bluuebunny/crossref_metadata_2025 huggingface dataset:
Median Nerve Somatosensory Evoked Potentials and the Glasgow Coma Scale as Predictors of Outcome in Comatose Patients with Head Injuries
Authors: Houlden D. A. , Li Chen , Schwartz M. L. , Katie Marko
Published: April 2011

Median nerve somatosensory evoked potential (SSEP) grades and Glasgow Coma Scale (GSC) scores were obtained from 51 patients with head injuries within 1 week after the injury to determine the relationship of these scores, both individually and combined, to outcome scores obtained more than 6 months after the injury. SSEP grading was based on the presence or absence of the cortical evoked potential, the amplitude of the early cortically generated P22 wave form, and the conduction time through the brain (P/N13-N20 interpeak latency). SSEP responses from both sides of the brain were combined and graded from 1 to 6. The GCS was graded without the verbal component (maximum score, 10), because all patients were intubated. All patients were unresponsive to commands. Median SSEP grades correlated better with Glasgow Outcome Scale and Barthel Index scores (R = 0.57 and 0.64, respectively; P < 0.00001) than GCS scores did (R = 0.35 and 0.37, respectively, P < 0.00001), and combining SSEP grades and GCS scores did not improve the predictive power of the model (R = 0.57 and 0.64, respectively; P < 0.00001). All SSEP Grade 1 patients (n = 13) either died or remained in a vegetative state. In contrast, all SSEP Grade 6 patients (n = 7) had a moderate disability or good recovery. This study demonstrates the prognostic value of early quantitative median nerve SSEP grading for patients with head injuries who are unresponsive to commands within 1 week after the injury.
Surgical Resection of Intrinsic Brain Stem Lesions: An Overview
Authors: Heffez Dan S. , Zinreich James S. , Long Donlin M.
Published: April 2011

A major limitation to the effective treatment of intrinsic mass lesions of the brain stem has been the inability to clearly define the pathological anatomy radiographically. The improved soft tissue resolution offered by magnetic resonance imaging, as compared with axial computed tomography, now makes it possible not only to accurately distinguish anatomical relationships, but also to predict the pathological nature of the lesion. Accordingly, we have been encouraged to pursue a more aggressive approach to intrinsic lesions of the brain stem that appear well circumscribed on magnetic resonance imaging scan. The object of this paper is to report the successfuly treatment of four intrinsic lesions of the brain stem and to present an overview of the relevant published experience.
Intracerebral Solitary Plasmacytoma
Authors: Wisniewski Thomas , Sisti Michael , Inhirami Giorgio , Knowles Daniel M. , Powers James M.
Published: April 2011

We report a rare occurrence of intraparenchymal plasmacytoma and review the literature. The clonal nature of the neoplasm is demonstrated by immunohistochemical and molecular techniques. The importance of the latter techniques in ruling out other pathological entities is stressed.
Saccular Aneurysms of the Distal Anterior Cerebral Artery
Authors: Ohno Kikuo , Monma Seiji , Suzuki Ryuta , Masaoka Hiroyuki , Matsushima Yoshiharu , Hirakawa Kimiyoshi
Published: April 2011

We report a series of 42 consecutive patients with aneurysms of the distal anterior cerebral artery (ACA). Of these, 36 patients had one aneurysm, 5 had two aneurysms, and one had three aneurysms. Thirty patients had a ruptured distal ACA aneurysm; among these patients, the size of the aneurysm was less than 5 mm in diameter in 20, 6 to 10 mm in 7, and larger than 11 mm in 3. Eighteen patients (42.9%) had multiple aneurysms, and distal ACA aneurysms were responsible for a subarachnoid hemorrhage in 10. Thirty-four patients underwent direct surgery, and 30 of these had excellent outcomes 3 months after surgery. The treatment of patients with distal ACA aneurysms is often technically difficult, because of their broad neck configuration and the coexistence of other aneurysms. Nevertheless, the present study emphasizes that distal ACA aneurysms tend to bleed, irrespective of their size, and that excellent outcomes are obtainable by direct surgery.
The Effect of Etomidate on Motor Evoked Potentials Induced by Transcranial Magnetic Stimulation in the Monkey
Authors: Ghaly Ramsis F. , Stone James L. , Levy Walter J. , Roccaforte Peter , Brunner Edward B.
Published: April 2011

Etomidate (ET) is a known hypnotic agent in neuroanesthesia. This study was designed to examine the reliability of motor evoked potentials (MEPs) after transcranial magnetic stimulation in monkeys anesthetized intravenously with ET. The ET regimen was as follows: an initial dose (0.5 mg/kg) followed by 13 doses (0.2 mg/kg every 6-12 min; mean, 8.0 ± 1.3 min). The total dose administered was 3.1 mg/kg. The magnetic coil was placed over the MEP scalp stimulation region. Evoked electromyographic responses were recorded from the contralateral abductor pollicis brevis (APB) and abductor hallucis (AH) muscles of the fore- and hindlimbs, respectively. Reproducible MEP responses were consistently recorded while the animal was under total ET anesthesia. The coil demography was altered and the MEP scalp topography was moderately reduced by ET injections. Significant threshold elevation was noted after a total dose of 1.7 mg/kg for APB responses and 0.5 mg/kg for AH responses (P < 0.05). Marked prolongation of latency was observed after a dose of 0.5 mg/kg for APB MEPs and 2.5 mg/kg for AH MEPs (P < 0.05). MEP amplitude responses showed marked variability. Repeated doses of ET produced a mean threshold rise of 14 to 28% for the APB and 19 to 29% for the AH. The mean latency delay was 5 to 11% for the APB and 0.5 to 8% for the AH, while the mean amplitude depression was 24 to 59% for the APB and 15 to 50% for the AH. Apparent seizure activity or abnormalities in behavior and feeding were not noted over a 1-year period. We conclude that monitoring of MEPs induced by transcranial magnetic stimulation under ET anesthesia is feasible. Clear MEP responses can be maintained under ET anesthesia. ET caused alterations in MEPs induced by transcranial magnetic stimulation, and awareness of such changes is important. Further investigation in humans is recommended.
A Study of the Effectiveness of the Iron-Chelating Agent Deferoxamine as Vasospasm Prophylaxis in a Rabbit Model of Subarachnoid Hemorrhage
Authors: Vollmer Dennis G. , Hongo Kazuhiro , Ogawa Hisayuki , Tsukahara Tetsuya , Kassell Neal F.
Published: April 2011

The pathogenesis of cerebral vasospasm occurring after subarachnoid hemorrhage (SAH) is unknown. Several lines of experimentation have suggested a free radical mechanism in the etiology of vasospasm. Iron is an important catalyst in the generation of free radicals and lipid peroxides in response to tissue injury. We hypothesize that the elaboration of iron from the subarachnoid clot might result in enhanced generation of free radicals and lipid peroxidation. If so. then treatment with deferoxamine, an iron-chelating compound, might reduce the formation of free radicals and thereby ameliorate vasospasm. This hypothesis was examined in a rabbit model of experimental cerebral vasospasm. New Zealand White rabbits were divided into the following experimental groups: control (normal) animals (n = 7), control animals treated with deferoxamine (n = 3), animals subjected to SAH and killed on Day 2 (n = 7), animals subjected to SAH on Day 2 and treated with deferoxamine (n = 9), animals subjected to SAH killed on Day 3 (n = 7). and animals subjected to SAH on Day 3 and treated with deferoxamine (n = 7). Deferoxamine treatment (50 mg/kg/8 hours) was begun 16 hours before the induction of SAH and continued until the animals were killed by perfusion fixation. The basilar artery caliber was assessed using morphometric techniques. The diameter of the basilar arteries in the control animals was 0.64 ± 0.02 mm. Deferoxamine treatment alone did not alter the artery diameter. SAH resulted in a decrease in basilar artery diameter by 20% on Day 2 and 27% on Day 3. Deferoxamine treatment attenuated the SAH-induced spasm minimally on Day 2 but significantly on Day 3 (Day 3 diameter = 0.60 ± 0.04; P < 0.015). These preliminary results show promise for deferoxamine therapy in the treatment of vasospasm occurring after SAH. These data support the notion that SAH-induced vasospasm is mediated by iron, possibly via the generation of free radicals.
Failure of Transluminal Angioplasty in the Treatment of Myointimal Hyperplasia of the Internal Carotid Artery: Case Report
Authors: Culicchia Frank , Spetzler Robert F. , Flom Richard A.
Published: April 2011

Recurrent stenosis of the carotid arteries after a carotid endarterectomy for atherosclerosis can occur as a result of myointimal hyperplasia. This condition was treated by percutaneous transluminal angioplasty. Excellent dilatation of the vessel lumen was documented after balloon dilatation. A 6-month follow-up angiographic study, however, demonstrated recurrent high-grade stenosis at the same level in both carotid arteries. Presumably, the failure of percutaneous transluminal angioplasty and the treatment of myointimal hyperplasia of the internal carotid artery results in the same condition after the original endarterectomy, that is, additional myointimal hyperplasia.
Progressive Coma after the Transsphenoidal Decompression of a Pituitary Adenoma with Marked Suprasellar Extension: Report of Two Cases
Authors: Decker Robert E. , Chalif David J.
Published: April 2011

Two cases of neurological deterioration and coma after the transsphenoidal decompression of a pituitary adenoma with marked suprasellar extension and invasion of the 3rd ventricle are presented. Emergency ventricular shunting led to prompt neurological improvement, which, supplemented by radiation therapy, allowed long-term amelioration of symptoms. Three possible explanations for this complication are offered: 1) traction of the attached 3rd ventricle into the decompression site, causing increased obstructive hydrocephalus, 2) vasopressin release by surgical manipulation of the pituitary stalk and circumventricular organs causing cerebral edema, and 3) edema in the residual tumor secondary to surgical manipulation causing further hydrocephalus. Subsequent patients with similar clinical and imaging criteria will have a planned perioperative ventricular shunting procedure performed.
Emergent Aneurysm Surgery without Cerebral Angiography for the Comatose Patient
Authors: Batjer H. Hunt , Samson Duke S.
Published: April 2011

Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.
Monitoring of Spinal Cord Stimulation Evoked Potentials during Thoracoabdominal Aneurysm Surgery
Authors: North Richard B. , Drenger Benjamin , Beattie Charles , McPherson Robert W. , Parker Stephen , Reitz Bruce A. , Williams Melville G.
Published: April 2011

Repair of a thoracoabdominal aneurysm involves a significant risk of ischemic injury to the spinal cord. Standard monitoring of somatosensory evoked potentials, which relies upon peripheral nerve stimulation, becomes nonspecific and insensitive during this surgery when aortic cross-clamping produces lower extremity ischemia causing a peripheral conduction block. Techniques for the insertion of percutaneous epidural electrodes, developed originally for pain management, have been adapted to this setting to permit direct stimulation of the spinal cord for intraoperative monitoring of evoked potentials. The clinical outcome in patients monitored by this technique has been consistent with evoked potential findings.
Treatment of Spinal Cord Compression by Epidural Malignancy in Childhood
Authors: Raffel Corey , Neave Victoria C. D. , Lavine Sean , McComb Gordon J.
Published: April 2011

Epidural spinal cord compression by a malignant tumor is a rare occurrence in children. Both the tumors involved and the extent of involvement of the vertebral column are different in children and adults. Often, the epidural tumor in a child is identified before significant spinal canal compromise has occurred, and these children frequently can be managed by radiation therapy and/or chemotherapy. There is a group of children, however, who have severe spinal canal encroachment by a tumor, as evidenced by a near complete or complete block on myelography. In this study, we report a group of patients with severe spinal cord compression, as documented by imaging studies. We compared the results of a decompressive laminectomy and subtotal tumor resection followed by adjuvant therapy with the results obtained with radiation therapy and/or chemotherapy alone. Thirty-three patients met the criteria for inclusion in the study. Twenty-six were treated with a laminectomy and adjuvant therapy, and 7 were treated without surgical intervention. With surgical therapy, 25 of 26 epidurals were either improved or stable, whereas 4 of 7 nonsurgical patients deteriorated. Especially notable was a decrease in pain in the operative patients immediately after their procedure. There was no surgical mortality or morbidity. The results of this study indicate that children with severe spinal cord compression as evidenced by a near complete or complete block on myelography or filling of 50% or more of the spinal canal on magnetic resonance imaging are best treated by a combination of surgical decompression and tumor removal followed by adjuvant therapy.
Association between Neuroepithelial Tumor and Multiple Intestinal Polyposis (Turcot's Syndrome): Report of a Case and Critical Analysis of the Literature
Authors: Mastronardi Luciano , Ferrante Luigi , Lunardi Pierpaolo , Cervoni Luigi , Fortuna Aldo
Published: April 2011

We report a case of association of a brain tumor with multiple intestinal polyposis (Turcot's syndrome) and offer a critical analysis of the relevant literature with a view to revising the classification of the syndrome in relation to familial multiple polyposis and Gardner's syndrome. For this purpose, we considered only cases of intestinal polyposis associated with a primary neuroepithelial tumor (medulloblastoma, glioma, or glioblastoma) as originally described by Turcot. Differences emerged, depending on the central nervous system tumor type, which suggests that this neoplastic association may be classified as two distinct syndromes.
Enterogenous Cyst of the Cerebellopontine Angle Cistern: Case Report
Authors: Umezu Hiromichi , Aiba Tadashi , Unakami Masamitsu
Published: April 2011

A case of an enterogenous cyst located in the cerebellopontine angle cistern is presented. These cysts have usually been found in the spinal canal, and their intracranial occurrence is exceptional. In the present case, the cyst was lined histologically by a single epithelial layer of cuboidal cells with some glandular structures resembling the fundic glands of the stomach. The unusual location of the cyst and its histological features are discussed.
Intrathecal Morphine for Postoperative Analgesia in Children after Selective Dorsal Root Rhizotomy
Authors: Harris Mark M. , Kahana Madelyn D. , Park T. S.
Published: April 2011

The authors report their experience with low doses (0.007-0.015 mg/kg);, moderate doses (0.016-0.025 mg/kg);, and high doses (0.026-0.035 mg/kg); of intrathecal morphine for postoperative analgesia after selective dorsal root rhizotomy surgery in 50 children, aged 3 to 12 years. After closure of the dura, a single dose of preservative-free morphine was injected into the subarachnoid space, and patients were assessed for 48 hours for level of comfort and side effects. The three doses of morphine provided equivalent analgesia and similar side effects. The duration of postoperative analgesia ranged from 3 to 48 hours (mean, 12.2 ± 9.5 h);. Common side effects were limited to nausea and vomiting (42%); and mild facial pruritus. No patient experienced late respiratory depression or generalized pruritus. The authors conclude that low doses of intrathecal morphine is as effective as moderate or high doses of morphine for reducing pain in the immediate postoperative period. Intrathecal morphine provides excellent analgesia after selective dorsal rhizotomy.
Gonadotropin-secreting Pineal Teratoma Causing Precocious Puberty
Authors: Cohen Alan R. , Wilson John A. , Sadeghi-Nejad Ab
Published: April 2011

A case of precocious puberty in a 7-year-old boy with a tumor of the pineal region is reported. Human chorionic gonadotropin levels were elevated in the serum and cerebrospinal fluid. Endocrinological evaluation of the hypothalamic-pituitary axis demonstrated a normal prepubertal response. The tumor was resected and proved to be an immature teratoma. Human chorionic gonadotropin levels were markedly elevated in the tumor cyst fluid. Sexual precocity regressed and human chorionic gonadotropin levels in the serum and cerebrospinal fluid fell to normal after surgery, suggesting that the precocious puberty was secondary to ectopic human chorionic gonadotropin production by the pineal teratoma.
Bilateral Symmetrical Striopallidodentate Calcification Associated with Pseudohypoparathyroidism Demonstrated in a Patient with Cerebellar Astrocytoma
Authors: Markov Lubomir L.
Published: April 2011

A case of calcification in the striopallidodentate system associated with pseudohypoparathyroidism, clinically manifested after operation for a cystic astrocytoma of the cerebellar vermis, is reported. Bilateral symmetrical striopallidodentate calcification accompanying a disturbance in calcium metabolism is rare. Only a few cases have been described previously in the literature, of which only six were accompanied by pseudohypoparathyroidism. The importance of identifying hypoparathyroidism, especially pseudohypoparathyroidism, early in the course of investigation is discussed.
Double Compartment Hydrocephalus in an Adult
Authors: Fedder Stephen L. , Richter Howard A.
Published: April 2011

A case of double-compartment hydrocephalus in an adult is presented. Although this entity is infrequently noted in children, it is diagnosed even more rarely in the adult population. A discussion of the spectrum of abnormal cerebrospinal fluid dynamics of the 4th ventricle and treatment options are presented.
Diagnosis and Monitoring of Subarachnoid Hemorrhage by Transcranial Color-Coded Real-Time Sonography
Authors: Becker G. , Greiner K. , Kaune B. , Winkler J. , Brawanski A. , Warmuth-Metz M. , Bogdahn U.
Published: April 2011

Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.
Millipore Analysis of Valvular Fluid in Sterile Valve Malfunctions
Authors: Traynelis Vincent C. , Willison Crystl D. , Follett Kenneth A. , Chambers Janet , Schochet Sydney S. , Kaufman Howard H.
Published: April 2011

Malfunctions of sterile shunts may result from valvular dysfunction. The cerebrospinal fluid shunt valves of 14 patients were excised during surgery for sterile shunt malfunctions. In 6 patients, the malfunction was due specifically to a valve malfunction. Cerebrospinal fluid from each valve was passed through a millipore filter, which was then stained using either hematoxylin and eosin or periodic acid-Schiff. The stained millipore filters were examined by a neuropathologist who was unaware of the cause of the shunt malfunction. Although inflammatory cells were detected in all cases, the patients with valve malfunctions were found to have numerous macrophages and giant multinucleated reactive cells within their valves, while cerebrospinal fluid from valves that had been removed during shunt revisions for reasons other than a malfunctioning valve contained only rare mononuclear cells or macrophages. No valve contained erythrocytes, fibrinous matter, neural or glial tissue, or choroid plexus. The possible causes of valve malfunction, including infection and allergic reactions, are discussed. All patients did well after simple replacement of the valve.
Prolonged Lumbar Spinal Drainage after the Resection of Tumors of the Skull Base: A Cautionary Note
Authors: Snow Robert B. , Kuhel William , Martin Stanley B.
Published: April 2011

A combined transcranial and facial approach was used for an en bloc resection of a malignant angiosarcoma of the ethmoid sinuses. The patient awoke neurologically intact and was monitored in the Intensive Care Unit. A lumbar subarachnoid drain was placed for the continuous removal of the cerebrospinal fluid (CSF). Approximately 36 hours after surgery, she deteriorated neurologically and demonstrated bilateral extensor posturing to painful stimuli. A computed tomographic scan demonstrated obliteration of the basal cisterns indicative of transtentorial herniation and a small amount of extradural air. Eight hours after the lumbar drain was turned off, the patient had recovered completely. We propose that the patient manifested transtentorial herniation caused by a pressure gradient between the supratentorial and lumbar cistern compartments brought on by the continuous removal of the CSF from the lumbar subarachnoid space. We suggest that ventricular drainage should be considered for these cases rather than lumbar drainage. This offers the same advantage of removing the CSF and maintaining low-to-normal intracranial pressure without the risk of transtentorial herniation.
Malignant Prolactinomas
Authors: Popovic Emil A. , Vattuone John R. , Siu Kevin H. , Busmanis Inny , Pullar Michael J. , Dowling John
Published: April 2011

Six cases of malignant prolactinoma have been reported; an additional two cases are presented here and the literature is reviewed. Diagnosis rests upon evidence of metastasis rather than histological criteria perse. Cases have arisen from known adenomas, particularly the invasive type. Bromocriptine is a useful palliative. The features and treatment of malignant prolactinoma are discussed. (Neurosurgery 29:127-130, 1991)
Herniated L4-L5 Disc after Placement of Harrington Instrumentation for a Fracture of the Thoracolumbar Spine
Authors: Segal Ricardo , Pollack Ian , Segal Eduardo , Hanley Edward , Scalbassi Robert , Hirsch William
Published: April 2011

The authors report a case in which L5 radiculopathy developed acutely after surgery for placement of Harrington rod instrumentation for an L1 body fracture. Computed tomographic myelography demonstrated a large L4-L5 herniated disc that had not been present in preoperative studies. An emergency laminectomy was performed, and a large, free, subligamentous disc fragment was removed. The patient subsequently regained L5 sensorimotor function. The postoperative development of lumbar radiculopathy is an uncommon complication of Harrington rod instrumentation that may result from several biomechanical features of the instrumentation. These injuries may not be detected by intraoperative monitoring of somatosensory evoked potentials, and therefore, the postoperative neurological examination assumes a crucial role in the early diagnosis of these lesions. As our case demonstrates, these radicular deficits may be reversible if their cause is promptly recognized and treated. (Neurosurgery 29:135-136, 1991)
Spinal Cord Herniation Associated with an Intradural Spinal Arachnoid Cyst Diagnosed by Magnetic Resonance Imaging
Authors: Isu Toyohiko , Iizuka Takashi , Iwasaki Yoshinobu , Nagashima Masafumi , Akino Minoru , Abe Hiroshi
Published: April 2011

Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst. (Neurosurgery 29:137-139, 1991)
Chronic Perineal Pain Related to Sacral Meningeal Cysts
Authors: Van de Kelft Erik , Van Vyve Michel
Published: April 2011

Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.
Evaluation and Treatment of Aneurysms of the Vertebral Artery: Different Strategies for Different Lesions
Authors: Pritz Michael B.
Published: April 2011

Aneurysms of the vertebral artery and its branches are relatively uncommon lesions. Their anatomy and presentation can be quite variable. A spectrum of aneurysms of the vertebral artery is presented to illustrate the neuroradiological evaluation, surgical treatment, and perioperative management of these complex lesions.
Ataxic Hemiparesis Associated with Ipsilateral Cerebellar Syndrome Caused by a Paracentral Gyrus Lesion
Authors: Donnet A. , Graziani N. , Njee B.T. , Vincentelli F. , Grisoli F.
Published: April 2011

The authors report a case of ataxic hemiparesis and an ipsilateral cerebellar syndrome in relation to a glioblastoma of the paracentral gyrus region. The physiopathology of this clinical presentation caused by compression of the corticopontine tract is discussed.
A Variable-angled Suction Nerve Root Retractor for Lumbar Spine Surgery
Authors: Lavyne Michael H.
Published: April 2011

A simple, variable-angled suction nerve root retractor is described for use primarilv in lumbar disc surgery.
Radiation-induced Cerebellar Glioblastoma Multiforme Subsequent to Treatment of an Astrocytoma of the Cervical Spinal Cord
Authors: Rappaport Zvi H. , Loven David , Ben-Aharon Uriel
Published: April 2011

A cerebellar glioblastoma multiforme was diagnosed in a 22-year-old woman. This originated in the zone adjacent to a field irradiated 14 years earlier after the removal of a noncontiguous astrocytoma of the spinal cord. The accepted criteria for radiation-induced tumors of the central nervous system are discussed.
Pituitary Apoplexy and Its Effect on Vision
Authors: McFadzean Robert M. , Doyle David , Rampling Roy , Teasdale Evelyn , Teasdale Graham
Published: April 2011

A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.
The Importance of Cerebral Ischemia during Carotid Endarterectomy
Authors: Zampella Edward , Morawetz Richard B. , McDowell Holt A. , van Zeiger H. E , Varner Pamela D. , McKay Robert D. , Halsey James H.
Published: April 2011

The importance of cerebral ischemia produced by carotid clamping during carotid endarterectomy remains controversial. In an effort to determine the importance of cerebral ischemia during carotid endarterectomy. 369 patients undergoing 431 consecutive carotid endarterectomies were studied by Xenon-133 (133Xe) clearance and electroencephalogram (EEG) monitoring. None of the patients was shunted during the procedures. The severity of ischemia as indicated by 133 Xe clearance from the ipsilateral hemisphere during 20 to 30 minutes of carotid occlusion did not predict the appearance of complications in this group of patients (x2 = 1.417: P = 0.841). There was a highly significant relationship between the depth of cerebral ischemia as demonstrated by 133Xe clearance and the appearance of abnormalities on the EEG (x2 = 42.043, P < 0.0001). In the subgroup of patients developing abnormalities as shown by EEG. there was a negative correlation (x2 = 17.495; P < 0.002) between reduction in blood flow and the appearance of complications, in that the higher the blood flow during occlusion the more likely the patient developing EEG changes would develop complications.
Vestibular Nerve Injury as a Complication of Microvascular Decompression
Authors: Sekiya Tetsuji , Iwabuchi Takashi , Hatayama Toru , Shinozaki Naoko
Published: April 2011

We report a case of hemifacial spasm in which hearing was well preserved after microvascular decompression, but the vestibular nerve was injured selectively. We review the pathophysiological mechanisms relevant to this complication in the light of results of animal experimental studies we have conducted. In addition, we discuss the clinical significance of this particular type of cranial nerve injury.
Subintimal Dissection of the Vertebral Artery in Subluxation of the Cervical Spine
Authors: Jabre Anthony
Published: April 2011

The vertebral arteries appear to be particularly susceptible to injury in trauma of the cervical spine because of their close anatomical relationship to the spine; however, traumatic subintimal disscction of the vertebral artery is rare judging from the paucity of cases reported in the literature. The case of a patient who developed a visual field defect secondary to a fracture-subluxation of the cervical spine is reported. Angiography demonstrated an intimal dissection of the vertebral artery at the site of the fracture-subluxation resulting in thrombus formation and subsequently in emboli occluding the posterior temporal branch of the posterior cerebral artery. Early angiography is recommended if extracranial injury of the vertebral artery is suspected, and the institution of heparin therapy is necessary if a subintimal dissection is demonstrated.
Hernia of the Spinal Cord: Case Report and Review of the Literature
Authors: Tronnier Volker M. , Steinmetz Anton , Albert Friedrich K. , Scharf Johannes , Kunze Stefan
Published: April 2011

A rare case of a true hernia of the spinal cord through a dural defect without evidence of acute trauma is presented. The cause and the differentiation from other congenital and traumatic spinal cord lesions, especially arachnoid cysts, are discussed.
Intradural Extramedullary Cavernous Angioma: Case Report
Authors: Mastronardi Luciano , Ferrante Luigi , Scarpinati Marco , Gagliardi Franco Maria , Celli Paolo , Fortuna Aldo
Published: April 2011

Cavernous angiomas represent 5 to 12% of spinal vascular malformations and usually are located at the vertebral body level with possible extension into the extradural space. The intradural intramedullary cavernoma occurs in about 3% of cases, whereas extramedullary localization is extremely rare. A new case of an intradural extramedullary cavernous angioma is reported, and the clinical, diagnostic, and therapeutic aspects of this rare malformation are analyzed.
Oscillopsia and Primary Cerebellar Ectopia: Case Report and Review of the Literature
Authors: Gingold Scott I. , Winfield Jeffrey A.
Published: April 2011

Oscillopsia, the visual sensation of stationary objects swaying back and forth or vibrating, has been described in association with downbeat nystagmus in patients with primary cerebellar ectopia (Chiari I malformation). A patient with symptomatic oscillopsia without downbeat nystagmus, who was diagnosed by magnetic resonance imaging to have displaced cerebellar tonsils below the foramen magnum, is presented here. Suboccipital craniectomy and upper cervical laminectomy completely relieved the visual disturbance of the patient. The pathogenesis and surgical management of oscillopsia are discussed with respect to the current literature. Early recognition and surgical decompression of cerebellar ectopia may lead to complete recovery in patients with minimal symptomatology.
Glycated Hemoglobin Predicts All-Cause, Cardiovascular, and Cancer Mortality in People Without a History of Diabetes Undergoing Coronary Angiography
Authors: Silbernagel Guenther , Grammer Tanja B. , Winkelmann Bernhard R. , Boehm Bernhard O. , März Winfried
Published: April 2011

OBJECTIVE

Glycated hemoglobin has been suggested to be superior to fasting glucose for the prediction of vascular disease and death from any cause. The aim of the present work was to analyze and compare the predictive value of glycated hemoglobin and fasting glucose on all-cause and cause-specific mortality in subjects who underwent coronary angiography.

RESEARCH DESIGN AND METHODS

We studied 2,686 participants of the Ludwigshafen Risk and Cardiovascular health study without a history of diabetes. The majority of this cohort had coronary artery disease. Glycated hemoglobin was measured at the baseline examination. The mean (± SD) duration of the follow-up for all-cause, cardiovascular, and cancer mortality was 7.54 ± 2.1 years.

RESULTS

A total of 508 deaths occurred during the follow-up. Of those, 299 were accounted for by cardiovascular diseases and 79 by cancer. Baseline glycated hemoglobin was predictive of all-cause, cardiovascular, and cancer mortality. The multivariable-adjusted hazard ratios (HR) (95% CI) for glycated hemoglobin values of <5.0, 5.0–5.4, 5.5–5.9, 6.0–6.4, 6.5–7.4, and ≥7.5% for all-cause mortality were 1.36 (0.85–2.18), 1.00 (0.76–1.32), 1.00 (reference), 1.11 (0.88–1.41), 1.39 (1.07–1.82), and 2.15 (1.32–3.53), respectively. Similar J-shaped relationships were found between glycated hemoglobin and cardiovascular and cancer mortality. The associations of glycated hemoglobin with all-cause and cardiovascular mortality remained significant after inclusion of fasting glucose as a covariate. However, fasting glucose was not significantly related to mortality when adjusting for glycated hemoglobin.

CONCLUSIONS

Glycated hemoglobin significantly and independently of fasting glucose predicts all-cause and cardiovascular mortality in whites at intermediate to high cardiovascular risk.
Primary Dietary Intervention Study to Reduce the Risk of Islet Autoimmunity in Children at Increased Risk for Type 1 Diabetes
Authors: Hummel Sandra , Pflüger Maren , Hummel Michael , Bonifacio Ezio , Ziegler Anette-G.
Published: April 2011

OBJECTIVE

To determine whether delaying the introduction of gluten in infants with a genetic risk of islet autoimmunity is feasible, safe, and may reduce the risk of type 1 diabetes–associated islet autoimmunity.

RESEARCH DESIGN AND METHODS

A total of 150 infants with a first-degree family history of type 1 diabetes and a risk HLA genotype were randomly assigned to a first gluten exposure at age 6 months (control group) or 12 months (late-exposure group) and were followed 3 monthly until the age of 3 years and yearly thereafter for safety (for growth and autoantibodies to transglutaminase C [TGCAs]), islet autoantibodies to insulin, GAD, insulinoma-associated protein 2, and type 1 diabetes.

RESULTS

Adherence to the dietary-intervention protocol was reported from 70% of families. During the first 3 years, weight and height were similar in children in the control and late-exposure groups, as was the probability of developing TGCAs (14 vs. 4%; P = 0.1). Eleven children in the control group and 13 children in the late-exposure group developed islet autoantibodies (3-year risk: 12 vs. 13%; P = 0.6). Seven children developed diabetes, including four in the late-exposure group. No significant differences were observed when children were analyzed as per protocol on the basis of the reported first gluten exposure of the children.

CONCLUSIONS

Delaying gluten exposure until the age of 12 months is safe but does not substantially reduce the risk for islet autoimmunity in genetically at-risk children.
Development of successive cambia, cambial activity, and their relationship to physiological traits inIpomoea arborescens(Convolvulaceae) seedlings
Authors: Terrazas Teresa , Aguilar‐Rodríguez Silvia , Ojanguren Clara Tinoco
Published: April 2011

•Premise of the study: The seedling stage is one of the most critical phases in the life history of plants; during this stage, plants must develop efficient conductive and storage systems before the end of the favorable season. Little is known about the origin of successive cambia in seedlings of tree species ofIpomoeaor about how many cambia are produced in one growth season. We studied the anatomy ofIpomoea arborescensseedlings to define when cambium is differentiated, to determine how many cambia differentiate in one year of growth, and to relate the development of successive cambia to physiological aspects of growth.

•Methods: Seedlings from 5 to 425 d of age were harvested, and their morphology as well as CO2and water exchange, were evaluated at 5 and 60 d after germination. Six stages of development were established to study origin of cambia.

•Key results: Cambium was differentiated 5 d after germination, at a time when seedlings had photosynthetic cotyledons with high specific area, assimilation rate, and stomatal conductance. Differentiation of the first successive cambium occurred in parenchyma cells below the endodermis or starch sheath. Development of reverse cambium and intraxylary phloem cambium demonstrated that ontogenetic shifts may occur in different stem regions. In the 10‐mo‐old plants, all cambia reactivated, and earlywood wide vessels were differentiated.

•Conclusions: The origin of successive cambia, the occurrence of more than one type of cambium, and parenchyma proliferation are features shared byI. arborescenswith its climbing ancestors as a strategy for survival in the harsh environment of tropical deciduous forests.
Isolation of SSR markers for two African tropical tree species, Erythrophleum suaveolens and E. ivorense (Caesalpinioideae)
Authors: Duminil Jérôme , Koffi Guillaume K. , Debout Gabriel , Sebastiani Federico , Vendramin Giovanni G. , Heuertz Myriam , González‐Martínez Santiago C. , Hardy Olivier J.
Published: April 2011

• Premise of the study: To characterize the level of genetic diversity and gene flow, as well as to identify unambiguously two African tropical tree species, Erythrophleum ivorense and E. suaveolens, we have developed a set of nuclear SSR (Simple Sequence Repeats) markers.

• Methods and Results: Nine SSRs that display polymorphism in both species were identified. The nine newly developed SSR markers can be amplified in only two multiplexed reactions. Levels of polymorphism were assessed in two populations per species, yielding two to fifteen alleles per locus in E. ivorense and three to sixteen alleles per locus in E. suaveolens.

• Conclusions: The SSR markers developed here are promising to study the spatial distribution of genetic diversity and the genetic delimitation of two Erythrophleum species from central Africa.
Using the 454 pyrosequencing‐based technique in the development of nuclear microsatellite loci in the alpine plant Arabis alpina (Brassicaceae)
Authors: Buehler Dominique , Graf René , Holderegger Rolf , Gugerli Felix
Published: April 2011

• Premise of the study: Polymorphic microsatellite markers were developed for the inbred alpine perennial plant Arabis alpina to infer life‐history parameters and measure patterns of contemporary gene flow within populations.

• Methods and Results: Using the 454 pyrosequencing technique, 19 microsatellite primer sets were developed for A. alpina. The primer sets were tested on 60 individuals sampled from three sub‐populations in the Swiss Alps. The primers amplified di‐ and trinucleotide repeats with two to five alleles per locus.

• Conclusions: Previous attempts to isolate microsatellite loci in A. alpina using enrichment libraries and cross‐amplification were difficult and produced an insufficient number of polymorphic microsatellite loci. In contrast, next‐generation sequencing technology was successful in identifying microsatellite repeats in A. alpina. These newly developed microsatellite primers will be useful to further develop A. alpina into a model species for eco‐genomic studies.
La citoyenneté à l'épreuve des rites : l'exemple des réunions de foyer dans un dispositif d'éducation spécialisée
Authors: Ossipow Laurence
Published: April 2011

Résumé Choisissant de définir a posteriori les moments qui, selon certaines dimensions, peuvent être compris comme des rites tandis que d’autres ressortent de la chronique ordinaire d’une institution, nous avons enquêté sur la vie quotidienne de trois foyers éducatifs genevois accueillant des adolescent-e-s de 14 à 18 ans selon différents types de placements. Parmi d’autres rites (étapes de placement, lever, coucher, repas, anniversaire, fêtes calendaires, camp, sorties d’institutions...), nous avons en particulier analysé les réunions de foyers parce qu’elles nous semblaient être riches en information sur la façon dont est exercé l’apprentissage formel et informel de la citoyenneté, une des missions principales (avec celle de l’autonomisation) que les équipes éducatives mettent en œuvre. Ces réunions hebdomadaires, qui rassemblent tous-toutes les jeunes placé-e-s ainsi qu’une partie des éducatrices et des éducateurs, régulent la vie collective, rappellent les règles de l’institution, gèrent des conflits menaçant le vivre-ensemble, ravivent un certain sentiment d’appartenance au foyer et font expérimenter certaines formes de citoyenneté et de civilité. Elles permettent aussi d’entériner certains changements individuels ou collectifs. Ce sont donc des moments de régulation, mais aussi, pour emprunter une expression d’Albert Piette, des « espaces de réflexion » (au double sens du terme) du groupe et sur le groupe.
THE SYSTEMATICS AND TAXONOMY OF FINAL-INSTAR LARVAE OF THE FAMILY APHIDIIDAE (HYMENOPTERA)
Authors: Finlayson Thelma
Published: April 2011

Characteristics of cephalic structures and spiracles of final-instar larvae of 65 species in 18 genera of the family Aphidiidae (Hymenoptera) are described and illustrated and keys are given for identification of genera and species. An additional seven species that were described and illustrated in an earlier paper (Mackauer and Finlayson 1967) are redescribed and included in the keys for a total of 72 species.On the basis of characteristics of final-instar larvae, taxonomic groupings of the family Aphidiidae mainly conform to those based on characteristics of adults, with the following exceptions.Within the tribe Aphidiini the genus Calaphidius appears to belong in a new subtribe because of the unusual form of the pleurostoma, and the presence of numerous small sensoria in the maxillary and labial palpi, and of an atrium in the prothoracic spiracle which is absent in all other species of this tribe.It is suggested that the tribe Trioxini (Aphidiinae) should be a separate subfamily, the Trioxinae, because of the presence of a hypostomal spur which was not found in any of the other aphidiids examined. Within this suggested new subfamily the genus Lipolexis appears to be the most primitive form examined because, in addition to a hypostomal spur, it has a complete epistoma which is lacking in all other aphidiids examined; it is suggested that this genus be placed in a separate tribe, the Lipolexini. The trioxines appear to be the most primitive of the Aphidiidae and form a bridge between the Braconidae and the Aphidiidae.The Aphidiini (Aphidiinae) appear to be at the peak of the evolutionary scale of the Aphidiidae because of the loss or reduction of the pleurostomal–hypostomal sclerite, making the identities of the pleurostoma and hypostoma less distinguishable.
2.0 MASS-PRODUCTION OF TRICHOGRAMMA MINUTUM RILEY ON FACTITIOUS HOST EGGS
Authors: Laing J.E. , Eden G.M.
Published: April 2011

A system was developed to produce large numbers (30 × 106 per week) of Trichogramma minutum Riley on eggs of the Angoumois grain moth, Sitotroga cerealella (Olivier). The parasitized host eggs were packaged and shipped in bulk for release against the spruce budworm, Choristoneura fumiferana (Clemens), and several other lepidopterous pests. Initial attempts to use the Mediterranean flour moth, Ephestia kuehniella (Zeller), as a host failed due to such factors as infestation by mites and parasitoids, low fecundity, long generation time, and the necessity for large labour inputs during moth collection. Eggs of S. cerealella, used to rear the host, remained viable when stored for up to 1 month at 9 °C, but eggs stored at 2 °C remained acceptable for parasitism for only 15 days. Rearing the host at high humidity (> 70% RH) gave better percentage emergence and infestation of grain than rearing at low humidity (< 30% RH). Developmental rates of T. minutum were determined over a range of temperatures and the developmental threshold and heat unit accumulations necessary for complete development were calculated. Using these values, Trichogramma were programmed, during the latter stages of production, to emerge within 24 h of exposure to light at room temperature. The programming facilitated shipment and handling of the parasitoids prior to their release.