that the iTRAQ technology is a new strategy for global proteomics analysis of the tissues of PCa. A significant up-regulation of periostin in PCa compared to BPH may provide clues for not only a promising biomarker for the prognosis of PCa but also a potential target for therapeutical intervention.
Recipient screening in IVF: First data from women undergoing anonymous oocyte donation in Dublin
Authors: Walsh Anthony PH , Omar Ahmed B , Marron Kevin D , Walsh David J , Salma Umme , Sills E Scott
Published: April 2011

Background

Guidelines for safe gamete donation have emphasised donor screening, although none exist specifically for testing oocyte recipients. Pre-treatment assessment of anonymous donor oocyte IVF treatment in Ireland must comply with the European Union Tissues and Cells Directive (Directive 2004/23/EC). To determine the effectiveness of this Directive when applied to anonymous oocyte recipients in IVF, we reviewed data derived from selected screening tests performed in this clinical setting.

Methods

Data from tests conducted at baseline for all women enrolling as recipients (n = 225) in the anonymous oocyte donor IVF programme at an urban IVF referral centre during a 24-month period were analysed. Patient age at programme entry and clinical pregnancy rate were also tabulated. All recipients had at least one prior negative test for HIV, Hepatitis B/C, chlamydia, gonorrhoea and syphilis performed by her GP or other primary care provider before reproductive endocrinology consultation.

Results

Mean (±SD) age for donor egg IVF recipients was 40.7 ± 4.2 yrs. No baseline positive chlamydia, gonorrhoea or syphilis screening results were identified among recipients for anonymous oocyte donation IVF during the assessment interval. Mean pregnancy rate (per embryo transfer) in this group was 50.5%.

Conclusion

When tests for HIV, Hepatitis B/C, chlamydia, gonorrhoea and syphilis already have been confirmed to be negative before starting the anonymous donor oocyte IVF sequence, additional (repeat) testing on the recipient contributes no new clinical information that would influence treatment in this setting. Patient safety does not appear to be enhanced by application of Directive 2004/23/EC to recipients of anonymous donor oocyte IVF treatment. Given the absence of evidence to quantify risk, this practice is difficult to justify when applied to this low-risk population.
Sparse estimation for structural variability
Authors: Hosur Raghavendra , Singh Rohit , Berger Bonnie
Published: April 2011

Background

Proteins are dynamic molecules that exhibit a wide range of motions; often these conformational changes are important for protein function. Determining biologically relevant conformational changes, or true variability, efficiently is challenging due to the noise present in structure data.

Results

In this paper we present a novel approach to elucidate conformational variability in structures solved using X-ray crystallography. We first infer an ensemble to represent the experimental data and then formulate the identification of truly variable members of the ensemble (as opposed to those that vary only due to noise) as a sparse estimation problem. Our results indicate that the algorithm is able to accurately distinguish genuine conformational changes from variability due to noise. We validate our predictions for structures in the Protein Data Bank by comparing with NMR experiments, as well as on synthetic data. In addition to improved performance over existing methods, the algorithm is robust to the levels of noise present in real data. In the case of Human Ubiquitin-conjugating enzyme Ubc9, variability identified by the algorithm corresponds to functionally important residues implicated by mutagenesis experiments. Our algorithm is also general enough to be integrated into state-of-the-art software tools for structure-inference.
General metabolism of Laribacter hongkongensis: a genome-wide analysis
Authors: Curreem Shirly O , Teng Jade L , Tse Herman , Yuen Kwok-Yung , Lau Susanna K , Woo Patrick C
Published: April 2011

Background

Laribacter hongkongensis is associated with community-acquired gastroenteritis and traveler's diarrhea. In this study, we performed an in-depth annotation of the genes and pathways of the general metabolism of L. hongkongensis and correlated them with its phenotypic characteristics.

Results

The L. hongkongensis genome possesses the pentose phosphate and gluconeogenesis pathways and tricarboxylic acid and glyoxylate cycles, but incomplete Embden-Meyerhof-Parnas and Entner-Doudoroff pathways, in agreement with its asaccharolytic phenotype. It contains enzymes for biosynthesis and β-oxidation of saturated fatty acids, biosynthesis of all 20 universal amino acids and selenocysteine, the latter not observed in Neisseria gonorrhoeae, Neisseria meningitidis and Chromobacterium violaceum. The genome contains a variety of dehydrogenases, enabling it to utilize different substrates as electron donors. It encodes three terminal cytochrome oxidases for respiration using oxygen as the electron acceptor under aerobic and microaerophilic conditions and four reductases for respiration with alternative electron acceptors under anaerobic conditions. The presence of complete tetrathionate reductase operon may confer survival advantage in mammalian host in association with diarrhea. The genome contains CDSs for incorporating sulfur and nitrogen by sulfate assimilation, ammonia assimilation and nitrate reduction. The existence of both glutamate dehydrogenase and glutamine synthetase/glutamate synthase pathways suggests an importance of ammonia metabolism in the living environments that it may encounter.

Conclusions

The L. hongkongensis genome possesses a variety of genes and pathways for carbohydrate, amino acid and lipid metabolism, respiratory chain and sulfur and nitrogen metabolism. These allow the bacterium to utilize various substrates for energy production and survive in different environmental niches.
Sites of Origin of Primary Intracerebral Malignant Lymphoma
Authors: Shibata Shobu
Published: April 2011

With the aim of finding characteristics pointing to the primary site, computed tomography examination from 9 patients with primary brain malignant lymphoma (non-Hodgkin's lymphoma originating in the central nervous system, NHL-CNS) (5 single, 4 multiple lesions) were analyzed. The tumors were usually situated in the basal ganglia, corpus callosum, or cerebellum and were always in contact with either the ependyma of the ventricles or the subarachnoid space. Tumors with widespread infiltration of white matter surrounding the ventricles were characteristic of NHL-CNS. Microscopic examination of 3 autopsy cases revealed infiltration of the subependymal layer of the lateral ventricles and the third and fourth ventricles by lymphoma cells. The entire extent of the choroid plexus was invaded by tumor cells. There were multiple foci of similar cells invading the periventricular white matter. The subarachnoid space was filled with lymphoma cells. In many areas the Virchow-Robin spaces and pial-glial membranes were disrupted, and invasion of the underlying gray matter by tumor cells was seen. The ultrastructure of the blood vessels of NHL-CNS was compared with those in glial, nonglial, and metastatic brain tumors. The essential feature in NHL-CNS was fenestrated vessels. They resembled the blood vessels found in nonglial and metastatic brain tumors, but were distinctly different from those seen in glial tumors with nonfenestrated vessels. Although the following scheme in proposed with reservations, it could account for the sites of origin of NHL-CNS: lymphocytes located in the choroid plexus stroma or the subarachnoid space are activated, caused to proliferate, and finally become neoplastic. Then these cells migrate through the underlying parenchyma along the Virchow-Robin spaces and multiply until they present themselves as primary brain tumors.
The Growth of Cerebral Cavernous Angiomas
Authors: Pozzati Eugenio , Giuliani Giuliano , Nuzzo Giacomo , Poppi Massimo
Published: April 2011

The natural history of cavernous angiomas is poorly understood, and their growth has rarely been documented. We report three cases of cavernous angiomas that grew to large size in 6 years, 2 years, and 2 months, respectively. An initial computed tomographic scan disclosed no abnormalities in one patient and demonstrated two “minimal” lesions in the other two. The mechanisms of growth of these lesions are discussed; subsequent hemorrhages and capsule formation played a major role in their enlargement.
Complications and Demographic Characteristics of Patients Undergoing Lumbar Discectomy in Community Hospitals
Authors: Ramirez Lincoln F. , Thisted Ronald
Published: April 2011

We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross-section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determing the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique.
Combination Jefferson Fracture of C1 and Type II Odontoid Fracture Requiring Surgery: Report of Two Cases
Authors: Deen Gordon H. , Tolchin Sidney
Published: April 2011

Two cases of simultaneous Jefferson fracture of C1 and Type II odontoid fracture requiring surgical stabilization are reported. One patient required early stabilization because alignment could not be maintained in a halo vest, and the second patient required late stabilization for nonunion after a 3-month period of immobilization in a two-poster cervical brace. Although this uncommon injury can often be managed conservatively, surgical fusion will need to be considered in the setting of early or late instability.
Anatomic Evaluation of Cisternal Puncture
Authors: Ward Em , Orrison William W. , Watridge Clarence B.
Published: April 2011

Cisternal puncture, although less frequently used since the advent of computed tomography and magnetic resonance imaging, is an important tool in the neurodiagnostic armamentarium. An anatomic study of cisternal puncture was conducted on fresh cadavers by direct visualization and fluoroscopic guidance of cisternal puncture. Anatomic and radiographic analyses demonstrated a dramatic dynamic anatomy of the cisternal space during cisternal puncture and indicated that “tenting” of the dura mater over the needle occurs reliably during cisternal puncture. Lateral fluoroscopy may decrease the risk of cisternal puncture by allowing visualization of needle depth in the cisternal space.
Permanent High-Activity Iodine-125 in the Management of Petroclival Meningiomas: Case Reports
Authors: Kumar Pradeep P. , Good Roger R. , Patil Angelo A. , Leibrock Lyal G.
Published: April 2011

Two cases of petroclival meningiomas are reported wherein the tumors were completely destroyed without surgical resection or external-beam irradiation by means of permanent stereotactic implantation of one or two high-activity iodine-125 seeds.
Partial Section of the Corpus Callosum: Focal Signs and Their Recovery
Authors: Castro-Caldas Alexandre , Poppe Patricia , Antunes João Lobo , Campos Jorge
Published: April 2011

A 30-year-old woman underwent surgical partial callosotomy (posterior half) for removal of an arteriovenous malformation. The patient submitted to neuropsychological evaluation before and after surgery for a period of 8 months. There was transient dysfunction attributable to disconnection of parietal, temporal, and occipital connections. Because the symptoms disappeared over time, we conclude that the transcallosal surgical approach can, in the long term, be considered a relatively harmless method.
Primary Intrasellar Microgerminoma Detected by Magnetic Resonance Imaging: Case Report
Authors: Oishi Mariko , Iida Takaharu , Koide Misako , Akazawa Yoshiharu , Azuma Yoshie , Fujisawa Ichiro , Takeuchi Juji
Published: April 2011

A case of primary intrasellar germinoma in a 24-year-old woman is presented. Her initial symptoms were diabetes insipidus and headaches. The neurological examination found no abnormalities, but the endocrinological examination disclosed a deficiency in growth hormone secretion. Her skull x-ray revealed a normal sella turcica, and a computed tomographic scan revealed no abnormal mass in the pituitary fossa, but a slightly enlarged stalk. Magnetic resonance imaging revealed a small tumor in the posterior lobe. Transsphenoidal exploration revealed a germinoma in the posterior pituitary lobe. Six cases of primary intrasellar germinoma, including our case, were reviewed. Our case is considered to be the smallest intrasellar germinoma yet reported.
Transoral Repair of a Rare Basioccipital Meningocele in a Neonate: Case Report
Authors: Azizkhan Richard G. , Cuenca Rosa E. , Powers Stephen K.
Published: April 2011

An extremely rare case of a basioccipital meningocele causing obstruction of the upper airway in a neonate is described. A transoral approach was used to remove the meningocele and repair the dural fistula. Bilateral posterior lateral pharyngeal releasing incisions were made to allow mucosal and muscle coverage over the dural repair. This report demonstrates and emphasizes the use of lateral pharyngeal releasing incisions to cover midline full thickness defects in the posterior oropharyngeal wall that might be encountered during transoral transclival operations.
Anterior Cervical Fusion and Caspar Plate Stabilization for Cervical Trauma
Authors: Caspar Wolfhard , Barbier Dragos D. , Klara Peter M.
Published: April 2011

A technique for anterior cervical iliac graft fusion with standardized, commercially available screw and plate fixation (Caspar plating) has been developed. The step-by-step procedure, as well as the instruments designed to facilitate the procedure, are described in this report. Sixty cases of cervical trauma (fractures, subluxations, ligamentous instability, or a combination of these problems) were treated with Caspar plating. All patients obtained fusion, and stability was achieved immediately after surgery without external stabilization. No unusual surgical complications occurred, and the most dreaded complication of dural penetration by drilling or screw placement was not observed. This report details the neurological presentation, anatomical lesions, surgical therapy, and outcome of these patients. Caspar plating combines the advantage of an anterior surgical approach with immediate postoperative stabilization without external stabilization. This advantage persists even in the presence of posterior ligamentous instability. The technique is an important addition to the surgical treatment of cervical trauma.
Fixation of Fractures of the Lower Cervical Spine Using Methylmethacrylate and Wire: Technique and Results in 99 Patients
Authors: Branch Charles L. , Kelly David L. , Davis Courtland H. , McWhorter J. M.
Published: April 2011

Surgical stabilization of traumatic fracture-dislocations of the lower cervical spine with wire and methylmethacrylate remains a controversial procedure. Yet, the resultant immediate fixation with minimal patient morbidity seems to indicate that this method provides an ideal stabilization construct. We describe and report the outcome of a technique of posterior cervical fixation with methylmethacrylate and wire for stabilization of traumatic fractures of the lower cervical spine. Over a 12-year period, 124 fracture-dislocations of the lower cervical spine in 99 patients (mean age, 32 years; range, 15-76 years) were treated at this institution using a posterior methylmethacrylate and wire technique. Eighty-two patients had a posterior element fracture; 28 had a vertebral compression with posterior ligamentous injury; and 14 had a ligamentous injury alone. Thirty-six patients were neurologically intact upon admission, while the rest had radiculopathy or partial or complete myelopathy. Ninety-one patients were available for follow-up [mean, 18.6 months; range, 1-100 months (8.33 years)]. Eighty-eight patients (97%) had a stable fixation and 77 (85%) had resumed preoperative activity or were working but with a residual deficit. Complications included fixation failure requiring a second operation in 3 patients, nonlethal pulmonary embolism in 2 patients, lethal pulmonary embolism in 1 patient, and a superficial wound infection in 3 patients (none affected the underlying fixation construct). These results indicate that this technique is a safe, simple, and effective method for stabilizing the lower cervical spine that allows rapid patient mobility with minimal morbidity.
Hemangioma of the Peroneal Nerve: Case Report and Review of the Literature
Authors: Bilge Turgay , Kaya Aziz , Alatli Metin , Bilge Semra , Alatli Canan
Published: April 2011

A case of hemangioma of the peroneal nerve is presented. The tumor, which exerted compression on the main trunk of the peroneal nerve, was excised without causing damage to the nerve. Symptoms due to compression vanished within a month, and there was no recurrence in the 14 months that followed.
Klippel-Feil Syndrome in Association with a Craniocervical Dermoid Cyst Presenting as Aseptic Meningitis in an Adult: Case Report
Authors: Diekmann-Guiroy Bernadette , Huang Peter S.
Published: April 2011

Intracranial tumors associated with Klippel-Feil syndrome usually occur in children, with spinal tumors being more common in adults affected by the syndrome. A rare case of a dermoid cyst at the craniocervical junction presenting as aseptic meningitis in an adult with Klippel-Feil syndrome is described. A review of the literature on tumors associated with this syndrome is also presented.
[11C]l-Methionine Uptake in Gliomas
Authors: Derlon Jean-Michel , Bourdet Catherine , Bustany Pierre , Chatel Marcel , Theron Jacques , Darcel Francoise , Syrota Andre
Published: April 2011

Treatment of gliomas remains disappointing in spite of a great number of experimental biological data and of randomized therapeutic studies. This could be partly explained by the inefficiency of our conventional methods to assess the regional metabolism of these tumors. The use of positron emission tomography (PET) brings encouraging possibilities in this field. We report our preliminary experience of measuring regional cerebral methionine uptake with PET after intravenous injection of [11C]l-methionine. Twenty-two patients with histologically confirmed gliomas were studied. An ECAT II positron emission tomograph was used for scanning. The position of the plane was chosen to include a major section of the tumor in the reconstructed brain slice. The protocol required a two-step examination: 1) after injection of 15 to 25 mCi of [11C]l-methionine, 12 scans were performed over a period of 46 minutes; and 2) 18 hours later, regional cerebral blood volume was measured in the same slice after intravenous injection of 2 to 4 mCi of 68GaCl3. The tumoral region of interest was determined as being the area of maximum activity. For each patient we calculated the ratio, R, between the activity in this tumor region of interest and the activity in the contralateral healthy symmetric region of interest which was used as an “internal standard” for the same patient. We correlated the ratio R with the histological grading. In 22 patients, mean values of R were calculated for each tumor: Grade II (n = 5): R = 1.04 ± 0.27; Grade III (n = 5): R = 1.68 ± 0.22; and Grade IV (n = 12): R= 2.33 ± 0.86. Correlations between hypermetabolism and grading are highly significant for Grades II/III (P = 0.0045) and II/IV (P = 0.00019), but not for Grades II/IV (P = 0.3141). We assessed the effects of radiotherapy: in 3 glioblastomas studied before and after radiotherapy, a significant decrease of R was observed: from 2.84 ± 1.43 to 1.35 ± 0.05. In one Grade II glioma, there was no change. Last, we assessed the early effects of intra-arterial chemotherapy: 8 patients were studied before and after the first course of treatment with an intracarotid injection of 1,3-bis-(2-chloroethyl)-l-nitrosourea (BCNU). Early modifications of R were correlated with clinical evolution after completion of treatment (intracarotid BCNU every 6 weeks). Despite a patient in whom a dramatic decrease of R was followed by a long survival with normalization of the computed tomographic scan, no significant correlation could be displayed between modifications in R and the length of survival. This approach will have to be developed in future studies.
Vertex Epidural Hematomas
Authors: Guha Abhijit , Perrin Richard G. , Grossman Harvey , Smyth Harley S.
Published: April 2011

Four cases of vertex epidural hematomas are presented to illustrate the unique management problems which set them apart from their more common counterparts located over the temporal convexity. Diagnosis requires a high degree of suspicion as vertex epidural hematomas are often missed by conventional horizontal scanning. Coronal computed tomographic scanning should be undertaken in all suspected cases. Clinical symptoms exceeding the small volume of clot may be present due to venous obstruction and disruption of cerebrospinal fluid absorption. Evacuation of the clot usually leads to clinical improvement.
Bilateral Extradural Hematomas in a Thrombocytopenic Infant Receiving Anticoagulants: Case Report
Authors: Grabel Jordan C. , Sacher Michael , Rothman Allen S.
Published: April 2011

A unique case of bilateral extradural hematomas in an infant is reported. Relevant aspects of the patient's history, including the absence of any known trauma and the presence of an underlying coagulopathy are discussed. The radiographic and operative findings of this case are presented, and an explanation of the mechanism of the hematomas is offered.
Calvarial Tuberculosis: A Report of Two Cases
Authors: Gupta P. K. , Kolluri Sastry V. R. , Chandramouli B. A. , Venkataramana N. K. , Das B. S.
Published: April 2011

Two cases of calvarial tuberculosis associated with neurological involvement are presented. The radiological features and therapeutic management are discussed and the literature is reviewed.
Sacral and Presacral Tumors: Problems in Diagnosis and Management
Authors: Feldenzer John A. , McGauley James L. , McGillicuddy John E.
Published: April 2011

We reviewed 9 cases of sacral tumors with presacral extension. These included 2 chordomas. 1 metastatic renal cell carcinoma, 2 schwannomas (1 malignant, 1 benign), 1 neurofibroma, 1 neurofibrosarcoma, 1 aneurysmal bone cyst, and an exceedingly rare meningioma. The sex of the patients was not significant. The age of the patients at diagnosis ranged from 13 to 68 years (mean, 47 years). Initial symptoms of low back and radiating leg pain were present in all but 1 patient. The duration of symptoms prior to diagnosis ranged from 1 month to 9 years (mean, 2.6 years). A delay in diagnosis of 2 years or more occurred in 6 of the 9 patients. Progressive perineal numbness and/or sphincter dysfunction were seen in 6 patients, and a palpable rectal mass was noted in 6 of 9 patients. The efficacy of various diagnostic tests is presented, as are the surgical options—needle biopsy and anterior and posterior approaches. Despite improved radiographic imaging techniques, these unusual tumors are often diagnosed at an advanced stage, and may masquerade as discogenic radiculopathy. Late diagnosis contributes to the difficulty of surgical extirpation. Anterior and posterior surgical approaches involving general, orthopedic, and urological surgeons may be required.
The Use of Electroencephalography and Brain Protection during Operation for Basilar Aneurysms
Authors: Muizelaar Paul J.
Published: April 2011

Intraoperative monitoring with electroencephalography and the use of brain protection with steroids, phenytoin, mannitol, and pentobarbital or etomidate were evaluated in 15 patients undergoing operation for an aneurysm of the upper basilar artery. One patient harbored a basilar trunk aneurysm, 1 an aneurysm of the proximal posterior cerebral artery, 3 an aneurysm of the superior cerebellar artery, and 10 an aneurysm at the basilar tip. The size of the aneurysms varied between 5 and 30 mm. Subarachnoid hemorrhage was the symptom exhibited in 12, mass effect the symptom in 2, and 1 patient was asymptomatic but had an angiogram because of amaurosis. There were 9 patients with multiple aneurysms, 5 of whom had aneurysms of the bilateral anterior circulation. Four patients underwent operation early. In 2 patients, the basilar artery was the sole or main blood supply of the whole brain. All patients except the one with the basilar trunk aneurysm were operated on via a transsylvian approach. All patients received 500 to 800 mg of phenytoin and 10 to 20 mg of dexamethasone shortly before and during surgery, and mannitol (0.8 g/kg) 15 minutes before the induction of hypotension or temporary clipping. Three patients showed slowing of electrical activity over the right hemisphere as a result of retraction of the internal carotid artery; with repositioning of the retractor, this disappeared within 10 minutes. Electrocortical silence was induced in 8 patients; this was in anticipation of prolonged moderate hypotension in 2, short deep hypotension in 2, temporary clipping of major vessels—including the basilar artery—in 2, and a combination of deep hypotension combined with temporary clipping in 2. At present, etomidate is preferred over thiopental for inducing electrocortical silence because it has no cardiovascular depressant effects, even in massive doses. Three patients awoke with contralateral hemiparesis, 2 of whom had spontaneous changes in the electroencep halogram and 1 in whom electrocortical silence was present for 1 hour. In all 3 patients, the electroencephalogram had returned to normal by the end of the operation, and the hemiparesis had completely resolved within 4 hours. One patient, in whom the basilar artery itself had ruptured and had to be occluded permanently, died. One patient, whose status was Grade 4 when operation was performed on Day 25, remained severely disabled. All other patients made a good recovery. The electroencephalogram was helpful in 10 cases (67%), and it allowed the surgeon to operate without stress in an unhurried manner and, when combined with pharmaceutical brain protection—even in the presence of deep hypotension—to perform temporary clipping.
Chordoma and Chondrosarcoma of the Cranial Base: An 8-Year Experience
Authors: Sen Chandra Nath , Sekhar Laligam N. , Schramm Victor L. , Janecka Ivo P.
Published: April 2011

Between 1980 and 1988, 8 patients with chordomas and 9 with low-grade chondrosarcomas involving the cranial base were treated. All the patients were investigated preoperatively and postoperatively with computed tomographic or magnetic resonance imaging scans, according to a standard protocol. The tumors and the involved bony structures were surgically removed in one or more operations using different operative approaches. Ten patients underwent postoperative radiation therapy, either at our institution or prior to their referral to us. Total removal was defined as the absence of identifiable tumor on magnetic resonance imaging or computed tomographic obtained 3 months postoperatively, and was accomplished in 9 patients. The ability to achieve total removal was greatly increased in patients with tumors that had not previously been operated on. We believe that these tumors must be treated by aggressive surgical resection when initially diagnosed, and this can be accomplished with low morbidity. The follow-up period in our patients was too short to allow us to determine whether such total removals can result in a cure or in long-term control of these formidable tumors.
Percutaneous Transfacial Needle Biopsy of a Middle Cranial Fossa Mass: Case Report and Technical Note
Authors: Stechison Michael T. , Bernstein Mark
Published: April 2011

A case of a patient with a middle fossa mass that was considered to be either a metastatic lesion or a benign intracranial neoplasm is presented. The definitive management of the patient depended on a tissue diagnosis. A biopsy was obtained using a transfacial needle aspiration technique through the foramen ovale. The details of this procedure are described.
Surgical and Electrophysiological Observations during Clipping of 134 Aneurysms with Evoked Potential Monitoring
Authors: Schramm Johannes , Koht Antoun , Schmidt Gerhard , Pechstein U. , Taniguchi M. , Fahlbusch Rudolf
Published: April 2011

Somatosensory evoked potentials (SEPs) were monitored during 113 operations for the clipping of 134 cerebral aneurysms. Changes in peak latency and amplitude of early cortical SEP as well as central conduction time were evaluated. In 58 cases surgical occlusion of arterial vessels or other events occurred, and in 17 of these cases such events were associated with SEP changes or loss. Arterial occlusions resulted from temporary clipping of a feeding blood vessel (22), accidental clipping of a vessel (12). and intentional permanent vessel occlusion (8). A total SEP loss was seen in 2 cases of accidental vessel occlusion and in 6 cases of temporary vessel clipping. Significant SEP changes were found in 6 patients with temporary clipping, and once each with retraction of the cerebellum, retraction of the middle cerebral artery, and after intentional permanent vessel occlusion. Response to these changes included reapplication of aneurysm clips, repositioning of retractors, or removal of temporary clips. Stable SEP signals during 13 cases allowed the surgeon to proceed with the surgical course. Despite the limitations of SEP monitoring in certain anatomical locations, it has been found to be helpful in the operative management of some cases such as multilobed aneurysms of the middle cerebral artery, giant aneurysms, trapping procedures, and procedures requiring temporary vessel occlusion. (Neurosurgery 26:61-70, 1990)
A Comparative Study in Opening and Closing Pressures of Cerebral Aneurysm Clips
Authors: Atkinson John L. D. , Anderson Robert E. , Piepgras David G.
Published: April 2011

Modern aneurysm clips with newer metallurgic properties and state-of-the-art designs have evolved through the years. Regretfully, manufacturers are still not required to provide product information regarding clip strength, and when such information is supplied, there is no interbrand consistency to how it is obtained. This experiment compares the closing pressures of 5 commonly used brands of aneurysm clips: Yasargil, Sugita, Sundt-Kees, Vari-Angle McFadden, and Heifetz. Interclip comparison is also made of opening pressures, that is, the arterial pressure required to open an aneurysm clip. Findings show a distinct difference in closing forces among these brands of aneurysm clips. The study of opening forces indicates that the important factors determining clip release or displacement were the failure of the clip to cross the vessel completely and intrinsic characteristics of the vascular wall. (Neurosurgery 26:80-85, 1990)
Intraoperative Determination of the Extent of Corpus Callosotomy for Epilepsy: Two Simple Techniques
Authors: Awad Issam A. , Wyllie Elaine , Luders Hans , Ahl Jennifer
Published: April 2011

There is increasing interest in staged corpus callosotomy for intractable generalized epilepsy. At the first procedure, a portion (usually the anterior two-thirds) of the corpus callosum is sectioned. If seizures persist, completion of callosotomy or alternative treatment approaches can be considered. It is obviously important to ascertain that the desired extent of callosotomy was in fact accomplished at the time of initial operation. Our experience and the published literature indicate that the surgeon's impression at operation can be erroneous. We describe a technique of determining extent of corpus callosotomy during the procedure. The magnetic resonance imaging (MRI) scan in the midsagittal plane is used to select the desired extent of callosotomy. That point on the corpus callosum is characterized using simple planar geometry in relation to three anatomic landmarks in that same plane: the glabella, the inion, and the bregma (midline intersection of the coronal suture). The same point along the corpus callosum can then be located on a lateral skull xray using these same three anatomic landmarks. At surgery, an intraoperative lateral skull x-ray is obtained with a marking clip, thereby verifying the actual extent of callosotomy. We have verified the reliability of this scheme in 5 callosotomy procedures and have used this technique for intraoperative localization of midline and parasagittal targets in another 7 cases (3 tumors, 2 aneurysms, and 2 placements of interhemispheric subdural grids). In addition, we reviewed corpus callosum topography on 25 randomly selected MRI scans. A perpendicular line bisecting the glabellainion line intersects the corpus callosum at a point near its two-thirds extent in every case. This allows a quick determination of the approximate two-thirds point along the corpus callosum by skull x-ray alone, without the need of an MRI scan. The use of the new technique and its simple modification for the two-thirds callosotomy allows a precise determination of the extent of corpus callosum section at surgery and should avoid unintended deviations from the desired procedure. (Neurosurgery 26:102-106, 1990)
Intracranial Mycotic Aneurysm in an Infant: Report of a Case
Authors: Lee Stuart K. , Liu Shih Sing , Spetzler Robert F. , Rekate Harold L.
Published: April 2011

Although mycotic aneurysms tend to occur with greater frequency in children than adults, few cases of intracranial infectious aneurysms have been reported in children less than 1 year of age. The case of a previously healthy 7-month-old patient who suffered intracerebral and subarachnoid hemorrhage from multiple aneurysms of the middle cerebral artery is reported. The aneurysms proved to be infectious, based on culture material obtained at surgery from the aneurysm contents and adjacent brain tissue. (Neurosurgery 26:129-133, 1990)
Recordings from Human Dorsal Column Nuclei Using Stimulation of the Lower Limb
Authors: Møller Aage R. , Jannetta Peter J. , Jho Hae Dong
Published: April 2011

Responses from the surface of the dorsal column nuclei and the dorsal surface of the spinal cord were recorded using monopolar electrodes after stimulation of the lower limbs (common peroneal nerve at the knee and posterior tibial nerve at the ankle) in patients undergoing neurosurgical operations for spasmodic torticollis. Those responses were smaller in amplitude than responses to stimulation of the upper limbs (median nerve at the wrist), and the waveforms differed. The negative deflection that is prominent in the response to stimulation of the upper limbs is more variable, broader, and relatively smaller in amplitude than the response to upper limb stimulation. Another difference between responses to upper and lower limb stimulation was that multiple peaks were superimposed on the initial response to stimulation of the lower limbs, but were not as consistently seen in the responses to upper limb stimulation. The negative peak in the response from the dorsal column nuclei to lower limb stimulation was of about the same latency as the P27peak in the far-field response (somatosensory evoked potential) to stimulation of the peroneal nerve.
The Management of Paralytic Spasticity
Authors: Herz David A. , Looman Janice E. , Tiberio Angela , Ketterling Kevan , Kreitsch Robert K. , Colwill John C. , Grin Oliver D.
Published: April 2011

The treatment of spasticity in severely paralyzed patients undergoing rehabilitation constitutes a significant neurosurgical challenge that requires comprehensive management. In this study, 118 patients were treated with invasive modalities when medical therapy failed. The results of percutaneous radiofrequency foraminal rhizotomy were initially successful in 95% of the 77 patients who underwent this procedure; the rate of minor complications was 5%. This procedure was satisfactorily supplemented with percutaneous radiofrequency sciatic neurectomy in 32 of these 77 patients. Four myelotomies were performed with complete success and no major complications in patients in whom percutaneous techniques had proven inadequate. In 35 instances of focal spasticity and incomplete paralysis, intramuscular neurolysis by phenol injection was used. The success rate was 89%. In 9 patients with persistent recurrent spasticity of the lower limb, open tenotomies and peripheral neurectomies were done. Success was complete and without complications. Multiple modalities must be available for the comprehensive management of patients with paralytic spasticity. (Neurosurgery 26:300-306, 1990)
Radiation-induced Meningioma after Treatment for Pituitary Adenoma: Case Report and Literature Review
Authors: Partington Michael D. , Davis Dudley H.
Published: April 2011

Radiation-induced meningiomas are becoming increasingly well-recognized. We report a case of a 35-year-old man who developed a suprasellar meningioma 9 years after receiving a radiation dose of 4480 cGy for a pituitary adenoma. The literature is also reviewed.
Long-term Intraventricular Infusion of Morphine for Intractable Pain in Cancer of the Head and Neck
Authors: Dennis Gary C. , DeWitty Robert L.
Published: April 2011

The authors' experience with seven patients with intractable pain that was treated by continuous intraventricular infusion of morphine through an implanted Infusaid pump is reported. The pain was caused by head and neck cancer in six patients and was associated with postpolio syndrome in one. The average follow-up was 7 months. Pain was effectively managed through intraventricular administration of a combination of morphine and mild oral narcotic analgesics. Complications included one case of transient respiratory depression, one pump pocket infection, and one pump failure. The morphine dose required to maintain analgesia increased over time in all patients treated. This is a safe and effective method of pain management in patients with head and neck cancer. It is useful as well in patients who have intractable pain that cannot be managed through an intrathecal route because of a contraindication to lumbar puncture or an inaccessible subarachnoid space.
A Clinical Evaluation of the Camino Subdural Screw and Ventricular Monitoring Kits
Authors: Chambers I. R. , Mendelow A. D. , Sinar E. J. , Modha P.
Published: April 2011

The aim of this study was to compare readings of intracranial pressure from a ventricular catheter with those obtained from a Camino catheter-tipped transducer. The Camino transducer was evaluated in two ways: firstly, when it was inserted by a subdural screw, and secondly, when it was inserted into a ventricular catheter using a ventricular monitoring kit. Data were recorded for 376 hours for the subdural screw method and for 486 hours for the ventricular monitoring kit. Average pressure readings were calculated every 5 minutes (10 half-minute values), and regression analysis was performed. For the subdural screw method, the correlation coefficient was 0.945 (gradient, 1.04; intercept, − 5.51. The results from the ventricular monitoring kit showed that the correlation coefficient was 0.901 (gradient, 0.93; intercept, −0.92. The correlation between recordings of ventricular fluid pressure and the Camino recordings obtained from both subdural screw insertions and ventricular monitoring kits was good, with the subdural screw method proving more accurate and reliable in clinical use.
The Diagnosis and Treatment of Pediatric Lumbar Spine Injuries Caused by Rear Seat Lap Belts
Authors: Johnson Dennis L. , Falci Scott
Published: April 2011

Over the past 3 years, during a time when seat belt use has increased, we have managed nine midlumbar spine fractures in children caused by standard rear seat lap belts. Children with a lap belt injury typically complained of abdominal and back pain, and the nature of their injuries was evident by the presence of a belt-shaped abrasion across the lower abdomen. Midlumbar spine fracture may be associated with paraplegia and life-threatening visceral injury. If the spine is analyzed as a beam, the full spectrum of the reported injuries is predictable. This study shows that the rear seat belts installed as standard equipment do not meet the special needs of children. Rear seat lap belts are better than no restraints, but the addition of a shoulder restraint is strongly advocated to reduce lumbar spine injury.
Metabolic and Hemodynamic Aspects of Peritumoral Low-Density Areas in Human Brain Tumor
Authors: Hino Akihiko , Imahori Yoshio , Tenjin Hiroshi , Mizukawa Norihiko , Ueda Satoshi , Hirakawa Kimiyoshi , Nakahashi Hisamitsu
Published: April 2011

With the use of positron emission tomography, regional cerebral blood flow, oxygen utilization, and glucose utilization were measured in the peritumoral low-density areas on x-ray computed tomographic images in 23 patients with supratentorial brain tumors: 7 meningiomas, 11 malignant gliomas, and 5 metastatic brain tumors. Findings on positron emission tomography in these areas revealed characteristic patterns associated with the types of tumor and the degree of mass effect. It is likely that two different types of pathophysiological states exist in “peritumoral edema”: 1) primary ischemia caused by mechanical compression by the tumor mass in meningiomas: and 2) primary metabolic suppression (mainly in oxygen metabolism) in malignant brain tumors.
Communicating Hydrocephalus in Adults: Prediction of Outcome after Ventricular Shunting Procedures
Authors: Benzel Edward C. , Pelletier Allen L. , Levy Pamela G.
Published: April 2011

A series of adult patients with idiopathic hydrocephalus in whom shunts were placed are presented. Preoperative diagnostic and prognostic criteria were evaluated. Findings on computed tomographic scans (significant ventricular enlargement, the absence of gyral atrophy, and the absence of sylvian fissure enlargement) and the clinical triad associated with hydrocephalus in adults (dementia, ataxia, and especially incontinence of urine) all contributed individually and in combination to the diagnosis of hydrocephalus that could be corrected by surgery. The use of radionucleotide cisternography did not add any additional information. Its use as a diagnostic or prognostic aid is, therefore, suspect. The use of high-pressure shunting systems for the initial shunting procedure is emphasized.