bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of different quinoid redox mediators on the simultaneous removal of p-cresol and sulphide in a denitrifying process
Authors: Meza-Escalante Edna R. , Texier Anne-Claire , Cuervo-López Flor , Gómez Jorge , Cervantes Francisco J.
Published: May 2009

The catalytic effects of different quinoid redox mediators (RM) on the simultaneous removal of sulphide and p-cresol in a denitrifying process were evaluated in batch studies. 2-Hydroxy-1,4-naphthoquinone (LAW) and anthraquinone-2,6-disulphonate (AQDS) did not significantly affect the sulphide oxidation rate, which, in contrast, was increased 14% in the presence of 1,2-naphthoquinone-4-sulphonate (NQS). The input of NQS on the oxidation of sulphide was also favourably reflected in a 13% higher sulphate production. All RM promoted a higher (up to 34% compared to the control lacking RM) degree of mineralization of p-cresol. LAW also supported a 47% higher denitrifying yield (YN2), compared to the control lacking quinones. Nevertheless, AQDS and NQS decreased the YN2 by 12–13%. Our results suggest that a proper scrutiny should be conducted before deciding the sort of quinone to be applied in denitrifying processes. The heterogeneous effects observed also advise to consider both the respiratory rates and the yields as important parameters for deciphering the impact of RM on denitrifying processes.
Evidence of specialized bromate-reducing bacteria in a hollow fiber membrane biofilm reactor
Authors: Martin K. J. , Downing L. S. , Nerenberg R.
Published: May 2009

Bromate is a carcinogenic disinfection by-product formed from bromide during ozonation or advanced oxidation. We previously observed bromate reduction in a hydrogen-based, denitrifying hollow fiber membrane biofilm reactor (MBfR). In this research, we investigated the potential existence of specialized bromate-reducing bacteria. Using denaturing gradient gel electrophoresis (DGGE), we compared the microbial ecology of two denitrifying MBfRs, one amended with nitrate as the electron acceptor and the other with nitrate plus bromate. The DGGE results showed that bromate exerted a selective pressure for a putative, specialized bromate-reducing bacterium, which developed a strong presence only in the reactor with bromate. To gain further insight into the capabilities of specialized, bromate-reducing bacteria, we explored bromate reduction in a control MBfR without any primary electron acceptors. A grown biofilm in the control MBfR reduced bromate without previous exposure, but the rate of reduction decreased over time, especially after perturbations resulting in biomass loss. The decrease in bromate reduction may have been the result of the toxic effects of bromate. We also used batch tests of the perchlorate-reducing pure culture, Dechloromonas sp. PC1 to test bromate reduction and growth. Bromate was reduced without measurable growth. Based on these results, we speculate bromate's selective pressure for the putative, specialized BRB observed in the DGGE was not growth related, but possibly based on resistance to bromate toxicity.
Blood Flow Distribution of Repaired Lip in Cleft Lip Patients
Authors: Kondo Yuko , Takahashi Takumi , Oba Yasuo , Kuroda Shingo , Tanaka Eiji , Moriyama Keiji
Published: May 2009

Objective: To investigate the blood flow distribution in the repaired lip of cleft patients using a laser Doppler imager and to evaluate the difference in blood flow of the scar tissue between unilateral cleft lip patients with and without cleft palate.

Materials and Methods: Twenty patients with either unilateral cleft lip only (CL group, n = 8) or cleft lip and palate (CLP group, n = 12) were used as subjects. The blood flow of the upper lip was two-dimensionally visualized by a color scale alongside the corresponding photo image of the tissue surface with laser Doppler imaging. The upper lip photo image was divided into five regions: scar, white lip on the cleft side, white lip on the noncleft side, red lip on the cleft side, and red lip on the noncleft side. The average flux score (AFS), which is proportional to blood flow, was analyzed in each region.

Results: The AFS for the scar region was significantly (P < .05) lower than in the other four regions. The AFS for the red lip on the cleft side was not significantly different from that for the noncleft side. The white lip revealed a significantly (P < .05) higher score on the cleft side than on the noncleft side. The AFS ratio (AFS in the scar region/AFS in the white lip region) was significantly (P < .01) lower in the CLP group than in the CL group.

Conclusions: These results suggest that blood flow distribution in the repaired lip might be affected by the anatomic features of the cleft.
Pain and Orthodontic Treatment
Authors: Krukemeyer Amy M. , Arruda Airton O. , Inglehart Marita Rohr
Published: May 2009

Objective: To explore whether patients' pain experiences and orthodontists' assessments of their patients' pain levels are consistent and whether orthodontists are aware of their patients' use of pain medication.

Materials and Methods: Survey data were collected from 116 adolescent patients (44 male, 72 female; aged 10 to 19 years; mean age, 14.27 years) and from their orthodontic care providers.

Results: While only 18.0% of these patients agreed that they had pain during their last orthodontic appointment, 58.5% indicated that they experienced pain for a few days after their appointment. On average, dentists underestimated the patients' pain during the last appointment (rated on a 5-point scale, with 1 indicating no pain: providers = 2.01 vs patients = 2.28; P = .042), immediately after the last appointment (1.93 vs 2.34; P = .005), and 1 day (1.77 vs 2.53; P < .001) and 2 days (1.57 vs 2.19; P < .001) after the previous appointment. Only 26.5% of the patients used pain medication immediately following and 1 day after the last appointment. Providers underestimated the amount of medication used.

Conclusion: Orthodontists underestimated the degree to which orthodontic treatment caused pain for their patients and their patients' use of pain medication.
Effects of Prior Use of Chopsticks on Two Different Types of Dexterity Tests: Moving Beans Test and Purdue Pegboard
Authors: Shin Sohee , Demura Shinichi , Aoki Hiroki
Published: May 2009

The Purdue Pegboard and Moving Beans with Tweezers test have been used in the rehabilitation of persons with nervous system disorders; however, these two tests differ in their methodology. In the latter test, the testee picks up items with chopsticks or tweezers, but in the former test, the testee grasps items directly with the fingers of one hand. Use experience of a tool may strongly influence performance. The present study examined the use of chopsticks in daily life on performance of the two tests of finger dexterity by two groups of 20 youths who habitually used chopsticks to eat and 20 who did not. Three 30-sec. trials with the dominant and nondominant hands were given. Analysis of variance gave a main effect for number of beans moved between the two groups, hand (nondominant vs dominant), and trials. Significantly more beans were moved by the group with prior chopsticks use than the nonusers by the dominant hand than the nondominant hand, and on Trials 2 and 3 than Trial 1. For the Purdue Pegboard, the only significant difference for trials showed fewer pegs moved on Trial 1 than Trial 3. In conclusion, the groups who habitually used chopsticks performed better on the Moving Beans with Tweezers test than the group without such experience. Also, the marked laterality and practice effects for chopstick users was not observed on the Purdue Pegboard.
Orientation Anisotropy in the Ternus Phenomenon
Authors: Petersik J. Timothy
Published: May 2009

The Ternus display is an ambiguous, multi-element, apparent-movement animation which can be perceived in two alternative organizations. One of these involves the simultaneous movement of several elements and is called group movement. The other involves the movement of one element only and is called element movement. The present study examined the influence of retinal eccentricity and organizational orientation on the percentage of group-movement reports obtained across a range of interstimulus intervals. Six participants observed 48 variations of the Ternus display over 100 replications and judged the type of movement seen on each trial. Analysis showed that retinal eccentricity had no effect on the appearance of the display. However, compared with horizontally organized elements, obliquely organized and vertically organized elements yielded progressively more group movement across all but the shortest interstimulus intervals. These results represent an orientational anisotropy in the processing of Ternus apparent movement.
Focal brain-stem astrocytomas causing symptoms of involvement of the facial nerve nucleus: long-term survival in six pediatric cases
Authors: Edwards Michael S. B. , Wara William M. , Ciricillo Samuel F. , Barkovich A. James
Published: May 2009

✓ Six children with a history of isolated facial nerve dysfunction or dizziness and nausea were treated for brain-stem glioma between 1984 and 1992. Computerized tomography and/or magnetic resonance (MR) imaging showed a focal, uniformly enhancing mass involving the facial nerve nucleus of the pons. All patients underwent biopsy; the histological diagnosis was juvenile pilocytic astrocytoma in five cases. In the remaining case the biopsy was nondiagnostic, although the surgeon believed that the lesion was a glioma. Postoperatively, five patients underwent conventional focal megavoltage radiation therapy (180 to 200 cGy/day) over a period of 5½ weeks to a total dose of approximately 5400 cGy. One child's family refused radiation therapy; she remained well and stable for 4 years, despite persistent facial weakness, and was eventually lost to follow-up review. Four irradiation-treated patients had complete resolution of their tumors on MR images and have had no evidence of neuropsychological or neuroendocrinological deficits during 4½ to 8 years of follow-up evaluation. Patients whose neuroradiological studies show a lesion resembling those in this series should undergo biopsy and, if the histology of a low-grade tumor (in particular, a juvenile pilocytic astrocytoma) is confirmed, should then receive focal radiation therapy with conventional megavoltage dosages.
Hematoma enlargement in spontaneous intracerebral hemorrhage
Authors: Fujii Yukihiko , Tanaka Ryuichi , Takeuchi Shigekazu , Koike Tetsuo , Minakawa Takashi , Sasaki Osamu
Published: May 2009

✓ In order to evaluate the incidence and risk factors of hematoma enlargement in spontaneous intracerebral hemorrhage (ICH), 419 cases of ICH were reviewed. The first computerized tomography (CT) scan was performed within 24 hours of onset and the second within 24 hours of admission; a blood sample was taken for laboratory examination within 1 hour of admission. In 60 patients (14.3%) the second CT scan showed an enlarged hematoma. The incidence of enlargement significantly decreased with time (p < 0.05) and significantly increased with the severity of liver dysfunction and the volume of the hematoma on the first CT scan. Patients with an irregularly shaped hematoma had a higher risk of hematoma growth than those with a round hematoma. In addition, patients with hematoma enlargement were more likely to have coagulation abnormalities (low platelet counts and low levels of fibrinogen, α2-antiplasmin activity and platelet aggregation). Moreover, hematoma growth was associated with a poor clinical outcome.

It is concluded that patients admitted to a hospital within 6 hours of onset of ICH, especially those admitted within 2 hours, and patients with liver dysfunction or irregularly shaped large hematomas should be closely observed for at least 6 hours after onset in preparation for emergency surgery, since the risk of hematoma growth in these circumstances is high.
Immunohistochemical expression of human chorionic gonadotropin and P-glycoprotein in human pituitary glands and craniopharyngiomas
Authors: Tachibana Osamu , Yamashima Tetsumori , Yamashita Junkoh , Takabatake Yasushi
Published: May 2009

✓ In order to clarify the cellular origin of craniopharyngiomas, the authors examined the distribution of P-glycoprotein (PGP) and human chorionic gonadotropin (HCG) in five normal adenohypophyses and in 23 craniopharyngiomas using peroxidase immunohistochemistry. The correlation between the expression of PGP in craniopharyngiomas and the recurrence of these tumors was also investigated. A number of pars intermedia cyst-lining cells immunostained positively for anti-PGP antibodies. A small number of adenohypophysial cells were also positive for PGP, but squamous epithelial nests were negative in all samples. However, HCG-β was consistently demonstrated in adenohypophysial cells, pars intermedia cyst-lining cells, and squamous epithelial nests. In 11 craniopharyngiomas, the apical portion of cuboidal cells and some polygonal cells immunostained positively with anti-PGP antibodies. In four HCG-producing craniopharyngiomas, a large number of tumor cells were immunostained with anti-PGP antibodies, three of which showed a recurrence of cystic tumors. By double labeling, the coexpression of HCG-β and PGP was demonstrated in these recurrent tumors. Accordingly, it is suggested that craniopharyngiomas produce HCG-like peptides and that craniopharyngiomas are unique squamous neoplasms arising in the sellar region from progenitor cells of a neuroendocrine lineage.
Improved visualization of the foramen ovale for percutaneous approaches to the gasserian ganglion
Authors: Gerber Arthur M.
Published: May 2009

✓ Percutaneous procedures for treating trigeminal neuralgia involve the penetration of foramen ovale using cutaneous landmarks and radiological guidance. The placement of radiopaque markers over the commonly used “zygomatic points” in front of the ears provides landmarks on intraoperative radiological studies that facilitate localization of the foramen ovale. Speed and safety of percutaneous trigeminal procedures should be enhanced. There is no increase in radiation exposure over that in other commonly used approaches.
The natural history of familial cavernous malformations: results of an ongoing study
Authors: Zabramski Joseph M. , Wascher Thomas M. , Spetzler Robert F. , Johnson Blake , Golfinos John , Drayer Burton P. , Brown Ben , Rigamonti Daniel , Brown Geraldine
Published: May 2009

✓ Cavernous malformations are congenital abnormalities of the cerebral vessels that affect 0.5% to 0.7% of the population. They occur in two forms: a sporadic form characterized by isolated lesions, and a familial form characterized by multiple lesions with an autosomal dominant mode of inheritance. The management of patients with cavernous malformations, particularly those with the familial form of the disease, remains a challenge because little is known regarding the natural history.

The authors report the results of an ongoing study in which six families afflicted by familial cavernous malformations have been prospectively followed with serial interviews, physical examinations, and magnetic resonance (MR) imaging at 6- to 12-month intervals. A total of 59 members of these six families were screened for protocol enrollment; 31 (53%) had MR evidence of familial cavernous malformations. Nineteen (61%) of these 31 patients were symptomatic, with seizures in 12 (39%), recurrent headaches in 16 (52%), focal sensory/motor deficits in three (10%), and visual field deficits in two (6%). Twenty-one of these 31 patients underwent at least two serial clinical and MR imaging examinations. A total of 128 individual cavernous malformations (mean 6.5 ± 3.8 lesions/patient) were identified and followed radiographically. During a mean follow-up period of 2.2 years (range 1 to 5.5 years), serial MR images demonstrated 17 new lesions in six (29%) of the 21 patients; 13 lesions (10%) showed changes in signal characteristics, and five lesions (3.9%) changed significantly in size. The incidence of symptomatic hemorrhage was 1.1% per lesion per year.

The results of this study demonstrate that the familial form of cavernous malformations is a dynamic disease; serial MR images revealed changes in the number, size, and imaging characteristics of lesions consistent with acute or resolving hemorrhage. It is believed that the de novo development of new lesions in this disease has not been previously reported. These findings suggest that patients with familial cavernous malformations require careful follow-up monitoring, and that significant changes in neurological symptoms warrant repeat MR imaging. Surgery should be considered only for lesions that produce repetitive or progressive symptoms. Prophylactic resection of asymptomatic lesions does not appear to be indicated.
Surgical management of unruptured intracranial aneurysms
Authors: Solomon Robert A. , Fink Matthew E. , Pile-Spellman John
Published: May 2009

✓ The surgical management of patients with unruptured intracranial aneurysms continues to be controversial. The criteria for withholding treatment or choosing between endovascular embolization and conventional microsurgery are not well delineated. The present study analyzes the morbidity and mortality that can be expected with modern surgical management of unruptured aneurysms, and therefore serves as a point of reference for clinical decision-making in this group of patients.

A total of 202 consecutive operations for attempted clipping of unruptured intracranial aneurysms are reported. Subarachnoid hemorrhage from another aneurysm was the most common presentation (55 cases). Thirty-seven patients presented with headache, 36 with mass effect from the aneurysm, and 19 with embolic events; 11 aneurysms were associated with an arteriovenous malformation, 10 caused seizures, and 34 were incidental findings. Excellent or good outcome was achieved in 100% of patients with aneurysms less than 10 mm in diameter, 95% with aneurysms 11 to 25 mm, and 79% with aneurysms greater than 25 mm.

Except for giant basilar aneurysms, size (and not location) of the aneurysm was the key predictor of risk for surgical morbidity. These data may be useful when discussing with patients the risk:benefit ratio of choosing between conservative management, endovascular embolization, and microsurgical clipping.
Continuous measurement of jugular venous oxygen saturation in response to transient elevations of blood pressure in head-injured patients
Authors: Fortune John B. , Feustel Paul J. , Weigle Carl G. M. , Popp A. John
Published: May 2009

✓ Following traumatic brain injury, continuous jugular venous oxygen saturation (SjvO2) measurements have been made and used to assess cerebral oxygenation. Transients of SjvO2 may reflect cerebral blood flow (CBF) changes if measurements are made over a short period of time during which cerebral metabolic rate for oxygen is assumed unchanged. In response to alterations in perfusion pressure, transients of SjvO2 may indicate the extent to which autoregulation has been preserved after injury. The effect of arterial pressure changes on SjvO2 was measured in 14 severely head-injured patients (Glasgow Coma Scale score < 8) within 36 hours of injury. Mean arterial blood pressure (MABP), arterial oxygen saturation, and intracranial pressure (ICP) data were also continuously recorded by a computer at the patients' bedside. The reliability of the SjvO2 oximetry measurements varied among patients, and an average 38% of SjvO2 measurements were off by more than 6% saturation, necessitating recalibration. During periods of satisfactory catheter performance, 120 instances were found in which MABP was elevated more than 8 torr (mean ± standard deviation: 32 ± 13 torr) due to endotracheal suctioning. In 94 of these measurements, there was an associated increase in the ICP of 5 torr or more, averaging 16.6 ± 10.2 torr. The SjvO2 was 0.62 ± 0.10 before the increase in MABP and rose to a peak of 0.77 ± 0.10 during the maximum MABP elevation, suggesting increased CBF during the transient hypertension. In 34 of 37 instances of persistent blood pressure elevations lasting for more than 10 minutes (mean 16.0 ± 8.0 minutes), the SjvO2 elevation persisted (average duration 15.0 ± 12.4 minutes), suggesting impaired or lost autoregulatory vasoconstriction. The presence or absence of hyperemia was unrelated to the extent of the autoregulation response. Results indicate that SjvO2 rises with increasing perfusion pressure during and after endotracheal suctioning, suggesting a feeble or absent autoregulatory response following traumatic brain injury.
Optimum degree of hemodilution for brain protection in a canine model of focal cerebral ischemia
Authors: Lee Sun Ho , Heros Roberto C. , Mullan John C. , Korosue Kazuyoshi
Published: May 2009

✓ The ability of hemodilution to lower blood viscosity and increase cerebral blood flow has been proven experimentally; however, the optimum hematocrit for maximum oxygen delivery to ischemic brain tissue is not known, and a study was designed to determine this. Fifty dogs were selected for inclusion in the study using criteria based on changes in somatosensory evoked potentials at the time of arterial occlusion, which were found in a previous study to predict the development of a moderate infarction of relatively constant size. Infarctions were induced by permanent occlusion of the left middle cerebral artery and the azygous anterior cerebral artery. The animals selected for inclusion were divided into five groups of 10 dogs each: 1) a control group; 2) a group with 25% hematocrit; 3) a group with 30% hematocrit; 4) a group with 35% hematocrit; and 5) a group with 40% hematocrit. Isovolemic hemodilution was accomplished 1 hour after occlusion of vessels using dextran infusion and blood withdrawal. The animals were sacrificed after 6 days and infarction volume was determined from fluorescein-stained sections. Statistical analysis was performed using Student's t-test and one-way analysis of variance.

Mean infarction volume for each group, expressed as a percentage of total hemispheric volume ± 1 standard error of the mean, was 28.3% ± 2.8% for the control group, 33.6% ± 3.4% for the 25% hematocrit group, 17.1% ± 2.2% for the 30% hematocrit group, 29.2% ± 4.3% for the 35% hematocrit group, and 29.9% ± 2.1% for the 40% hematocrit group. The 30% hematocrit group showed the smallest average infarction size and this size differed significantly (p = 0.02) from the average infarction size in the control animals. These results show that, in this model of focal ischemia, a hematocrit of approximately 30% is optimum for protecting the brain.
Intrastriatal implantation of interleukin-1
Authors: Wang Jin , Bankiewicz Krzysztof S. , Plunkett Robert J. , Oldfield Edward H.
Published: May 2009

✓ Intrastriatal implantation with dopaminergic or nondopaminergic tissue can elicit behavioral recovery in parkinsonian animals. Because in these animals, especially in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned monkeys, there are still considerable numbers of dopaminergic neurons left in the mesencephalon, implantation-induced trophic effects on host residual dopaminergic neurons have been suggested as a mechanism underlying the behavioral recovery. Gliosis around the graft is a universal finding in any implantation procedure and is probably mediated by interleukin-1 (IL-1); in addition, activated astrocytes secrete several neurotrophic factors in vitro. Therefore, the authors postulated that trophic effects from IL-1-induced gliosis may be a “final common pathway” for recovery in parkinsonian animals after implantation.

Hemiparkinsonism was induced in rats by injection of 6-hydroxydopamine either directly into the substantia nigra or into the median forebrain bundle. The substantia nigra-lesioned rats showed complete depletion of dopaminergic neurons in the substantia nigra but sparing of those in the ventral tegmental area, whereas the median forebrain bundle-lesioned animals had depletion of dopaminergic cells in the substantia nigra and the ventral tegmental area. Polymer pellets containing either slow-released IL-1 alpha and beta or placebo pellets were implanted in the caudate nucleus on the lesioned side in both groups. The rats' rotational response to amphetamine was tested weekly for 8 weeks. Selective substantia nigra-lesioned rats with implantation of IL-1 pellets had a 45% reduction in amphetamine-induced rotation, whereas placebo-implanted substantia nigra-lesioned rats had a 14% reduction in rotation. In the median forebrain bundle-lesioned group, neither IL-1 nor placebo implantation elicited any effect on turning. Immunohistochemical staining for glial fibrillary acidic protein was markedly increased surrounding the IL-1 pellets compared to the placebo pellets. In the selective substantia nigra-lesioned rats with IL-1 pellets implanted in the caudate nucleus, a considerable number of tyrosine hydroxylase immunoreactive (TH-IR) fibers were observed in the medial and middle portions of the caudate nucleus. Fewer TH-IR fibers were seen in the rats with placebo-bearing pellets.

These results suggest that neurotrophic activities mediated by IL-1 and reactive astrocytes might be a common path through which tissue trauma and some tissue transplants exert their beneficial effects in parkinsonian animals. Furthermore, most of the sprouted dopaminergic fibers induced by IL-1 in the caudate nucleus come from dopaminergic neurons in the ventral tegmental area.
Efficacy of direct intratumoral therapy with targeted protein toxins for solid human gliomas in nude mice
Authors: Laske Douglas W. , Ilercil Orhan , Akbasak Aytac , Youle Richard J. , Oldfield Edward H.
Published: May 2009

✓ Targeted protein toxins are a new class of reagents with the potential for great tumor selectivity and cytotoxic potency. Two such compounds were studied: 1) Tf-CRM107, a conjugate of human transferrin (Tf) and diphtheria toxin with a point mutation (CRM107); and 2) 454A12-rRA, a conjugate of a monoclonal antibody (454A12) to the human Tf receptor and recombinant ricin A chain (rRA). Both compounds are potent and specific in killing human glioblastoma cell linesin vitro. The authors investigated the activity of these reagents administered intratumorally against solid U251 MG human gliomasin vivo.

Nude mice with established U251 MG flank tumors (0.5 to 1.0 cm in diameter) were randomly assigned to be treated with 100-µl intratumoral injections of Tf-CRM107 (10 µg) or 454A12-rRA (10 µg), equimolar doses of CRM107 (4.3 µg), 454A12 antibody (7.5 µg), or rRA (1.5 µg), or phosphate-buffered saline (PBS) every 2 days for a total of four doses. Tumor volume and animal weight were assessed by a blinded observer before each treatment and biweekly for 30 days after initiating therapy. With Tf-CRM107 administration, tumor regression of greater than 95% occurred by Day 14 (p < 0.01) and tumors did not recur by Day 30. Treatment with 454A12-rRA caused a 30% decrease in tumor volume by Day 14 (p < 0.01). Treatment with equimolar doses of the unconjugated targeted protein toxin components CRM107, 454A12, or rRA caused significant U251 MG tumor growth inhibition, but the effects were less potent than the antitumor effects of the conjugates.

This study also characterized the dose-response effect of Tf-CRM107 on tumor growth and tumor weight on Day 30. Nude mice with established U251 MG flank tumors (0.5 to 1.0 cm in diameter) were treated with 100-µl intratumoral injections of 10, 1.0, or 0.1 µg of Tf-CRM107 or PBS every 2 days for a total of four doses. All three doses of Tf-CRM107 significantly inhibited tumor growth by Day 14 (p < 0.01) and at Day 30 (p < 0.05), with a significant dose-response relationship.

This study demonstratedin vivoefficacy of the targeted toxins Tf-CRM107 and 454A12-rRA against a human glioma. With intratumoral administration, the effect of Tf-CRM107 was tumor-specific and in some animals curative. Regional therapy with these potent tumor-specific agents using direct intratumoral infusion should limit systemic toxicity and may be efficacious against brain tumors.
Antitumor effects of antiprogesterones on human meningioma cells in vitro and in vivo
Authors: Matsuda Yasuhiro , Kawamoto Keiichi , Kiya Katsuzo , Kurisu Kaoru , Sugiyama Kazuhiko , Uozumi Tohru
Published: May 2009

✓ The presence of the progesterone receptor (PR) in meningioma tissue has been confirmed by previous investigations. Studies have shown that the antiprogesterone drug, mifepristone, is a potent agent that inhibits the growth of cultured meningioma cells and reduces the size of meningiomas in experimental animal models and humans. However, these studies have not fully examined the relationship between the antitumor effects of an antiprogesterone agent and the expression of the PR.

The present study examined the antitumor effects of mifepristone and a new potent antiprogesterone agent, onapristone; a correlation between the antitumor effects of these antiprogesterones and the presence of PR's in meningiomasin vitroandin vivowas also investigated. Meningioma tissue surgically removed from 13 patients was used in this study. In thein vitroarm of the study, mifepristone and onapristone exhibited cytostatic and cytocidal effects against cultured meningioma cells, regardless of the presence or absence of PR's; however, three PR-negative meningiomas showed no response to any dose of mifepristone and/or onapristone. In thein vivoarm, meningioma cells, embedded in a collagen gel, were implanted into the renal capsules of nude mice. Antiprogesterone treatment resulted in a marked reduction of the tumor volume regardless of the presence or absence of PR's. No histological changes in the meningioma cells suggestive of necrosis or apoptosis were detected in any of the mice treated with antiprogesterones. These findings suggest that mifepristone and onapristone have an antitumor effect against meningioma cells via the PR's and/or another receptor, such as the glucocorticoid receptor.
In vivo transfer of the human interleukin-2 gene: negative tumoricidal results in experimental brain tumors
Authors: Ram Zvi , Walbridge Stuart , Heiss John D. , Culver Kenneth W. , Blaese R. Michael , Oldfield Edward H.
Published: May 2009

✓ The authors have recently shown the feasibility of eradicating brain tumors usingin vivoretroviral-mediated transduction of tumors with the herpes simplex thymidine kinase (HStk) gene and ganciclovir therapy. However, thymidine kinase-transduced subcutaneous tumors in immunocompromised (athymic) mice were less responsive to this therapy than in immunocompetent animals, suggesting a role of the immune system in the process of tumor eradication. Broad suppression of humoral and cell-mediated immunity is found in patients with malignant gliomas. Interleukin-2 (IL-2) production and IL-2 receptor expression are decreased in glioma patients. These findings and the proposed association between lymphocytic infiltration of brain tumors and survival suggest that immune response modifiers may be useful in treating glioma patients.

To evaluate the role of local cytokine expression by tumor cells, alone or combined with HStk gene transfer and ganciclovir therapy, the authors investigated the efficacy of tumor (9L gliosarcoma) eradication in Fischer rats byin vitroandin vivotumor transduction with the IL-2 gene alone or with a combined vector carrying both the HStk and IL-2 genes. Tumors injected with HStk vector-producer cells alone, with or without ganciclovir, and rats inoculated in the brain and subcutaneously with 9L cells that had previously been transducedin vitroserved as controls. Murine vector-producer cells (3 × 106/50 µl) were injected into the brain tumors 7 days after tumor inoculation. Ganciclovir (15 mg/kg) was administered intraperitoneally twice daily for 10 days to animals that received HStk with or without IL-2 vector-producer cells, starting 5 days after producer-cell injection. The experiment was repeated with continuous daily treatment of all rats with oral dexamethasone (0.5 mg/kg). Rats were sacrificed 21 days after tumor inoculation, and the brains were removed for histological and immunohistochemical analysis for IL-2. Within each experimental group, tumors were found in a similar proportion in the dexamethasone-treated and untreated rats. Large brain tumors developed in all 10 rats that had been inoculated with 9L cells which had been pretransducedin vitrowith the IL-2 gene, whereas only three of eight rats receiving subcutaneous inoculation of similar cells developed palpable tumors. No enhancement of tumor eradication was observed by adding the IL-2 gene in the HStk vector construct compared to the use of the vector with HStk alone. Lymphocytic infiltration was absent in all dexamethasone-treated rats but was observed in all treatment groups not receiving steroids. The degree of lymphocytic infiltration was not enhanced by intratumoral injection of IL-2 or IL-2/HStk vector-producer cells.

The findings suggest a limited role, if any, for immune enhancement by transduction with IL-2 to eradicate brain tumors, either used alone or in combination with HStk.
Pleomorphic xanthoastrocytoma in the spinal cord
Authors: Herpers Marcel J. H. M. , Freling Gerard , Beuls Emile A. M.
Published: May 2009

✓ The authors present the clinical, radiological, and pathological features of a patient with a recurrent pleomorphic xanthoastrocytoma located in the spinal cord. This is the first report of a pleomorphic xanthoastrocytoma at this location; until now, only cerebral supratentorial pleomorphic xanthoastrocytomas have been described. The treatment of this case is discussed.
Basal interfalcine approach through a frontal sinusotomy with vein and nerve preservation
Authors: Fujitsu Kazuhiko , Sekino Tsunemi , Sakata Katsumi , Kawasaki Takashi
Published: May 2009

✓ The authors describe a new method for a frontal interhemispheric approach when treating craniopharyngiomas of the third ventricle or anterior communicating artery aneurysms. This technique ensures preservation of the bridging veins and the olfactory nerves. This “basal interfalcine approach” involves a craniotomy in the centrobasal portion of the frontal bone (the frontal sinus), removal of the inner tables and the crista galli, and splitting the basal portion of the falx into two leaves, through which the basal interhemispheric fissure is opened. The olfactory nerves are protected by the leaves of the falx, and the bridging veins are preserved because the approach is low enough to spare them. The surgical techniques are described together with a unilateral variation of this approach. The significance of preserving the bridging veins is discussed in connection with avoidance of postoperative contusional hemorrhage.
Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography
Authors: Kitanaka Chifumi , Tanaki Jun-Ichi , Kuwahara Masanori , Teraoka Akira , Sasaki Tomio , Takakura Kintomo
Published: May 2009

✓ The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated nonsurgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the findings continued to change during the first few months after onset. Four cases ultimately showed “angiographic cure,” while fusiform aneurysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram despite negative initial angiographic findings.

These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.
Treatment and prevention of tethered and retethered spinal cord using a Gore-Tex surgical membrane
Authors: Inoue Hiroshi K. , Kobayashi Satoshi , Ohbayashi Katsumi , Kohga Hideaki , Nakamura Masaru
Published: May 2009

✓ The incidence of the tethered cord syndrome after repair of spinal dysraphism is not insignificant. A retethered spinal cord may also develop after an untethering operation. In order to treat and/or prevent the tethered and retethered spinal cord, the authors developed and successfully used a new method in 12 cases. After complete release and reconstruction of the spinal cord, a Gore-Tex surgical membrane was placed over the cord and fixed to the lateral dural surface with stay sutures. During a postoperative follow-up period ranging from 23 months to 7 years, no further neurological deterioration was observed in the 12 patients and magnetic resonance imaging studies showed no adhesion of the spinal cord to the operative site. It is concluded that this simple new method is effective for the treatment and prevention of tethering and/or retethering of the spinal cord, although a longer follow-up study is required.
Stenosis of central canal of spinal cord in man: incidence and pathological findings in 232 autopsy cases
Authors: Milhorat Thomas H. , Kotzen René M. , Anzil Archinto P.
Published: May 2009

✓ The central canal of the spinal cord is generally regarded as a vestigial structure that is obliterated after birth in 70% to 80% of the general population. This report describes the first detailed histological study of the human central canal in 232 subjects ranging in age from 6 weeks' gestation to 92 years. Whole spinal cords were harvested at autopsy and sectioned serially from the conus medullaris to the upper medulla. Histological findings and morphometric analysis of the cross-sectional luminal area were used to grade stenosis at seven levels of the canal. Varying grades of stenosis were present at one or more levels in none (0%) of 60 fetuses, one (3%) of 34 infants, three (18%) of 17 children, 21 (88%) of 24 adolescents and young adults, 67 (96%) of 70 middle-aged adults, and all 27 adults aged 65 years or older (100%). The stenotic process was most pronounced in the thoracic segments of the canal and involved more levels with higher grades of stenosis in older individuals. Histological findings consisted of disorganization of the ependymal epithelium, formation of ependymal rosettes or microcanals, proliferation of subependymal gliovascular buds, and intracanalicular gliosis. These features are consistent with a pathological lesion involving ependymal injury and scarring and are less compatible with an involutional or degenerative process. Stenosis of the central canal probably influences the anatomical features of syringomyelia and may account for variations in cavity formation such as the prevalence of holocord syrinxes in children, the formation of focal and paracentral syrinxes in adults, and the rare incidence of syrinx formation in many older individuals with acquired lesions known to produce syringomyelia.
Expression of a functional endothelin (ETA) receptor in human meningiomas
Authors: Kitagawa Naoki , Tsutsumi Keisuke , Niwa Masami , Himeno Akihiko , Yamashita Kimihiro , Shibata Shigeki , Taniyama Kohtaro , Kurihara Masaki , Kawano Teruaki , Yasunaga Akio , Shibata Shobu
Published: May 2009

✓ Endothelin (ET) receptor subtypes (ETAand ETB) in human meningiomas were characterized using quantitative receptor autoradiography. A single class of high-affinity125I-ET-1 binding sites was localized in all meningioma tissue studied (dissociation constant: 2.4 ± 0.3 nM, maximum binding capacity: 319 ± 66 fmol/mg (mean ± standard error of the mean for 13 tumors)). Unlabeled ET-1 showed a strong affinity for125I-ET-1 binding to tissue sections of the tumors with a 50% inhibiting concentration (IC50) of 2.9 ± 0.7 × 10−9M, whereas ET-3 showed a much lower affinity (IC50: 8.4 ± 2.5 × 10−6M). Sarafotoxin S6c, a selective agonist for the ETBreceptor, could not compete for125I-ET-1 binding to meningiomas. Endothelin-1 significantly stimulated deoxyribonucleic acid (DNA) synthesis in a dose-dependent manner in cultured human meningioma cells. In contrast, no significant stimulation of DNA synthesis occurred with an S6c concentration up to 10−7M. Pretreatment of the meningioma cells with pertussis toxin, a bacterial toxin that adds adenosine 5'-diphosphateribose to the α subunit of guanine nucleotide binding (G) proteins such as Gior Go, induced a concentrationdependent reduction in ET-stimulated DNA synthesis in meningioma cells, but did not affect the epidermal growth factor-induced DNA synthesis. These observations suggest that the ETAreceptor is predominantly expressed in human meningioma tissue and that ET may act as a growth factor on the meningioma cells by interacting with the ETAreceptor and by pertussis toxin-sensitive mechanisms.
Accurate placement of coronal ventricular catheter using stereotactic coordinate-guided free-hand passage
Authors: Pang Dachling , Grabb Paul A.
Published: May 2009

✓ Long-term patency of the ventricular catheter of a cerebrospinal fluid shunt depends on the positioning of the hole-bearing segment of the catheter. Placement of this segment near the choroid plexus or injured ependyma increases the probability of obstruction. Proper positioning for a coronal shunt in turn depends on the ventricular catheter length and target coordinates. The authors describe a method of calculating the catheter length based on bone landmarks on skull radiographs, and a technique for accurate ventricular catheter placement using free-hand passage guided by simple stereotactic coordinates based on visible and palpable surface anatomy. The insertion trajectory is aligned with the coronal obliquity of the lateral ventricle so that, even with slit ventricles, the entire hole-bearing segment of the catheter can be reliably situated within the anterior horn. The predetermined catheter length also fixes the tip at the foramen of Monro, away from the choroid plexus and injured ependyma.

Of 160 children undergoing ventriculoperitoneal shunt insertion using this technique, only three required catheter revision during a mean follow-up period of 39 months. Radiographic grading of the ventricular catheter position in 112 children showed a satisfactory placement rate of 93.2%; all three children with occlusion showed poor catheter positioning. Thus, this method results in accurate ventricular catheter placement with a 1.9% obstruction rate, which compares favorably to the 16% to 18% incidence of proximal obstruction reported in the literature. This technique is applicable to patients of all ages but is particularly suitable for children because of the greater variability in head size.
Intraoperative transdural functional mapping
Authors: Silbergeld Daniel L.
Published: May 2009

✓ During craniotomy for supratentorial intraparenchymal space-occupying lesions, with the patient either under general anesthesia or awake, a smaller durotomy designed to expose only the region of resection may be desirable because of brain swelling. Similarly, during repeat craniotomy or craniotomy following cerebral injury or infection, pial-dural adhesions increase the risk of damage to essential cortex, making a limited dural opening desirable. Intraoperative transdural somatosensory evoked potentials and transdural cortical stimulation mapping permit localization of functional cortex prior to durotomy. These techniques can be combined with intraoperative transdural ultrasonography to identify topographical landmarks and borders of mass lesions.
Stereotactic transtentorial hiatus ventriculoperitoneal shunting for the sequestered fourth ventricle
Authors: Montes José L. , Clarke David B. , Farmer Jean-Pierre
Published: May 2009

✓ The authors describe a technique of stereotactic transtentorial hiatus ventriculoperitoneal shunting for the treatment of the sequestered fourth ventricle, used successfully in the care of four patients. They recommend it as a safe, effective treatment of patients suffering from an isolated fourth ventricle.
Surgical treatment of recurrent carotid artery stenosis
Authors: Meyer Fredric B. , Piepgras David G. , Fode Nicolee C.
Published: May 2009

✓ Ninety-two surgical procedures were performed in 82 patients for recurrent carotid artery stenosis. The etiology was recurrent atherosclerosis in 45 cases, myointimal hyperplasia in 20, organized thrombus without a significant underlying plaque in 20, and scarring along the proximal arteriotomy site in seven. The operations included a repeat endarterectomy in 66 cases and reconstruction with an interposition graft in 22. All five major neurological complications occurred in symptomatic patients, and included three instances of intraoperative embolization during exposure of the carotid artery. The majority of neurological complications occurred in symptomatic patients who had intraluminal thrombus confirmed at surgery. There were four perioperative deaths, due to cerebral hemorrhage in two patients and myocardial infarction in two.

In the patients whose original surgery was performed at the Mayo Clinic, the risk of recurrent carotid artery stenosis was 3.1% with a primary closure compared to 1.6% when a patch graft was used. These results indicate that surgery for recurrent carotid artery stenosis is technically more difficult and carries a significantly higher risk than surgery for primary disease. The difficulty is due to the friable recurrent plaque associated with intraluminal thrombus, which increases the risk of embolization during carotid artery exposure. In the majority of patients with recurrent atherosclerosis, a repeat endarterectomy can be achieved. However, in some patients, there is scarring without a definite plane of cleavage between the recurrent disease and the underlying media, making an endarterectomy difficult. In these cases, excision of the diseased segment and reconstruction with an interposition graft is the best treatment. The findings presented here also suggest that closure of the original arteriotomy with a patch graft decreases the risk of recurrent carotid artery stenosis.
A multicenter trial of the efficacy of nimodipine on outcome after severe head injury
Authors: _ _
Published: May 2009

✓ Between January 1, 1989, and June 30, 1991, 852 severely head-injured patients were entered into a prospective placebo-controlled trial of the efficacy of nimodipine administration. The patients could not obey commands at the time of entry into the trial, which was within 12 hours after the start of the inability to obey commands and within 24 hours of injury. The main hypothesis that nimodipine would increase the percentage of patients with a favorable outcome (moderate disability or good recovery) from 50% to 60% was rejected.

A trend toward a favorable effect was seen in patients who exhibited traumatic subarachnoid hemorrhage (SAH) on the computerized tomography (CT) scan obtained prior to entry into the study. The effect was statistically significant in those patients who complied with all protocol requirements. This finding is consistent with the effect of nimodipine on secondary ischemia following spontaneous SAH. The results of the study warrant a clinical trial of the efficacy of nimodipine in severely head-injured patients who show traumatic SAH on the initial CT scan.