bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency and Causes of Overanticoagulation and Underanticoagulation in Patients Treated with Warfarin
Authors: Wittkowsky Ann K. , Devine Emily Beth
Published: September 2004

Study Objective. To determine the frequency and the specific causes of over‐and underanticoagulation in patients who receive warfarin therapy and are managed in an anticoagulation clinic.

Design. Retrospective medical record review.

Setting. University‐affiliated anticoagulation clinic.

Subjects. One thousand twenty patients (mean age 60.2 yrs [range 17–84 yrs]) receiving warfarin therapy during a 1‐year index period.

Measurements and Main Results. Of 12,897 international normalized ratios (INRs) evaluated, 6642 (51.5%) were within range and 8525 (66.1%) were within 0.2 INR units of range. Among 2881 out‐of‐range INRs below 2.0, the most common cause of underanticoagulation was indeterminate (856, 29.7%). Response to previous change in dosage (16.4%), noncompliance or dosing errors (16.3%), and initiation of therapy (15.6%) were other common causes of underanticoagulation. Changes in drugs, medical condition, dietary vitamin K intake, alcohol use, and activity level, in combination, accounted for only 15.1% of INRs below 2.0. Among 603 out‐of‐range INRs greater than 4.0, the most common cause of overanticoagulation was indeterminate (43.0%). Changes in medical condition (15.9%), response to a previous change in warfarin dosage (11.4%), and interactions with prescription drugs (7.3%) were other common causes of overanticoagulation. In combination, noncompliance or dosing errors, initiation of therapy, and change in dietary vitamin K intake accounted for only 15.4% of INR values above 4.0.

Conclusion. Out‐of‐range INRs are encountered frequently during warfarin therapy as a result of changes in numerous factors. Despite extensive evaluation of potential causes of over‐ and underanticoagulation, a specific cause commonly cannot be determined.
Cyanide Poisoning and Its Treatment
Authors: Gracia Rebeca , Shepherd Greene
Published: September 2004

Cyanide is both widely available and easily accessible throughout the world. Although the compound is not frequently encountered, it has been used as a poison and contaminant in the past and is a potential terrorist agent. Cyanide has the ability to cause significant social disruption and demands special attention to public health preparedness. It can be obtained from a variety of sources, including industrial, medical, and even common household products. Another frequently encountered source of cyanide exposure is residential fires. Exposure to high concentrations of the chemical can result in death within seconds to minutes. Long‐term effects from cyanide exposure can cause significant morbidity. The only treatment for cyanide toxicity approved for use in the United States is a kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate. Future research aims to find a faster‐acting, more effective, and better tolerated treatment for cyanide toxicity.
Intentional Overdose with Insulin Glargine and Insulin Aspart
Authors: Tofade Toyin S. , Liles E. Allen
Published: September 2004

Reports of intentional massive overdoses of insulin are infrequent. A review of the literature revealed no reports of overdose attempts with either insulin glargine or insulin aspart. We report the case of a 33‐year‐old woman without diabetes mellitus who intentionally injected herself with an overdose of both products, which belonged to her husband. She arrived at the emergency department 15 hours after her suicide attempt, which took place the night before. Her husband had checked her blood glucose level throughout the night and had given her high‐carbohydrate drinks and foods. The patient had a history of obsessive‐compulsive disorder, major depression, and numerous suicide attempts. She recovered from the resulting hypoglycemia after 40 hours of dextrose infusion and was transferred to a mental health facility. The main danger associated with insulin overdose is the resultant hypoglycemia and its effects on the central nervous system; hypokalemia, hypophosphatemia, and hypomagnesemia also can develop with excess insulin administration. Dextrose infusion, with liberal oral intake when possible, and monitoring for electrolyte changes, making adjustments as needed, are recommended for the treatment of intentional insulin overdose.
Collaboration and Social Inquiry: Multiple Meanings of a Construct and Its Role in Creating Useful and Valid Knowledge
Authors: Trickett Edison J. , Espino Susan L. Ryerson
Published: September 2004

The concept of collaboration in community research and intervention, although not new, has grown tremendously in importance in the past 20 years. Yet, it is both a contested concept in terms of its intent and a still evolving idea in terms of its meaning and implications. The purpose of this monograph is to begin to “unpack” the collaboration construct in terms of its many meanings, rationales, goals, models, dynamics, and accomplishments. Although models of collaboration are often well articulated there is “partial paradigm acquisition” (E. J. Trickett, 1984) in terms of understanding their behavioral and ethical implications. There is more theology than conclusion. The promise of collaboration, although considerable, is still in need of multiple and varied empirical examples of how collaboration contributes to both the process and goals of community research and intervention, however defined. The monograph closes with a brief overview of what we have learned from reviewing this literature, an articulation of the kinds of questions that need to be addressed, and a series of recommendations for how to increase our understanding of the collaboration construct in community research and intervention.
Racial Identity, Parental Support, and Alcohol Use in a Sample of Academically At‐Risk African American High School Students
Authors: Caldwell Cleopatra Howard , Sellers Robert M. , Bernat Debra Hilkene , Zimmerman Marc A.
Published: September 2004

This study examined racial identity and parental support as predictors of alcohol use in a sample of 488 African American adolescents. Two dimensions of racial identity were investigated: (1) racial centrality (i.e., the significance that one places on race in defining oneself) and (2) private regard (i.e., the extent to which one feels positively about Black people). In addition, perceived support from mothers and fathers was examined. Multivariate results showed that private regard and father support were associated with less self‐reported alcohol use after partialling out the effects of age and gender. An interaction between the two racial identity dimensions was also found such that private regard was associated with less alcohol use for adolescents who reported that race was a more central part of their identity.
Targeted cytoplasmic irradiation induces bystander responses
Authors: Shao Chunlin , Folkard Melvyn , Michael Barry D. , Prise Kevin M.
Published: September 2004

The observation of radiation-induced bystander responses, in which cells respond to their neighbors being irradiated, has important implications for understanding mechanisms of radiation action particularly after low-dose exposure. Much of this questions the current dogma of direct DNA damage driving response in irradiated systems. In this study, we have used a charged-particle microbeam to target individual helium ions (
3
He
2+
) to individual cells within a population of radioresistant glioma cells cultured alone or in coculture with primary human fibroblasts. We found that even when a single cell within the glioma population was precisely traversed through its cytoplasm with one
3
He
2+
ion, bystander responses were induced in the neighboring nonirradiated glioma or fibroblasts so that the yield of micronuclei was increased by 36% for the glioma population and 78% for the bystander fibroblast population. Importantly, the yield of bystander-induced micronuclei was independent of whether the cytoplasm or nucleus of a cell was targeted. The bystander responses were fully eliminated when the populations were treated with 2-(4-carboxyphenyl)-4,4,5,5-tetramethyl-imidazoline-1-oxyl-3-oxide or filipin, which scavenge nitric oxide (NO) and disrupt membrane rafts, respectively. By using the probe 4-amino-5-methylamino-2′,7′-difluorofluorescein, it was found that the NO level in the glioma population was increased by 15% after 1 or 10 cytoplasmic traversals, and this NO production was inhibited by filipin. This finding shows that direct DNA damage is not required for switching on of important cell-signaling mechanisms after low-dose irradiation and that, under these conditions, the whole cell should be considered a sensor of radiation exposure.
Comparative structural modeling and inference of conserved protein classes in
Drosophila
seminal fluid
Authors: Mueller Jacob L. , Ripoll Daniel R. , Aquadro Charles F. , Wolfner Mariana F.
Published: September 2004

The constituents of seminal fluid are a complex mixture of proteins and other molecules, most of whose functions have yet to be determined and many of which are rapidly evolving. As a step in elucidating the roles of these proteins and exposing potential functional similarities hidden by their rapid evolution, we performed comparative structural modeling on 28 of 52 predicted seminal proteins produced in the
Drosophila melanogaster
male accessory gland. Each model was characterized by defining residues likely to be important for structure and function. Comparisons of known protein structures with predicted accessory gland proteins (Acps) revealed similarities undetectable by primary sequence alignments. The structures predict that Acps fall into several categories: regulators of proteolysis, lipid modifiers, immunity/protection, sperm-binding proteins, and peptide hormones. The comparative structural modeling approach indicates that major functional classes of mammalian and
Drosophila
seminal fluid proteins are conserved, despite differences in reproductive strategies. This is particularly striking in the face of the rapid protein sequence evolution that characterizes many reproductive proteins, including
Drosophila
and mammalian seminal proteins.
Methamphetamine and MDMA (Ecstasy) Neurotoxicity: 'of Mice and Men'
Authors: Itzhak Yossef , Achat‐Mendes Cindy
Published: September 2004

Methamphetamine (METH) and 3,4‐meythylenedioxymethamphetamine (MDMA; 'ecstasy') are currently major drugs of abuse. One of the major concerns of amphetamines abuse is their potential neurotoxic effect on dopaminergic and serotonergic neurons. Although data from human studies are somewhat limited, compelling evidence suggests that these drugs cause neurotoxicity in rodents and primates. Recent studies in transgenic and knockout mice identified the role of dopamine transporters, nitric oxide, apoptotic proteins, and inflammatory cytokines in amphetamines neurotoxicity. Further research into the mechanisms underlying the dopaminergic and serotonergic neurotoxicity and the behavioral corollaries of these neuronal insults could facilitate our understanding of the consequences of human abuse of METH and MDMA on cognition, drug‐seeking behavior, extinction and relapse.
IUBMB Life, 56: 249‐255, 2004
Ephrins and their Receptors: Binding versus Biology
Authors: Blits‐Huizinga Carla T. , Nelersa Claudiu M. , Malhotra Arun , Liebl Daniel J.
Published: September 2004

Ephrins and Eph receptors play important roles in the development of the central nervous system and peripheral tissues by orchestrating cellular movements, resulting in events such as axonal growth cone guidance, tissue segmentation, and angiogenic remodeling. To understand the role of specific ephrin and Eph receptor interactions, it is important to identify the binding specificity between individual ligand‐receptor complexes. To date, a dogma in the field suggests that there may be promiscuous binding within the subclasses of the ephrin family. However, this overlooks and contradicts several binding studies that suggest specificity within each subclass. Although binding studies only provide evidence on the dynamics and strength of protein interactions, they do not indicate whether particular interactions are physiologically relevant. Thus, distribution and gene targeted mutations of ephrins and their receptors can provide critical insights into the relevance of specific ligand‐receptors interactions. This review mainly focuses on the B‐class family and will evaluate the differences between binding affinities and biological functions, importance of oligomeric interactions, and structural differences and similarities between classes.
IUBMB Life, 56: 257‐265, 2004
Viruses and the Development of Quantitative Biological Electron Microscopy
Authors: Crowther RA
Published: September 2004

The electron microscope has become an important tool for determining the structure of biological materials of all kinds. Many technical advances in specimen preparation and in sophisticated methods of image analysis, initially based on optical systems but latterly on computer processing, have contributed to the development of the subject. Viruses of various kinds have often provided a convenient and appropriate test specimen. This paper describes the major technical advances and shows how viruses have had an important role in most of the developments.
IUBMB Life, 56: 239‐248, 2004
Altering dietary nutrient intake that reduces glycogen content leads to phosphorylation of nuclear p38 MAP kinase in human skeletal muscle: association with IL‐6 gene transcription during contraction
Authors: Chan M. H. Stanley , McGee Sean L. , Watt Matthew J. , Hargreaves Mark , Febbraio Mark A.
Published: September 2004

To determine the effect of glycogen availability and contraction on intracellular signaling and IL‐6 gene transcription, eight males performed 60 min of exercise on two occasions: either with prior ingestion of a normal (Con) or low carbohydrate (LCHO) diet that reduced pre‐exercise muscle glycogen content. Muscle biopsies were obtained and analyzed for IL‐6 mRNA. In addition, nuclear proteins were isolated from the samples and analyzed for the mitogen‐ activated protein kinases (MAPK) c‐jun amino‐terminal kinase (JNK) 1 and 2 and p38 MAPK. Nuclear fractions were also analyzed for the phosphorylated forms of JNK (p‐JNK) and p38 MAPK (p‐ p38 MAPK) and the abundance of the nuclear transcription factors nuclear factor of activated T cells (NFAT) and nuclear factor kappa‐β (NF‐κβ). No differences were observed in the protein abundance of total JNK 1/2, p38 MAPK, NFAT, or NF‐κβ before exercise, but the nuclear abundance of p‐p38 MAPK was higher (P<0.05) in LCHO. Contraction resulted in an increase (P<0.05) in nuclear p‐JNK 1/2, but there were no differences when comparing CON with LCHO. The fold increase in IL‐6 mRNA with contraction was potentiated (P<0.05) in LCHO. A correlation between pre‐exercise nuclear phosphorylated p38 MAPK and contraction‐induced fold increase in IL‐6 mRNA was performed, revealing a highly significant correlation (r=0.96; P<0.01). We next incubated L6 myotubes in ionomycin (a compound known to induce IL‐6 mRNA) with or without the pyridinylimidazole p38 MAPK inhibitor SB203580. Treatments did not affect total nuclear p38 MAPK, but ionomycin increased (P<0.05) both nuclear p‐p38 MAPK and IL‐6 mRNA. The addition of SB203580 to ionomycin decreased (P<0.05) nuclear p‐ p38 MAPK and totally abolished (P<0.05) the ionomycin‐ induced increase in IL‐6 mRNA. These data suggest that reduced carbohydrate intake that results in low intramuscular glycogen leads to phosphorylation of p38 MAPK at the nucleus. Furthermore, phosphorylation of p38 MAPK in the nucleus appears to be an upstream target for IL‐6, providing new insights into the regulation of IL‐6 gene transcription.
Adenosine up‐regulation of the mucin gene, MU2, in asthma
Authors: McNamara Nancy , Gallup Marianne , Khong Amy , Sucher Anatol , Maltseva Inna , Fahy John V. , Basbaum Carol
Published: September 2004

Mucus hypersecretion is a hallmark of asthma that contributes to airway obstruction. While the etiology is not well understood, hypersecretion has been linked to the presence of cytokines such as IL‐4, IL‐5, IL‐9, and IL‐13 in the inflamed airway. The presence of adenosine has also been noted in asthmatic airways, and adenosine‐mediated signaling in mast cells has been implicated in the severe bronchoconstriction and inflammation prevalent in these patients (1, 2). Here we examine the possibility that adenosine also contributes to mucus hypersecretion by airway epithelial cells. Results in cultured airway epithelial cells showed that MUC2 mucin expression increased in response to adenosine. This appeared to be mediated by a pathway initiated at the adenosine A1 receptor that transduced signals through a Ca2+‐activated Cl− channel and EGFR. That this signaling cascade is relevant to asthmatic hypersecretion was indicated by results showing that mucin induction by asthmatic tracheal aspirates was reduced by A1, CLCA1, and EGFR inhibitors. These results suggest that adenosine cooperates with inflammatory cytokines to stimulate mucin production in the asthmatic airway and supports the use of A1, CLCA1, and EGFR inhibitors in the treatment of asthma.
Putting copper into action: copper‐impregnated products with potent biocidal activities
Authors: Borkow Gadi , Gabbay Jeffrey
Published: September 2004

Copper ions, either alone or in copper complexes, have been used for centuries to disinfect liquids, solids, and human tissue. Today copper is used as a water purifier, algaecide, fungicide, nematocide, molluscicide, and antibacterial and antifouling agent. Copper also displays potent antiviral activity. We hypothesized that introducing copper into clothing, bedding, and other articles would provide them with biocidal properties. A durable platform technology has been developed that introduces copper into cotton fibers, latex, and other polymeric materials. This study demonstrates the broad‐spectrum antimicrobial (antibacterial, antiviral, antifungal) and antimite activities of copper‐impregnated fibers and polyester products. This technology enabled the production of antiviral gloves and filters (which deactivate HIV‐1 and other viruses), antibacterial self‐sterilizing fabrics (which kill antibiotic‐resistant bacteria, including methicillin‐resistant Staphylococcus aureus and vancomycin‐resistant Enterococci), antifungal socks (which alleviate symptoms of athlete’s foot), and anti‐dust mite mattress covers (which reduce mite‐related allergies). These products did not have skin‐sensitizing properties, as determined by guine pig maximization and rabbit skin irritation tests. Our study demonstrates the potential use of copper in new applications. These applications address medical issues of the greatest importance, such as viral transmissions; nosocomial, or healthcare‐associated, infections; and the spread of antibiotic‐resistant bacteria.
Transplantation of low dose CD34+Kdr+ cells promotes vascular and muscular regeneration in ischemic limbs
Authors: Madeddu Paolo , Emanueli Costanza , Pelosi Elvira , Salis Maria Bonaria , Cerio Anna Maria , Bonanno Giuseppina , Patti Mariella , Stassi Giorgio , Condorelli Gianluigi , Peschle Cesare
Published: September 2004

Hematopoietic progenitor cell transplantation can contribute to revascularization of ischemic tissues. Yet, the optimal cell population to be transplanted has yet to be determined. We have compared the therapeutic potential of two subsets of human cord blood CD34+ progenitors, either expressing the VEGF‐A receptor 2 (KDR) or not. In serum‐free starvation culture, CD34+KDR+ cells reportedly showed greater resistance to apoptosis and ability to release VEGF‐A, as compared with CD34+KDR− cells. When injected into the hind muscles in immunodeficient SCIDbg mice subjected to unilateral ischemia, a low number (103) of CD34+KDR+ cells improved limb salvage and hemodynamic recovery better than a larger dosage (104) of CD34+KDR− cells. The neovascularization induced by KDR+ cells was significantly superior to that promoted by KDR− cells. Similarly, endothelial cell apoptosis and interstitial fibrosis were significantly attenuated by KDR+ cells, which differentiated into mature human endothelial cells and also apparently skeletal muscle cells. This study demonstrates that a low number of CD34+KDR+ cells favors reparative neovascularization and possibly myogenesis in limb ischemia, suggesting the potential use of this cell population in regenerative medicine.
Intraoperative Mild Hypothermia Ameliorates Postoperative Cerebral Blood Flow Impairment in Patients with Aneurysmal Subarachnoid Hemorrhage
Authors: Karibe Hiroshi , Sato Kiyotaka , Shimizu Hiroaki , Tominaga Teiji , Koshu Keiji , Yoshimoto Takashi
Published: September 2004

OBJECTIVE

Intraoperative mild hypothermia has been used during cerebral aneurysm surgery to reduce ischemic injury induced by temporary vessel occlusion and brain retraction. However, the clinical effects on cerebral hemodynamics are unclear. This study investigated the effects of intraoperative mild hypothermia on cerebral blood flow (CBF) after surgery to treat aneurysmal subarachnoid hemorrhage.

METHODS

Twenty-four patients with ruptured internal carotid or middle cerebral artery aneurysms, of preoperative Hunt and Hess Grade II or III, underwent aneurysm clipping within 72 hours after the onset of subarachnoid hemorrhage. During surgery, patients were randomly assigned to either intraoperative mild hypothermia (33.5°C, n = 12) or normothermia (37°C, n = 12). Brain single photon emission computed tomography with 99m Tc-hexamethylpropylenamine oxime or 99m Tc-l,l-ethylcysteinate dimer was performed on Days 4, 7, and 14 after subarachnoid hemorrhage. Regional CBF was determined in the basal ganglia and cingulate, frontal, and frontoparietal cortices, using a semiquantitative method.

RESULTS

CBF in the frontal cortex ipsilateral to the aneurysm was significantly higher in the hypothermia group than in the normothermia group on Day 4 (P < 0.01) but not Day 7 or 14. There was a similar trend in the ipsilateral frontoparietal cortex, but it was not significant. There were no differences in regional CBF in the ipsilateral cingulate cortex or basal ganglia or in any contralateral region during the study period.

CONCLUSION

Intraoperative mild hypothermia may reduce the severity of ischemia induced by intraoperative temporary vessel occlusion and brain retraction, thus ameliorating postoperative CBF impairment. (47;601;2000)
Magnesium Sulfate in the Management of Patients with Fisher Grade 3 Subarachnoid Hemorrhage: A Pilot Study
Authors: Boet Ronald , Mee Edward
Published: September 2004

OBJECTIVE

To evaluate the effect of magnesium sulfate (MgSO4) on the clinical course of patients with severe aneurysmal subarachnoid hemorrhage (SAH).

METHODS

Ten patients with Fisher Grade 3 aneurysmal SAH were evaluated. The patients were given a bolus as well as a constant infusion of intravenous MgSO4 up to 10 days postictus. Blood magnesium levels were obtained to adjust the daily requirement of MgSO4. The goal was to raise the serum level to 2.0 to 2.5 mmol/L or twice the baseline serum level. Daily transcranial Doppler (TCD) ultrasonography was performed on each patient, insonating both anterior cerebral and middle cerebral arteries. Further management followed standard protocols, including the use of nimodipine and hypervolemic therapy. TCD ultrasonographic findings, as well as clinical evidence of cerebral vasospasm, were documented. All patients had a 3-month assessment using the Glasgow Outcome Scale.

RESULTS

After administration of a 20 mmol MgSO4 bolus infusion and an average daily continuous infusion of 84.7 mmol, 8 of 10 patients achieved the predetermined serum magnesium levels. No adverse affects were noted during the infusions. Five patients exhibited evidence of vasospasm on TCD ultrasonography; vasospasm was severe in two patients (velocities, >200 cm/s). Three patients, including the two patients in whom TCD ultrasonography demonstrated severe vasospasm, exhibited clinical evidence of vasospasm. Two patients had a Glasgow Outcome Scale score of 3; the remainder had Glasgow Outcome Scale scores of 5.

CONCLUSION

Administration guidelines for the use of MgSO4 in aneurysmal SAH were established. A prospective double-blind placebo-controlled trial is required to establish the effectiveness of MgSO4 for treating vasospasm in aneurysmal SAH.
Persistent Headache after Supratentorial Craniotomy
Authors: Kaur Amrit , Selwa Linda , Fromes Gail , Ross Donald A.
Published: September 2004

OBJECTIVE

Although the incidence, possible causes, and treatment of persistent headache after suboccipital craniotomy have been discussed extensively, few data have been published regarding persistent headache after supratentorial craniotomy.

METHODS

We retrospectively analyzed the senior author's patient series of 145 consecutive anterior temporal lobectomies for intractable epilepsy performed during a 9-year period. To eliminate confounding causes of headache, all patients studied were seizure-free, none had progressive mass lesions or persisting vascular anomalies, and none had major complications of surgery. With the permission of the institutional review board, information on headache was obtained from patient records, the patients' neurologists, and the patients themselves.

RESULTS

Of the 145 consecutive patients who underwent operations, 126 patients had adequate follow-up for analysis. Of the 126 patients, 104 did not have headaches and were not using regular analgesics 2 months postoperatively. Twenty-two patients had headaches persisting beyond 2 months. Seven (5.6%) of the 126 patients had headaches that lasted more than 2 months but less than 1 year, and they were free of recurrent headaches 1 year postoperatively. Fifteen (11.9%) of the 126 patients had ongoing headaches 1 year after surgery. Regarding headache severity, 4.0% of patients had medically uncontrolled headaches, and 3.2% continued to require prescription drugs for headaches 1 year postoperatively.

CONCLUSION

Although the incidence of persistent head pain after supratentorial craniotomy is lower than that reported for posterior fossa procedures, the incidence is not trivial. The cause of persistent pain deserves further investigation.
Surgery for Cervical Spinal Cord Compression in Patients with Multiple Sclerosis
Authors: Bashir Khurram , Cai Christopher Y. , Moore Thomas A. , Whitaker John N. , Hadley Mark N.
Published: September 2004

OBJECTIVE

The goal of this study was to investigate the clinical and paraclinical features, treatment, and outcomes of patients with multiple sclerosis (MS) and coexisting spinal cord compression secondary to either cervical spondylosis or cervical disc disease. Patients with MS commonly experience neurological disabilities that present as myelopathy associated with bladder dysfunction. For some patients with MS, however, this neurological deterioration may result from coexisting spinal cord compression attributable to either spondylosis or a herniated disc. Overlapping symptoms of the two conditions do not allow clear clinical determination of the underlying cause of worsening.

METHODS

Patients with MS who underwent cervical decompression surgery were selected. Medical records were retrospectively reviewed, to collect data on their pre- and postoperative clinical courses.

RESULTS

Nine women and five men with definite MS were selected for cervical decompression surgery to treat neurological deterioration considered to be at least partially attributable to spinal cord compression. The most common symptoms were progressive myelopathy (n = 13), neck pain (n = 11), and cervical radiculopathy (n = 10). Bladder dysfunction was notably absent among these patients with MS with moderate disabilities. Surgical intervention was frequently delayed because the neurological deterioration was initially thought to be attributable to MS. The majority of patients experienced either improvement or stabilization of their preoperative symptoms in the immediate postoperative period; three subjects (21%) maintained this improvement after a mean follow-up period of 3.8 years. No MS relapses, permanent neurological worsening, or serious complications resulting from surgery or general anesthesia were noted.

CONCLUSION

Carefully selected patients with MS and cervical spinal cord compression secondary to either spondylosis or disc disease may benefit from surgical decompression, with minimal associated morbidity. Clinical features (especially neck pain and cervical radiculopathy) and magnetic resonance imaging may assist clinicians in differentiating between the two conditions and may guide appropriate treatment without undue delay.
Cellular Transplantation and Spinal Cord Injury
Authors: Barami Kaveh , Diaz Fernando G.
Published: September 2004

SPINAL CORD INJURY is often characterized by immediate and irreversible loss of sensory and motor functions below the level of injury. Cellular transplantation in various experimental models of spinal cord injury has been used as a strategy for reducing deficits and improving functional recovery. The general strategy has been aimed at promoting regeneration of intrinsic injured axons with the development of alternative pathways that facilitate a partial functional connection. Other objectives of cellular transplantation studies have included replacement of lost cellular elements, alleviation of chronic pain, and modulation of the inflammatory response after injury. This review focuses on the cell types that have been used in spinal cord transplantation studies in the context of evolving biological perspectives, technological advances, and new therapeutic strategies and serves as a point of reference for future studies.
Clinically Silent Corticotroph Tumors of the Pituitary Gland
Authors: Scheithauer Bernd W. , Jaap Alan J. , Horvath Eva , Kovacs Kalman , Lloyd Ricardo V. , Meyer Fredric B. , Laws Edward R. , Young William F.
Published: September 2004

OBJECTIVE

To determine the clinical presentation, imaging characteristics, microscopic and ultrastructural characteristics, and treatment outcomes of patients with clinically silent pituitary corticotroph adenomas.

METHODS

All silent corticotroph adenomas diagnosed at the Mayo Clinic during the years 1975 through 1997 were selected from the files of the Mayo Tissue Registry.

RESULTS

We studied 23 cases, occurring in 16 male and 7 female patients (age range, 11–79 yr; mean age, 48 yr), who presented with headaches (50%), visual field defects (61%), extraocular muscle paresis (13%), hypopituitarism (26%), and galactorrhea/amenorrhea (43%/29% of the female patients). No patients exhibited clinical hypercortisolism. All tumors were macroadenomas (2.4 ± 0.8 cm; range, 1.5–4.0 cm) and exhibited suprasellar extension in 87% of the cases and hemorrhage, necrosis, and/or cystic changes in 61%. All tumors stained were variably periodic acid-Schiff-, adrenocorticotropic hormone-, and β-endorphin-positive, particularly Subtype I lesions. Ultrastructural classification was performed in 19 cases. In a comparison of Subtype I and II tumors, differences were observed with respect to sex (male/female, 1.4:1 versus 6:1), preoperative hyperprolactinemia (5 of 16 versus 0 of 6 cases), preoperative hypopituitarism (9 of 16 versus 5 of 7 cases), radiographic or gross invasion (7 of 16 versus 5 of 7 cases), and partial or total postoperative pituitary failure (6 of 16 versus 6 of 6 cases). The overall median postoperative follow-up period was 4.9 years (range, 0.3–16.6 yr); 54% of the patients had persistent or recurrent tumors.

CONCLUSION

Clinically silent corticotroph adenomas behave in an aggressive manner and are characterized by the following: lack of clinical signs or symptoms of Cushing's syndrome and normal cortisol levels; no or only minor elevations of serum adrenocorticotropic hormone levels; macroadenomas with hemorrhagic infarction; and presentation dominated by mass effect symptoms. The high persistence/recurrence rate underscores the need for long-term follow-up.
Spasmodic Torticollis Due to Neurovascular Compression of the Spinal Accessory Nerve by the Anteroinferior Cerebellar Artery: Case Report
Authors: Alafaci Concetta , Salpietro Francesco M. , Montemagno Gaspare , Grasso Giovanni , Tomasello Francesco
Published: September 2004

OBJECTIVE AND IMPORTANCE

Spasmodic torticollis is a neuromuscular disorder characterized by uncontrollable clonic and intermittently tonic spasm of the neck muscles. We report a case of spasmodic torticollis attributable to neurovascular compression of the right XIth cranial nerve by the right anteroinferior cerebellar artery (AICA).

CLINICAL PRESENTATION

A 72-year-old man with a 2-year history of right spasmodic torticollis underwent magnetic resonance imaging, which demonstrated compression of the right XIth cranial nerve by an abnormal descending loop of the right AICA.

INTERVENTION

The patient underwent microvascular decompression surgery. During surgery, it was confirmed that an abnormal loop of the right AICA was compressing the right accessory nerve. Compression was released by the interposition of muscle between the artery and the nerve.

CONCLUSION

The patient's postoperative course was uneventful, and his symptoms were fully relieved at the 2-year follow-up examination. This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery.
Radiosurgery for Hemangiomas of the Cavernous Sinus and Orbit: Technical Case Report
Authors: Thompson Todd P. , Lunsford L. Dade , Flickinger John C.
Published: September 2004

OBJECTIVE AND IMPORTANCE

Hemangiomas of neurosurgical interest are histologically benign vascular tumors that most often occur in the orbit or cavernous sinus. Hemangiomas can be diagnosed by their characteristic radiographic and angiographic appearance and their tendency to bleed excessively during attempted removal. Intracranial or intraorbital hemangiomas require treatment when they become symptomatic.

CLINICAL PRESENTATION

We report four hemangioma patients who presented with ocular symptoms or signs, such as orbital pain, ophthalmoplegia, proptosis, or impaired visual acuity. Before our evaluation, two patients had each had incomplete resections aborted because of excessive blood loss, one patient had undergone a nondiagnostic transsphenoidal biopsy, and one patient had had an unsuccessful embolization.

INTERVENTION

All four patients were treated with gamma knife radiosurgery. Tumors received a minimal tumor dose that ranged from 14 to 19 Gy. Follow-up evaluations were performed 6 to 24 months after radiosurgery and revealed a reduction in tumor volume in three patients and no tumor progression in the fourth. All patients had symptomatic improvement, but one had persistent diplopia.

CONCLUSION

In this early experience, stereotactic radiosurgery proved to be an effective management strategy that avoided the potentially serious complications associated with surgery or embolization of cavernous sinus hemangiomas.
Predicting Delayed Ischemic Deficits after Aneurysmal Subarachnoid Hemorrhage Using a Transient Hyperemic Response Test of Cerebral Autoregulation
Authors: Lam Joseph M. K. , Smielewski Peter , Czosnyka Marek , Pickard John D. , Kirkpatrick Peter J.
Published: September 2004

OBJECTIVE

To assess whether the development of delayed ischemic deficits (DIDs) after aneurysmal subarachnoid hemorrhage can be predicted using transcranial Doppler ultrasonography and the transient hyperemic response test (THRT).

METHODS

An increase in the middle cerebral artery peak flow velocity (FV) of more than 9% of baseline values after 5 to 9 seconds of carotid artery compression was defined as a normal THRT result, indicating good autoregulatory reserve. The transcranial Doppler criteria for vasospasm were a FV of more than 120 cm/s and a Lindegaard ratio of more than 3. Twenty patients with no immediate postoperative neurological deficits were studied. The FVs at all of the major cerebral arteries were measured daily after surgery, and the THRT results were assessed bilaterally.

RESULTS

Five of six patients with abnormal THRT results in the first examination after surgery (primary THRT impairment) developed DIDs; none of the remaining patients developed DIDs (Fisher exact test, P = 0.0004). All five patients with DIDs initially exhibited low FVs but all subsequently developed increases in FVs to values of more than 150 cm/s and four exhibited FVs of more than 200 cm/s. The time of onset of DIDs corresponded to the time of onset of moderate vasospasm (FV > 150 cm/s). None of the patients with initially normal THRT results developed DIDs, although four patients did exhibit late (secondary) THRT impairment, which was associated with FVs of more than 120 cm/s.

CONCLUSION

When the effects of primarily impaired (after surgery) autoregulation are magnified by vasospasm, the risk of DIDs seems to be very high. Vasospasm alone does not seem to cause DIDs. The development of DIDs could therefore be predicted using the THRT for patients after aneurysm clipping.
Radiosurgery for Childhood Intracranial Arteriovenous Malformations
Authors: Levy Elad I. , Niranjan Ajay , Thompson Todd P. , Scarrow Alan M. , Kondziolka Douglas , Flickinger John C. , Lunsford L. Dade
Published: September 2004

OBJECTIVE

The optimal management of intracranial arteriovenous malformations (AVMs) in children remains controversial. Children with intracranial AVMs present a special challenge in therapeutic decision-making because of the early recognition of their future life-long risks of hemorrhage if they are treated conservatively. The goals of radiosurgery are to achieve complete AVM obliteration and to preserve neurological function. We present long-term outcomes for a series of children treated using radiosurgery.

METHODS

The findings for 53 consecutive children who underwent at least 36 months of imaging follow-up monitoring after radiosurgery were reviewed. The median age at the time of treatment was 12 years (range, 2–17 yr). Thirty-one children (58%) presented after their first intracranial hemorrhaging episodes, two (4%) after their second hemorrhaging episodes, and one (2%) after five hemorrhaging episodes. Nineteen children (36%) presented with unruptured AVMs, and a total of 25 children (47%) exhibited neurological deficits. AVMs were graded as Spetzler-Martin Grade I (2%), Grade II (23%), Grade III (36%), Grade IV (9%), or Grade VI (30%). The median AVM volume was 1.7 ml (range, 0.11–10.2 ml). The median marginal dose was 20 Gy (range, 15–25 Gy).

RESULTS

Results were stratified according to AVM volumes (Group 1, ≤3 ml; Group 2, >3 ml to ≤10 ml; Group 3, >10 ml). Twenty-eight patients (80%) in Group 1 and 11 (64.7%) in Group 2 achieved complete obliteration. The only patient in Group 3 did not achieve obliteration. Complications included brainstem edema (n = 1) and transient pulmonary edema (n = 1). Four patients experienced hemorrhaging episodes, 30, 40, 84, and 96 months after radiosurgery. Multivariate logistic regression analysis demonstrated that only volume was significantly correlated with obliteration rates (P = 0.0109).

CONCLUSION

Radiosurgery is safe and efficacious for selected children with AVMs. The obliteration rates and the attendant low morbidity rates suggest a primary role for stereotactic radiosurgery for pediatric AVMs.
Craniopharyngiomas of the Third Ventricle: Trans-Lamina Terminalis Approach
Authors: Maira Giulio , Anile Carmelo , Colosimo Cesare , Cabezas Daniel
Published: September 2004

OBJECTIVE

Craniopharyngiomas usually grow on the cisternal surface of the hypothalamic region; these tumors can also grow from the infundibulum or tuber cinereum on the floor of the third ventricle, developing exclusively into the third ventricle. The aim of the present work was to establish the usefulness of the pterional trans-lamina terminalis approach for the removal of these tumors.

METHODS

Eight patients who were surgically treated for craniopharyngiomas located exclusively within the third ventricle were considered. The initial symptoms were acute hydrocephalus in two cases, psychological disturbances in two, amenorrhea in two, headaches in one, and hypopituitarism in one. The diagnoses were established, in all cases except one, with magnetic resonance imaging. In all cases, the tumor completely filled the third ventricle.

RESULTS

Total removal of the lesion was achieved in seven cases. One patient underwent partial removal. In the immediate postoperative period, no major complications were observed. Five patients required replacement hormonal therapy. All patients returned to a normal life. Many months after surgery, two patients exhibited psychological disturbances and died, the first because of voluntary withdrawal of replacement therapy (12 mo after surgery) and the second because of a severe imbalance in body fluids and electrolytes, with a subsequent hyperosmolar coma (27 mo after surgery). Only one patient who underwent initial total removal experienced a small recurrence of the lesion (30 mo after surgery); after 3 years, the lesion exhibited unchanged size.

CONCLUSION

In our experience, the trans-lamina terminalis approach is a valid choice for the removal of purely intraventricular craniopharyngiomas. These tumors can be removed without significant sequelae related to the surgical approach. The proximity to the hypothalamus requires accurate neuroendocrine and electrolyte control in the postoperative period, in some cases even years after surgery.
Three-dimensional Reconstructed Images after Rotational Angiography in the Evaluation of Intracranial Aneurysms: Surgical Correlation
Authors: Tanoue Shuichi , Kiyosue Hiro , Kenai Hiroyuki , Nakamura Takaharu , Yamashita Masanori , Mori Hiromu
Published: September 2004

OBJECTIVE

To evaluate the diagnostic accuracy of three-dimensional reconstructed images from rotational

subtraction angiography in the surgical treatment of intracranial aneurysms.

METHODS

Twenty-two patients with 34 intracranial aneurysms underwent biplane angiography (40 degrees per s, 4.5 degrees per image, 8.8 frames per s). Three-dimensional (3-D) reconstructed images were obtained at a separate Advantage 3.1 workstation (General Electric, Milwaukee, WI) after the rotational images were transferred. The available visualization techniques included maximum intensity projection, shaded surface display, and virtual endoluminal view. All images were evaluated in correlation with intrasurgical visual data recorded on

videotapes.

RESULTS

3-D reconstructed images correlated well with surgical findings. The shape of the aneurysms, their neck size, and their relationships to the parent vessels and other branches were depicted clearly, especially compared with images obtained by two-dimensional conventional

subtraction angiography and magnetic resonance angiography.

CONCLUSION

3-D

subtraction angiography enables the surgeon to understand the 3-D structure of lesions and is very useful in planning the surgical treatment of cerebral aneurysms.
Carotid Stenting and “Extarterectomy” in the Management of Head and Neck Cancer Involving the Internal Carotid Artery: Technical Case Report
Authors: Nussbaum Eric S. , Levine Samuel C. , Hamlar David , Madison Michael T.
Published: September 2004

OBJECTIVE AND IMPORTANCE

Head and neck cancer that invades the internal carotid artery (ICA) represents a significant management challenge. We describe a novel technique that allows for aggressive tumor removal without disrupting blood flow through the affected ICA.

CLINICAL PRESENTATION

A 62-year-old man was referred to our institution for management of a neck malignancy involving the ICA. Cerebral angiography suggested that there was good collateral flow from the opposite hemisphere, but the patient reported visual loss in the ipsilateral eye during balloon test occlusion of the ICA.

INTERVENTION

A self-expanding stent was deployed in the ICA; it spanned the entire length of the artery involved by tumor. One month later, the patient underwent tumor resection. During surgery, a long ICA arteriotomy was performed directly down to the mesh of the stent. A neoendothelium had formed within the stent, which prevented arterial bleeding. The carotid wall was dissected from the stent without difficulty and removed en bloc with the surrounding tumor. The exposed stent was wrapped circumferentially with a synthetic patch material. The patient tolerated the procedure well, and postoperative angiography demonstrated normal filling of the ICA.

CONCLUSION

We describe a novel approach to a patient with head and neck cancer involving the cervical ICA. Preliminary stenting, which allows time for endothelialization before surgery, may permit aggressive tumor resection without interrupting flow through the ICA. This technique obviates the need for complicated carotid reconstruction procedures and avoids the risk of delayed ischemia from carotid sacrifice.
Electrical Bone Graft Stimulation for Spinal Fusion: A Review
Authors: Oishi Masaki , Onesti Stephen T.
Published: September 2004

ALTHOUGH ELECTRICAL STIMULATION to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.
Parameters for Contralateral Approach to Ophthalmic Segment Aneurysms of the Internal Carotid Artery
Authors: Kakizawa Yukinari , Tanaka Yuichiro , Orz Yasser , Iwashita Tomomi , Hongo Kazuhiro , Kobayashi Shigeaki
Published: September 2004

OBJECTIVE

This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA).

METHODS

Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. All aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter B, the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram.

RESULTS

Parameters A to F were 8.8 mm (range, 5.4–11.1 mm), 14.5 mm (range, 10.4–22.2 mm), 0.9 mm (range, 0.6–1.3 mm), and 3.0 mm (range, 2.3–4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3–2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm.

CONCLUSION

Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.