bluuebunny/crossref_metadata_2025 huggingface dataset:
Hematoma in the Posterior Fossa Secondary to a Tangential Gunshot Wound of the Occiput: Case Report and Discussion
Authors: Stone James L. , Ladenheim Eric , Wilkinson Steven B. , Cybulski George R. , Oldershaw John B.
Published: April 2011

The case of 16-year-old boy who incurred a subdural hematoma in the posterior fossa and an intracerebellar hematoma after a tangential civilian gunshot wound is reported. The skull was not fractured, and yet surgically significant clots required removal. The patient recovered. The discussion centers on the mechanism of injury and seriousness of tangential gunshot wounds and traumatic hematomas in the posterior fossa.
Benign Recurrence of a Pilocytic Cerebellar Astrocytoma 36 Years after Radical Removal: Case Report
Authors: Pagni Carlo Alberto , Giordana Maria Teresa , Canavero Sergio
Published: April 2011

A benign recurrence of a cerebellar juvenile astrocytoma was found in a 52-year-old woman 36 years after the initial radical removal, which was performed when she was 16 years of age. To our knowledge, this is the third detailed case report of the late benign recurrence of cerebellar astrocytoma after total removal. The problem of recurrence of cerebellar astrocytoma is reviewed.
Failed Back Surgery Syndrome: 5-Year Follow-Up in 102 Patients Undergoing Repeated Operation
Authors: North Richard B. , Campbell James N. , James Carol S. , Conover-Walker Mary Kay , Wang Henry , Piantadosi Steven , Rybock John D. , Long Donlin M.
Published: April 2011

The indications for repeated operation in patients with persistent or recurrent pain after lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and in no case has mean follow-up exceeded 3 years. We report 5-year mean follow-up for a series of repeated operations performed between 1979 and 1983. Patient characteristics and modes of treatment have been assessed as predictors of long-term outcome. One hundred two patients with “failed back surgery syndrome” (averaging 2.4 previous operations), who underwent a repeated operation for lumbosacral decompression and/or stabilization, were interviewed by a disinterested third party a mean of 5.05 years postoperatively. Successful outcome (at least 50% sustained relief of pain for 2 years or at last follow-up, and patient satisfaction with the result) was recorded in 34% of patients. Twenty-one patients who were disabled preoperatively returned to work postoperatively; 15 who were working preoperatively became disabled or retired postoperatively. Improvements in activities of daily living were recorded, overall, as often as decrements. Loss of neurological function (strength, sensation, bowel and bladder control) was reported by patients more often than improvement. Most patients reduced or eliminated analgesic intake. Statistical analysis (including univariate and multivariate logistic regression) of patient characteristics as prognostic factors showed significant advantages for young patients and for female patients. Favorable outcome also was associated with a history of good results from previous operations, with the absence of epidural scar requiring surgical lysis, with employment before surgery, and with predominance of radicular (as opposed to axial) pain. These results suggest that selection criteria for repeated operation on the lumbosacral spine require further refinement, together with critical analysis of treatment outcome, and that alternative approaches to failed back surgery syndrome should be considered.
Intracerebral Temperature in Neurosurgical Patients
Authors: Mellergård Pekka , Nordström Carl-Henrik
Published: April 2011

Recent laboratory results have indicated that the ischemic brain is very sensitive to minor variations in temperature. This has created new interest in hypothermia and brain temperature. There is, however, very little information available regarding human intracerebral temperature and its relation to body core temperature during normal and pathological circumstances. We therefore made continuous measurements of the temperature of the lateral ventricle in 15 neurosurgical patients utilizing a newly developed technique with copper-constantan thermocouples introduced through a plastic catheter also used for monitoring intracranial pressure. The intraventricular temperature was higher than the rectal temperature during approximately 90% of all measurements. The largest temperature gradient measured was 2.3°C. Usually the difference between the temperature of the rectum and the brain was much smaller, the mean value being 0.33°C. For the patients in the most severe condition, the rectal temperature was sufficiently close to the brain temperature to afford a reliable basis for adequate clinical judgment.
A Shape-Corrective Shunt-Passer using a Titanium-Nickel Alloy
Authors: Oi Shizuo , Matsumoto Satoshi
Published: April 2011

The authors describe a new shunt-passer using a shape memory alloy that is malleable enough to be molded into any contour and is straightened automatically during autoclave sterilization.
A Familial Coincidence of Pseudotumor Cerebri and Communicating Hydrocephalus
Authors: Johnston Ian , Morgan Michael K.
Published: April 2011

A family in which the mother and two of four daughters had a diagnosis of pseudotumor cerebri and one son developed communicating hydrocephalus is described. The other two daughters both have a long history of headaches but no signs of intracranial hypertension. The argument is advanced that there exists a defect of cerebrospinal fluid absorption common to pseudotumor cerebri and communicating hydrocephalus.
Brain Stem Abscess Treated Successfully by Medical Therapy
Authors: Ruelle Antonio , Zerbi Daniela , Zuccarello Mario , Andrioli Giancarlo
Published: April 2011

A case of a solitary brain stem abscess in a 55-year-old man is presented. The computed tomographic scan and clinical picture allowed the presumptive diagnosis to be made. The abscess resolved completely after treatment with chloramphenicol, vancomycin, and ceftazidime administered intravenously. Medical therapy should be considered as an effective treatment of a brain stem abscess, provided the antibiotic therapy is administered under close clinical and computed tomographic monitoring.
Continuous Intratumoral Infusion of Methotrexate for Recurrent Glioblastoma: A Pilot Study
Authors: Nierenberg David , Harbaugh Robert , Maurer Herbert L. , Reeder Teddi , Scott Gregory , Fratkin Jonathan , Newman Edward
Published: April 2011

Five patients with documented recurrences of glioblastoma multiforme were given continuous infusions of methotrexate delivered intratumorally using implantable catheters and subcutaneous refillable pumps. A continuous infusion of methotrexate (1 mg/d) was begun with concomitant oral administration of folinic acid. The methotrexate dose was increased every 2 weeks to 3, 10, 30, and, ultimately, 75 mg/d in two patients. Samples of serum and ventricular cerebrospinal fluid (CSF) were obtained to determine the levels of methotrexate and total bioactive folates, and brain tissue was obtained from two patients for determination of methotrexate concentration. The patients survived from 7 to 49 weeks after the implantation of the infusion device. Neither the clinical examination nor sequential radiological studies gave clear evidence of reduction in tumor size. Pneumonia developed in one patient, and mild hepatitis and increased seizure frequency in another. Methotrexate was stable in the delivery system over 12 days, and ventricular CSF reached steady-state levels by 5 days. Steady-state ventricular CSF levels of methotrexate were higher than serum levels in some patients, while the reverse was true in others. Levels of total bioactive folates in the CSF did not increase above the normal range. Methotrexate concentrations were highest at the center of the tumor, but measurable amounts of methotrexate were detectable in all areas of the brain. At autopsy in four patients, variable liquefactive necrosis of the brain tumors was seen, and viable tumor was found at the periphery of the tumor bed. These preliminary results suggest that it is technically feasible to infuse methotrexate into brain tumor cavities, and show that little central nervous system or systemic toxicity was encountered in five patients. Better delineation of the safety and efficacy of this therapeutic approach will require further clinical trials.
Computer- and Robot-assisted Resection of Thalamic Astrocytomas in Children
Authors: Drake James M. , Joy Michael , Goldenberg Andrew , Kreindler David
Published: April 2011

Six children ranging in age from 2 to 10 years who harbored deep benign astrocytomas were operated upon using a computer- and robot-assisted system. A radical excision was achieved in all cases with no significant morbidity nor any mortality. The system consists of an interactive, three-dimensional display of computed tomographic image contours and digitized cerebral angiograms taken using the Brown-Roberts-Wells stereotactic frame. The surgical retractor is held and manipulated using a PUMA 200 robot. The position and orientation of the surgical retractor is displayed on the three-dimensional display. Preoperative planning and simulation are important features of this system. Movement of the brain after removal of the tumor and cerebrospinal fluid is substantial, so the tumor removal is based on visually defined margins. Enhanced computer graphics and robotic devices are important adjuncts to neurosurgical procedures and will find increasing use in the future. (Neurosurgery 29:27-31, 1991)
Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures
Authors: Nayel Mohamed H. , Awad Issam A. , Luders Hans
Published: April 2011

The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P<0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P<0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)
Complete Temporal Lobectomy for Surgical Resuscitation of Patients with Transtentorial Herniation Secondary to Unilateral Hemispheric Swelling
Authors: Nussbaum Eric S. , Wolf Aizik L. , Sebring Leslie , Mirvis Stuart
Published: April 2011

Transtentorial herniation is an ominous finding in the patient with head injuries. We report our experience with 10 patients suffering from acute transtentorial herniation secondary to posttraumatic unilateral hemispheric swelling who were treated aggressively with temporal lobectomy. Eight patients were men and 2 were women. Their ages ranged from 22 to 61 years, with a mean of 37 years. Their preoperative Glasgow Coma Scale scores ranged from 3 to 6, with a mean of 4. All patients had both computed tomographic and clinical evidence of unilateral hemispheric shift and acute herniation without a significant subdural or epidural hematoma. Seven patients had unilateral nonreactive pupils and 3 had bilateral nonreactive pupils. All were taken to the operating room within 2 hours of clinical signs of herniation. Complete unilateral temporal lobectomies including the mesial structures, amygdala, and uncus were performed. In this series, the mortality rate was 30%, including a single patient who was neurologically stable but died from nonneurological injuries. Of the 7 survivors, 4 were functionally independent and 3 required minimal assistance with the activities of daily living. Aggressive, early decompression via complete temporal lobectomy may thus significantly improve the outcome in patients with transtentorial herniation accompanying posttraumatic hemispheric swelling and midline shift. (Neurosurgery 29:62-66, 1991)
Clinical Application of a Patient-controlled Apparatus for Ventricular Administration of Morphine in Intractable Pain: Report of 28 Cases
Authors: Shoulong Lu , Jianlong Wang , Rongzeng Weng , Quan Wang
Published: April 2011

The authors developed a patient-controlled apparatus (L-224) for ventricular administration of pain-relieving medication and utilized it in the treatment of 28 patients with intractable pain. The initial dose of morphine hydrochloride was 1 mg, which afforded pain relief for an average of 170 hours. At an average dose of 1.8 mg, the average time of pain relief obtained was 137 hours. Therefore, they conclude that L-224 is a satisfactory apparatus for the ventricular administration of pain medication; it is patient controlled, safe, and reliable in clinical application. (Neurosurgery 29:73-75, 1991)
Monitoring of Somatosensory Evoked Potentials during Surgery for Middle Cerebral Artery Aneurysms
Authors: Friedman William A. , Chadwick Geraldine M. , Verhoeven Frank J. S. , Mahla Michael , Day Arthur L.
Published: April 2011

Somatosensory evoked potentials (SEPs) were monitored during 53 procedures for aneurysms of the middle cerebral artery (MCA). “Significant” changes were reported to the surgeon, who took corrective action when possible. Changes in the SEPs were categorized as follows: Type I, no change; Type II, significant change with complete return to baseline; Type III, significant change with incomplete return to baseline; Type IV, complete loss with no return; and Type V, no response at baseline. Only 1 of 37 patients with a Type I SEP had a new neurological deficit, and this was a patient who could not be examined for several days after surgery because he was in a pentobarbital coma. All 4 patients with Type III and IV changes had new postoperative neurological deficits. Perhaps of greater importance, 4 of 5 patients with Type II changes had no new deficit. These patients all had changes in SEPs that were completely reversible by clip adjustment (2), prompt removal of temporary clips (1), and inducing hypertension after aneurysm trapping (1). These cases may, therefore, represent instances in which SEP monitoring allowed the clinicians to prevent a neurological deficit. The MCA supplies the area of the somatosensory cortex that controls the hand. Median nerve SEPs are, therefore, a theoretically ideal monitor during surgery for MCA aneurysms. This study suggests that the results of MCA aneurysm surgery may be accurately predicted and improved with SEP monitoring. (Neurosurgery 29:83-88, 1991)
Giant Aneurysms of the Horizontal Segment of the Anterior Cerebral Artery: Report of Two Cases
Authors: Morota Nobuhito , Kobayashi Shigeaki , Sugita Kenichiro , Muraoka Shinsuke , Hara Hideaki , Nagashima Hisashi , Nitta Junpei
Published: April 2011

Two cases of giant aneurysm of the horizontal segment of the anterior cerebral artery (A1) are presented. The rare occurrence of a giant aneurysm in this location necessitates evaluation of the cross-flow through the anterior communicating artery when planning surgical strategy. On the basis of angiographic findings, trapping of the A1 on both sides of the aneurysm neck was performed in Case 1, and aneurysmorrhaphy utilizing and angioplastic multiple-clipping method of Al endarterectomy was accomplished in Case 2. The postoperative courses of both patients were satisfactory. (Neurosurgery 29:97-101, 1991)
The Danger of an Ultra-Early Computed Tomographic Scan in a Patient with an Evolving Acute Epidural Hematoma
Authors: Smith Harold K. , Miller Jimmy D.
Published: April 2011

A case of an acute traumatic epidural hematoma that developed after an ultra-early computed tomographic scan of the head is discussed. Serial neurological examinations in patients with head injuries are recommended.
Cystic Cerebellar Schwannoma: Case Report
Authors: Tran-Dinh H.D. , Soo Y.S. , O'Neil P. , Chaseling R.
Published: April 2011

We report a case of cerebellar schwannoma in a 64-year-old woman. The tumor was defined on computed tomographic and magnetic resonance imaging scans and confirmed on surgery. The solid part of the tumor appeared to be derived from the inferior vermis of the cerebellum, the cystic part extending toward the medulla oblongata and the foramen magnum. The problem of preoperative diagnosis based on magnetic resonance imaging findings is discussed.
Lumbar Disc Surgery: Results of the Prospective Lumbar Discectomy Study of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons
Authors: Abramovitz Joel N. , Neff Samuel R.
Published: April 2011

The Prospective Lumbar Discectomy Study enrolled 740 patients in a multiphysician, multicenter, consecutive patient protocol to evaluate the indications and efficacy of lumbar discectomy. Five hundred and thirteen patients could be evaluated at 3 months after surgery. Stepwise logistic regression showed that the factors of fraction of pain referred to the back, work-related injury, absence of back pain on straight leg-raise examination, correspondence of leg pain to typical radicular patterns, leg pain on straight leg-raise examination, and reflex asymmetry were independently predictive of good outcome from surgery. Univariate analysis of the cases with different numbers of predictive factors present showed that use of the operating microscope, sensory deficit, central disc bulge, and free disc fragment were correlated with outcome only in subgroups. An analysis of unsatisfactory outcomes showed two patterns: one of failure as a result of mechanical back pain and one of failure as a result of radiculopathy. Factors predictive of outcome did not influence the type of failure, In a stepwise logistic regression analysis, facetectomy and preoperative sensory deficit were associated with increased likelihood of mechanical back pain failure, while preoperative motor deficit was associated with an increased likelihood of radicular failure. The results support several intuitively derived and commonly believed principles of lumbar disc surgery.
Surgical Access to the Base of Skull and Upper Cervical Spine by Extended Maxillotomy
Authors: James David , Crockard Alan H.
Published: April 2011

An extended maxillotomy has been developed to permit wider surgical access to the base of the skull. It has proven particularly useful in the management of the previously untreatable neuraxial compression caused by basilar invagination in cases of osteogenesis imperfecta. In addition, patients with extensive extradural space-occupying lesions have been treated. The surgical technique is described and the results of its use in nine patients are presented.
Adaptation of Rigid Fixation to Cranial Flap Replacement
Authors: Smith Stewart C. , Pelofsky Stan
Published: April 2011

The use of titanium craniofacial plates and the principles of rigid fixation have been adapted to cranial flap replacement. The technique has been in use for more than 18 months with no complications related to the technique or implant. The advantages of using titanium screws and plates to achieve superior healing and cosmesis, as well as the reduction of postoperative artifacts on magnetic resonance imaging and computed tomographic scans, are of benefit to neurosurgical patients.
Infection of a Shunt by Mycobacterium fortuitum: Case Report
Authors: Chan Kwan-Hon , Mann Kirpal S. , Seto W. H.
Published: April 2011

Mycobacterium fortuitum is a rare cause of central nervous system infection: however, shunt infection caused by this organism has not been reported. We report a case of shunt infection subsequent to insertion of a ventriculoatrial shunt for obstructive hydrocephalus caused by a cerebellar hematoma. The shunt infection was controlled by removal of the shunt and a combination of systemic and intraventricular administration of amikacin, and oral administration of ofloxacin. The case is discussed and the pertinent literature reviewed.
Multiple Cerebral Angiomas and Rendu-Osler-Weber Disease: Case Report
Authors: Aesch B. , Lioret E. , de Toffol B. , Jan M.
Published: April 2011

A 25-year-old man was hospitalized after suffering a subarachnoid hemorrhage. Arteriograms disclosed two arteriovenous malformations, one of which was asymptomatic. Rendu-Osler-Weber disease was suspected because of the concomitant existence of cutaneous telangiectases, Review of the literature shows that in 12 previously published cases involving multiple arteriovenous malformations, this diagnosis was established five times. The indications for surgical treatment are discussed.
Low-Grade Astrocytoma of the Tectal Region as an Unusual Cause of Knee Pain: Case Report
Authors: Rutka James T. , George Richard E. , Davidson George , Hoffman Harold J.
Published: April 2011

A 12-year-old boy was investigated for knee pain and contractures, and was found to have an intraspinal tumor of a lumbar nerve root and a tumor in the tectal region, both low-grade astrocytomas, We postulated that the tectal region astrocytoma metastasized to the lumbar intraspinal region. After surgery, the child underwent focal irradiation to the posterior fossa supplemented by craniospinal irradiation and a boost dose to the region of the lumbar spinal tumor. A low-grade astrocytoma rarely presents as spinal metastasis. This case may represent the first of a primary tectal low-grade astrocytoma manifesting as a symptomatic spinal mass.
Desmoplastic Medulloblastoma Metastatic to the Pancreas: Case Report
Authors: Krouwer Hendrikus G.J. , Vollmerhausen John , White Joel , Prados Michael D.
Published: April 2011

A case is reported in which a desmoplastic medulloblastoma metastasized to the pancreas and to the surrounding soft tissues but did not recur locally or disseminate within the central nervous system. Multidrug chemotherapy and local radiation therapy resulted in a complete remission. In all four previously reported cases of medulloblastoma metastasizing to the pancreas, the diagnosis was not made until the postmortem examination, and all of these patients also had extensive metastases in other organ systems. Modification of the Weiss criteria defining extraneural metastases from tumors of the central nervous system is suggested.
Stereotactic Radiosurgery with the Cobalt-60 Gamma Unit in the Treatment of Growth Hormone-Producing Pituitary Tumors
Authors: Thorén Marja , Rähn Tiit , Wan-Yuo Guo , Sigbritt Werner
Published: April 2011

Stereotactic radiosurgery on the pituitary given with the cobalt-60 gamma unit was used in the treatment of 21 patients with growth hormone (GH)-producing pituitary adenomas and acromegaly. All but one patient had locally invasive macroadenomas, and in the majority of cases, there was parasellar growth. Radiosurgery was the initial treatment for seven patients. Fourteen patients were previously treated by pituitary surgery, eight of whom had undergone conventional external pituitary irradiation as well. All patients had clinical signs of active acromegaly before radiosurgery. The radiation doses given to the previously untreated patients or those who only underwent surgery were 40 to 70 Gy in each of one to three irradiations. The patients with previous external irradiation received a lower dose of 30 to 50 Gy in each of one or two irradiations. The patients were observed during a period of 1 to 21 years from the first radiosurgical session. Two young patients had a clinical remission with a substantial decline of GH levels to near normal serum profiles. Another eight patients obtained reduction of GH levels and clinical activity. More than half of the patients (11 of 21) had minor or no effects from the treatment. There were no complications from the radiosurgery except the development of pituitary insufficiency in 2 of 13 patients who did not undergo previous conventional external irradiation. The remission rates were lower than the results previously reported by us for radiosurgery for Cushing's disease. This may be a result of the predominance in the present study of invasive macroadenomas and single treatments and to the lower radiation doses used in the patients who underwent conventional irradiation previously. In the future, the effect of higher radiation doses will be evaluated. The presently available stereotactic magnetic resonance imaging with contrast enhancement, which improves the visualization of the target volume, may aid in improving future radiosurgical results in the treatment of GH-producing pituitary tumors.
Isolated Lesion of the Axillary Nerve: Surgical Treatment and Outcome in 12 Cases
Authors: Nucci Francesco , Ramundo Epimenio Orlando , D'Andrea Vito , Salvati Maurizio , Artico Marco
Published: April 2011

We report a series of 12 cases of isolated lesions of the axillary nerve treated surgically. We discuss the pathogenesis, clinical pattern, and surgical treatment of this lesion together with the results obtained.
Radiolucent Osteoma of the Skull: Case Report
Authors: Shibata Yasushi , Yoshii Yoshihiko , Tsukada Atsuro , Nose Tadao
Published: April 2011

A rare case of a radiolucent osteoma of the skull is reported. The radiological and pathological findings of this lesion, including magnetic resonance imaging findings, are presented, and the efficacy of magnetic resonance imaging for the diagnosis of this skull tumor is evaluated. The differential diagnosis of radiolucent bone tumors is discussed.
Neurological Features of Cranial Vault Lymphomas: Report of Two Cases
Authors: Herkes Geoffrey K. , Partington Michael D. , O'Neill Brian P.
Published: April 2011

Two patients who had focal neurological deficits as the initial manifestation of a malignant non-Hodgkin's lymphoma involving the skull are described. Soft-tissue masses and variable bone destruction were the predominant computed tomographic findings, and magnetic resonance imaging studies revealed meningeal involvement in one case and sinus thrombosis in the other. Malignant non-Hodgkin's lymphomas initially appearing in the skull are rare, but these lesions should be considered in patients with a palpable scalp mass who have focal neurological signs.
Cerebral Metastasis from an Epithelioid Malignant Schwannoma: Case Report
Authors: D'Angelo Vincenzo , Casadei Gianpiero , Bizzozero Luigi
Published: April 2011

The authors present a case of brain metastasis from an epithelioid malignant schwannoma. The patient previously had undergone a surgical resection of the primary tumor in the right forearm. The neoplasm was composed of nests of cells with an entirely epithelioid appearance without spindle cell areas. Immunohistochemically, the tumor cells stained positive for S100 protein and negative for cytokeratin, neuron-specific enolase, and anti-melanoma antiserum. To our knowledge, this is the first reported case of cerebral metastasis from an epithelioid malignant tumor of the peripheral nerve sheath.
Marked Growth of a Cerebral Arteriovenous Malformation: Case Report and Review of the Literature
Authors: Wakabayashi Shin-ichi , Ohno Kikuo , Shishido Tsuneo , Tamaki Masashi , Matsushima Yoshiharu , Hirakawa Kimiyoshi
Published: April 2011

A case demonstrating the marked growth of an angiographically occult arteriovenous malformation is presented. A review of 58 cases in which an increase in the size of an arteriovenous malformation occurred suggested that the patient's initial age may have had an important role in such growth and that both the age and the duration of follow-up were related to the extent of growth. Follow-up neuroradiological examinations are thought to be necessary for patients who have had an episode of intracranial hemorrhage of unknown cause during childhood, even if the initial angiograms revealed no vascular lesion.
Technical note
Authors: Huhn Stephen L. , Wolf Aizik L. , Ecklund James
Published: April 2011

Cervical instability secondary to fracture/dislocation or traumatic subluxation involving the posterior elements may be treated by a variety of fusion techniques. The rigidity of the stainless steel wires used in posterior cervical fusions often leads to difficulty with insertion, adequate tension, and conformation of the graft construct. This report describes a technique of posterior cervical fusion employing a wire system using flexible stainless steel cables. The wire consists of a flexible, 49-strand, stainless steel cable connected on one end to a short, malleable, blunt leader with the opposite end connected to a small islet. The cable may be used in occipitocervical, atlantoaxial, facet-to-spinous process, and interspinous fusion techniques. The cable loop is secured by using a tension/crimper device that sets the desired tension in the cable. In addition to superior biomechanical strength, the flexibility of the cable allows greater ease of insertion and tension adjustment. In terms of direct operative instrumentation in posterior cervical arthrodesis, involving both the upper and lower cervical spine, the cable system appears to be a safe and efficient alternative to monofilament wires.
The Metabotropic Glutamate Receptor Activates the Lipid Kinase PI3K in Drosophila Motor Neurons Through the Calcium/Calmodulin-Dependent Protein Kinase II and the Nonreceptor Tyrosine Protein Kinase DFak
Authors: Chun-Jen Lin Curtis , Summerville James B , Howlett Eric , Stern Michael
Published: April 2011

Ligand activation of the metabotropic glutamate receptor (mGluR) activates the lipid kinase PI3K in both the mammalian central nervous system and Drosophila motor nerve terminal. In several subregions of the mammalian brain, mGluR-mediated PI3K activation is essential for a form of synaptic plasticity termed long-term depression (LTD), which is implicated in neurological diseases such as fragile X and autism. In Drosophila larval motor neurons, ligand activation of DmGluRA, the sole Drosophila mGluR, similarly mediates a PI3K-dependent downregulation of neuronal activity. The mechanism by which mGluR activates PI3K remains incompletely understood in either mammals or Drosophila. Here we identify CaMKII and the nonreceptor tyrosine kinase DFak as critical intermediates in the DmGluRA-dependent activation of PI3K at Drosophila motor nerve terminals. We find that transgene-induced CaMKII inhibition or the DFakCG1 null mutation each block the ability of glutamate application to activate PI3K in larval motor nerve terminals, whereas transgene-induced CaMKII activation increases PI3K activity in motor nerve terminals in a DFak-dependent manner, even in the absence of glutamate application. We also find that CaMKII activation induces other PI3K-dependent effects, such as increased motor axon diameter and increased synapse number at the larval neuromuscular junction. CaMKII, but not PI3K, requires DFak activity for these increases. We conclude that the activation of PI3K by DmGluRA is mediated by CaMKII and DFak.
Incidence of Diabetes Following Ramipril or Rosiglitazone Withdrawal
Authors:   The DREAM Trial Investigators
Published: April 2011

OBJECTIVE

To examine the impact of withdrawing rosiglitazone and ramipril medication on diabetes incidence after closeout of the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial.

RESEARCH DESIGN AND METHODS

The 3,366 DREAM subjects at trial end who had not developed diabetes while taking double-blind study medication were transferred to single-blind placebo for 2 to 3 months before undergoing an oral glucose tolerance test. Glycemic status was analyzed for the trial plus washout period and for the washout period alone.

RESULTS

Following median (interquartile range) 71 (63–86) days drug withdrawal, overall glycemic status remained modestly improved in those allocated ramipril during the trial with an 11% increase in regression to normoglycemia, compared with placebo. In those previously allocated rosiglitazone, glycemic status remained substantially improved with a 49% reduction of new-onset diabetes or death and a 22% increase in regression to normoglycemia, compared with placebo. However, during the washout phase alone the incidence of diabetes or death was identical for those allocated previously to ramipril or placebo, or to rosiglitazone or placebo.

CONCLUSIONS

In people allocated to ramipril compared with those not allocated ramipril during the trial, the postwashout normoglycemia incidence was higher. In people allocated to rosiglitazone compared with those not allocated rosiglitazone during the trial, the postwashout incidence of diabetes was significantly lower and the incidence of normoglycemia was higher. During the washout period, diabetes incidence was the same for ramipril versus placebo and for rosiglitazone versus placebo. Rosiglitazone delays disease progression during treatment but the process resumes at the placebo rate when the drug is stopped.
3.5 SUPPRESSION OF SPRUCE BUDWORM POPULATIONS BY TRICHOGRAMMA MINUTUM RILEY, 1982–1986
Authors: Smith S.M. , Wallace D.R. , Howse G. , Meating J.
Published: April 2011

The ability of the egg parasitoid, Trichogramma minutum Riley, to suppress outbreak populations of the spruce budworm, Choristoneura fumiferana (Clemens), was studied annually near Hearst, Ont., from 1982 through 1986. Timing of broadcast parasitoid-releases was linked to spruce budworm moth emergence and oviposition. These phenological relationships were predicted from a regression based on larval development at least 2 weeks before expected emergence; this allowed sufficient time to regulate (program) parasitoid emergence during mass-rearing. Emergence of caged spruce budworm adults was used to monitor moth eclosion in the field. Pheromone traps provided daily information on the activity of male moths and helped to synchronize the parasitoid releases with spruce budworm oviposition. Information on parasitoid activity was obtained from sentinel (laboratory-reared) and naturally occurring spruce budworm egg masses. A curvilinear relationship between the rate of parasitoid release and parasitism of sentinel egg masses was developed. Two parasitoid releases, 1 week apart, early in the oviposition period of spruce budworm, significantly increased parasitism of host eggs by 14–83% and reduced larval populations correspondingly from 42 to 82%. Single releases were less effective and increased parasitism by 0.3–52% (single ground release, 1986). Two parasitoid releases, combined with a spring application of Bacillus thuringiensis Berliner to larval populations, was the most effective strategy and resulted in 83% egg parasitism and 93% larval reduction. Release rates greater than 12–16 × 106 ♀ ♀ T. minutum per hectare were not warranted based on impact and costs. The effects of release timing, weather, host density, and parasitoid quality on the future successful use of T. minutum are discussed.
A REVISION OF THE GENERA MYCETOPORUS MANNERHEIM AND ISCHNOSOMA STEPHENS (COLEOPTERA: STAPHYLINIDAE: TACHYPORINAE) OF NORTH AND CENTRAL AMERICA
Authors: Campbell J.M.
Published: April 2011

The North and Central American species formerly placed in the genus Mycetoporus are revised. Two genera are recognized, Mycetoporus Mannerheim and Ischnosoma Stephens, each with 18 species. The morphological and historical basis for this division is discussed. Ten species of Mycetoporus are described as new: bipunctatu, floridensis, impunctatus, neomexicanus, nidicola, pacificus, rufohumeralis, segregatus, smetanai, and triangulatus. Ten species of Ischnosoma are described as new: arizonense, ashei, costale, durangoense, fimbriatum, hermani, lecontei, mexicanum, pecki, and suteri. Mycetoporus boreelus J. Sahlberg, a species restricted to the Palearctic region, is removed from synonymy with M. nigrans Mäklin and Mycetoporus insignis Mäklin is found to be a junior synonym of M. americanus Erichson. Mycetoporus discalis, M. punctatissimus, and M. punctulatus, all species described by Hatch (1957), are transferred to the genus Bryoporus subgenus Bryophacis and the name Tachinus humidus Say is treated as a nomen dubium in the genus Mycetoporus.The usage of the generic names Mycetoporus Mannerheim and Ischnosoma Stephens is discussed. The North American species of the genus Mycetoporus are placed in six species groups and those of the genus Ischnosoma are placed in four species groups.A neotype is designated for Mycetoporus nigrans Mäklin and lectotypes are designated for M. americanus Erichson, M. insignis Mäklin, M. tenuis Horn, M. lucidulus LeConte, M. consors LeConte, Ischnosoma pictum (Horn) and I. flavicolle (LeConte). The following species were transferred from Mycetoporus to Ischnosoma and are new combinations: pictum Horn, splendidum Gravenhorst, flavicolle LeConte, virginiense Bernhauer, coxale Sharp, hospitale Fall, californicum Bernhauer and Schubert, and curtipenne Bernhauer.All genera, species groups, and species are described and the species are illustrated with line drawings and scanning electron photomicrographs. Keys are provided to distinguish the genera Mycetoporus and Ischnosoma and for all the species in each genus. The New World distribution of each species is mapped. The biology of each species, if known, is discussed.
Gp130-Dependent Astrocytic Survival Is Critical for the Control of Autoimmune Central Nervous System Inflammation
Authors: Haroon Fahad , Drögemüller Katrin , Händel Ulrike , Brunn Anna , Reinhold Dirk , Nishanth Gopala , Mueller Werner , Trautwein Christian , Ernst Matthias , Deckert Martina , Schlüter Dirk
Published: April 2011

Astrocytes are activated in experimental autoimmune encephalomyelitis (EAE) and have been suggested to either aggravate or ameliorate EAE. However, the mechanisms leading to an adverse or protective effect of astrocytes on the course of EAE are incompletely understood. To gain insight into the astrocyte-specific function of gp130 in EAE, we immunized mice lacking cell surface expression of gp130, the signal-transducing receptor for cytokines of the IL-6 family, with myelin oligodendrocyte glycoprotein35–55 peptide. These glial fibrillary acid protein (GFAP)-Cre gp130fl/fl mice developed clinically a significantly more severe EAE than control mice and succumbed to chronic EAE. Loss of astrocytic gp130 expression resulted in apoptosis of astrocytes in inflammatory lesions of GFAP-Cre gp130fl/fl mice, whereas gp130fl/fl control mice developed astrogliosis. Astrocyte loss of GFAP-Cre gp130fl/fl mice was paralleled by significantly larger areas of demyelination and significantly increased numbers of CD4 T cells in the CNS. Additionally, loss of astrocytes in GFAP-Cre gp130fl/fl mice resulted in a reduction of CNS regulatory Foxp3+ CD4 T cells and an increase of IL-17–, IFN-γ–, and TNF-producing CD4 as well as IFN-γ– and TNF-producing CD8 T cells, illustrating that astrocytes regulate the phenotypic composition of T cells. An analysis of mice deficient in either astrocytic gp130– Src homology region 2 domain-containing phosphatase 2/Ras/ERK or gp130–STAT1/3 signaling revealed that prevention of astrocyte apoptosis, restriction of demyelination, and T cell infiltration were dependent on the astrocytic gp130–Src homology region 2 domain-containing phosphatase 2/Ras/ERK, but not on the gp130–STAT1/3 pathway, further demonstrating that gp130-dependent astrocyte activation is crucial to ameliorate EAE.
An Endogenously Anti-Inflammatory Role for Methylation in Mucosal Inflammation Identified through Metabolite Profiling
Authors: Kominsky Douglas J. , Keely Simon , MacManus Christopher F. , Glover Louise E. , Scully Melanie , Collins Colm B. , Bowers Brittelle E. , Campbell Eric L. , Colgan Sean P.
Published: April 2011

Tissues of the mucosa are lined by an epithelium that provides barrier and transport functions. It is now appreciated that inflammatory responses in inflammatory bowel diseases are accompanied by striking shifts in tissue metabolism. In this paper, we examined global metabolic consequences of mucosal inflammation using both in vitro and in vivo models of disease. Initial analysis of the metabolic signature elicited by inflammation in epithelial models and in colonic tissue isolated from murine colitis demonstrated that levels of specific metabolites associated with cellular methylation reactions are significantly altered by model inflammatory systems. Furthermore, expression of enzymes central to all cellular methylation, S-adenosylmethionine synthetase and S-adenosylhomocysteine hydrolase, are increased in response to inflammation. Subsequent studies showed that DNA methylation is substantially increased during inflammation and that epithelial NF-κB activity is significantly inhibited following treatment with a reversible S-adenosylhomocysteine hydrolase inhibitor, DZ2002. Finally, these studies demonstrated that inhibition of cellular methylation in a murine model of colitis results in disease exacerbation while folate supplementation to promote methylation partially ameliorates the severity of murine colitis. Taken together, these results identify a global change in methylation, which during inflammation, translates to an overall protective role in mucosal epithelia.
The role of angiotensin II in the central regulation of feed intake in sheep
Authors: Sunagawa Katsunori , Weisinger Richard S. , McKinley Michael J. , Purcell Brett S. , Thomson Craig , Burns Peta L.
Published: April 2011

The objective was to determine the role of Angiotensin II (ANG) in the central regulation of feed intake by ruminants. As a control treatment, artificial cerebrospinal fluid (CSF) was given (over a period of 98.5 h) as a continuous intracerebroventricular (ICV) infusion (0.2 mL h–1) into the lateral ventricle of ewes (n = 5). Approximately 9 d later, the infusion was repeated with the same ewes, but the CSF contained ANG (25 g μL–1). The ewes were fed dried alfalfa chaff for 2 h once daily and both water and a 0.5 M NaCl solution were available ad libitum (except that water intake was restricted on the first day of ANG infusion). Infusion of ANG resulted in severe thirst that persisted when water intake was restricted to an amount equal to voluntary intake during the control infusion. Furthermore, when ewes had ad libitum access to water, consumption during ANG infusion was 1.4 to 2.8-fold greater than that during CSF infusion (P < 0.01). Compared with CSF infusion, ANG infusion decreased eating rates by an average of 46.5% (range, 31.8–62.6%; P < 0.01) and feed intake by 25.0% (5.4–48.1%; P < 0.01), and increased salt intake by 273.8% (124.0–417.6%; P < 0.01). We concluded that ANG produced thirst sensations in the brain, resulting in excessive water intake that caused ruminal distension and significantly reduced feed intake. Key words: Angiotensin, brain, thirst, feed intake, sheep
The effect of duration and temperature of simulated transport on the performance of early-weaned piglets
Authors: Berry R. J. , Lewis N. J.
Published: April 2011

The responses and tolerances of early-weaned piglets to transport are not well documented. It is believed that the additive stress incurred by transporting early-weaned pigs predisposes them to increased disease risk and compromised performance. The objective of this work was to investigate the relationship between two primary transportation stressors, duration and temperature, and their effects on piglet performance. Prior to housing on flatdecks at 30°C, transport was simulated by placing 17-d (± 1 d) old weaned piglets into wooden boxes of dimensions 1.2 × 1.2 × 1 m (space allowance range 0.18 to 0.36 m2 pig–1) with straw bedding. Two trials were conducted. In each trial, 96 piglets were randomly mixed in groups of four and assigned to the following simulated transport durations: no transport (control), 6 h, 12 h (Trial 2 only) and 24 h. Piglets undergoing transport simulation were kept at one of the following temperatures 20, 25 (Trial 1 only), 30 and 35°C. There was a significant interactive effect between transport duration and temperature upon liveweight change in the first 24 h in both trials (P < 0.01). The animals that incurred the greatest liveweight deficit after weaning relative to untransported control groups were predominantly either those that had been transported for 24 h at high transport temperatures (35 and 30°C) or those transported for 6 h at 20°C in Trial 1 and 35°C in Trial 2. The effect of simulated transport was measureable for up to 5 d post-transport. However, by 14 d post-transport there was no detectable influence of transport treatment on feed consumption or weight gain (P > 0.05). The study found piglets are able to recover and perform adequately in the early post-weaning period if extremes of transport duration and temperature are avoided. Key words: Transportation, early weaning, temperature, piglets
The effect of adding exogenous phytase to nutrient-reduced corn- and wheat-based diets on performance and egg quality of two strains of laying hens
Authors: Scott T. A. , Kampen R. , Silversides F. G.
Published: April 2011

A laying trial was conducted in which ISA-Brown and ISA-White hens were fed diets based on corn or wheat that had been pelleted to eliminate endogenous phytase. Control diets were formulated to contain adequate levels of all nutrients. Nutrient-reduced diets were formulated to account for nutrients released by the phytase. To formulate these diets, phytase was entered into the matrix with a value, on a weight basis, of 1,173% for CP (60.5% for lys, 29.4% for met plus cys, 40.0% for thr), 39 900 kcal kg–1 for AME, 666% for Ca, and 333% for available P. A negative control diet was based on the modified formulation but did not include phytase. Differences between diets were observed for tibia ash, and Ca and P in the ash, as well as for BW and measures of egg quality. Egg production likely provided the best measure of the adequacy of P nutrition. In the final period of production, feed intake and egg production of hens fed the nutrient-reduced corn-based diet without enzyme was lower (P < 0.05) than that of hens on the control diet. Egg production of hens fed the nutrient-reduced diet with phytase was similar to that of hens fed the control diet, showing that inclusion of phytase permits formulation of corn-based diets with reduced levels of energy, CP, Ca, and P. No major effect of diet was seen for the hens fed wheat-based diets indicating that the formulation changes used may not have been appropriate for evaluating a response to exogenous phytase in wheat-based diets. Key words: Phytase, layers, corn, wheat, phosphorus