bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrocephalus in achondroplasia: the possible role of intracranial venous hypertension
Authors: Steinbok Paul , Hall Judith , Flodmark Olof
Published: May 2009

✓ The significance and cause of ventriculomegaly in achondroplasia was investigated in five achondroplastic children. The intraventricular pressure (IVP) was monitored over 24 hours, followed by intraventricular injection of radionuclide alone or in combination with water-soluble contrast material. The IVP was elevated and the reabsorption of cerebrospinal fluid (CSF) into the sagittal sinus was slow in all cases, but there was no obstruction to CSF flow. The spinal subarachnoid space was well seen in all patients. Jugular venograms with pressure monitoring were obtained in four patients (bilaterally in one). These studies confirmed a narrow jugular foramen in all patients with a significant venous pressure gradient (3 to 10 mm Hg) obtained while the catheter was being pulled back from the sigmoid sinus through the foramen. A second gradient was found in the jugular vein in two patients at the level of the upper thoracic aperture. This gradient was 6 and 14 mm Hg, respectively. Identical venograms and monitoring of the venous pressure in a control group showed no pressure gradients across the jugular foramen and smaller gradients (2 to 5 mm Hg) across the thoracic inlet.

It is concluded from these studies that ventriculomegaly in achondroplastic children represents hydrocephalus, which is likely secondary to raised intracranial venous pressure due to hemodynamically significant stenosis of the jugular foramen and, in some cases, the jugular vein in the thoracic aperture.
Proto-oncogene abnormalities and their relationship to tumorigenicity in some human glioblastomas
Authors: U Hoi Sang , Kelley Patricia Y. , Hatton James D. , Shew Jin Y.
Published: May 2009

✓ Human glioblastomas are highly malignant intracranial tumors, some of which demonstrate amplification of the epidermal growth factor-receptor (EGF-R) gene. Overexpression of this gene is seen in the majority of primary tumors; however, the role of the EGF-R gene in glial tumorigenesis is unknown. The authors explored the relationship between EGF-R gene expression and glioblastoma cell growth in vitro and in vivo and found that the level of EGF-R gene expression did not correlate with tumor cell growth either in soft agar or in the nude mouse. This suggests that the EGF-R gene is not involved in effecting direct growth stimulation in glial oncogenesis. Tumorigenesis involves differentiation arrest; therefore, the expression of several proto-oncogenes in neuroectodermal tumors was investigated to evaluate the potential involvement of the EGF-R gene in glial differentiation. A nonoverlapping expression of the N-myc and EGF-R genes was found in neuronal-derived and glial-derived tumors, respectively. This suggests that the EGF-R gene may be involved in differentiation or its arrest in glia.
Head injury mortality in two centers with different emergency medical services and intensive care
Authors: Colohan Austin R. T. , Alves Wayne M. , Gross Cynthia R. , Torner James C. , Mehta V. S. , Tandon P. N. , Jane John A.
Published: May 2009

✓ The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p < 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p < 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with “moderate” head injuries.
Quantification of the c-myc oncoprotein in human glioblastoma cells and tumor tissue
Authors: Engelhard Herbert H. , Butler Albert B. , Bauer Kenneth D.
Published: May 2009

✓ The identification of a quantifiable oncoprotein marker in glial cells could lead to its use as an aid in the diagnosis, grading, and treatment of tumors of glial origin. In this study, monoclonal antibodies to the c-myc oncoprotein were used in conjunction with immunofluorescence microscopy, flow cytometry, and immunoblot analysis to quantitate and characterize the expression of this oncoprotein in neoplastic and benign cultured glial cells and brain-tumor tissue.

Flow cytometric analysis revealed that the c-myc oncoprotein was highly expressed in neoplastic cell lines and in glioblastoma tumor specimens. In contrast, anti-c-myc oncoprotein staining was not present in a non-neoplastic glial cell line or in a benign brain tissue specimen. Immunoblot analysis revealed two distinct c-myc oncoprotein bands, having molecular weights of 64 and 75 kD. Densitometric determinations of the relative levels of the 64-kD protein were in good agreement with the determinations made by flow cytometry.

Flow cytometry was also used to relate the quantity of the c-myc oncoprotein present in the cells to their cell cycle phase. In the malignant cultured cells, the protein underwent an approximate twofold increase as the cells progressed from G1/G0 to G2/M in the cell cycle. The present results suggest that the c-myc oncoprotein may prove to be a useful marker for the proliferative status and/or malignancy of glial cells.
Primary intracranial leiomyosarcoma
Authors: Louis David N. , Richardson E. P. , Dickersin G. Richard , Petrucci Debra A. , Rosenberg Andrew E. , Ojemann Robert G.
Published: May 2009

✓ A case of primary intracranial leiomyosarcoma is presented, with clinical, radiological, light microscopic, immunohistochemical, and ultrastructural data. The histogenesis is discussed and the literature on smoothmuscle tumors of the central nervous system is reviewed.
Sparganosis of the spinal cord
Authors: Fung C. F. , Ng Thomas H. K. , Wong W. T.
Published: May 2009

✓ Sparganosis of the spinal cord is a rare disease: only two cases have previously been described. A third case of spinal sparganosis is reported in which a sparganum was removed from the central canal of the patient's spinal cord. The clinical presentation and pathology are described. A brief review of the life cycle of the Spirometra is given and the possible mode of infestation is discussed.
Heterogeneity and modulation of tumor-associated antigens in human glioblastoma cell lines
Authors: Colombatti Marco , Dipasquale Bruno , Del-l'Arciprete Lorena , Gerosa Massimo , Tridente Giuseppe
Published: May 2009

✓ Seven human glioblastoma cell lines established in vitro from primary tumor explants were studied. A marked heterogeneity of glial fibrillary acidic protein was observed whereas vimentin was uniformly expressed by all cell lines. Indirect immunofluorescence and flow cytofluorometry revealed a heterogeneous distribution of surface GE 2 and CG 12 tumor-associated antigens (TAA's): three cell lines were positive (> 69% TAA-positive cells) and three cell lines were negative (< 9% TAA-positive cells). One cell line (Hu 228) was moderately positive at early culture passages and subsequently acquired a TAA-negative phenotype. The difference in the relative amounts of surface TAA's of the three positive cell lines was less than twofold. In spite of the heterogeneous distribution of surface TAA's, all cell lines exhibited considerable amounts of intracellular TAA. Treatment with phorbol esters and density-dependent growth arrest decreased the percentage of the TAA-positive cells and the amount of cell-surface TAA's in one cell line (Hu 195). Interferon-γ treatment in vitro increased the percentage of CG 12-positive cells by 12% and the amount of cell-surface CG 12 antigens by 38% as compared to untreated cells. The percentage of TAA-positive cells among phorbol ester-treated cells of the Hu 195 cell line was lowest 48 hours after treatment, but returned to normal values within the next 48 hours. Reduction of 3H-thymidine incorporation preceded the decrease in number of TAA-positive cells by about 18 hours. Two-color fluorescence analysis performed in positive cell lines for simultaneous determination of surface TAA's and deoxyribonucleic acid content or reactivity with the proliferation-associated Ki67 intracellular marker indicated that GE 2 and CG 12 antigens are expressed preferentially by actively proliferating glioma cells. The results of this study indicate the existence of two different phenotypes in cultured human glioblastoma cells: surface TAA-positive/cytosol TAA-positive and surface TAA-negative/cytosol TAA-positive cell populations. In addition, modulation of TAA expression was dependent on the cell-cycle differentiation stage, culture conditions, and proliferative state of the cells.
Analysis of mixed lymphocyte-tumor culture in patients with malignant brain tumor
Authors: Yoshida Seiichi , Tanaka Ryuichi , Ono Masashi , Takai Nobuyuki , Saito Takafumi
Published: May 2009

✓ To ascertain whether tumor-specific immune response occurs in patients with malignant brain tumors, lymphocyte blastogenetic responses to tumor cells were examined in 18 patients prior to operation and other treatment. Among 12 patients with malignant glioma, the peripheral blood lymphocytes (PBL's) showed a positive blastogenetic response to their own glioma cells in seven (58.3%), whereas the tumor-infiltrating lymphocytes (TIL's) showed a positive response in only three (25%). In four (66.7%) of six patients with metastatic brain tumors, however, both the PBL's and TIL's showed a positive blastogenetic response to their own tumor cells. In these four patients, this lymphocyte blastogenetic response to tumor cells were at a much lower level compared with phytohemagglutinin P or allogeneic lymphocyte stimulation. Furthermore, these responses were increased when the cells were cultured with interferon-γ (500 U). Other lymphokines had no effect on the response. This method appears to be useful in identifying the tumor-specific immune response in patients with malignant brain tumor.
Changes in xanthine oxidase in ischemic rat brain
Authors: Kinuta Yuji , Kimura Mieko , Itokawa Yoshinori , Ishikawa Masatsune , Kikuchi Haruhiko
Published: May 2009

✓ Xanthine oxidase activity in the rat brain was measured by means of high-performance liquid chromatography with electrochemical detection of uric acid. Cerebral ischemia was produced by a four-vessel occlusion method. In the control rat, the enzyme activity was 0.87 ± 0.13 nmol/gm wet weight/min at 25°C (mean ± standard deviation), of which 92.4% was associated with the nicotinamide adenine dinucleotide (NAD)-dependent dehydrogenase form and only 7.6% with the oxygen-dependent superoxide-producing oxidase form. However, the ratio of the latter form increased to 43.7% after 30 minutes of global ischemia, despite the total xanthine oxidase activity remaining the same. Thus, it was revealed that uric acid can be synthesized in the rat brain and that cerebral ischemia induced the conversion of xanthine oxidase from an NAD-dependent dehydrogenase to an oxygen-dependent superoxide-producing oxidase. Although the xanthine oxidase pathway has been proposed as a source of oxygen-derived free radicals in various ischemic organs other than brain, the results of the present study suggest the involvement of the oxygen free radicals generated from this pathway in the pathogenesis of the ischemic injury of the rat brain.
Characterization of insulin-like growth factor I and epidermal growth factor receptors in meningioma
Authors: Kurihara Masaki , Tokunaga Yoshiharu , Tsutsumi Keisuke , Kawaguchi Tsutomu , Shigematsu Kazuto , Niwa Masami , Mori Kazuo
Published: May 2009

✓ Receptors for insulin-like growth factor I (IGF-I) and epidermal growth factor (EGF) were localized and characterized in eight samples of human meningioma (four fibrous, two meningothelial, and two angioblastic types), using quantitative autoradiographic techniques. Effects of both growth factors on deoxyribonucleic acid (DNA) synthesis in the cultured meningioma cells were examined. High numbers of specific binding sites for both IGF-I and EGF were homogeneously present in tissue sections derived from fibrous and meningothelial types of meningiomas, whereas binding sites for these growth factors were not detectable in adjacent leptomeninges. While relatively large numbers of IGF-I binding sites were located in the wall of the intratumoral vasculature, the number of binding sites in the stromal component was lower in angioblastic-type meningiomas, including a low number of EGF binding sites detected only in the stromal portion. Scatchard analysis revealed the presence of a single class of high-affinity binding sites for both IGF-I and EGF in the meningiomas examined (dissociation constant (Kd) = 0.6 to 2.9 nM, and the maximum number of binding sites (Bmax) = 16 to 80 fmol/mg for IGF-I; and Kd = 0.6 to 4.0 nM, Bmax = 3 to 39 fmol/mg for EGF). Both growth factors increased the synthesis of DNA, in a dose-dependent manner, as measured by 3H-thymidine incorporation. The combination of IGF-I and EGF synergistically stimulated the synthesis of DNA, and the effects seen with 10% fetal bovine serum could be reproduced at a concentration of 10−10 M. These observations can be interpreted to mean that both IGF-I and EGF may be involved in the growth modulation of meningiomas, possibly through paracrine or autocrine mechanisms.
The role of glucose uptake and metabolism in hyperglycemic exacerbation of neurological deficit in the paraplegic rat
Authors: LeMay Daniel R. , Zelenock Gerald B. , D'Alecy Louis G.
Published: May 2009

✓ Previous studies indicate that hyperglycemia, particularly that induced by exogenous glucose administration, exacerbates neurological deficits in the rat spinal cord ischemic model. The effect of inhibition of glucose uptake (glucose transporter) and initial metabolism (hexokinase) on neurological outcome was evaluated in the present investigation using the competitive inhibitors 2-deoxyglucose (2-DG) and 3-O-methylglucose (3-OMG). Sprague-Dawley rats, weighing 200 to 300 gm each, received either 0.25, 1, or 2 gm/kg 2-DG; 2 gm/kg 3-OMG; 2 gm/kg glucose; or an equivalent volume of 0.9% saline intraperitoneally. Rats were intubated and ventilated with 1% to 1.5% halothane. The aortic arch was exposed and snares were placed on the right and left subclavian arteries and the aorta distal to the left subclavian artery. The three vessels were occluded for 10, 11, 12, or 13 minutes. Lower-extremity neurological deficits were evaluated at 1, 4, 18, and 24 hours postocclusion based on a 15-point scale (normal = 0, severe deficit =15). Lower-extremity neurological deficits were significantly less severe in the groups treated with 2-DG (0.25 and 1 gm/kg) at 18 and 24 hours postocclusion (p < 0.05 for 0.25 gm/kg and p < 0.005 for 1 gm/kg, Student's t-test with Bonferroni correction). The lower 2-DG dose of 0.25 gm/kg did not significantly increase the plasma glucose level, suggesting that the glucose transporter was not markedly inhibited, and that the improved neurological outcome was more likely due to inhibition of hexokinase. The higher 2-DG dose of 1 gm/kg afforded protection despite significantly increasing the plasma glucose level, implying a strong inhibition of both the glucose transporter and hexokinase. Administration of 3-OMG, which only inhibits glucose uptake and not hexokinase, actually worsened the neurological deficit in a manner similar to that observed in rats treated with glucose. The authors conclude that the activity of the glucose transporter by itself does not significantly contribute to hyperglycemic exacerbation of neurological deficits. In contrast, the hexokinase step, at least in combination with the transporter and possibly alone, plays a significant role in hyperglycemic exacerbation of the lower-extremity neurological deficit in the paraplegic rat.
Symptomatic hydrocephalus and reversible spinal cord compression in Listeria monocytogenes meningitis
Authors: Raps Eric C. , Gutmann David H. , Brorson James R. , O'Connor Michael , Hurtig Howard I.
Published: May 2009

✓ Central nervous system infections with Listeria monocytogenes result in varied clinical syndromes ranging from meningitis to rhomboencephalitis. A case of Listeria meningitis complicated by symptomatic communicating hydrocephalus and hydrostatic cervical cord compression is presented which clinically and radiographically improved with aggressive ventricular drainage.
Acute axis fractures: a review of 229 cases
Authors: Hadley Mark N. , Dickman Curtis A. , Browner Carol M. , Sonntag Volker K. H.
Published: May 2009

✓ Eighteen percent of acute cervical spine fractures involve the C-2 vertebra. The odontoid Type II fracture is the most common axis fracture and it is also the most difficult to treat. The degree of odontoid dislocation has been identified as the single most important fracture feature that helps separate those patients who have a high likelihood of healing with nonoperative therapy from those who are likely to fail nonoperative therapy and should be offered early surgical stabilization. The difference is statistically significant (p < 0.001, x2 = 30.20).

The present series includes 229 patients with acute axis fractures. Follow-up data were available in 92% of these patients, for a median duration of 4 years 9 months. Treatment guidelines and results are offered for each subtype of axis fracture based on this experience.
Incidence and clinicopathological features of meningioma
Authors: Rohringer Martin , Sutherland Garnette R. , Louw Deon F. , Sima Anders A. F.
Published: May 2009

✓ The incidence of intracranial meningioma in Manitoba, Canada, was reviewed from 1980 through 1987. During that time, 193 tumors were diagnosed, with a male:female ratio of 1:2. This occurrence corresponded to crude incidence rates of 2.3/100,000 for all meningiomas and 0.17/100,000 for malignant meningiomas. Among malignant meningiomas, the male:female ratio was 1:1. The age-specific annual incidence rate increased with age up to the eighth decade where it peaked at 8.4/100,000. The distribution of histopathological subtypes was: 74 meningotheliomatous (38%), 64 transitional (33%), 14 malignant (7%), 14 fibroblastic (7%), seven psammomatous (4%), four angioblastic (2%), and 16 unknown (8%). The diagnosis of malignant meningioma was based on the World Health Organization criteria, with only Grade III and IV tumors included in this subtype. Clinical features did not allow for differentiation of benign from malignant neoplasms. Individuals with malignant tumors were, however, more likely to suffer paresis (50%) and less likely to be without deficit (14%) than their benign counterparts. The radiographic appearance of “mushrooming” was observed only in patients with malignant meningioma. All malignant tumors showed evidence of peritumoral edema; however, none exhibited calcification. During the 8-year study interval, the tumor recurred in 10 (71%) of the 14 patients with malignant meningioma. Tumor recurrence was accompanied by dedifferentiation from a more benign histology in four patients (2% of the total material).
Surgical management of midline skull-base tumors: a new approach
Authors: Uttley David , Moore Anne , Archer Daniel J.
Published: May 2009

✓ Many surgical approaches to the clivus and upper cervical spine have been used in the treatment of skull-base tumors over the past 50 years. However, the outcome of surgery has been complicated by difficulties of access to the whole clivus, together with pharyngeal wound breakdown with subsequent development of cerebrospinal fluid (CSF) fistula and meningitis. A technique described recently utilized Le Fort I osteotomy to improve exposure of the clivus in the approach to vertebrobasilar aneurysms, facilitating control of the aneurysm and reducing the risk of posttraumatic CSF fistula. The same approach, via maxillotomy, has permitted partial or total tumor resection in 13 consecutive procedures carried out at Atkinson Morley's Hospital on 10 patients presenting with tumors of the skull base. Neurological status was either improved or unchanged in all patients postoperatively, and pain relief was obtained in five of eight cases in which this was a presenting symptom. No patient developed a CSF fistula following surgery. Cosmetic results were good, and no problems related to malocclusion were reported. This approach may be used to advantage in the surgical treatment of skull-base tumors, at initial presentation, and can be repeated without undue difficulty should there be tumor recurrence.
Spontaneous tone of cerebral parenchymal arterioles: a role in cerebral hyperemic phenomena
Authors: Takayasu Masakazu , Dacey Ralph G.
Published: May 2009

✓ An isolated cerebral arteriole preparation was used to test the hypothesis that a temporary reduction in transmural pressure causes a subsequent vasodilation mediated by mechanisms intrinsic to the vessel wall. Thirty-five cerebral vessels of 44.7 ± 1.4 µm (± standard error of the mean) mean diameter were cannulated in vitro and pressurized at a transmural pressure of 60 mm Hg; after an equilibration period the vessels developed spontaneous tone. When transmural pressure was decreased to 0 mm Hg for a period of 4 minutes then returned to 60 mm Hg, vessels dilated to 155.1% ± 6.8% of control diameter before gradually redeveloping spontaneous tone in 5.5 ± 0.7 minutes. Varying the duration of the period during which transmural pressure was at 0 mm Hg had no significant effect on the degree of vasodilation. Conversely, varying the level of decreased transmural pressure between 0 and 20 mm Hg significantly affected both the magnitude of vasodilation and the time course of spontaneous tone recovery. These findings indicate that a temporary period of decreased transmural pressure may result in a loss of spontaneous tone in the resistance vessels of the cerebral microcirculation. Mechanisms intrinsic to the vessel wall may play a significant role in the early stage of post-reperfusion hyperemia. Such mechanisms could also be implicated in other hyperemic phenomena affecting the cerebral circulation, such as the rapid increase in intracranial pressure after subarachnoid hemorrhage, the development of the normal perfusion pressure breakthrough phenomenon, and the initiation of intracranial pressure plateau waves.
Experimental missile wound to the brain
Authors: Carey Michael E. , Sarna Gurcharan S. , Farrell J. Bryan , Happel Leo T.
Published: May 2009

✓ Among civilians in the United States, 33,000 gunshot wound deaths occur each year; probably half of these involve the head. In combat, head wounds account for approximately half of the immediate mortality when death can be attributed to a single wound. No significant reduction in the neurosurgical mortality associated with these wounds has occurred between World War II and the Vietnam conflict, and very little research into missile wounds of the brain has been undertaken. An experimental model has been developed in the anesthetized cat whereby a ballistic injury to the brain may be painlessly reproduced in order that the pathophysiological effects of brain wounding may be studied and better treatments may be designed to lower the mortality and morbidity rates associated with gunshot wounds.

Prominent among physiological effects observed in this model was respiratory arrest even though the missile did not injure the brain stem directly. The incidence of prolonged respiratory arrest increased with increasing missile energy, but arrest was often reversible provided respiratory support was given. It is possible that humans who receive a brain wound die from missile-induced apnea instead of brain damage per se. The mortality rate in humans with brain wounding might be reduced by prompt respiratory support. Brain wounding was associated with persistently increased intracranial pressure and reduced cerebral perfusion pressure not entirely attributable to intracranial bleeding. The magnitude of these derangements appeared to be missile energy dependent and approached dangerous levels in higher-energy wounds.

All wounded cats exhibited postwounding increases in blood glucose concentrations consistent with a generalized stress reaction. A transient rise in hematocrit also occurred immediately after wounding. Both of these phenomena could prove deleterious to optimal brain function after injury.
Multifocal glioblastoma with liver metastases in the absence of surgery
Authors: Leifer Dana , Moore Teri , Ukena Thomas , Wilner David , Thor Ann , Hedley-Whyte E. Tessa
Published: May 2009

✓ A patient with two intracerebral glioblastomas of differing histology with metastases to the liver in the absence of surgery is reported. The gliomatous nature of the lesions was confirmed by staining for glial fibrillary acidic protein. Histological and immunohistochemical evidence suggests that the metastases arose from the more poorly differentiated of the intracerebral tumors. One of the intracerebral tumors had enhanced expression of the ras p21 oncogene as compared to the other tumors and as compared to nonmalignant brain tissue from this patient.
Surgery for acoustic neurinoma
Authors: Hardy David G. , Macfarlane Robert , Baguley David , Moffat David A.
Published: May 2009

✓ A consecutive series of 100 translabyrinthine operations for removal of acoustic neurinoma is reported. Complete tumor removal was achieved in 97% of cases. There were three perioperative deaths, and the postoperative morbidity rate was low. The facial nerve was preserved anatomically in 82% of patients. Preoperative facial weakness and tumor size larger than 2.5 cm were predictive of poor facial recovery. In patients with an intact nerve but complete facial palsy 1 week after surgery, electroneuronography was a good predictor of the final facial outcome and may influence the timing of rehabilitative procedures. With the exception of patients who have small tumors and good speech discrimination (where a suboccipital approach may preserve hearing acuity), the translabyrinthine operation is the procedure of choice for removal of acoustic neurinomas in patients who have normal hearing in the contralateral ear.
Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases
Authors: Itoyama Youichi , Uemura Syouzaburou , Ushio Yukitaka , Kuratsu Jun-Ichi , Nonaka Nobuhito , Wada Hidetaka , Sano Yoshinori , Fukumura Akinobu , Yoshida Kensei , Yano Tatsushi
Published: May 2009

✓ The clinical course of 50 patients with conservatively treated intracranial arteriovenous malformations (AVM's) was followed, most of them for more than 5 years. The average follow-up period was 13.4 years. The initial symptom was intracranial bleeding in 29 patients (58%) and seizure in 15 patients (30%). Small and deep-seated AVM's were associated with a high incidence of bleeding; however, repeated hemorrhages were not necessarily indicative of a poor prognosis. Children younger than 15 years had a better prognosis than adults. There was no correlation between pregnancy and bleeding. In the hemorrhage group, the incidence of rebleeding was 6.9% in the 1st year after initial rupture, 1.91% per year after 5 years, and 0.92% per year after 15 years. The overall incidence of rebleeding was 34.5% in the hemorrhage group. Of the 50 patients, 37 (74%) had a good clinical outcome, four (8%) had a fair outcome, and four (8%) had a poor outcome; five patients died.
The lateral extracavitary approach to the spine using the three-quarter prone position
Authors: Benzel Edward C.
Published: May 2009

✓ A three-quarter prone position for the lateral extracavitary operative approach to the thoracic and lumbar spine is described. This approach has been used in 40 patients with anterior spinal cord compressive lesions in the thoracic and/or lumbar region. In this patient population, it has allowed a safe ventral decompression of the spinal cord. It also allows placement of spinal instrumentation through the same incision. Both the operating surgeon and the assistant have an excellent view of the operative site, including the dural sac. Patient positioning and the operative approach are described and illustrated.
Acute subdural hematomas: an age-dependent clinical entity
Authors: Howard Matthew A. , Gross Alan S. , Dacey Ralph G. , Winn H. Richard
Published: May 2009

✓ Reports prior to 1980 describe overall mortality rates for acute subdural hematomas (SDH's) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. A relatively large number of older patients (34 patients over 65 years old) were treated recently at Harborview Medical Center, enabling a retrospective comparison with similarly treated younger patients (33 patients aged 18 to 40 years). Clinical information and computerized tomography morphometric data were obtained. Patients in the younger group were most often injured in motor-vehicle accidents (15 cases), whereas falls were most frequent in the older group (19 cases). Patients in both groups were rapidly resuscitated in the field; more than 30% were treated within 1 hour after the time of injury. Injury severity, determined by the admission Glasgow Coma Scale score, was similar for the two groups. Mean acute SDH volume was significantly larger in the older patients than in the younger group (mean ± standard deviation: 96.2 ± 117.2 vs. 21.6 + 27.7 cu cm), as was the amount of midline shift (1.2 ± 1.69 vs. 0.6 ± 0.75 cm). Surgical treatments were similar, but outcomes were dramatically different for the younger and older patients. Mortality rates were more than four times higher in older patients than in younger ones (74% vs. 18%). Three older patients and 25 younger patients were functional survivors. Old age, a larger SDH volume, and a larger midline shift all correlated with a poor outcome. The results of this study suggest that the pathophysiology of acute SDH varies with age, and that currently employed resuscitation and treatment methods have differentially improved the outcome for younger patients.
Forced subarachnoid air in transsphenoidal excision of pituitary tumors (pumping technique)
Authors: Spaziante Renato , de Divitiis Enrico
Published: May 2009

✓ Inversion and prolapse into the sella of the superior capsule and the diaphragma sellae is the only condition that warrants, at least macroscopically, radical removal of tumors with suprasellar extension operated on via the transsphenoidal route. If this does not occur spontaneously, air can be introduced into the subarachnoid space through a lumbar spinal catheter to produce forced dissection of the suprasellar cisterns and collapse of the tumor capsule (“pumping technique”). This method permits complete removal of the neoplastic tissue. In a series of 124 transsphenoidal operations for tumors with suprasellar extension, spontaneous descent of the capsule occurred in only 26 cases. Forced dissection using air distension of the cisterns was carried out in 88 cases, with complete success in 56 cases, partial success in 20, and no effect in 12. There were no complications or unwanted side effects in any patient.
A controlled study of efficacy of interstitial or external irradiation in a virus-induced brain-tumor model in rats
Authors: El-Hennawi Yehia , Gillespie G. Yancey , Mahaley M. Stephen , Varia Mahesh A. , Bigner Darell D. , Stanton Constance
Published: May 2009

✓ In a controlled study of interstitial radiotherapy in the avian sarcoma virus (ASV)-induced glioma model in rats, prolongation of survival was demonstrated (p = 0.08 in Experiment 1 and p = 0.03 in Experiment 2) following mean dosages of 7582 to 9902 cGy 125I, when compared to nontreatment or to control studies with implantation of nonradioactive seeds. More significant (p = 0.02) prolongation of survival was demonstrated following external beam whole-head radiotherapy with nine fractions of 333 cGy, three times weekly over 3 weeks (total dose 3000 cGy). Survival was more prolonged when whole-head radiotherapy was begun 35 days following virus inoculation rather than at 71 days, probably reflecting a greater efficacy with smaller tumor targets.
Microsurgical anatomy of the tentorial sinuses
Authors: Matsushima Toshio , Suzuki Satoshi O. , Fukui Masashi , Rhoton Albert L. , de Oliveira Evandro , Ono Michio
Published: May 2009

✓ Variations of the tentorial sinus of cadaver cerebellar tentoria were examined under a surgical microscope. The tentorial sinuses were classified into four groups: Group I, in which the sinus receives venous blood from the cerebral hemisphere; Group II, in which the sinus drains the cerebellum; Group III, in which the sinus originates in the tentorium itself; and Group IV, in which the sinus originates from a vein bridging to the tentorial free edge. The tentorial sinuses of Groups I and II were frequently located in the posterior portion of the tentorium. The sinuses of Group I were short and most frequently present in the lateral portion of the tentorium. The tentorial sinuses of Group II, which were usually large and drained into the dural sinuses near the torcular, were separated into five subtypes according to the draining veins and direction of termination. The tentorial sinuses of Groups III and IV were located near the tentorial free edge or the straight sinus. The draining patterns of the tentorial sinuses and their draining veins (so-called “bridging veins”) were present in most cases. Knowledge of this anatomy can benefit the neurosurgeon carrying out repair near or on the cerebellar tentorium.
Intracerebral myiasis from Hypoderma bovis larva in a child
Authors: Kalelioğlu Müfit , Aktürk Gönül , Aktürk Fadiil , Komsuoğlu Sezer Ş. , Kuzeyü Kayhan , Tiğin Yhlmaz , Karaer Zafer , Bingöl Recep
Published: May 2009

✓ Cerebral myiasis with a 10-day history of convulsions due to an intracerebral hematoma caused by a Hypoderma bovis larva is reported in an 8-year-old child. Computerized tomography (CT) showed the hematoma in a right parieto-occipital location. The H. bovis larva and the extensive intracerebral hematoma were discovered during surgery. Among human parasitoses, cerebral myiasis is rare: a review of the literature revealed only two reports, one published in 1969 and one in 1980. This is the first case that has been diagnosed as cerebral myiasis with exact identification of the Hypoderma bovis larva both from the CT scans and at surgery in a patient during life.
Intervertebral disc embolization resulting in spinal cord infarction
Authors: Kestle John R. W. , Resch Lothar , Tator Charles H. , Kucharczyk Walter
Published: May 2009

✓ A case of spinal cord infarction resulting from embolization of fibrocartilaginous intervertebral disc material is presented. Cases from the literature are reviewed and the theories of pathogenesis are discussed. In all reported cases the diagnosis was not made until postmortem examination.
Eosinophilic granuloma of the cervicothoracic junction
Authors: Sweasey Thomas A. , Dauser Robert C.
Published: May 2009

✓ A case is reported of eosinophilic granuloma at the cervicothoracic junction presenting with profound quadriparesis preoperatively. The patient underwent excision via an anterior approach, with splitting of the sternum to gain access to the T-1 vertebra. Postoperatively, he has had an excellent return of function.
A Systematic Review of Arsenic Exposure and Its Social and Mental Health Effects with Special Reference to Bangladesh
Authors: Brinkel Johanna , Khan Mobarak H. , Kraemer Alexander
Published: May 2009

Undergroundwater in many regions of the world is contaminated with high concentrations of arsenic and the resulting toxicity has created a major environmental and public health problem in the affected regions. Chronic arsenic exposure can cause many diseases, including various physical and psychological harms. Although the physical problems caused by arsenic toxicity are well reported in literature, unfortunately the consequences of arsenic exposure on mental health are not adequately studied. Therefore we conducted a review of the available literature focusing on the social consequences and detrimental effects of arsenic toxicity on mental health. Chronic arsenic exposures have serious implications for its victims (i.e. arsenicosis patients) and their families including social instability, social discrimination, refusal of victims by community and families, and marriage-related problems. Some studies conducted in arsenic affected areas revealed that arsenic exposures are associated with various neurologic problems. Chronic arsenic exposure can lead to mental retardation and developmental disabilities such as physical, cognitive, psychological, sensory and speech impairments. As health is defined by the World Health Organization as “a state of complete physical, mental and social wellbeing”, the social dimensions have a large impact on individual’s mental health. Furthermore studies in China und Bangladesh have shown that mental health problems (e.g. depression) are more common among the people affected by arsenic contamination. Our study indicates various neurological, mental and social consequences among arsenic affected victims. Further studies are recommended in arsenic-affected areas to understand the underlying mechanisms of poor mental health caused by arsenic exposure.
Toward Improving Human Islet Isolation from Younger Donors: Rescue Purification is Efficient for Trapped Islets
Authors: Miki A. , Ricordi C. , Messinger S. , Yamamoto T. , Mita A. , Barker S. , Haetter R. , Khan A. , Alejandro R. , Ichii H.
Published: May 2009

Several reports suggest that islets isolated from younger donor pancreata are of better quality for clinical islet transplantation. The relative inefficiency of the continuous gradient purification process (CGP) is one of the major obstacles to the utilization of these younger donor pancreata. This study demonstrates the benefits of utilizing an additional purification step, rescue gradient purification (RGP), to recover trapped islets and examines the possible superiority of these rescued islets. Seventy-three human islet isolations purified by RGP following CGP were divided into two groups based on age, and the isolation results were retrospectively analyzed (group I: age ≤40, group II: age >40). The quality of islets from both CGP and RGP were assessed by β-cell fractional viability (βFV) and ADP/ATP ratio. Significant increases in the percent islet recovery from RGP and the percent trapped islets in group I compared to group II were observed. Donor age correlated negatively to the percent islets recovered from RGP ( R = 0.440) and to the percent of trapped islets ( R = 0.511). RGP islets had higher βFV and better ADP/ATP ratio compared to CGP islets. In conclusion, RGP improved the efficiency in the purification of trapped islets, which often come from younger donor pancreata. The better quality of β-cells in RGP islets encourages us to perform RGP, considering the higher quality as well as the quantity of remaining islets.
Constraints on leaf structural traits in wetland plants
Authors: Vernescu Corina , Ryser Peter
Published: May 2009

A plant species’ ecology is associated with leaf economics, characterized, e.g., by photosynthetic rate, construction costs, and leaf life span. Specific leaf area (SLA, leaf area per leaf dry mass) is often considered to be a key trait in this respect, explaining interspecific variation in leaf economics. To understand factors constraining the specific leaf area, we investigated size‐related biomechanical constraints of the traits that determine the SLA—leaf thickness, leaf dry matter content and leaf density—and the constraints these traits exert on each other among 33 herbaceous wetland species of northern Ontario with a wide variety of leaf forms, ranging from wide laminar leaves to long, narrow, and relatively thick columnar leaves. Data from garden experiments were compared with field data. The results agree with biomechanical predictions that lamina thickness and leaf dry matter content are positively and leaf density (fresh mass per volume) negatively associated with leaf length. The traits also constrain each other, but these intertrait relationships are confounded by interspecific variation in leaf length. We conclude that for a full understanding of the adaptive significance of leaf structural design, it is essential to include leaf size in the considerations.
CHARACTERISTIC FUNCTIONS FOR STURM—LIOUVILLE PROBLEMS WITH NONLOCAL BOUNDARY CONDITIONS
Authors: Štikonas Artūras , Štikonienė Olga
Published: May 2009

This paper presents some new results on a spectrum in a complex plane for the second order stationary differential equation with one Bitsadze‐Samarskii type nonlocal boundary condition. In this paper, we survey the characteristic function method for investigation of the spectrum of this problem. Some new results on characteristic functions are proved. Many results of this investigation are presented as graphs of characteristic functions. A definition of constant eigenvalues and the characteristic function is introduced for the Sturm‐Liouville problem with general nonlocal boundary conditions.
TWO‐POINT BOUNDARY VALUE PROBLEMS AT RESONANCE
Authors: Yermachenko Inara
Published: May 2009

Consider two‐point boundary value problems of resonance type x″ +x = f(t, x, x′), x(0) = x(π) = 0. We investigate existence and multiplicity of solutions to such problems by using the quasilinearization process.
A Unified Strategy for Exceptionally High Diastereoselectivity in the Photochemical Ring Closure of Chiral Diarylethenes
Authors: Yokoyama Yasushi , Shiozawa Tatsuya , Tani Yutaka , Ubukata Takashi
Published: May 2009

Into my arms: Photochemical cyclization of diarylethenes that have two chiral side arms showed up to 100 % de (see scheme). Introduction of these chiral side arms onto the carbon atoms where ring closure occurs is a general strategy for the highly diastereoselective cyclization of diarylethenes.

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Kinetic Resolution of Aliphatic β‐Amino Acid Amides by β‐Aminopeptidases
Authors: Heck Tobias , Seebach Dieter , Osswald Steffen , ter Wiel Matthijs K. J. , Kohler Hans‐Peter E. , Geueke Birgit
Published: May 2009

Access to enantiopure β‐amino acids: β‐Aminopeptidases are hydrolases that possess the unique ability to cleave N‐terminal β‐amino acids from peptides and amides. Hydrolysis of racemic β‐amino acid amides catalyzed by these enzymes displays enantioselectivity with strong preference for substrates with the L‐configuration, and gives access to various aliphatic β‐amino acids of high enantiopurity.

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The growing demand for enantiomerically pure β‐amino acids to be used in the pharmaceutical industry and as fine chemicals requires the development of new strategies for their synthesis. The β‐aminopeptidases BapA from Sphingosinicella xenopeptidilytica 3‐2W4, BapA from Sphingosinicella microcystinivorans Y2, and DmpA from Ochrobactrum anthropi LMG7991 are hydrolases that possess the unique ability of cleaving N‐terminal β‐amino acids from peptides and amides. Hydrolysis of racemic β3‐amino acid amides catalyzed by these enzymes displays enantioselectivity with a strong preference for substrates with the L‐configuration and gives access to various aliphatic β3‐amino acids of high enantiopurity. This approach presents a new access to enantiopure β3‐amino acids under mild reaction conditions and complements chemical asymmetric synthesis strategies.
Transcatheter creation of an aortopulmonary shunt in an animal model
Authors: Sabi Titus Mbah , Schmitt Boris , Sigler Matthias , Zanjani Keyhan Sayadpour , Ovroutski Stanislav , Peters Bjoern , Miera Oliver , Nagdyman Nicole , Kuehne Titus , Berger Felix , Ewert Peter
Published: May 2009

Background:

The surgical creation of an aortopulmonary shunt is an important tool in the therapy of complex congenital heart defects. We report on a transcatheter approach to establish an aortopulmonary shunt in piglets.

Material, Methods and Results:

In 10 piglets with a median body weight of 10.5 kg (8–12 kg), a central aortopulmonary shunt was created by radiofrequency perforation from the aorta to the pulmonary trunk, followed by stent implantation. The procedures were performed via the femoral vessels through 5F sheaths under biplane fluoroscopy guidance. A total of six bare metal coronary stents and five polytetrafluoroethylene‐covered coronary stents of 3–4 mm diameter were deployed. Four animals were sacrificed immediately after intervention; six pigs were reevaluated 4–5 weeks later for stent patency and measurement of shunt volume. The procedure was successful in all pigs. Median shunt volume was Qp:Qs = 2.4:1. At re‐evaluation median body weight had increased to 18 kg (15.5–27.5 kg) P < 0.028. Four of six stents were completely obstructed due to tissue ingrowth in the bare metal stents (two cases) and thrombus formation in the covered stents (two cases). A third bare metal stent had a residual lumen, and a third covered stent was fully open without any thrombus formation or tissue ingrowth.

Conclusions:

Transcatheter creation of an aortopulmonary shunt by radiofrequency perforation and stent implantation is feasible. The use of appropriate covered stents and an effective anticoagulatory regimen seem to be crucial to keep the shunts open. © 2009 Wiley‐Liss, Inc.
Emesis predicts bacteremia in immunocompromised children with central venous catheters and fever
Authors: Richardson Matthew W. , Grewal Satkiran S. , Visintainer Paul F.
Published: May 2009

BACKGROUND:

The objective of this study was to determine whether vomiting at presentation of a febrile illness in immunocompromised children with central venous catheters (CVCs) predicts bacteremia.

METHODS:

A chart review was conducted of children who were admitted to the hospital with a diagnosis of cancer or aplastic anemia, fever, and a CVC. Data were collected on the presence or absence of vomiting, catheter type, presence or absence of severe neutropenia, C‐reactive protein (Crp) value, and culture results.

RESULTS:

There were 143 admissions for fever among 48 children. Among 35 admissions with emesis, 19 included bacteremia; whereas, among 107 admissions without emesis, 19 included bacteremia (P < .001). There was a 5‐fold greater risk of bacteremia in children with children without vomiting (odds ratio, 5.50; 95% confidence interval, 2.20‐13.67). Gram‐negative organisms were more likely to be associated with vomiting than Gram‐positive organisms (P = .008). Children with severe neutropenia did not have a significantly higher rate of bacteremia than children who had neutrophil counts >500 cells/mm3. Other factors that were associated with higher rates of bacteremia were underlying diagnosis and catheter type.

CONCLUSIONS:

Immunocompromised children with a CVC and a fever who presented with vomiting were more likely to have bacteremia than similar children who presented without vomiting. Gram‐negative organisms were more likely to be associated with emesis than Gram‐positive organisms. The absence of severe neutropenia was not associated with a decreased likelihood of bacteremia. These findings may be useful in identifying children who are at high risk for bacteremia and in determining initial, empiric therapy. Cancer 2009. © 2009 American Cancer Society.