bluuebunny/crossref_metadata_2025 huggingface dataset:
Tetherin does not significantly restrict dendritic cell-mediated HIV-1 transmission and its expression is upregulated by newly synthesized HIV-1 Nef
Authors: Coleman Christopher M , Spearman Paul , Wu Li
Published: April 2011

Background

Dendritic cells (DCs) are among the first cells to encounter HIV-1 and play important roles in viral transmission and pathogenesis. Immature DCs allow productive HIV-1 replication and long-term viral dissemination. The pro-inflammatory factor lipopolysaccharide (LPS) induces DC maturation and enhances the efficiency of DC-mediated HIV-1 transmission. Type I interferon (IFN) partially inhibits HIV-1 replication and cell-cell transmission in CD4+ T cells and macrophages. Tetherin is a type I IFN-inducible restriction factor that blocks HIV-1 release and modulates CD4+ T cell-mediated cell-to-cell transmission of HIV-1. However, the role of type I IFN and tetherin in HIV-1 infection of DCs and DC-mediated viral transmission remains unknown.

Results

We demonstrated that IFN-alpha (IFNα)-induced mature DCs restricted HIV-1 replication and trans-infection of CD4+ T cells. Tetherin expression in monocyte-derived immature DCs was undetectable or very low. High levels of tetherin were transiently expressed in LPS- and IFNα-induced mature DCs, while HIV-1 localized into distinct patches in these DCs. Knockdown of induced tetherin in LPS- or IFNα-matured DCs modestly enhanced HIV-1 transmission to CD4+ T cells, but had no significant effect on wild-type HIV-1 replication in mature DCs. Intriguingly, we found that HIV-1 replication in immature DCs induced significant tetherin expression in a Nef-dependent manner.

Conclusions

The restriction of HIV-1 replication and transmission in IFNα-induced mature DCs indicates a potent anti-HIV-1 response; however, high levels of tetherin induced in mature DCs cannot significantly restrict wild-type HIV-1 release and DC-mediated HIV-1 transmission. Nef-dependent tetherin induction in HIV-1-infected immature DCs suggests an innate immune response of DCs to HIV-1 infection.
Spondylarthritis presenting with an allergic immediate systemic reaction to adalimumab in a woman: a case report
Authors: Benucci Maurizio , Manfredi Mariangela , Testi Sergio , Iorno Maria L , Valentini Maurizio , Soldaini Francesca , Campi Paolo
Published: April 2011

Introduction

The efficacy of adalimumab, a fully human anti-tumor necrosis factor α recombinant antibody, has dramatically improved the quality of life of patients with rheumatoid and psoriatic arthritis and Crohn's disease. Because it is fully human, one should not expect immune reactions to this molecule. Adverse reactions to adalimumab are limited mainly to injection site reactions and are very common. Immediate systemic reactions are rarely reported.

Case presentation

We report the case of a 61-year-old Caucasian woman who was treated with adalimumab for spondylarthritis and developed injection site reactions after the sixth dose. After a two-month suspension, she recommenced therapy and experienced two systemic reactions. The first occurred after one hour with itching of the palms and soles and angioedema of the tongue and lips. Thirty minutes after the next dose the patient had itching of the palms and soles with diffusion to her whole body, angioedema of the lips, dizziness and visual disturbances. A skin-prick test and intra-dermal tests with adalimumab gave strong positive results at the immediate reading. However, serum-specific immunoglobulin E (IgE) to adalimumab were not detectable by using Phadia solid phase, especially harvested for this case, in collaboration with our Immunology and Allergy Laboratory Unit. Her total IgE concentration was 6.4 kU/L.

Conclusion

We describe what is, to the best of our knowledge, the first reported case of immediate systemic reaction to adalimumab studied with a skin test giving positive results and a serum-specific IgE assay giving negative results. The mechanism of the reaction must be immunologic but not IgE-mediated.
Involvement of the conserved Hox gene Antennapedia in the development and evolution of a novel trait
Authors: Saenko Suzanne V , Marialva Marta SP , Beldade Patrícia
Published: April 2011

Background

Hox proteins specify segment identity during embryogenesis and have typical associated expression patterns. Changes in embryonic expression and activity of Hox genes were crucial in the evolution of animal body plans, but their role in the post-embryonic development of lineage-specific traits remains largely unexplored. Here, we focus on the insect Hox genes Ultrabithorax (Ubx) and Antennapedia (Antp), and implicate the latter in the formation and diversification of novel, butterfly-specific wing patterns.

Results

First, we describe a conserved pattern of Ubx expression and a novel pattern of Antp expression in wing discs of Bicyclus anynana butterflies. The discrete, reiterated domains of Antp contrast with the typical expression of Hox genes in single continuous regions in arthropod embryos. Second, we show that this pattern is associated with the establishment of the organizing centres of eyespots. Antp upregulation is the earliest event in organizer development described to date, and in contrast to all genes implicated in eyespot formation, is exclusive to those centres. Third, our comparative analysis of gene expression across nymphalids reveals unexpected differences in organizer determination.

Conclusions

We show that the Antp's recruitment for the formation of novel traits in butterfly wing discs involved the evolution of new expression domains, and is restricted to a particular lineage. This study contributes novel insights into the evolution of Antp expression, as well as into the genetic mechanisms underlying morphological diversification. Our results also underscore how a wider representation of morphological and phylogenetic diversity is essential in evolutionary developmental biology.
Anterior Screw Fixation of Posteriorly Displaced Type II Odontoid Fractures
Authors: Geisler Fred H. , Cheng Charles , Poka Attila , Brumback Robert J.
Published: April 2011

Posteriorly displaced Type II odontoid fractures (Type II-P) are difficult to stabilize in an anatomic position with accepted methods of posterior atlantoaxial arthrodesis. Nine patients with Type II-P odontoid fractures with 4 to 15 mm displacement were treated with anterior odontoid screw stabilization. Seven of these patients had associated fractures or defects of the posterior arch of the first cervical vertebra (C1). Atlantoaxial posterior arthrodesis in these patients would not have been possible initially because of the lack of structural integrity of the posterior arch of C1. Two patients, later in the study, had no injury to the ring of C1. The odontoid fractures were stabilized with two 4.0-mm cancellous screws inserted through an anterior approach to the neck under fluoroscopic control with the skin incision at the C5 level. Preoperative reduction of the displaced odontoid process and immediate operative stability of the atlantoaxial complex were obtained in each case. No neurological complications related to the procedure occurred. Two patients died of causes unrelated to their cervical fracture surgery. The 7 patients who survived were followed for a minimum of 6 months. Fracture union and cervical stability were demonstrated in each of the surviving patients, without evidence of screw loosening or loss of fixation. Normal range of motion of the neck was documented at follow-up in all surviving patients. Although this series represents a limited experience with this treatment technique, anterior odontoid screw fixation has significant advantages over accepted methods of cervical stabilization for Type II-P odontoid fractures. Immediate cervical stabilization is obtained, with a predictably high rate of fracture union and preservation of atlantoaxial motion. We believe this technique to be the treatment method of choice for Type II-P odontoid fractures displaced 4 mm or more accompanied by fractures of the posterior arch of the first cervical vertebra.
Neurosurgical Aspects of Cerebral Cryptococcosis
Authors: Chan Kwan-Hon , Mann Kirpal S. , Yue Chung P.
Published: April 2011

Eleven patients with raised intracranial pressure caused by cerebral cryptococcosis developed complications requiring neurosurgical operations. Two patients were fully conscious on admission, and 9 had impaired consciousness, four of whom were comatose. Seven patients were found to have hydrocephalus only. Two patients had cerebral edema initially, and 2 had cystic lesions. One of the latter developed subdural effusion. All patients eventually developed progressive hydrocephalus requiring placement of a ventriculoperitoneal shunt. Four patients were initially treated by external ventricular drainage. When external ventricular drainage was used initially, there were no associated complications; however, there was a high incidence of complications (4 of 7 patients) when a ventriculoperitoneal shunt was placed as the initial treatment. Of the 11 patients, 10 (91%) survived; of these 9 (82%) made an excellent recovery and 7 (64%) returned to their original work. The patient who died had been receiving steroid therapy for hypopituitarism.
Cyst Fluids of Malignant Human Brain Tumors Contain Substances That Stimulate the Growth of Cultured Human Gliomas of Various Histological Type
Authors: Westphal Manfred , Nausch Hildergard , Herrmann Hans-Dietrich
Published: April 2011

The contents of 14 cysts that were located within human intracranial tumors were obtained at surgery by needle aspiration. These tumor cyst fluids (TCFs) were mostly derived from glial tumors (10 cases). TCFs from one metastasis from a mammary carcinoma, one cystic meningioma, one hemangioblastoma, and a cystic acoustic neurinoma were also included. These TCFs were added to primary cultures of human gliomas, established human glioma cell lines, and normal human arachnoid cells in culture. The presence of proliferation-promoting factors in all cyst fluids could be demonstrated. On the basis of the response patterns of the cultures, it was possible to distinguish different levels of growth autonomy and growth factor sensitivity among these cultures and to speculate about varying degrees of cellular autocrine activation. The TCFs appear to contain factors that are not normally present in fetal calf serum, which is a regular constituent of most cell culture media. Some primary cultured cells as well as cell lines react in an oversensitive manner to the addition of TCFs.
Reconstruction of Cranial Defects with Porous Hydroxylapatite Blocks
Authors: Waite Peter D. , Morawetz Richard B. , Zeiger Evan H. , Pincock James L.
Published: April 2011

Repair of cranial defects for brain protection and aesthetics is currently a surgical problem for which there is no completely satisfactory solution. Material used for repair of cranial defects should ideally be incorporated by the body and provided a blood supply. No substance to date, including autologous bone, consistently achieves this. Hydroxylapatite is a polycrystalline, nonresorptive, biocompatible ceramic that allows osseous tissue ingrowth and ultimate transformation into vascularized bone. The authors have used granular hydroxylapatite successfully for reconstructing calvarial defects, but have experienced problems with migration of granules, prolonged mobility, and, in one patient, resorption of an underlying supporting bone graft. The use of hydroxylapatite in block form precludes most of these problems. Porous block or strips are easily contoured and can be fixed at the margin of the calvarial defect, providing immediate stability. Ingrowth of osteoblastic and fibrous tissue provides added strength and stability. This paper describes our experience with porous hydroxylapatite blocks for reconstructive cranioplasty.
Methods of Surgical Stabilization for Metastatic Disease of the Spine
Authors: Cybulski George R.
Published: April 2011

A variety of surgical techniques is available for treatment of metastatic disease of the spine. Prior emphasis on the use of these procedures has been on their benefit as a palliative measure to relieve signs and symptoms of spinal cord and nerve root compression not aided by radiation therapy and corticosteroid administration. More recently, development of surgical techniques that combine neural decompression with restoration of spinal stability has brought about consideration of additional indications for surgery in the treatment of metastatic disease of the spine. The present scope of such surgical procedures is reviewed along with identification of the most reliable selection factors for surgical candidates in order to improve functional outcome from surgical treatment of metastatic disease of the spine. Over 70 surgical series with more than 2,000 patients treated were reviewed.
Chemical Meningitis: Unusual Presentation of a Cerebellar Astrocytoma: Case Report and Review of the Literature
Authors: Lunardi Pierpaolo , Missori Paolo , Fraioli Bernardo
Published: April 2011

Chemical meningitis resulting from the spillage of the contents of a cystic tumor rarely constitutes the sole manifestation of a cranial or spinal tumor. The case of a man who initially had signs and symptoms of meningitis that on computed tomographic scan was shown to be a space-occupying cerebellar lesion is reported. Thirty-five cases of cranial and spinal tumors in which the presenting symptom was chemical meningitis are also reviewed.
Detection of Brain Death in Barbiturate Coma: The Dilemma of an Intracranial Pulse
Authors: Kaufman Howard H. , Geisler Fred H. , Kopitnik Thomas , Higgins William , Stewart Dan
Published: April 2011

Patients treated with barbiturate coma for elevated intracranial pressure after head injury may suffer brain death. Since such patients have an iatrogenically induced absence of neurological function, brain death cannot be diagnosed clinically. Furthermore, as demonstrated by two of our patients, monitoring of intracranial pressure, even in the face of brain death, may show a low intracranial pressure and an intracranial pulse, suggesting the presence of adequate cerebral perfusion pressure and, therefore, brain viability. Under these circumstances. however, significant intracranial blood flow may be absent. Therefore, we suggest that a patient in barbiturate coma should undergo serial blood flow studies. even when the intracranial pressure is low and an intracranial pulse is present. to determine whether brain death has occurred.
Multiple Intracerebral Arteriovenous Malformations: Report of Two Cases
Authors: Nakayama Yoshiya , Tanaka Akira , Yoshinaga Shinya , Tomonaga Masamichi , Maehara Fumiaki , Ohkawa Masayuki
Published: April 2011

We report the cases of two patients, each of whom had two separate angiographically demonstrable intracerebral arteriovenous malformations (AVMs). One patient had an intraventricular hemorrhage with AVMs in the basal ganglia and the insula on the left side, and the other had a pontine hemorrhage with AVMs in the pons and the occipital lobe on the right side. The AVMs in the former patient were removed totally without residual neurological deficit. We discuss the diagnostic problems of multiple intracerebral AVMs and stress the need for thorough neuroradiological evaluation so as not to miss an occult AVM. We also stress the necessity of total excision of all the lesions and point out several problems faced in surgery for AVMs.
Correlation between Magnetic Resonance Imaging and Surgical Findings in the Tethered Spinal Cord
Authors: Moufarrij Nazih A. , Palmer Joann M. , Hahn Joseph F. , Weinstein Meredith A.
Published: April 2011

Between October 1982 and August 1987, 20 patients underwent magnetic resonance imaging (MRI) and subsequent surgical release of a tethered spinal cord. The tethering was caused by a thick filum terminale in 6 patients. On MRI scans, the conus medullaris was at L4 in 2 patients, at L2 in 3 patients, and the filum terminale appeared thick in 1 patient. The spinal cord was tethered to an intradural lipoma correctly demonstrated by MRI in 6 patients. Increased epidural fat was misdiagnosed as an intradural lipoma in one patient and a lipomatous stalk was not identified in 2 other patients. Scar tissue resulting from repair of a meningocele had tethered the cord in the remaining 8 patients. On MRI scans, the conus medullaris was located between L3 and S3; in 5 of the patients, scar tissue was apparent on the MRI scan. This correlative study supports the use of MRI as the initial, and possibly the only, imaging modality when a tethered spinal cord is suspected. Improved or more recent MRI techniques will help demonstrate these anomalies better.
The Effect of the Thermoplastic Minerva Cervical Spine Motion
Authors: Maiman Dennis , Millington Pamela , Novak Sue , Kerk Julie , Ellingsen JoAnne , Wenninger William
Published: April 2011

In order to determine the extent of cervical spine immobilization provided by the thermoplastic Minerva body jacket (TMBJ) 20 healthy male subjects underwent analysis of cervical spine motion before and after TMBJ placement. Maximal cervical flexion/extension and lateral bending were measured from lateral and anteroposterior roentgenograms, respectively. Maximal cervical rotation was measured from overhead photographs. The TMBJ significantly limited flexion/extension at each level of the cervical spine, as well as rotation and lateral bending (P< 0.001). Flexion/extension at each cervical level was found to be equal to that allowed by the halo with body jacket at most levels and less at the occiput-C1, C3-C4, and C6-C7 (as reported in studies using similar methodology). The present study suggests that the thermoplastic Minerva body jacket is a valuable option for rigid external immobilization of the cervical spine.
Internal Carotid Artery Occlusion for Cavernous Segment Aneurysm
Authors: Little John R. , Rosenfeld Jeffrey V. , Awad Issam A.
Published: April 2011

We review our recent experience with occlusion of the cervical internal carotid artery (ICA) in 15 patients with symptomatic aneurysms of the cavernous segment. All the patients were women and ranged in age from 38 to 74 years. Ten patients sought treatment initially for ophthalmoplegia, 9 for retro-orbital pain, 8 for facial paresthesia, and 3 for loss of vision. Two patients had symptoms of transient ocular or brain ischemia. The diameter of the aneurysm was greater than 3 cm in 10 patients. Ten patients underwent gradual occlusion of the ICA by Selverstone clamp under anticoagulation and monitoring of neurological status. One patient underwent ligation of a severely stenotic ICA under general anesthesia and electroencephalographic monitoring. Four patients underwent trapping of the aneurysm (after attempts at direct obliteration) under electroencephalographic and cerebral blood flow monitoring. Two patients with incompetent circle of Willis collaterals underwent prophylactic superficial temporal artery to middle cerebral artery bypass surgery prior to ICA occlusion. There was no postoperative clinical change in 9 patients. Ophthalmoplegia improved in 2 patients, and facial pain improved in 3. Three patients developed new extraocular muscle palsies within hours of ICA occlusion; these resolved in all patients by 1 week postoperatively. No change in aneurysm size was documented by serial postoperative computed tomographic or magnetic resonance imaging scans. After a follow-up of 5 to 6 years (range, 6 months-9 years), 11 patients have remained neurologically stable. Two patients experienced delayed transient worsening of visual or facial symptoms. Two patients developed delayed ipsilateral brain ischemia: one patient had a visibly patent superficial temporal artery to middle cerebral artery bypass; the second patient had an occluded A-1 segment that previously had been patent. These results are discussed in light of direct approaches and recent techniques of intervention.
The Case Against Staged Operative Resection of Cerebral Arteriovenous Malformations
Authors: Morgan Michael K. , Sundt Thoralf M.
Published: April 2011

Three cases of large cerebral arteriovenous fistulae are presented in which surgical ablation was complicated by brain swelling from hyperperfusion breakthrough believed to be caused by acute intraoperative hypoperfusion superimposed on chronic preoperative hypoperfusion. On the basis of these cases, experimental data, and theoretical considerations, we seriously question the wisdom of using staged surgical resection of cerebral arteriovenous malformation to prevent complications related to alterations in cerebral hemodynamics. The reasons for this concern are: the repeated occurrence of acute-on-chronic hypoperfusion during staged resection; a lack of understanding of the time course for the correction of a disordered autoregulation; risk of hemorrhage between the initial and final resection; difficulty in assessing and substantiating flow reduction after subtotal resection; the rapidity of collateralization; the divergence of flow from large, readily accessible feeding arteries to deep penetrating vessels; and attenuation of the wall thickness in collateral vessels as a consequence of increased flow.
Spontaneous Lateral Pontine Hemorrhage with Associated Trigeminal Nerve Root Hematoma
Authors: Veerapen Richard
Published: April 2011

Spontaneous hemorrhage into the lateral part of the pons with sequelae compatible with survival has been documented previously. The author describes an unusual case with spontaneous hemorrhage into the lateral pons, with intraneural extension into the right trigeminal nerve root. Radiological features were of an expanding mass of the cerebellopontine angle. The patient was treated surgically with success.
Management of Hydromyelia
Authors: Wisoff Jeffrey H. , Epstein Fred
Published: April 2011

The authors review their experience in the management of 22 patients with hydromyelia over a 26-month period. Ten children had Chiari I malformations and hydromyelia; 4 children had myelomeningoceles (3 with large thoracic spinal cord cavitations and 1 with cervical hydromyelia); 6 children had distal hydromyelia associated with tethered cords and occult dysraphism; and 2 patients had cavitation subsequent to arachnoiditis. All patients were investigated preoperatively with MRI and intraoperatively with ultrasound. These neurodiagnostic examinations dictated the type of surgical intervention. Patients with Chiari I or Chiari II malformations, cervical hydromyelia, or basal arachnoiditis underwent decompression of the hindbrain malformations, myelotomy with drainage of the cyst, and placement of a stent. When the area of hydromyelia extended to the obex, as demonstrated by intraoperative ultrasound, the obex was plugged. Cyst-pleural shunts were placed in the children who had myelomeningoceles and thoracic hydromyelia. Patients with distal hydromyelia underwent modified terminal ventriculostomy. The classical presentation of brachial amyotrophy and dissociated sensory loss was present in only 3 patients. Progressive scoliosis without neurological deficit, pain, and Lhermitte's phenomenon were common presentations. The patients with tethered cords were generally asymptomatic from their cysts. The authors discuss operative technique, utilization of intraoperative ultrasound, and surgical outcome.
Evidence of Redistribution of Cerebral Blood Flow during Treatment for an Intracranial Arteriovenous Malformation
Authors: Batjer Hunt H. , Purdy Phillip D. , Giller Cole A. , Samson Duke S.
Published: April 2011

The presence of an intracranial arteriovenous malformation has a dramatic impact on local circulatory dynamics. Treatment of some arteriovenous malformations can result in disastrous hyperemic states caused by redistribution of previously shunted blood. This report describes serial hemodynamic measurements of both cerebral blood flow and flow velocity in 3 patients during treatment for arteriovenous malformations. Measurements of cerebral blood flow were made by computed tomographic scan employing the stable xenon inhalation technique; flow velocity, including autoregulatory characteristics, was measured by transcranial Doppler ultrasonogram. Substantial hyperemia developed in one patient (Case 1) after resection and in another (Case 3) after embolization. Embolization resulted in restoration of normal regional cerebral blood flow in a patient who demonstrated hypoperfusion before treatment (Case 2). In Patient 1, postoperative hyperemia was associated with persistently elevated flow velocities, and may have been accompanied by hemispheric neurological deficits. Sequential hemodynamic measurements may predict patients at risk of perioperative complications, and may become useful clinical guidelines for the extent and timing of embolization and for the timing of surgery after intracranial hemorrhage or preoperative embolization procedures.
Corpus Callosotomy for Refractory Seizures in a Patient with Cortical Heterotopia: Case Report
Authors: Stearns Michael , Wolf Aizik L. , Barry Elizabeth , Bergey Gregory , Gellad Fouad
Published: April 2011

Heterotopia of the cerebral cortex, a disorder of neuronal migration, may be associated with medically intractable seizures. We report on a patient with bihemispheric cortical heterotopia who had medically intractable atonic seizures that were successfully treated by corpus callosotomy. The clinical and radiographic aspects of cortical heterotopia and the surgical management of seizures associated with heterotopia are discussed.
Radiation-Induced Osteosarcoma of the Sphenoid Bone
Authors: Tanaka Shigeya , Nishio Shunji , Morioka Takato , Fukui Masashi , Kitamura Katsutoshi , Hikita Koutaro
Published: April 2011

The case of a patient who developed osteosarcoma in the sphenoid bone 15 years after radiation therapy for a craniopharyngioma is reported. Radiation-induced osteosarcoma of the sphenoid bone has not been reported previously. Reported cases of radiation-induced osteosarcomas are reviewed.
Giant Invasive Intracerebral Dermoid Tumor with Subependymoma-like Reaction: Case Report
Authors: Fenstermaker Robert A. , Ganz Edward , Roessmann Uros
Published: April 2011

A large, completely intracerebral, dermoid tumor with extensive outgrowth of appendages into brain tissue caused prominent reactive changes in the surrounding white matter, similar to those seen in a typical subependymoma. This case lends support to the notion that some subependymomas are reactive in etiology.
Transcranial Doppler Sonographic Identification of a Subgroup of Patients with Normal Pressure Hydrocephalus with Coexistent Vascular Disease and Treatment Failure
Authors: Fritz Wolfram , Kalbarczyk Henry k , Schmidt Klaus
Published: April 2011

We report on transcranial Doppler sonography with carbogen reactivity testing of flow velocity as applied to patients with normal pressure hydrocephalus. A subgroup can be differentiated that shows coexistent cerebrovascular disease, The surgical prognosis in these patients is bad. A flow chart demonstrating the proposed clinical examination is presented.
Brain Mapping Techniques to Maximize Resection, Safety, and Seizure Control in Children with Brain Tumors
Authors: Berger Mitchel S. , Kincaid Joseph , Ojemann George A. , Lettich Ettore
Published: April 2011

Intraoperative brain mapping techniques were used to localize language cortex, sensorimotor pathways, and seizure foci in children with supratentorial brain tumors. The methods of direct cortical and subcortical stimulation, in addition to electrocorticography, enabled us to maximize tumor resection, minimize morbidity, and eradicate epileptogenic zones which were always adjacent to, but not involving, the tumor nidus. Language localization was found to be quite variable in the children tested and anatomically unpredictable based on the preoperative neurological or radiological examination. Physiological mapping techniques, therefore, appear to be safe, reliable, and very useful for operations on tumors located within or adjacent to eloquent brain regions in the pediatric population.
Independent Evaluation of a Multidisciplinary Rehabilitation Program for Chronic Low Back Pain
Authors: Cassisi Jeffrey E. , Sypert George W. , Salamon Anita , Kapel Larry
Published: April 2011

Severe chronic low back pain was diagnosed in 236 patients by one physician and they were referred to the University of Miami Comprehensive Pain and Rehabilitation Center (UMCPRC) over a 5-year period for an intensive 4-week inpatient treatment program. Of these 143 (61%) were able to be contacted by telephone and given a structured interview designed for the study. The average time elapsed at follow-up from referral for all patients was 22.5 months. Outcome was measured in the following terms: current levels of pain, percent decrease in pain, subsequent health care utilization, activities of daily living, and attitudes toward treatment. After completion of the interview, the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Questionnaire were sent to the patients. The patients fell into five groupings: Group 1—participants in the UMCPRC program (n = 39); Group 2—those whose participation was not approved by insurance (n = 30); Group 3—those who declined participation (n = 46); Group 4—participants in other programs (n = 14); Group 5—dropouts (n = 14). The five groups were not meaningfully different with regard to prereferral demographics. Interestingly, Group 1 patients exhibited significantly greater prereferral pain and unemployment levels. Despite this, at follow-up significantly more Group 1 members were employed and they exhibited a greater percent decrease in pain as compared to the nonparticipant groups. Returned McGill and Oswestry Questionnaires mirrored these findings. Group 1 members also demonstrated significantly lower rates of subsequent health care utilization, i.e., physician visits, hospitalizations, and surgery than the nonparticipant groups. In conclusion, independent evaluation suggests that the type of program given at UMCPRC is effective for the treatment of chronic intractable low back pain. Future directions are briefly discussed.
Epidermoid Tumors of Meckel's Cave: Case Report and Review of the Literature
Authors: Miyazawa Nobuhiko , Yamazaki Hiromichi , Wakao Tetsuo , Nukui Hideaki
Published: April 2011

Lesions of Meckel's cave are extremely uncommon and difficult to diagnose. The symptoms and signs are variable, and the lesion may not appear on routine roentgenographic or computed tomographic examination. A patient with a small epidermoid tumor of Meckel's cave that was diagnosed by magnetic resonance imaging is herein reported. The epidermoid appeared as a low-intensity mass on the T1-weighted image and as a high-intensity mass on the T2-weighted image. Coronal sections defined the anatomic relationship to the trigeminal nerve. Preoperative recordings of the trigeminal sensory evoked response may be predictive of postoperative recovery of neurological deficits. Furthermore, intraoperative recording was extremely useful in avoiding inadvertent neurological injury. Review of the literature confirms the rarity of this lesion and the usefulness of magnetic resonance imaging in diagnosing it, although based on a limited number of cases.
Traumatic Trochlear Nerve Palsy Diagnosed by Magnetic Resonance Imaging: Case Report and Review of the Literature
Authors: Burgerman Robert S. , Wolf Aizik L. , Kelman Shalom E. , Elsner Henry , Mirvis Stuart , Sestokas Anthony K.
Published: April 2011

Although head trauma is the leading cause of acquired trochlear nerve dysfunction, it receives little attention in the neurosurgical literature. A case is reported of closed head injury that resulted in a right superior oblique palsy in association with incoordination on the left side. Diagnostic imaging revealed a normal cranial computed tomographic scan and a left dorsal midbrain lesion on magnetic resonance imaging scan. The relevant anatomy is reviewed, as well as the action of the superior oblique muscle, its agonists and antagonists, and the clinical manifestations of superior oblique dysfunction. This case is one of the few we are aware of in which a relatively isolated trochlear nerve palsy is the result of a lesion that can be documented by diagnostic imaging, and the first in which the imaging modality is magnetic resonance imaging scan.
Laser-Assisted Microsurgical Extirpation of a Brain Stem Cavernoma: Case Report
Authors: Seifert Volker , Gaab Michael R.
Published: April 2011

A 43-year-old woman presented with progressing signs of a space-occupying brain stem lesion. A computed tomographic scan revealed a hyperdense process located in the pons. Magnetic resonance imaging confirmed the lesion, which had a reticulated core of increased and decreased signal intensity. Vertebral angiography did not show any vascular supply of the process. The patient was operated upon in the lateral park bench position. The lesion, being located close to the exit zone of the trigeminal nerve, could be removed totally with incision of the brain stem and atraumatic vaporization of the tumor tissue with the CO2laser. Despite the fact that the histopathological examination revealed a cavernous angioma the application of laser energy was judged to be extremely valuable for the surgical procedure. It was concluded that with proper selection of application mode and wattage the CO2laser may be used for extirpation of vascularized lesions also especially when situated in or close to deep lying vital structures of the brain.
Aneurysms of the Intracavernous Carotid Artery: Clinical Presentation, Radiographic Features, and Pathogenesis
Authors: Linskey Mark E. , Sekhar Laligam N. , Hirsch William , Yonas Howard , Horton Joseph A.
Published: April 2011

Thirty-seven patients with 44 intracavernous carotid artery aneurysms (ICCAAns) were seen at one institution from 1976 through 1988. Fifteen patients had multiple intracranial aneurysms and 7 had bilateral ICCAAns. Age at diagnosis ranged from 15 to 80 (median 61). Thirty patients were women. Sixteen had a history of hypertension. In 34% of patients the ICCAAns were asymptomatic at diagnosis. 36% were associated with headache, and 57% had associated signs or symptoms of mass effect including sixth nerve paresis (43%). trigeminal pain or sensory loss (32%), third nerve paresis (20%), decreased vision or visual field cut (18%), fourth nerve paresis (16%), and Horner's syndrome (7%). In 4 patients the ICCAAns ruptured, leading to subarachnoid hemorrhage in 3 and epistaxis in 1. Two patients with ICCAAns were seen with spontaneous thrombosis of the ipsilateral internal carotid artery leading to distal ischemic symptoms in 1. More than 90% of the ICCAAns were saccular. Thirty-four percent were small (<1 cm), 48% were large (1 to 2.5 cm), and 16% were giant (>2.5 cm). The majority arose from the anterior genu of the intracavernous internal carotid artery, followed in frequency by the horizontal segment, and then the posterior genu. Magnetic resonance imaging is superior to computed tomography for diagnosing ICCAAns and is the screening procedure of choice. Angiography remains the “gold standard” for diagnosis and determining specific anatomic details necessary to plan therapy. Analyzing the radiographic anatomy of 44 ICCAAns, we conclude that theories attributing the origin of aneurysms to arterial bifurcations may be inadequate to explain the point of origin and direction of take off of up to one-fourth of ICCAAns. (Neurosurgery 26:71-79, 1990)
Combined Frontotemporal-Orbitozygomatic Approach for Tumors of the Sphenoid Wing and Orbit
Authors: McDermott Michael W. , Durity Felix A. , Rootman Jack , Woodhurst W. B.
Published: April 2011

An extension of a combined frontotemporal and orbitozygomatic exposure was developed to remove 8 hyperostosing invasive sphenoid wing meningiomas (Group 1) and 11 complicated intraorbital tumors with and without intracranial extension (Group 2). Two separate bone flaps were created: a free frontotemporal-sphenoidal (pterional) bone flap and en bloc removal of the superior and lateral orbital margins with attached zygomatic arch. Cranio-orbital reconstruction was performed using the inner table of the pterional bone flap. Complete tumor removal was achieved in 14 patients and near total removal in 5. There was no mortality and in those patients who did not require orbital exenteration excellent to good cosmetic results were achieved in all but one case. This approach affords a wide exposure of the orbit and anterior and middle skull base, so that large tumors of the orbit and tumors involving the orbital apex, sphenoid wing, and infratemporal and pterygopalatine fossae can be removed. (Neurosurgery 26:107-116, 1990)
Extensive Dural Sinus Thrombosis Treated by Surgical Removal and Local Streptokinase Infusion
Authors: Persson Lennart , Lilja Anders
Published: April 2011

This article describes the clinical course, including measurements of intracranial pressure (ICP), radiological findings, and treatment, of a gravely ill patient with extensive thrombosis involving the superior sagittal and both transverse sinuses, and the galenic venous system. When “conventional” therapy including anticoagulants and neuro-intensive care failed to reverse the progressive neurological deterioration or to control the ICP, the condition was approached surgically and thrombotic material was removed from the dural sinuses without much difficulty. The effect on the ICP was dramatic, although short-lived. A second operation, combined with local infusion of streptokinase in the sagittal sinus, had a permanent effect as judged from the ICP measurements, radiological findings, and clinical improvement. The combination of direct operative removal of thrombotic material and local infusion of a thrombolytic agent (streptokinase) proved to be an effective treatment of severe dural sinus thrombosis in this patient. (Neurosurgery 26:117-121, 1990)
Primary Neuroendocrine (Merkel Cell) Carcinoma Presenting in the Calvarium: Case Report
Authors: Wojak Joan C. , Murali Raj
Published: April 2011

A case of a primary neuroendocrine carcinoma arising in the calvarium and involving the bone, dura, and underlying brain is presented. The histopathology and immunohistochemical staining characteristics of tumor were consistent with those of Merkel cell tumor. The natural history and histopathology of this tumor are discussed, along with the possible explanation for the origin of this tumor in the calvarium. (Neurosurgery 26:137-139, 1990)
Progressive Necrosis of the Conus Medullaris: Magnetic Resonance Imaging and Surgical Findings
Authors: de Toffol B. , Cotty P. , Gaymard B. , Velut S.
Published: April 2011

A 67-year-old man with non-insulin-dependent diabetes mellitus progressively developed, over a 2-year period, lower extremity sensory and motor defects associated with impaired bladder function and perineal and perianal sensation related to a disease of the conus medullaris extending from T12 to S5. The magnetic resonance imaging scan suggested myelomalacia and the diagnosis of progressive necrotic myelopathy was confirmed by surgical intervention. (Neurosurgery 26:147-149, 1990)
Neurosurgical Applications of Fibrin Glue: Augmentation of Dural Closure in 134 Patients
Authors: Shaffrey Christopher I. , Spotnitz William D. , Shaffrey Mark E. , Jane John A.
Published: April 2011

In a wide variety of neurosurgical procedures performed on 134 patients over a 3-year period. fibrin glue has been applied as an adjunct to dural closure. Overall success at preventing cerebrospinal fluid (CSF) leakage was 90% (121 of 134, 90% effective). In patients considered to be at high risk for CSF leakage intraoperatively but without pre-established fistulae (Group 1), the success rate was higher (111 of 119, 93% effective). In patients with pre-established CSF fistulae (Group 2), the success rate was lower (10 of 15, 67% effective). As single donor sources of concentrated fibrinogen are now available with reduced risks of blood-borne disease transmission, fibrin glue may be a valuable clinical tool for the neurosurgeon. (Neurosurgery 26:207-210, 1990)
Magnetic Resonance Imaging and Cervical Spondylotic Myelopathy
Authors: Mehalic Thomas F. , Pezzuti Roger T. , Applebaum Brett I.
Published: April 2011

Nineteen patients were examined for cervical spondylotic myelopathy with magnetic resonance imaging. Pre- and postoperative magnetic resonance scans were obtained in most cases. Surgical confirmation of the pathological condition was obtained for all 19 patients. On the T2-weighted scans, there was increased signal intensity within the spinal cord at the point of maximal compression. The exact cause of the increased signal intensity on the T2-weighted images is not known, but is suspected to represent edema, inflammation, vascular ischemia, myelomalacia, or gliosis. The increased signal intensity diminished postoperatively in the patients who improved clinically, and remained the same or increased in those whose conditions remained unchanged or worsened after decompression. The authors suggest that these T2-weighted images carry prognostic significance.
Percutaneous Automated Biopsy in the Diagnosis of Primary Infectious Spondylitis
Authors: Onik Gary , Shang Yulin , Maroon Joseph , Eichenblat Mario , Mercer David , Bailes Julian E.
Published: April 2011

Three cases of primary infectious spondylitis, two caused by Staphylococcus aureus and one by tuberculosis, were diagnosed using the method previously described for automated percutaneous discectomy. All three patients, in whom biopsy using fine needle techniques previously was unsuccessful, had positive cultures from specimens obtained using the automated method. The method combines the advantages of local anesthesia and minimal morbidity with the obtaining of adequate material for culture and pathological examination.
Selective Uptake of Hematoporphyrin Derivative into Human Cerebral Glioma
Authors: Hill John S. , Kaye Andrew H. , Sawyer William H. , Morstyn George , Megison Phillip D. , Stylli Stanley S.
Published: April 2011

The uptake of hematoporphyrin derivative (HpD) into human cerebral glioma was measured using a porphyrin extraction technique. Patients with cerebral glioma were injected with HpD at a dose of 5 mg/kg body weight 24 hours before surgery and photoradiation therapy (PRT). Biopsies of tumor, and where possible, adjacent brain and normal brain were taken for analysis of HpD uptake. HpD was selectively localized into all grades of glioma, and there was a direct correlation between the grade of glioma and HpD level in the tumor. The levels were highest in glioblastoma multiforme (mean uptake of 5.9 mg of HpD/g of tumor wet weight) and lower in the intermediate-grade anaplastic astrocytoma (mean uptake of 2.4 mg/g of tumor) and the low-grade astrocytoma (1.6 mg/g of tumor), Uptake into normal brain tissue taken from HpD-sensitized patients was 0.2 mg/g. HpD was also localized into the “brain adjacent to tumor” region. The selective uptake into the low-grade glioma suggests that PRT may be of use as an adjuvant therapy in these tumors and the detection of HpD in this region indicates that PRT may control the spread of tumor infiltrating into the adjacent normal brain.
Cerebral Gliosarcomas: Correlation of Computed Tomographic Findings, Surgical Aspect, Pathological Features, and Prognosis
Authors: Maiuri Francesco , Stella Lucio , Benvenuti Dino , Giamundo Arcangelo , Pettinato Guido
Published: April 2011

The cases of 5 patients with cerebral gliosarcomas examined by computed tomography are reported and the correlations among the computed tomographic (CT) findings, the surgical and histological aspects, and the prognosis are discussed. In some patients, these tumors appear on CT scan as intracerebral lesions, with large necrotic areas and peripheral contrast enhancement; this CT aspect, similar to that of glioblastomas, corresponds to a diffusely infiltrating growth of the tumor and the prevalence of a gliomatous component. In other patients, the tumor appears on the CT scan as a hyperdense mass with well-defined margins and homogenous contrast enhancement;; this CT finding, which may mimic that of a meningioma, corresponds to a rather well-demarcated surgical aspect and the prevalence of sarcomatous component. In our series, we have also noticed a more prolonged survival in a patient with a CT aspect that suggested a meningioma and prevalence of the sarcomatous component.
Traumatic Pseudoaneurysm of the Cervical Carotid Artery: The Value of Arteriography
Authors: Applegate Laura Jones , Pritz Michael B. , Pribram Henry F. W.
Published: April 2011

A patient who sustained a gunshot wound to the neck and subsequent blunt trauma is presented. No angiogram was performed after the initial injury. Subsequently, the patient developed a cerebral embolus from a thrombus dislodged from a pseudoaneurysm of the cervical carotid artery, resulting in complete occlusion of the distal internal carotid artery. After antiplatelet therapy, the distal internal carotid artery recanalized. and the pseudoaneurysm occluded spontaneously. We stress the need for the use of arteriography in the initial evaluation of penetrating injuries to the neck and the utility of repeated arteriograms for further treatment planning as these traumatic lesions can change with time.
Congenital Aneurysmal Dilatation of the Petrous-Cavernous Carotid Artery and Vertebral Basilar Junction in a Child
Authors: Guha Abhijit , Montanera Walter , Hoffman Harold J.
Published: April 2011

The occurrence of intracranial aneurysms in the pediatric population is a rare phenomenon. An unusual case of aneurysmal dilatation of both petrous and cavernous carotid arteries and the vertebral-basilar junction in a child is presented. The underlying etiology, natural history, and possible modes of management are reviewed and discussed.
Intraneural Synovial Cyst of the Peroneal Nerve: Report of Two Cases and Review of The Literature
Authors: Nucci Francesco , Artico Marco , Santoro Antonio , Bardella Lia , Delfini Roberto , Bosco Sandro , Palma Lucio
Published: April 2011

We report two cases of peroneal nerve compression caused by an intraneural synovial cyst and discuss the pathogenesis. clinical and electrophysiological diagnosis, and treatment of these uncommon lesions in the light of the salient published work on the subject.
Anticopper Treatment Inhibits Pseudopodial Protrusion and the Invasive Spread of 9L Gliosarcoma Cells in the Rat Brain
Authors: Brem Steven , Tsanaclis Ana Maria C. , Zagzag David
Published: April 2011

The copper ion, a cofactor of angiogenesis, is sequestered in human brain tumors and the adjacent brain. The invasive spread of neoplastic cells has been linked to angiogenesis and involves similar mechanisms of migration and tumormatrix interaction. In this report, copper depletion inhibited the infiltrative spread of the normally invasive 9L gliosarcoma. Twenty male Fischer 344 rats were each injected with 1 x 1059L cells; 10 rats were treated with a lowcopper diet and penicillamine. In the normocupremic control rats, a “diffuse” invasive pattern was observed in all 10 animals. In the hypocupremic group, a “nodular” pattern, with a discrete border between tumor and brain, was found in 7 of 10 rats (P< 0.01). In a second experiment, the brains of 16 tumor-bearing rats were studied by electron microscopy. In the 8 normocupremic control rats, cytoplasmic extensions and pseudopodial protrusions, cytological markers of invasive cells, were prominent at the tumor-brain interface. In striking contrast, pseudopodia were absent along the border of the tumors in the 8 hypocupremic rats. These findings suggest a biological role of copper in the neoplastic spread of brain tumor cells. Pharmacological and metabolic alteration of the cellular microenvironment to inhibit invasiveness represents a novel therapeutic approach, especially for tumors of the brain in which malignancy is a function of regional invasiveness.