bluuebunny/crossref_metadata_2025 huggingface dataset:
Oligodendroglioma: incidence and biological behavior in a defined population
Authors: Mørk Sverre J. , Lindegaard Karl-Fredrik , Halvorsen Tore B. , Lehmann Egil H. , Solgaard Torfinn , Hatlevoll Reidulv , Harvei Sverre , Ganz Jeremy
Published: May 2009

✓ The cases of 208 patients with histologically confirmed oligodendrogliomas were studied. The incidence represents 4.2% of all primary brain tumors diagnosed in the Norwegian population over a 25-year period. All of these tumors were cerebral and the majority affected the frontal lobe. The patients' median age at diagnosis was 47 years, with a range from 3 to 76 years; 6% of the oligodendrogliomas occurred in children. The median duration of symptoms before diagnosis was 20.5 months (mean 43 months). Plain skull x-ray films showed calcified deposits in 28% of the tumors. At operation, most of the tumors were poorly defined, without cyst formation, hematoma necrosis, or calcification. The median duration of disease from onset of symptoms until death was 14 months in nine untreated cases. In surgically treated oligodendroglioma patients the median survival time from onset of symptoms was 74 months. The median postoperative survival time was 35 months (mean 52 months). Tumor calcification, as seen on plain skull x-ray films, was associated with a significantly longer survival period. The surgical findings of gross necrosis, gross hypervascularity, and soft tumor consistency were all related to a shorter total duration of disease. Grossly well demarcated lesions were associated with a significantly longer postoperative survival. The length of postoperative survival correlated with the preoperative clinical status. The cumulative proportion of patients surviving 5 years was 0.342. The patient's age and sex did not have a statistically significant influence on survival time. The extent of surgical excision only seemed to play a role when the neurosurgeon considered that he had removed the whole lesion: these patients had a median postoperative survival period 14 months longer than the other oligodendroglioma patients. The ABO blood group of the oligodendroglioma patient was of prognostic value. In particular, patients with blood group A had a distinctly poorer prognosis than patients with O or B blood. The survival data from this unselected series indicate that cerebral oligodendrogliomas have a less favorable prognosis than has generally been believed.
Beagle puppy model of perinatal cerebral infarction
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C. , Cole Judy , Pitt Bruce R.
Published: May 2009

✓ Perinatal cerebral infarction is a not uncommon finding in newborn babies surviving intensive care. Asphyxia, with its attendant hypotension, is the most common cause of this problem and may result in neuropathological changes in the periventricular white matter. Previous studies have demonstrated uncoupling of cerebral blood flow and metabolism in the periventricular white matter regions of newborn beagle pups exposed to hemorrhagic hypotension. This work examines the effects of hypotension on serum and regional cerebral prostaglandin levels in the newborn beagle pup. The animals were anesthetized, tracheostomized, and paralyzed. Pups were randomly assigned to two groups: one was subjected to hemorrhagic hypotension and the other received no insult. Hypotension was induced by slow venous hemorrhage calculated to maintain a mean arterial blood pressure at 20 to 30 mm Hg. Serum prostaglandin determinations were made immediately before and 15 minutes after random assignment to hypotension or control groups. In addition, regional cerebral prostaglandin determinations were performed 15 minutes after randomization. Analysis of the serum prostaglandin data revealed that there were no significant differences in the values for thromboxane B2 or 6-keto-prostaglandin (PG) F1α, which are the stable breakdown products of thromboxane A2 and prostacyclin, respectively. Prostaglandin E2 levels increased in response to hemorrhagic hypotension insult. Regional cerebral prostaglandin determinations demonstrated decreases in thromboxane B2 and 6-keto-PGF1α in both gray and white matter. Although gray matter PGE2 was increased in pups exposed to hemorrhagic hypotension, this increase was not found in the periventricular white matter of injured pups. This regional difference in PGE2 synthesis in response to insult may explain the periventricular white matter neuropathological changes attributed to it.
Immunohistochemical investigation of cerebral ischemia during recirculation
Authors: Yoshimine Toshiki , Morimoto Kazuyoshi , Brengman Joan M. , Homburger Henry A. , Mogami Heitaro , Yanagihara Takehiko
Published: May 2009

✓ Immunohistochemical methods for the determination of tubulin, creatine kinase BB-isoenzyme, and astroprotein-glial fibrillary acidic protein were used to investigate recovery of the ischemic lesion after temporary occlusion of a common carotid artery in the gerbil and the evolution of the postischemic lesion following reperfusion. One group of gerbils was followed from 15 minutes to one month after an ischemic period of 30 minutes, and another group was examined after 7 days following an ischemic period of 5 to 30 minutes. It was found that the postischemic lesion, visualized as loss of the immunohistochemical reaction for tubulin and creatine kinase BB-isoenzyme, evolved within 60 minutes after reperfusion in the hippocampus and cerebral cortex and within 3 hours in the caudoputamen and thalamus. Resolution of the preexisting ischemic lesion was possible only after an ischemic period of less than 10 minutes in the cerebral cortex and caudoputamen and less than 15 minutes in the thalamus. In the CA1-CA2 region of the hippocampus, the ischemic lesion already existed after an ischemic period of 5 minutes and was mostly irreversible. The immunohistochemical method of testing for different cellular and subcellular components was very useful for investigation of cerebral ischemia and may also be advantageous for investigation of other pathophysiological conditions of the nervous system.
Delayed CSF lavage for arteriographic and morphological vasospasm after experimental SAH
Authors: Alexander Eben , Black Peter McL. , Liszczak Theodore M. , Zervas Nicholas T.
Published: May 2009

✓ Irrigation of the subarachnoid space after aneurysmal subarachnoid hemorrhage (SAH) has been reported to alleviate subsequent arterial vasospasm. The authors have investigated the effect of lavage of the cerebrospinal fluid (CSF) space in the two-hemorrhage canine model of vasospasm. Twelve dogs had basilar cistern lavage with 120 cc of artificial CSF 24 hours after each of two SAH's, and 12 control dogs had two sequential SAH's without intervening lavage of clot. The amount of clot on the ventral brain stem was evaluated at sacrifice and was graded from 0 (no clot) to 4 (maximum clot) to assess the adequacy of clot removal. Dogs that had undergone lavage had a median grade of 1 (range Grade 0 to 2); control dogs had a median grade of 2 (range Grade 1 to 3.5, p < 0.001, Wilcoxon rank sum test), indicating significant reduction of gross clot by lavage. The neurological findings were graded from 0 to 5, based on meningismus, ataxia, paresis, and cranial nerve deficits. No significant differences in neurological grade were found on any day between the two groups.

Satisfactory angiograms were obtained before and 7 days after hemorrhage and were controlled for blood pressure and blood gases; these showed significant spasm in both groups. There was a mean reduction (± standard deviation) of 21.6% ± 16.2% in basilar artery diameter in control dogs, compared to a 28.8% ± 15.1% reduction in dogs with lavage (difference not significant, t-test). There was a strong, but insignificant, trend toward reduction of endothelial desquamation in the basilar and middle cerebral arteries in dogs with lavage compared to control animals (p = 0.06). Corrugation and tearing of the elastica, thickened intima, intimal fibroplasia, vacuolization of the endothelial or smooth-muscle cells, and presence of blood cells in the adventitia occurred similarly in both groups.

It appears that cisternal lavage 24 hours after hemorrhage in this model has no effect on the angiographic, neurological, or most morphological sequelae of SAH, in spite of evidence for removal of clot as seen at sacrifice. Any postulated interaction of clot and vessel resulting in chronic vasospasm must occur before this time. Evaluation of the effect of much earlier lavage (for instance, 1 hour after hemorrhage) may elucidate the point at which vasospasm is instigated after SAH, and help in determining what factors cause vasospasm.
Mucocele of the pterygoid recess treated by laser surgery
Authors: Wilberger James E. , Abla Adnan , Kennerdell John , Maroon Joseph C.
Published: May 2009

✓ Mucoceles arising from accessory paranasal sinuses about the orbit are quite rare. A case is reported of a retro-orbital mucocele arising from the pterygoid recess of the sphenoid sinus. The clinical and anatomical presentations, computerized tomographic and magnetic resonance imaging characteristics, and laser surgical management of such lesions are described.
Spontaneous reduction in size of prolactin-producing adenoma after delivery
Authors: Fujimoto Masahito , Yoshino Eiji , Mizukawa Norihiko , Hirakawa Kimiyoshi
Published: May 2009

✓ The authors describe the case of a pregnant woman with a large prolactin-producing pituitary adenoma that regressed after delivery. The patient's neurological signs and symptoms spontaneously disappeared soon after delivery without treatment. Reduction in tumor size was confirmed on computerized tomography scans. It is hypothesized that the growth rate of a prolactinoma may be accelerated by estrogen.
Intrasellar cysticercosis
Authors: Rafael Hernando , Gómez-Llata Sergio
Published: May 2009

✓ Cysticercosis of the pituitary fossa is a rare finding. A case is described in which intra- and suprasellar cysticercosis produced disturbances in both visual acuity and visual fields. On clinical examination, angiography, and computerized tomography, it simulated an intrasellar tumor with suprasellar extension. The diaphragma sellae was absent.
A guide for ventricular catheter placement
Authors: Ghajar Jamshid B. G.
Published: May 2009

✓ The author describes a device designed to guide a catheter into the anterior ventricular system.
Intrinsic brain-stem tumors of childhood: surgical indications
Authors: Epstein Fred , McCleary E. Larry
Published: May 2009

✓ This report summarizes the first author's experience with radical excision of intrinsic non-exophytic brain-stem gliomas in 34 pediatric patients. On retrospective analysis, these tumors may be classified into three subgroups: focal, diffuse, and cervicomedullary. A focal neoplasm is a circumscribed mass less than 2 cm in diameter and without associated edema. Tumors of a larger size or in which the “focal” neoplasm is associated with a large area of apparent edema are classified as diffuse. Cervicomedullary neoplasms occur at the junction of the medulla and spinal cord and involve both of the structures but do not extend rostrally into the pons.

A radical tumor excision was carried out in all patients, and the only mortality and morbidity occurred in children harboring diffuse gliomas. All of the diffuse gliomas were malignant (grade III or IV astrocytomas), whereas three of the four focal astrocytomas and all of the cervicomedullary tumors were grade II astrocytomas. No patient with a diffuse astrocytoma was benefitted by surgery, while two of the focal astrocytomas and all of the cervicomedullary neoplasms either became stable or improved postoperatively. It is concluded that, although surgery may be accomplished within the substance of the brain stem with low morbidity and mortality rates, it is not indicated for malignant astrocytomas as it has no impact on the biology of the neoplasm. Therefore, while primary radical excision is recommended for cervicomedullary neoplasms, which are often benign, the more traditional radiation therapy and/or chemotherapy remain appropriate for tumors above the medulla.
Effects of ACNU and radiotherapy on malignant glioma
Authors: Takakura Kintomo , Abe Hiroshi , Tanaka Ryuichi , Kitamura Koichi , Miwa Tetsuro , Takeuchi Kazuo , Yamamoto Shinjiro , Kageyama Naoki , Handa Hajime , Mogami Heitaro , Nishimoto Akira , Uozumi Tohru , Matsutani Masao , Nomura Kazuhiro
Published: May 2009

✓ A randomized clinical study of irradiation and irradiation combined with ACNU in the treatment of malignant gliomas was performed in order to determine if there was an enhancing therapeutic effect of ACNU given in addition to radiotherapy. An effect was defined as a reduction in tumor size, changes in neurological signs and performance status within 1 month after the completion of radiotherapy, or statistically improved survival times. Seventy-seven patients from 14 neurosurgical clinics were included in this validated study group. Radiotherapy with a total dose of 5000 to 6000 rads, given in 25 to 30 subdoses, was applied to the whole brain and to a generous field surrounding the tumor. Patients who were assigned to receive chemotherapy were given ACNU intravenously once or twice during radiotherapy at a dose of 100 mg/sq m of body surface area.

The response rate (more than 50% reduction of the tumor size) was 13.5% in the group treated by radiotherapy alone and 47.5% in the group with radiotherapy and ACNU. The hematological toxicity was more severe in the group treated with radiotherapy and ACNU. Other toxicity was mild and acceptable. The survival rates of patients with astrocytoma grade III and glioblastoma multiforme at 36 months after the surgery were 48.9% and 0% for radiotherapy alone and 59.0% and 16.3% for radiotherapy plus ACNU, respectively. The differences between the survival curves were not significant at the p = 0.05 level.

This study has demonstrated that, although the use of ACNU during radiotherapy suppressed malignant gliomas more than radiotherapy alone, the survival time was not extended significantly. It is necessary to continue to search for an effective chemotherapeutic regimen to prolong survival of patients with malignant gliomas.
Recurrence of intracranial meningiomas: the role played by regional multicentricity
Authors: Borovich Bernardo , Doron Yaffa
Published: May 2009

✓ Meningiomas are regarded as benign dural tumors that can be totally removed; however, after a resection that appears to the naked eye to be total, their recurrence rate is high. Malignancy in a few cases and an erroneous belief in many others that the excision was total are among the most accepted explanations. Few studies have mentioned multicentricity as a cause of “relapse.” Therefore, the authors decided to examine the dura mater around globular meningiomas for evidence of regional multifocality. A radial strip of dura was removed from the line of attachment of globular meningiomas in 14 consecutive patients. Meningotheliomatous cell aggregates were demonstrated in 100% of these dural strips in the form of either intradural clusters or nodes protruding from the inner aspect of the dura. The benign appearance of the cells and the great prevalence in this study of the benign types of meningioma seem to exclude malignancy; the intradural position of the clusters and their independence from blood vessels apparently negate seeding and dural metastasis. Control strips of convexity dura mater taken from 10 neurosurgical patients without meningioma failed to show these meningotheliomatous conglomerates. These findings indicate that solitary globular meningiomas represent only the most visible growth in the midst of a neoplastic field change spreading over a wide area of dura mater. The authors believe that this can explain some unexpected “recurrences,” and that a wide resection of dura around globular meningiomas, whenever possible, could reduce the incidence of clinical growth after true total excision of the most visible lesion. It remains to be determined what factors cause the acceleration of growth of these cell aggregates after removal of the dominant tumor.
In vitro killing of human glioblastoma by interleukin-2-activated autologous lymphocytes
Authors: Jacobs Steven K. , Wilson Debra J. , Kornblith Paul L. , Grimm Elizabeth A.
Published: May 2009

✓ Culture of peripheral blood lymphocytes (PBL) from brain-tumor patients with recombinant interleukin-2 (IL-2) results in the activation of lymphokine-activated killer cells (LAK) with the capacity to lyse autologous and allogeneic glioblastoma. In this study, PBL obtained from brain-tumor patients were cultured with or without IL-2 for 3 to 7 days and then tested for their ability to lyse target cells in a 4-hour chromium release cytotoxicity assay. The PBL were drawn 1 to 2 weeks following operative tumor debulking. Cells used as targets included fresh brain-tumor cells obtained at the time of craniotomy, fresh brain-tumor cells grown from 1 to 3 weeks in tissue culture, fresh autologous PBL, and allogeneic glioblastoma cells grown in tissue culture.

Peripheral blood lymphocytes from brain-tumor patients that were cultured without IL-2 did not significantly lyse autologous or allogeneic glioblastoma. However, when these PBL were cultured with IL-2, LAK were generated which produced marked lysis of autologous as well as allogeneic tissue-culture glioblastoma in all of eight cases. Significant lysis of autologous fresh tumor by patient LAK was observed in four of five experiments. By contrast, patient LAK did not kill autologous normal PBL. The ability to generate LAK was not influenced by the patient's age, previous therapy, or the administration of steroids.
Development of cyclooxygenase and lipoxygenase metabolites of arachidonic acid after transient cerebral ischemia
Authors: Dempsey Robert J. , Roy Mark W. , Meyer Kathleen , Cowen David E. , Tai Hsin-Hsiung
Published: May 2009

✓Vasoactive arachidonic acid metabolites are postulated to play a role in the pathogenesis of cerebral ischemia. In order to characterize the local generation of cyclooxygenase and lipoxygenase metabolites of arachidonic acid in transient ischemia with reperfusion, Mongolian gerbils were studied for regional cerebral blood flow (CBF), using the hydrogen clearance technique, and for cerebral levels of the thromboxane metabolite TXB2, and prostaglandins 6-keto-PGF1α and PGE2, as well as the leukotriene LTB4. The gerbils were anesthetized with pentobarbital, and half of the animals were pretreated with the cyclooxygenase inhibitor indomethacin. All received 10 or 20 minutes of dense forebrain ischemia followed by reperfusion of 10 minutes, 50 minutes, or 100 minutes. A separate control group received no ischemic lesion.

Regional CBF decreased significantly from 23.7 ± 2.6 to 4.3 ± 1.7 cc/100 gm/min during ischemia (p < 0.01). Reperfusion resulted in initially normal flows (22.5 ± 5.1 cc/100 gm/min) followed by a progressive hypoperfusion (11.3 ± 2.7 cc/100 gm/min). All metabolites showed parallel significant (p < 0.05) increases after transient ischemia and reperfusion compared to baseline levels (values (in pg/mg protein) were: TXB2 45.5 ± 7.1 vs 23.3 ± 3.6; 6-keto-PGF1α 262.8 ± 47.9 vs 175.8 ± 26.8; PGE2 256.5 ± 35.6 vs 112.5 ± 11.2; and LTB4 37.8 ± 4.6 vs 24.6 ± 6). These levels were all significantly decreased (p < 0.05) by pretreatment with indomethacin except for the leukotriene LTB4, which was increased. Transient cerebral ischemia results in a reperfusion abnormality and the local generation of cyclooxygenase products, which are reduced by pretreatment with indomethacin; however, cyclooxygenase inhibition may result in increased substrate availability for the lipoxygenase system. Studies of such an interaction may lead to new understandings of the pharmacological modification of detrimental vascular changes after transient cerebral ischemia.
A model of brain abscess: septic homologous blood clot emboli in rats
Authors: Matsuura Hiroshi , Kudo Motoshige , Ikeda Yukio , Isayama Kazuo , Nakazawa Shozo
Published: May 2009

✓ Brain abscesses in rats were produced by intra-arterial injection of septic homologous blood clot emboli. The production rate was 100% and the histopathological features closely resembled those seen in other animal models and in spontaneously occurring brain abscesses in humans. This small-animal model may be useful for systematic study of the development of brain abscesses as well as for evaluation of various therapeutic procedures.
Direct spinal arteriovenous fistula: a new type of spinal AVM
Authors: Heros Roberto C. , Debrun Gerard M. , Ojemann Robert G. , Lasjaunias Pierre L. , Naessens Pierre J.
Published: May 2009

✓ A patient presenting with progressive paraparesis was found to have a spinal arteriovenous fistula at the T3–4 vertebral level. The lesion consisted of a direct communication of the anterior spinal artery with a very distended venous varix that drained mostly superiorly to the posterior fossa and simulated a posterior fossa arteriovenous malformation (AVM) on vertebral angiography. The patient was treated by surgical ligation of the fistula through an anterior transthoracic approach. He deteriorated abruptly on the 4th postoperative day, probably because of retrograde thrombosis of the enlarged anterior spinal artery. Over the next few months, he improved to the point of being able to walk with crutches. He has also regained sphincter control.

The different types of spinal AVM's are reviewed. Our case does not fit into any of these groups. A new category, Type IV, is proposed to designate direct arteriovenous fistulas involving the intrinsic arterial supply of the spinal cord.
Cerebral venous thrombosis due to high-altitude polycythemia
Authors: Fujimaki Takamitsu , Matsutani Masao , Asai Akio , Kohno Takeshi , Koike Morio
Published: May 2009

✓ A case of cerebral venous thrombosis due to polycythemia secondary to adaptation to a high altitude is reported. A 27-year-old previously healthy man developed severe neurological symptoms after climbing 8511m. Computerized tomography and cerebral angiography suggested hemorrhagic infarction or intratumoral hemorrhage, and a craniotomy was performed. Pathological examination confirmed the diagnosis of hemorrhagic infarction secondary to cortical venous thrombosis. The etiology and incidence of cerebral venous thrombosis secondary to polycythemia are discussed.
Intraoperative cervical spine stabilization using the halo ring and the Mayfield three-pin skull clamp
Authors: Rhea Andrew H. , Tranmer Bruce I. , Gross Cordell E.
Published: May 2009

✓ A technique for intraoperative cervical spine stabilization is described. The method involves use of a halo ring and the Mayfield three-pin skull clamp.
Surgical management of aneurysms of the distal extracranial internal carotid artery
Authors: Sundt Thoralf M. , Pearson Bruce W. , Piepgras David G. , Houser O. Wayne , Mokri Bahram
Published: May 2009

✓ Results, complications, and operative techniques of the surgical management of 20 aneurysms of the distal extracranial internal carotid artery (ICA) in 19 patients are reviewed. The proximity of these aneurysms to the styloid process is not considered as a chance occurrence, and the possibility is raised that these lesions are related to trauma from that structure. False aneurysms from spontaneous dissections are believed to occur only in those dissections that begin distally; they are not found in dissections that begin proximally. Treatment was individualized and dependent upon: 1) the size and location of the aneurysm; 2) symptomatology; and 3) hemodynamic considerations based upon intraoperative cerebral blood flow (CBF) measurements determined from the clearance of xenon-133 injected into the ipsilateral ICA. Methods of treatment included: resection of the aneurysm with placement of an interposition saphenous vein graft in seven patients; resection of the aneurysm with end-to-end anastomosis of the ICA in five; ICA ligation in three; clipping of the aneurysm in one; and extracranial-to-intracranial bypass in four. One patient sustained a postoperative cerebral ischemic complication from embolization which resulted in a mild permanent impairment in right hand dexterity. There were no other cerebral ischemic complications in the group, largely attributable, it is thought, to the use of intraoperative CBF measurements and continuous electroencephalograms. Four patients had transient dysphagia from traction damage to the pharyngeal and superior laryngeal nerves, and one patient with preoperative difficulty in swallowing required a gastrostomy. Long-term results have been excellent. Use of the operating microscope facilitated the suturing of the distal anastomosis in cases in which the ICA was reconstructed by an interposition vein graft or end-to-end anastomosis.
Supratentorial ependymomas
Authors: Centeno Ricardo S. , Lee Arthur A. , Winter James , Barba David
Published: May 2009

✓ In 10 patients with supratentorial ependymomas, the tumors exhibited hyperdensity on computerized tomography (CT) scanning prior to contrast infusion and, with one exception, all tumors were mixed lesions with the low densities suggesting cystic or necrotic portions. Eighty percent of the tumors contained small calcifications. Characteristically, the tumors were well demarcated and demonstrated moderate to marked enhancement after the intravenous administration of contrast material. Angiograms obtained in some patients showed mild hypervascular tumor staining and absence of large feeding arteries. The degree of contrast enhancement, angiographic vascularity, and tumor stain was compared to the pathological anaplasia of the tumors. No correlation was observed. Of four patients who were still alive during a follow-up period of 4 years or longer, three had recurrences with inoperable tumors; the remaining patient is without recurrence after craniospinal radiation. This same patient belonged to a group of five patients with a diagnosis of high-grade ependymoma, four of whom had recurrence. Follow-up CT accurately recorded the clinical course of each patient. Annual routine follow-up examinations are proposed for patients with low-grade ependymomas, and for those with high-grade ependymomas follow-up CT should be performed every 6 months. The characteristic appearance and behavior of these tumors include several distinctive features on angiographic and CT images.
Biomechanical study of full-contact karate contrasted with boxing
Authors: Schwartz Michael L. , Hudson Alan R. , Fernie Geoffrey R. , Hayashi Ken , Coleclough Allan A.
Published: May 2009

✓ It is known that boxers suffer a characteristic cumulative brain injury from repeated blows to the head that correlates well with the number of bouts fought. Much less is known about full-contact karate (kickboxing), which is relatively new. In full-contact karate, punches and kicks are actually landed, rather than being focused to culminate just short of an opponent, as practiced in traditional karate. Although a combatant can win on points, the surest means of victory is a knockout. Consequently, fighters strive to land blows to the head.

To investigate the relative force of kicks and punches, a dummy head was mounted 175 cm above the floor (to simulate a 50th-percentile man standing erect) and 125 cm above the floor (to simulate the man in a crouched position) on a universal joint permitting motion about three axes. The mechanism was contrived to provide constant rotational stiffness, and springs provided constant restorative moments about the three axes. The texture of soft tissue was simulated by a mask of visco-elastic foamed materials. Fourteen karate experts punched and kicked the dummy. Accelerometer measurements in the 90- to 120-G range indicated that safety-chops (hand protectors) and safety-kicks (foot padding) did not reduce acceleration of the dummy. Ten-ounce boxing gloves mitigated peak acceleration to some extent. Kicks and punches produced accelerations in the same range.

Violent acceleration of the head by any means produces injury. The authors conclude that, if full-contact karate is widely practiced, cases of kickboxer's encephalopathy will soon be reported.
Neurological deterioration after lumbar puncture below complete spinal subarachnoid block
Authors: Hollis Peter H. , Malis Leonard I. , Zappulla Rosario A.
Published: May 2009

✓ The risk of neurological deterioration after removal of cerebrospinal fluid below the level of a complete spinal subarachnoid block is generally accepted. The actual incidence of deterioration after lumbar puncture in the presence of a complete block remains unknown. The present retrospective case analysis includes a review of 100 patients found to have complete block on myelography: 50 cases with a lumbar puncture and 50 cases with a Cl-2 puncture. Each group consisted of a similar age range, neurological status prior to myelography, level of block, and nature of disease. Seven patients (14%) had significant neurological deterioration after lumbar puncture, while no deterioration was seen after a Cl-2 puncture. A summary of those cases in which deterioration followed lumbar puncture is presented and the possible pathophysiology is discussed. From this analysis, the estimated risk of downward spinal coning after lumbar puncture below a complete spinal subarachnoid block caused by a mass lesion is at least 14%.
In vivo imaging of intracranial human glioma xenografts comparing specific with nonspecific radiolabeled monoclonal antibodies
Authors: Bullard Dennis E. , Adams Carol J. , Coleman R. Edward , Bigner Darell D.
Published: May 2009

✓ Current diagnostic and therapeutic modalities for malignant human gliomas are largely nonspecific. The development of monoclonal antibodies (MA's) with their high degree of specificity may allow precise tumor imaging and selective administration of therapeutic agents. However, the ability of these antibodies to specifically localize tumor tissue in vivo remains speculative. This study compares the localization and imaging properties of two MA's: a specific human glioma-associated extracellular matrix glycoprotein MA, 81C6, and a nonspecific control MA, 45.6, against a human glioma cell line, D-54 MG, intracranially inoculated into athymic rats. Forty-one animals received MA's labeled with iodine-131 (131I) or 125I and underwent imaging with a gamma camera. The images were independently evaluated and compared to tissue radioactivity levels. Radiolabeled antiglioma MA 81C6 specifically localized in intracranial xenografts. The percent of injected dose per gram of tissue for tumor was 1.707 ± 0.405/gm for 81C6 and 0.118 ± 0.056/gm for 45.6. All other organs had equivalent levels of specific and nonspecific MA's. For brain, these were 0.004 ± 0.002/gm and 0.005 ± 0.005/gm, respectively, and for the other organs, the range was from 0.053 to 0.284/gm. Statistically, 45.6 achieved levels in tumor that were significantly higher than normal brain (p < 0.05) but significantly less than that achieved with 81C6 (p < 0.005). With 81C6, the degree of localization was high enough to allow imaging of intracranial tumors at sizes as small as 20 mg. Intracranial tumors were imaged with 45.6 only when they achieved sizes greater than 300 mg. In this imaging study, radiolabeled 81C6, a specific antiglioma MA, proved to be significantly better for imaging small and intermediate-sized tumors than the control MA's. Large tumors were visualized by both MA's, although higher quality scans were obtained earlier and more frequently with specific MA's than with nonspecific immunoglobulin G. These data suggest that specific MA's have a role to play in both the diagnosis and treatment of primary intracranial human tumors.
Variations in pressure-volume index and CSF outflow resistance at different locations in the feline craniospinal axis
Authors: Takizawa Hideo , Gabra-Sanders Thea , Miller J. Douglas
Published: May 2009

✓ Pressure volume index (PVI) and cerebrospinal fluid (CSF) outflow resistance (Ro) were estimated in spontaneously breathing anestheized cats by the bolus injection test under normal conditions and also under abnormal conditions produced by slow infusion of saline into the CSF space. Bolus injections were made separately into the lumbar subarachnoid space, cisterna magna, and lateral ventricle. The mean PVI values in the lumbar sac, cisterna magna, and lateral ventricle under normal conditions were 0.70, 0.71, and 0.64 ml, respectively; not significantly different from each other. Saline infusion lowered PVI significantly at every site; PVI values in the lumbar sac, cisterna magna, and lateral ventricle were 0.54, 0.52, and 0.53 ml, respectively; not significantly different from each other. Indirect values of PVI were calculated from the pressure responses observed at sites other than where the bolus had been injected. These indirect PVI values were always greater than PVI at the injection site under normal conditions, but differences between direct and indirect PVI values were abolished during saline loading of the CSF space. The Ro was estimated under normal conditions in the lumbar sac, cisterna magna, and lateral ventricle to be 81.6, 85.6, and 110.3 mm Hg/ml/min, respectively. The lateral ventricle Ro was significantly higher than at other places. These findings suggest that, when there is no blockage in the craniospinal axis, the pressure response to a bolus change in CSF volume is freely transmitted, direct measurements of PVI are independent of location, and indirect measurements are larger because of “buffering” in the CSF space. When PVI is lowered and buffering capacity is exhausted, these differences between direct and indirect PVI values disappear.
Experimental spinal cord injury: quantitation of axonal damage by automated image analysis
Authors: Iizuka Hideaki , Yamamoto Teiji , Iwasaki Yuzo , Konno Hidehiko , Kadoya Satoru
Published: May 2009

✓ The severity of acute experimental spinal cord injury in rats was assessed quantitatively with the aid of an automated image analyzer by measuring the amount of degenerating axons that had developed distal to the site of mechanical insult. Spinal cord injury was produced in adult male rats by epidural compression at T-11 with a Biemer vascular clip. On the 7th postoperative day, the animals were graded according to the degree of hindlimb motor deficit, as follows: Grade 0: normal (three rats); Grade 1: crawling with difficulty (10 rats); Grade 2: some voluntary movement (nine rats); and Grade 3: no voluntary movement (nine rats). The rats were then sacrificed. The L-6 segment was chosen for selective silver impregnation of degenerating axons by the Fink-Heimer method.

Silver grains, representing degenerating axons and their terminals, were accumulated in the descending tracts and in Rexed's laminae VII and VIII. The extent of axonal damage was expressed by the percentage of the area occupied by silver grains in Rexed's lamina VIII. The area occupied by silver grains was 17.0% (mean) in Grade 0 rats, 22.3% ± 2.63% (mean ± standard deviation) in Grade 1 rats, 28.7% ± 3.35% in Grade 2 rats, and 35.9% ± 2.76% in Grade 3 rats. The severity in Grade 3 rats was close to that of rats with transected cords (37.6% ± 0.89%). The differences among the groups were statistically significant (p < 0.001). This method may serve as a useful tool for the objective assessment of therapeutic modalities in large series of small experimental animals.
Optic nerve apoplexy
Authors: Reilly Peter L. , Oatey Peter E.
Published: May 2009

✓ Two patients who suffered loss of vision due to spontaneous optic nerve hematomas are described. The hemorrhage was contained within the pial confines of the involved optic nerve, although there was some extension more posteriorly. The diagnosis of an intraneural cryptic arteriovenous malformation was histologically confirmed in one case and was supported by evidence in the other. Surgical evacuation by the subfrontal approach was undertaken and visual function improved.
Hemangioblastoma of the cervicomedullary junction
Authors: Sanford Robert A. , Smith Robert A.
Published: May 2009

✓ Solid hemangioblastomas of the cervicomedullary junction are benign vascular neoplasms malignantly located. Their unusual and characteristic clinical presentations include loss of involuntary respiratory drive, neurogenic hypertension, and emesis; these are secondary to their involvement of the tractus solitarius in the medulla. Although angiography is diagnostic, the computerized tomography appearance and unusual location also suggest the diagnosis. The correct preoperative diagnosis is particularly important for the successful surgical excision of these vascular tumors. The microsurgical removal of cervicomedullary hemangioblastomas is described in three patients.
Multiple brain abscesses associated with a mycotic aneurysm of the left common carotid artery
Authors: Imamura Junichi , Watanabe Yutaka
Published: May 2009

✓ A case is reported of multiple microabscesses confined to the left cerebral hemisphere and an aneurysm of the left common carotid artery. The aneurysm was presumed to be mycotic, secondary to extension of a tonsillar and pharyngeal infection. Infected microemboli dislodged from the aneurysmal sac were presumed to be the cause of the multiple microabscesses.
Extraspinal meningioma
Authors: Ibrahim A. Wahab , Satti Mohamed B. , Ibrahim E. Mustafa
Published: May 2009

✓ A case of ectopic extraspinal meningioma is reported which presented as a tumor at the back of the neck of a 51-year-old woman. This neoplasm was of considerable size and arose extradurally in the region of the C-2 nerve root, with its main bulk lying almost totally outside the spinal canal in the right suboccipital region. Total resection was accomplished in two stages, with no evidence of recurrence after 1 year. The rarity of such cases prompted this report.
Prognosis in subarachnoid hemorrhage of unknown etiology
Authors: Juul Roar , Fredriksen Torbjørn A. , Ringkjøb Rolf
Published: May 2009

✓ Thirty-two patients with subarachnoid hemorrhage of unknown etiology were followed for periods from 1 to 6½ years. Two more patients had normal initial angiograms, but were excluded when repeat angiography revealed an aneurysm. The mortality rate in this series was 6%. There was one possible early and no late episode of rebleeding. One patient developed epilepsy. Five patients developed communicating hydrocephalus and underwent a shunting procedure. A complete recovery was observed in 12 patients. An additional eight had minimal disability, seven were more severely disabled, and three patients were totally disabled. Antifibrinolytic treatment (tranexamic acid) was given in a nonstandardized regimen to 14 patients who showed a poorer result than did the 18 untreated patients.
Temporal lobectomy in children with epilepsy
Authors: Meyer Fredric B. , Marsh W. Richard , Laws Edward R. , Sharbrough Frank W.
Published: May 2009

✓ The results of temporal lobectomy for medically refractory seizures are analyzed in 29 boys and 21 girls with a mean age of 15.8 years. The average age at onset of seizures was 7.5 years, and the time between onset and surgery averaged 8.3 years. Postoperatively, 27 patients (54%) were seizure-free, 12 patients (24%) had only occasional auras without loss of consciousness, five patients (10%) had fewer seizures, and six (12%) were unchanged. Therefore, 78% were essentially seizure-free and 88% benefited significantly from the operation. There was no significant change in the Wechsler Intelligence Scale scores before and after surgery; however, the shorter the time between seizure onset and surgery, the greater the likelihood of improvement in verbal and perceptual intelligence quotient. Social outcome was significantly improved, and a large percentage of patients were either in school or actively employed. Early consideration of temporal lobectomy in children with medically refractory seizures is recommended.
The occurrence of dural invasion in pituitary adenomas
Authors: Selman Warren R. , Laws Edward R. , Scheithauer Bernd W. , Carpenter Sandra M.
Published: May 2009

✓ This report describes 60 dural specimens from patients with pituitary adenomas treated by transsphenoidal microsurgery, and attempts to define more precisely the clinical and pathological correlation of microscopic dural invasion. Analysis of the adenomas was based on four characteristics; size, surgical invasiveness (based on the surgeon's assessment of involvement by tumor of bone, dura, or cavernous sinus), histological evidence of invasion, and immunohistochemical staining characteristics. The incidence of surgical invasiveness (24 cases, 40%) was greater than previously reported, but most important was the frequent occurrence of microscopic dural invasion (51 cases, 85%). There was a clear progression of microscopic evidence of dural invasion with increasing tumor size: 69%, 88%, and 94% of the dural specimens from microadenomas, macroadenomas, and tumors with suprasellar extension, respectively, showed microscopic dural invasion. A correlation of invasiveness with immunohistochemical classification of tumor type was not evident.
Experience with Althesin in the management of persistently raised ICP following severe head injury
Authors: Bullock Ross , van Dellen James R. , Campbell Derek , Osborn Ian , Reinach S. Gustav
Published: May 2009

✓ Of 243 patients who underwent intracranial pressure (ICP) monitoring after severe head injury, 42 (17%) were found to have severe persistently raised ICP, in spite of hyperventilation, mannitol, and surgical decompression. Althesin was infused to reduce ICP in these patients. This agent was shown to be effective and safe in reducing ICP, and a significant improvement in cerebral perfusion pressure was demonstrated. In this respect, Althesin may be more effective than barbiturates. However, no improvement in patient outcome was demonstrated in this series.
Nizofenone administration in the acute stage following subarachnoid hemorrhage
Authors: Ohta Tomio , Kikuchi Haruhiko , Hashi Kazuo , Kudo Yoshio
Published: May 2009

✓ A multi-center controlled double-blind clinical study was carried out to evaluate the effects of nizofenone in patients with subarachnoid hemorrhage who were treated within 2 weeks of the ictus. The test drug was administered as an addition to conventional therapy, which was maintained during the study. Of 208 patients studied, 102 were treated with nizofenone and 106 with placebo. Treatment with nizofenone was significantly more effective (p < 0.05) than that with placebo based on functional recovery and other clinical findings. Although no significant difference was found in mortality rate between the nizofenone- and placebo-treated groups, a higher percentage of survivors in the former group exhibited a good outcome (p < 0.05). The effects of nizofenone administration were found to be especially notable in patients with delayed ischemic symptoms, moderately severe preoperative deficits (Hunt and Hess Grade II or III), and diffuse high-density areas in preand postoperative computerized tomography scans. No significant side effects were observed.
Selective hemoglobin inhibition of endothelium-dependent vasodilation of rabbit basilar artery
Authors: Fujiwara Shigeru , Kassell Neal F. , Sasaki Tomio , Nakagomi Tadayoshi , Lehman Richard M.
Published: May 2009

✓ The effect of hemoglobin on endothelium-dependent vasodilation of the isolated rabbit basilar artery was examined using an isometric tension recording method. Acetylcholine (ACh) (10−7−10−4 M) evoked a dose-dependent vasodilation of isolated rabbit basilar artery previously contracted by 10−6 M serotonin. This vasodilating action disappeared after removal of the endothelium. The ACh-induced vasodilation of rabbit basilar artery is thought to be strictly endothelium-dependent. Hemoglobin (10−7-10−5 M) inhibited this ACh-induced endothelium-dependent vasodilation conditional upon the dose. Adenosine triphosphate (ATP, 10−7-10−4 M) also relaxed isolated rabbit basilar artery already contracted by 10−6 M serotonin. This vasodilating action was slightly inhibited by adenosine antagonist, 8-phenyltheophylline (8-PT), and markedly attenuated by removal of the endothelium. This ATP-induced vasodilation is thought to be composed of ATP itself (endothelium-dependent) and ATP degradation products (endothelium-independent) such as adenosine monophosphate or adenosine. Hemoglobin markedly inhibited ATP-induced vasodilation, but there still remained a small vasodilation, which was blocked by 8-PT. Papaverine-induced vasodilation was not affected by removal of the endothelium, and hemoglobin did not inhibit the papaverine-induced vasodilation. These results suggest that rabbit basilar artery has endothelium-dependent vasodilating mechanisms induced by ACh and ATP, and that hemoglobin selectively blocks the endothelium-dependent vasodilation. This finding may relate to the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage: there is a possibility that the presence of hemoglobin released from lysed erythrocytes inhibits the endothelium-dependent vasodilation of cerebral arteries; furthermore, the endothelial degeneration following subarachnoid hemorrhage may impair the vasodilating mechanisms of cerebral artery smooth-muscle cells.
Medulla oblongata edema associated with neurogenic pulmonary edema
Authors: Brown Robert H. , Beyerl Brian D. , Iseke Richard , Lavyne Michael H.
Published: May 2009

✓ Neurogenic pulmonary edema (NPE) occurs in association with central nervous system disease without underlying cardiopulmonary problems. It is characterized by profound pulmonary vascular congestion and a fulminant clinical course. Although several reports document a role for experimental brain-stem lesions in the production of NPE, there have been only two studies in man correlating specific brain-stem lesions with NPE. The authors report a case of NPE occurring in a patient with von Hippel-Lindau disease and a dorsal medullary syrinx with postoperative dorsal medullary edema. The anatomical location of this patient's lesion is reviewed in the context of alternative theories of the pathogenesis of NPE.
Subcortical electrical stimulation for control of intractable pain in humans
Authors: Hosobuchi Yoshio
Published: May 2009

✓ Chronic electrical stimulation of the subcortical area of the brain by implanted electrodes provides satisfactory control of a number of intractable pain syndromes that are refractory to medication. This series of 122 patients who underwent electrode implantation for the control of severe chronic pain was evaluated over a follow-up period of 2 to 14 years. Of the 65 patients with pain of peripheral origin, who were treated with stimulation of the periaqueductal gray region (PAG), 50 obtained successful pain control. Of 76 patients with a deafferentation pain syndrome, 44 obtained control of the dysesthesia with stimulation of the subcortical somatosensory region. Nineteen patients with both leg and back pain received electrodes in the PAG and the somatosensory regions; whereas back pain was relieved by PAG stimulation, dysesthetic leg pain was controlled more effectively by somatosensory region stimulation. The electrical stimulation technique appears to provide long-term pain control safely, with few side effects or complications.
Medical imaging of fetal ventriculomegaly
Authors: Hanigan William C. , Gibson Jack , Kleopoulos Nicholas J. , Cusack Thomas , Zwicky George , Wright Robert M.
Published: May 2009

✓ Five cases of fetal ventriculomegaly are described in detail. Following ultrasonography, either computerized tomography or magnetic resonance imaging was used in an attempt to clarify the structural pathology of the ventriculomegaly. In two patients, a precise diagnosis was achieved while a probable diagnosis was established in a third patient. The diverse etiology of fetal ventriculomegaly in these five cases demonstrates that ancillary medical imaging may be necessary to achieve diagnostic precision prior to therapeutic intervention.