bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective extradural anterior clinoidectomy for supra- and parasellar processes
Authors: Yonekawa Yasuhiro , Ogata Nobuyoshi , Imhof Hans-Georg , Olivecrona Magnus , Strommer Kevin , Kwak Tae Eon , Roth Peter , Groscurth Peter
Published: June 2009

✓ Removal of the anterior clinoid process (ACP) facilitates radical removal of tumors or radical neck clipping of aneurysms in the supra- and parasellar regions by providing a wide operative exposure of the internal carotid artery (ICA) and the optic nerve and by reducing the need for brain retraction.

Over a period of 3 years, anterior clinoidectomy was performed in 40 patients, 30 of whom harbored aneurysms (18 of the ICA and 13 of the basilar artery [one patient had two aneurysms]) and 10 of whom had tumors (four large pituitary tumors, four craniopharyngiomas, and two sphenoid ridge meningiomas). The ACP was removed extradurally in 31 cases and intradurally in nine cases.

Extradural clinoidectomy was performed in all cases of pituitary adenoma and craniopharyngioma and in most cases of basilar artery aneurysm. Intradural clinoidectomy was performed in two cases of ICA—ophthalmic artery aneurysm, two cases of ICA—posterior communicating artery aneurysm, two cases of ICA cavernous aneurysm, one case of basilar artery aneurysm, and two cases of sphenoid ridge meningioma. The outcome was satisfactory in all patients, except for one patient who underwent clipping of a basilar tip aneurysm and suffered a thalamic and midbrain infarction. Three patients who underwent extradural clinoidectomy suffered a postoperative diminution of visual acuity or a visual field defect on the side of the clinoidectomy. These deficits may have been caused either by drilling of the ACP or by other operative manipulation of the optic nerve. Cerebrospinal fluid rhinorrhea, which required reoperation, occurred in one patient.

The authors' experience suggests that the extradural technique of ACP removal is easier and less time consuming than the intradural one and provides better operative exposure. It can be used routinely in treating lesions in the supra- and parasellar regions.
Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter
Authors: Cozzens Jeffrey W. , Chandler James P.
Published: June 2009

✓ The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation.

Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55).

It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.
Dutch Normal-Pressure Hydrocephalus Study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid
Authors: Boon Agnita J. W. , Tans Joseph T. J. , Delwel Ernst J. , Egeler-Peerdeman Saskia M. , Hanlo Patrick W. , Wurzer Hans A. L. , Avezaat Cees J. J. , de Jong Dirk A. , Gooskens Rob H. J. M. , Hermans Jo
Published: June 2009

✓ The authors examined whether measurement of resistance to outflow of cerebrospinal fluid (Rcsf) predicts outcome after shunting for patients with normal-pressure hydrocephalus (NPH).

In four centers 101 patients (most of whom had idiopathic NPH) who fulfilled strict entry criteria underwent shunt placement irrespective of their level of Rcsf obtained by lumbar constant flow infusion. Gait disturbance and dementia were quantified by using an NPH scale and the patient's level of disability was assessed by using the modified Rankin scale (mRS). In addition the Modified Mini-Mental State Examination was performed. Patients were assessed prior to and 1, 3, 6, 9, and 12 months after surgery. Primary outcome measures were based on differences between the preoperative and last NPH scale scores and mRS grades. Improvement was defined as a change measuring at least 15% in the NPH scale score and at least one mRS grade.

Intention-to-treat analysis of all patients at 1 year yielded improvement for 57% in NPH scale score and 59% in mRS grade. Efficacy analysis, excluding serious events and deaths that were unrelated to NPH, was performed for 95 patients. Improvement rose to 76% in NPH scale score and 69% in mRS grade. Six cut-off levels of Rcsf were related to improvement in NPH scale score using two-by-two tables. Positive predictive values were approximately 80% for an Rcsf of 10, 12, or 15 mm Hg/ml/minute, 92% for an Rcsf of 18 mm Hg/ml/minute, and 100% for an Rcsf of 24 mm Hg/ml/minute. Negative predictive values were low. More important was the highest likelihood ratio of 3.5 for an Rcsf of 18 mm Hg/ml/minute. Extensive comorbidity was a major prognostic factor.

Measurement of Rcsf reliably predicts outcome if the limit for shunting is raised to 18 mm Hg/ml/minute. At lower Rcsf values the decision depends mainly on the extent to which clinical and computerized tomography findings are typical of NPH.
Pallidal stimulation: an alternative to pallidotomy?
Authors: Tronnier Volker M. , Fogel Wolfgang , Kronenbuerger Martin , Steinvorth Sarah
Published: June 2009

A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the “on” symptoms of PD, such as dyskinesias, as well as the “off” symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the “freezing” phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.
Cathepsin B and middle cerebral artery occlusion in the rat
Authors: Seyfried Donald , Han Yuxia , Zheng Zhang , Day Nancy , Moin Kamiar , Rempel Sandra , Sloane Bonnie , Chopp Michael
Published: June 2009

✓ Lysosomal proteases, although tightly regulated under physiological conditions, are known to contribute to cell injury after various forms of tissue ischemia have occurred. Because cathepsin B is a prominent lysosomal protease found in brain parenchyma, the authors hypothesized that it may contribute to neuronal cell death after focal cerebral ischemia. The authors measured the expression and spatial distribution of cathepsin B within the ischemic brain in 43 animals by means of immunohistochemical analysis in a rat model of transient middle cerebral artery (MCA) occlusion. Cathepsin B activity was also measured within specific ischemic brain regions by using an in vitro assay (22 animals). In addition, the authors tested the therapeutic effect of preischemic intraventricular administration of stefin A, a cysteine protease inhibitor, on the volume of cerebral infarction after transient MCA occlusion (15 animals). Increased cathepsin B immunoreactivity was detected exclusively within the ischemic neurons after 2 hours of reperfusion following a 2-hour MCA occlusion. Cathepsin B immunolocalization in the ischemic region decreased by 24 hours of reperfusion, but then increased by 48 hours of reperfusion because the infarct was infiltrated by inflammatory cells. Increased immunolocalization of cathepsin B in the inflammatory cells located in the necrotic infarct core continued through 7 days of reperfusion. Cathepsin B enzymatic activity was significantly increased in the ischemic tissue at 2, 8, and 48 hours, but not at 24 hours of reperfusion after 2 hours of MCA occlusion. Continuous intraventricular infusion of stefin A, before 2 hours of MCA occlusion (15 animals), significantly reduced infarct volume compared with control animals (12 animals): the percentage of hemispheric infarct volume was 20 ± 3.9 compared with 33 ± 3.5 (standard error of the mean; p = 0.025). These data indicate that neuronal cathepsin B undergoes increased expression and activation within 2 hours of reperfusion after a 2-hour MCA occlusion and may be a mechanism contributing to neuronal cell death. Intraventricular infusion of stefin A, an inhibitor of cathepsin B, significantly reduces cerebral infarct volume in rats.
Generation of the catalytic fragment of protein kinase C alpha in spastic canine basilar artery
Authors: Sato Motohiko , Tani Eiichi , Matsumoto Tsuyoshi , Fujikawa Hirokazu , Imajoh-Ohmi Shinobu
Published: June 2009

✓ In previous studies of topical application of calphostin C, a specific inhibitor of the regulatory domain of protein kinase C (PKC), and calpeptin, a selective inhibitor of calpain, to spastic canine basilar artery (BA) researchers have suggested that the catalytic fragment of PKC (known as PKM) is probably formed by a limited proteolysis of continuously activated µ-calpain, but there has been no direct evidence for PKM formation in vasospasm. The present immunoblot study with anti-PKCα antibody shows a significant decrease in cytosolic 80-kD PKCα and a concomitantly significant increase in membrane PKCα in the spastic canine BA. In addition, an immunoblot study in which cleavage site—directed antibodies were used demonstrated a significant increase in immunoreactive 45-kD PKM. The changes in membrane PKCα and PKM were enhanced with the lapse of time after subarachnoid hemorrhage. The cleavage site—directed antibodies distinguish the proteolyzed from the unproteolyzed forms of PKC for in situ analyses of enzyme regulation mediated by proteolysis. The data indicate that PKCα in spastic canine BA is translocated to the cell membrane, where PKCα is rapidly cleaved into PKM as a result of proteolysis of the isozyme by µ-calpain but not by µ-calpain. The authors hypothesize that µ-calpain is continuously activated in spastic canine BA and produces PKM by limited proteolysis of PKCα.
Microsurgical excision of a primary isolated hypothalamic eosinophilic granuloma
Authors: d'Avella Domenico , Giusa Maria , Blandino Alfredo , Angileri Filippo Flavio , Rosa Giovanni La , Tomasello Francesco
Published: June 2009

✓ Solitary focal eosinophilic granuloma (EG) is one element in the spectrum of diseases associated with Langerhans' cell histiocytosis (LCH). This report documents the occurrence of a primary isolated hypothalamic EG in a man who presented with diabetes insipidus and panhypopituitarism. His treatment consisted of complete microsurgical excision of the lesion. After a 13-month follow-up period, no residual tumor was evident on magnetic resonance imaging and no other lesions were present in peripheral tissues. This case is unique in several respects: 1) it is the third documented case of a primary isolated hypothalamic LCH granuloma diagnosed in a living patient; 2) it is the only known example of complete microsurgical excision of such a lesion in the hypothalamic region; and 3) it demonstrates the efficacy of direct surgery in this scenario, as compared with other treatment modalities such as biopsy and irradiation, suggesting that complete surgical excision may represent the treatment of choice for isolated intracerebral LCH granulomas, being curative in most instances. Also, the literature is reviewed for information about the diagnosis and treatment of this particular type of unifocal brain lesion.
Massive osteolysis of the skull and upper cervical spine
Authors: Khosrovi Houman , Ortiz Orlando , Kaufman Howard H. , Schochet Sydney S. , Reddy Gurijala N. , Simmons Donn
Published: June 2009

✓ Massive osteolysis is a type of idiopathic osteolysis in which there is spontaneous onset of bone resorption. Almost any bone in the body can be affected. The authors present the case of a 62-year-old man diagnosed with massive osteolysis of the occipital bone and the upper two cervical vertebrae. Despite extensive pneumocephalus, no neurological sign or spinal instability was evident. In this case 4000 cGy of radiation in 200-cGy fractions was administered to the diseased area while the patient was kept in a Miami-J collar. At the 2-year follow-up examination, arrest of the disease process and new bone formation was evident on radiographic studies.
Reversed-flow saphenous vein grafts for cerebral revascularization
Authors: David Carlos A. , Zabramski Joseph M. , Spetzler Robert F.
Published: June 2009

✓ The authors sought to create a saphenous vein interposition graft to be used in cerebral bypass procedures that would be more physiologically appropriate than standard vein grafts and would provide a better match between the graft and recipient vessels at the anastomotic sites. The saphenous vein graft was prepared by lysing the valves with a valvulotome. The blood flow could then be reversed in the vein, allowing it to be used in either direction as a bypass graft. An illustrative case including angiograms that confirm good patency and blood flow through the reversed-flow bypass graft is presented. It is concluded that the reversed-flow saphenous vein graft provides a more physiologically suitable conduit than standard vein grafts. Lysis of the valves allows the graft to be used in an orientation that takes advantage of the natural tapering of the vein to produce a better match with the recipient vessels at the anastomotic sites. Minimizing diameter changes at the proximal and distal anastomoses helps reduce turbulence, which has been implicated as a cause of early graft failure and thrombosis.
Unilateral posterior atlantoaxial transarticular screw fixation
Authors: Song Geun Sung , Theodore Nicholas , Dickman Curtis A. , Sonntag Volker K. H.
Published: June 2009

✓ Bilateral posterior C1–2 transfacet screw placement with associated posterior bone graft wiring is the accepted treatment for patients with atlantoaxial instability. This technique was modified to treat 19 patients with atlantoaxial instability and unilateral anomalies that prevented placement of a screw across the C1–2 facet. In these cases, a single contralateral transarticular screw was placed in conjunction with interspinous bone graft wiring to avoid neural or vertebral artery injury and to provide C1–2 stability. Postoperatively, all 19 patients were placed in Philadelphia collars (mean immobilization 8 weeks, range 6–12 weeks). Unilateral C1–2 facet screw fixation was needed for the following reasons: a high-riding transverse foramen of the C-2 vertebra present in 13 patients (left side in eight, right side in five), poor screw purchase in two (left side in both), screw malposition in one (left side), severe degenerative arthritis in one (right side), neurofibroma in one (right side), and fracture of the C-1 lateral mass in one (left side). Six weeks postsurgery, one patient presented with a broken screw and required occipitocervical fusion with a Steinmann pin and wire cable from the occiput to C-3 to achieve solid fusion. Solid fusions were achieved in the other 18 patients (mean follow-up period 31 months, range 14–54 months); there was no delayed screw breakage, wire breakage, or spinal instability. There were no operative or postoperative neurological or vascular complications. The authors' experience demonstrates that unilateral C1–2 facet screw fixation with interspinous bone graft wiring is an excellent alternative in the treatment of atlantoaxial instability when bilateral screw fixation is contraindicated.
Vertical translocation: the enigma of the disappearing atlantodens interval in patients with myelopathy and rheumatoid arthritis. Part I. Clinical, radiological, and neuropathological features
Authors: Casey Adrian T. H. , Crockard H. Alan , Geddes Jennian F. , Stevens John
Published: June 2009

✓ This statistical comparison between patients with cervical myelopathy secondary to horizontal atlantoaxial subluxation and those with vertical translocation is designed to elucidate the mechanisms responsible for cranial settling and the effect of translocation on the development of spinal cord compression.

In a 10-year study of a cohort of 256 patients, 186 suffered from myelopathy and 116 (62%) of these exhibited vertical translocation according to the Redlund-Johnell criteria. Vertical translocation occurred after a significantly longer period of disease than atlantoaxial subluxation (p < 0.001). Translocation was characterized clinically by a high cervical myelopathy with features of a cruciate paralysis present in 35% of individuals compared with 26% who exhibited horizontal atlantoaxial subluxation (p = 0.29), but there was a surprising paucity of cranial nerve problems. The patients with vertical translocation had a greater degree of neurological disability (p = 0.002) and poorer survival rates (p = 0.04).

Radiologically, vertical translocation was secondary to lateral mass collapse and associated with a progressive decrease in the atlantodens interval ([ADI], r = 0.4; p < 0.001) and pannus (p = 0.003). Thirty percent of patients exhibited an ADI of less than 5 mm. This phenomenon has been termed pseudostabilization. The authors' studies emphasize that the ADI (frequently featured in the literature) is totally unreliable as an indicator of neuraxial compromise in the presence of vertical translocation.
Vertical translocation. Part II. Outcomes after surgical treatment of rheumatoid cervical myelopathy
Authors: Casey Adrian T. H. , Crockard H. Alan , Stevens John
Published: June 2009

✓ This is a prospective observational study in 116 patients with rheumatoid arthritis and vertical translocation who underwent cervical spine surgery after developing symptomatic myelopathy. These patients, whose mean age was 62 years, had suffered from rheumatoid arthritis for almost 25 years. Surgery was performed via a combination of anterior (67 transoral decompressions) and posterior approaches. Surgical morbidity was recorded in 39% of patients, with a 30-day mortality rate of 10.3%, which was largely related to poor preoperative neurological grade. Neurological improvement of at least one Ranawat class was observed in 55 patients.

Univariate analysis revealed the following clinical variables to be associated with a good neurological outcome (Ranawat class): younger age and good preoperative muscle power. Significant radiological variables included the degree of vertical translocation as measured by the Redlund-Johnell method and the preoperative spinal cord area. The degree of transgression in the foramen magnum did not significantly affect neurological outcome. Neither the anterior nor the posterior atlantodens interval predicted neurological recovery. Multiple logistic regression models were constructed based on the preliminary evidence of the authors' univariate analysis and these confirmed the importance of preoperative neurological function, spinal cord area, and the degree of vertical translocation in influencing the final neurological grade.
The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma
Authors: Tsutsumi Kazuo , Maeda Keiichirou , Iijima Akira , Usui Masaaki , Okada Yoshihumi , Kirino Takaaki
Published: June 2009

✓ Although chronic subdural hematoma (CSDH) is a well-known entity, its recurrence rate has remained uncertain. There is little knowledge concerning whether the results of radiological imaging can be used to predict CSDH recurrence or whether surgical methods can influence this rate. The first aim of this study is to evaluate the relationship between the recurrence rate of CSDHs and their appearance on preoperative magnetic resonance (MR) or computerized tomography images. The second aim is to evaluate by means of a prospective randomized method the usefulness of closed-system drainage.

From January 1988 through June 1996, the authors surgically treated 257 consecutive adult patients with CSDHs. Data obtained in 199 patients who were evaluated preoperatively by MR imaging were analyzed. Thirty-one of these patients underwent bilateral operations and thus 230 operative sites of CSDH were included in the analyses. The cases of CSDH were separated into high- and nonhigh-intensity groups on the basis of the appearance on T1-weighted MR images. From July 1992 to June 1996, the authors conducted a prospective randomized study on the recurrence rate of CSDH in patients undergoing burr-hole irrigation with or without closed system drainage.

The recurrence rate of 3.4% in the high-intensity group was significantly lower than the 11.6% rate found in the nonhigh-intensity group (p < 0.05). The recurrence rates following irrigation with and without closed system drainage were significantly different (p < 0.025): 3.1% with closed system drainage and 17% following burr-hole irrigation alone. The surgical procedures were correlated with the MR findings. In the high-intensity group, 1.1% of CSDHs recurred in patients in whom closed system drainage was used and 11.1% in patients without closed system drainage. In the nonhigh-intensity group, 8.1% of CSDHs recurred in patients in whom drainage was used and 23.1% in patients without closed system drainage.

Magnetic resonance T1-weighted imaging was useful in predicting the propensity of CSDHs to recur. Closed system drainage significantly reduced the recurrence rate of CSDHs regardless of MR findings.
Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries
Authors: Samii Madjid , Carvalho Gustavo A. , Nikkhah Guido , Penkert Götz
Published: June 2009

✓ Over the last 16 years, 345 surgical reconstructions of the brachial plexus were performed using nerve grafting or neurotization techniques in the Neurosurgical Department at the Nordstadt Hospital, Hannover, Germany. Sixty-five patients underwent graft placement between the C-5 and C-6 root and the musculocutaneous nerve to restore the flexion of the arm. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 54 patients: 1) time interval between injury and surgery; 2) choice of the donor nerve (C-5 or C-6 root); and 3) length of the grafts used for repairs between the C-5 or C-6 root and the musculocutaneous nerve.

The postoperative follow-up interval ranged from 9 months to 14.6 years, with a mean ± standard deviation of 4.4 ± 3 years. Reinnervation of the biceps muscle was found in 61% of the patients. Comparison of the different preoperative time intervals (1–6 months, 7–12 months, and > 12 months) showed a significantly better outcome in those patients with a preoperative delay of less than 7 months (p < 0.05). Reinnervation of the musculocutaneous nerve was demonstrated in 76% of the patients who underwent surgery within the first 6 months postinjury, in 60% of the patients with a delay of between 6 and 12 months, and in only 25% of the patients who underwent surgery after 12 months. Comparison of the final outcome according to the root (C-5 or C-6) that was used for grafting the musculocutaneous nerve showed no statistical difference.

Furthermore, statistical analysis (regression test) of the length of the grafts between the donor (C-5 or C-6 root) nerve and the musculocutaneous nerve displayed an inverse relationship between the graft length and the postoperative outcome.

Together, these results provide additional information to enhance the functional outcome of brachial plexus surgery.
Enhancing nerve regeneration across a silicone tube conduit by using interposed short-segment nerve grafts
Authors: Francel Paul C. , Francel Thomas J. , Mackinnon Susan E. , Hertl Cathy
Published: June 2009

✓ Isolated nerve segments may inherently contain all of the necessary factors required to support regeneration within a silicone tube conduit placed across a nerve gap. Thirty-six adult Lewis rats each weighing approximately 250 g were randomized into three groups. A sciatic nerve gap (13–15 mm in length) was bridged by an empty silicone tube (Group I), a silicone tube containing a short 2-mm interposed nerve segment (Group II), or a nerve autograft (Group III). At 16 weeks postoperatively, no regeneration was observed through the empty silicone tube. In contrast, regeneration across the silicone tube containing the isolated nerve segment was equivalent to that noted through nerve autografts as assessed by histological, electrophysiological, and functional criteria. Thus, an interposed nerve segment will extend the length of successful nerve regeneration through a silicone tube conduit.
Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery
Authors: Higashida Randall T. , Smith Wade , Gress Daryl , Urwin Ross , Dowd Christopher F. , Balousek Peter A. , Halbach Van V.
Published: June 2009

✓ The authors demonstrate the technical feasibility of using intravascular stents in conjunction with electrolytically detachable coils (Guglielmi detachable coils [GDCs]) for treatment of fusiform, broad-based, acutely ruptured intracranial aneurysms and review the literature on endovascular approaches to ruptured aneurysms and cerebral stent placement. A 77-year-old man presented with an acute subarachnoid hemorrhage of the posterior fossa. A fusiform aneurysm with a broad-based neck measuring 12 mm and involving the distal vertebral artery (VA) and proximal third of the basilar artery (BA) was demonstrated on cerebral angiography. The aneurysm was judged to be inoperable. Six days later a repeated hemorrhage occurred. A 15-mm-long intravascular stent was placed across the base of the aneurysm in the BA and expanded to 4 mm to act as a bridging scaffold to create a neck. A microcatheter was then guided through the interstices of the stent into the body and dome of the aneurysm, and GDCs were deposited for occlusion.

The arteriogram obtained after stent placement demonstrated occlusion of the main dome and body of the aneurysm. The coils were stably positioned and held in place by the stent across the distal VA and BA fusiform aneurysm. Excellent blood flow to the distal BA and posterior cerebral artery was maintained through the stent. There were no new brainstem ischemic events attributable to the procedure. No rebleeding from the aneurysm had occurred by the 10.5-month follow-up evaluation, and the patient has experienced significant neurological improvement.

Certain types of intracranial fusiform aneurysms may now be treated by combining intravascular stent and GDC placement for aneurysm occlusion via an endovascular approach. This is the first known clinical application of this novel approach in a ruptured cerebral aneurysm.
The crucial decade: modern neurosurgery's definitive development in Harvey Cushing's early research and practice, 1900 to 1910
Authors: Greenblatt Samuel H.
Published: June 2009

✓ When Harvey Cushing announced his full-time commitment to neurological surgery in 1904, it was a discouraging and discouraged enterprise. Other surgeons' mortality rates for patients with brain tumors were 30 to 50%. By 1910 Cushing had operated on 180 tumors; he had a thriving practice, with a patient mortality rate of less than 13%. The three essential ingredients of his success were: 1) a new surgical conceptualization of intracranial pressure (ICP); 2) technical innovations for controlling ICP; and 3) establishment of a large referral base.

In the years 1901 through 1905, the implications of his research on the “Cushing reflex” were quickly translated into surgical techniques for controlling ICP. In the period between 1906 and 1910, Cushing built up his referral practice by publishing widely, and especially by lecturing to medical audiences throughout the United States and Canada. His scientific work on ICP was essential to his clinical success, but without his professional and social ability to build a thriving practice, there would have been insufficient material for him to use to improve his approaches.
Biological Effects and Safety in Magnetic Resonance Imaging: A Review
Authors: Hartwig Valentina , Giovannetti Giulio , Vanello Nicola , Lombardi Massimo , Landini Luigi , Simi Silvana
Published: June 2009

Since the introduction of Magnetic Resonance Imaging (MRI) as a diagnostic technique, the number of people exposed to electromagnetic fields (EMF) has increased dramatically. In this review, based on the results of a pioneer study showing in vitro and in vivo genotoxic effects of MRI scans, we report an updated survey about the effects of non-ionizing EMF employed in MRI, relevant for patients’ and workers’ safety. While the whole data does not confirm a risk hypothesis, it suggests a need for further studies and prudent use in order to avoid unnecessary examinations, according to the precautionary principle.
Characterization of Long-period Grating Refractive Index Sensors and Their Applications
Authors: Tsuda Hiroshi , Urabe Kei
Published: June 2009

The influence of grating length and bend radius of long-period gratings (LPGs) on refractive index sensing was examined. Sensitivity to refractive indexes smaller than that of silica could be enhanced by bending LPGs. Bent LPGs lost sensitivity to refractive indexes higher than that of silica, whereas a 20-mm-long LPG arranged in a straight line had considerable sensitivity. These experimental results demonstrated that the sensitivity characteristics of LPGs to refractive index could be controlled by grating length and bend radius.
The Elusive Path to Cartilage Regeneration
Authors: Hunziker Ernst B.
Published: June 2009

Numerous attempts have been made to develop an efficacious strategy for the repair of articular cartilage. These endeavors have been undaunted, if not spurred, by the challenge of the task and by the largely disappointing outcomes in animal models. Of the strategies that have been lately applied in a clinical setting, the autologous‐chondrocyte‐transplantation technique is the most notorious example. This methodology, which was prematurely launched on the clinical scene, was greeted with enthusiasm and has been widely adopted. However, a recent prospective and randomized clinical trial has revealed the approach to confer no advantage over conventional microfracturing. Why is the repair of articular cartilage such a seemingly intractable problem? The root of the evil undoubtedly lies in the tissue's poor intrinsic healing capacity. But the failure of investigators to tackle the biological stumbling blocks systematically rather than empirically is hardly a less inauspicious circumstance. Moreover, it is a common misbelief that the formation of hyaline cartilage per se suffices, whereas to be durable and functionally competent, the tissue must be fully mature. An appreciation of this necessity, coupled with a thorough understanding of the postnatal development of articular cartilage, would help to steer investigators clear of biological cul‐de‐sacs.
Preparation and characterization of polysiloxane‐acrylate latexes with MPS‐PDMS oligomer as macromonomer
Authors: Yan Ping , Qiu Liying
Published: June 2009

The latexes of polysiloxane and acrylate with methacryloxypropyl trimethoxysilane (MPS)–polydimethylsiloxane (PDMS) oligomer as macromonomer and Gemini surfactant as coemulsifier were prepared by emulsion copolymerization and characterized by 1H‐nmr, gel‐permeation chromatography (GPC), FTIR, x‐ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM).

First, the oligomer of MPS‐PDMS (SiOSi chain length = 24) were synthesized by the hydrolysis of MPS and the ring‐opening polymerization of octamethyl tetracyclosiloxane (D4), the 1H‐NMR and FTIR spectra indicated that when the reaction time was prolonged to 2 h, more than 90% of Si (OCH3)3 groups were hydrolyzed; Then, the emulsion polymerization was performed with the oligomer as macromonomer and Gemini Surfactant as coemulsifier, the result of FTIR indicated that almost all the macromonomer had been exhausted because there was no CC characteristic peaks in the spectrum. XPS investigation of the latexes showed that with the increase of siloxane content, more and more polysiloxane occupied the outer layer of the membrane, which agreed well with the conclusion of contact angle and AFM measurements. With Gemini surfactant as coemulsifier in the system, the PDMS content in the system could reach to 50%, which was far higher than the other reported value. © 2009 Wiley Periodicals, Inc. Journal of Applied Polymer Science, 2009
Microarray analysis of gene expression changes in feeding female and male lone star ticks, Amblyomma americanum (L)
Authors: Aljamali Majd N. , Ramakrishnan Vijay G. , Weng Hua , Tucker James S. , Sauer John R. , Essenberg Richard C.
Published: June 2009

A collection of EST clones from female tick Amblyomma americanum salivary glands was hybridized to RNA from different feeding stages of female tick salivary glands and from unfed or feeding adult male ticks. In the female ticks, the expression patterns changed dramatically upon starting feeding, then changed again towards the end of feeding. On beginning feeding, genes possibly involved in survival on the host increased in expression as did many housekeeping genes. As feeding progressed, some of the survival genes were downregulated, while others were upregulated. When the tick went into the rapid feeding phase, many of the survival genes were downregulated, while a number of transport‐associated genes and genes possibly involved in organ degeneration increased. In the males, the presence of females during feeding made a small difference, but feeding made a larger difference. Males showed clear differences from females in expression, as well. Protein synthesis genes were expressed more in all male groups than in the partially fed females, while the putative secreted genes involved in avoiding host defenses were expressed less. © 2009 Wiley Periodicals, Inc.
Zur Statik der Bodenbewehrung
Authors: Kolymbas Dimitrios , Renk Daniel
Published: June 2009

In dieser Arbeit werden zwei Ansätze zur Bemessung von Nagelwänden unter Berücksichtigung von Deformationen im Gebrauchszustand vorgestellt. Der erste Ansatz basiert auf einem Vergleich von Dissipationsarbeit des Boden‐Nagel‐Systems infolge einer Scherung im Grenzzustand und Arbeit der äußeren Kräfte. Grundlage des zweiten Ansatzes ist die Homogenisierung des Boden‐Nagel‐Systems. Anhand der Mischungstheorie lässt sich der erforderliche Bewehrungsgrad einer vernagelten Böschung ermitteln.

Neben Anmerkungen zu den herkömmlichen Standsicherheitsnachweisen und der Herleitung zweier alternativer Bemessungsansätze dienen Berechnungsbeispiele der näheren Erläuterung der vorgestellten Verfahren.
Zwei Kuppeln in München: Armeemuseum und Anatomie (1903–1905) – Die ersten Betonschalen Europas
Authors: Pogacnik Marco
Published: June 2009

1903 wird die Eisenbeton‐Gesellschaft als Zusammenschluss von Wayss & Freytag mit Heilmann & Littmann gegründet, um Eisenbetonarbeiten in München und Umgebung durchzuführen. In zwei Jahren errichtete diese Gesellschaft unter der Leitung von Ludwig Zöllner die fortschrittlichsten Bauten, die mit dem neuen Material Eisenbeton realisiert wurden: die Isarbrücke bei Grünwald und die Kuppeln des Armeemuseums und der anatomischen Anstalt.

Der Aufsatz befasst sich mit den beiden letzten Werken, zwei Schalen, wofür der junge Ingenieur Emil Mörsch die statischen Berechnungen unterzeichnete. Die gewagten Konstruktionen, die 7 cm Schalendicke und lichte Weiten von 16 und 22 m aufweisen, sind eine Höchstleistung, zu der noch die Kuppeln des Justizpalastes (1891) und des Verkehrsministeriums (1904) hinzuzurechnen sind, innerhalb einer historischen Entwicklung vom Eisenbau des 19. Jh. zur Kuppel mit Rippengewölbe im 20. Jh.

Während bei dem Armeemuseum die hohe technische Leistung noch hinter einer historisierenden Hülle verborgen wurde, benutzte der Architekt Max Littmann bei der Anatomie den Beton als Sichtmaterial, so dass Form, Konstruktion und Material das erste Mal in so überzeugender Weise als organische Einheit inszeniert wurden.
Structure and conformational stability of a tetrameric thermostableN‐succinylamino acid racemase
Authors: Pozo‐Dengra Joaquín , Martínez‐Rodríguez Sergio , Contreras Lellys M. , Prieto Jesús , Andújar‐Sánchez Montserrat , Clemente‐Jiménez Josefa M. , Las Heras‐Vázquez Francisco J. , Rodríguez‐Vico Felipe , Neira José L.
Published: June 2009

The N‐succinylamino acid racemases (NSAAR) belong to the enolase superfamily and they are large homooctameric/hexameric species that require a divalent metal ion for activity. We describe the structure and stability of NSAAR from Geobacillus kaustophilus (GkNSAAR) in the absence and in the presence of Co2+by using hydrodynamic and spectroscopic techniques. The Co2+, among other assayed divalent ions, provides the maximal enzymatic activity at physiological pH. The protein seems to be a tetramer with a rather elongated shape, as shown by AU experiments; this is further supported by the modeled structure, which keeps intact the largest tetrameric oligomerization interfaces observed in other homooctameric members of the family, but it does not maintain the octameric oligomerization interfaces. The native functional structure is mainly formed by α‐helix, as suggested by FTIR and CD deconvoluted spectra, with similar percentages of structure to those observed in other protomers of the enolase superfamily. At low pH, the protein populates a molten‐globule‐like conformation. The GdmCl denaturation occurs through a monomeric intermediate, and thermal denaturation experiments indicate a high thermostability. The presence of the cofactor Co2+did alter slightly the secondary structure, but it did not modify substantially the stability of the protein. Thus, GkNSAAR is one of the few members of the enolase family whose conformational propensities and stability have been extensively characterized. © 2009 Wiley Periodicals, Inc. Biopolymers 91: 757–772, 2009.

This article was originally published online as an accepted preprint. The “Published Online” date corresponds to the preprint version. You can request a copy of the preprint by emailing the Biopolymers editorial office at biopolymers@wiley.com
Rieselbettreaktoren unter künstlichem Schwerkrafteinfluss – Prinzip, Umsetzung, Auswirkung und Anwendung
Authors: Catalin Munteanu M. , Schubert M. , Larachi F.
Published: June 2009

Die Anwendung von Magnetfeldern hat sich als vielversprechender Ansatz zur Beeinflussung von Gas/Flüssig‐Strömungen erwiesen. Obwohl organische Flüssigkeiten gewöhnlich kein magnetisches Verhalten zeigen, kann durch starke Gradienten‐Magnetfelder mittels supraleitender Magneten auch in katalytischen Mehrphasenreaktoren, wie zum Beispiel Rieselbettreaktoren, der Schwerkraft entgegengewirkt und damit die Strömung einer erdgebundenen Mikrogravitation ausgesetzt werden. Unter diesen Bedingungen können der Flüssigkeitsanteil in der Katalysatorschüttung und der Benetzungsgrad an der Katalysatoroberfläche effektiv beeinflusst und damit Stofftransport und Umsatz einer katalytischen Reaktion deutlich gesteigert werden.
Modeling Monthly Mean Flow in a Poorly Gauged Basin by Fuzzy Logic
Authors: Toprak Zeynel Fuat , Eris Ebru , Agiralioglu Necati , Cigizoglu Hikmet Kerem , Yilmaz Levent , Aksoy Hafzullah , Coskun Hilal Gonca , Andic Gokhan , Alganci Ugur
Published: June 2009

The estimation of the monthly mean flow is a critical issue in many water resource development projects. However, in practice the mean flow is not easily determined in ungauged and poorly gauged basins. Therefore, in the literature, various flow estimation methods have been developed recently for mountainous regions which are generally ungauged or poorly gauged basins. In this study a fuzzy logic model based on the Mamdani approach was developed to estimate the flow for poorly gauged mountainous basins. This model was applied to the Solakli Basin which is located in the Eastern Black Sea Region of Turkey. Limited rainfall and flow data are available for this basin. In addition to these variables, the stream and time coefficients were introduced and used as variables for modeling. The data was divided into training and testing phases. The model results were compared with the measured data. The comparison depends on seven statistical characteristics, four different error modes and the contour map method. It was observed that the fuzzy model developed in this study yielded reliable results.
Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma
Authors: Brandes Alba A. , Franceschi Enrico , Tosoni Alicia , Benevento Francesca , Scopece Luciano , Mazzocchi Valeria , Bacci Antonella , Agati Raffaele , Calbucci Fabio , Ermani Mario
Published: June 2009

BACKGROUND:

A recent randomized study conducted on newly diagnosed glioblastoma (GBM) patients demonstrated that concomitant and adjuvant temozolomide added to standard radiotherapy had a survival advantage compared with radiotherapy alone. The overall survival benefit of this aggressive treatment, however, was attenuated in older or poor performance status patients. The aim of the present study was to verify the activity and the toxicity of temozolomide administration concurrent and adjuvant to radiotherapy as first‐line treatment for elderly GBM patients, and to explore correlations between clinical outcome and O6 methylguanine‐DNA methyltransferase (MGMT) promoter methylation status.

METHODS:

Newly diagnosed GBM patients ≥65 years were considered eligible. Treatment comprised radiotherapy (60 Gy in 30 fractions over 6 weeks) plus continuous daily temozolomide (75 mg/m2/day), followed by 12 maintenance temozolomide cycles (150 mg/m2 once a day for 5 consecutive days every 28 days) if MRI showed no enhancement suggesting a tumor; otherwise, chemotherapy was delivered until complete response or unequivocal progression.

RESULTS:

A total of 58 patients (34 males; median age, 68 years; range, 65‐82 years) were enrolled. Sixteen patients (43%) presented MGMT promoter methylated and 21 unmethylated (57%) status. The median progression‐free survival and median survival time (MST) were 9.5 months (95% confidence interval [CI], 8.6‐10.5) and 13.7 months (95% CI, 10‐17.3 months), respectively. Mental status deterioration grade 3‐4 was detected in 25% of patients. Leukoencephalopathy was diagnosed in 10% of patients.

CONCLUSIONS:

The overall and progression‐free survival of patients given concomitant and adjuvant temozolomide are greater than in those given radiotherapy alone; however, this regimen incurs a greater deterioration in mental status. Further randomized trials should, therefore, be conducted to investigate the efficacy and against the toxicity of this regimen as first‐line therapy in patients with GBM. Cancer 2009. © 2009 American Cancer Society.
Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma
Authors: Hattangadi Jona A. , Hong Theodore S. , Yeap Beow Y. , Mamon Harvey J.
Published: June 2009

BACKGROUND:

Although adjuvant chemoradiation is used commonly in the United States for the treatment of resected pancreatic cancer, there is no consensus on the benefit of this therapy, because the results from randomized trials are conflicting. The authors of this report reviewed their experience in a consecutive, unselected series of patients who received adjuvant 5‐fluorouracil (5‐FU) and radiation therapy (RT) for resected pancreatic adenocarcinoma.

METHODS:

Eighty‐six patients with resected pancreatic adenocarcinoma who received adjuvant therapy from 1998 to 2005 were identified, and their medical records were reviewed. Ninety‐three percent of patients were treated with external beam RT to ≥50.4 grays, and 91% of patients received concurrent 5‐FU by continuous infusion. Forty‐five percent of patients went on to receive adjuvant gemcitabine.

RESULTS:

The median follow‐up was 31 months (range, 21‐62 months) among the 20 patients who remained alive. Less than half of patients had positive (33%) or close (<1 mm; 15%) resection margins, 81% of tumors were classified as T3, and 66% of patients had involved lymph nodes. The median overall survival (OS) for all patients was 22 months. Negative lymph node status (P = .016) was a significant prognostic factor for improved OS, whereas treatment with gemcitabine trended toward improved OS (P = .080). The median disease‐free survival (DFS) for all patients was 10 months: Treatment with gemcitabine (P = .044) and the receipt of any chemotherapy (P = .047) were significant predictors of DFS. Seventy‐five patients (87%) had disease recurrence, and the majority recurred with peritoneal metastases (55%) or liver metastases (53%). Patients who had negative lymph nodes trended toward a lower rate of distant failure (P = .060).

CONCLUSIONS:

The median survival of the current cohort was greater than that of the chemoradiation arms of European Organization for Research and Treatment of Cancer trials and European Study Group for Pancreatic Cancer 1 trials and was comparable to the survival observed on the Gastrointestinal Tumor Study Group chemoradiation arm. Lymph node status and treatment with adjuvant chemotherapy were significant predictors of OS and DFS, respectively. Future survival improvements should be directed at reducing peritoneal and liver metastases. Further randomized trials will be required to define the role of adjuvant therapy for pancreatic adenocarcinoma. Cancer 2009. © 2009 American Cancer Society.