bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of growth and angiogenesis of human neurofibrosarcoma by heparin and hydrocortisone
Authors: Lee Jung Kyo , Choi Benjamin , Sobel Raymond A. , Chiocca E. Antonio , Martuza Robert L.
Published: May 2009

✓ A human neurofibrosarcoma was removed at surgery from a patient with neurofibromatosis and implanted into the subrenal capsule of female nude mice (nu/nu). A solid tumor grew and was transferred to 78 additional mice for this study. The animals were randomly assigned to one of four groups: 1) control, 27 animals; 2) oral heparin (200 or 500 U/ml), 17 animals; 3) oral hydrocortisone (0.3 mg/ml), 10 animals; or 4) oral heparin (200, 500, or 1000 U/ml) with hydrocortisone (0.3 mg/ml), 24 animals. After 10 days of treatment, the animals were sacrificed and the tumor size and degree of neovascularization were compared to the pretreatment data. Heparin treatment alone stimulated angiogenesis and resulted in tumor growth greater than in the control group (p < 0.001). Administration of hydrocortisone alone caused a minimal reduction in tumor growth and had a minimal effect on angiogenesis (p < 0.05 vs. control group). In contrast, heparin administered with hydrocortisone inhibited both angiogenesis and tumor growth (p < 0.001 vs. control group). These studies suggest that angiogenesis modulators are worthy of further study as a feasible means of treating human neurofibrosarcoma.
Antiproliferative effect of trapidil, a platelet-derived growth factor antagonist, on a glioma cell line in vitro
Authors: Kuratsu Jun-ichi , Ushio Yukitaka
Published: May 2009

✓ Platelet-derived growth factor (PDGF) is produced by glioma cells. However, there is heterogeneity among glioma cell lines in the production of PDGF. It has been demonstrated that U251MG cells produce a PDGF-like molecule while U105MG cells do not.

Trapidil, a specific antagonist of PDGF, competes for receptor binding with PDGF. Therefore, the inhibitory effect of trapidil on the proliferation of glioma cells was investigated in vitro using two glioma cell lines. At 100 µg/ml, trapidil significantly inhibited the proliferation of U251MG cells (which produce the PDGF-like molecule). At the same trapidil concentration, the proliferation of U105MG cells (which do not produce the PDGF-like molecule) was not inhibited. The inhibitory effect of trapidil was remarkable on Days 3 and 4 of culture. After 4 days of incubation, the proliferation of U251MG cells was 46% of the control preparation. Trapidil enhanced the antitumor effect of 3-((4-amino-2-methyl-5-pyrimidinyl)ethyl)-1-(2-chloroethyl)-1-nitro-sourea (ACNU) against U251MG cells. The enhancing effect was highest on Days 4 and 6 of culture. After 6 days of incubation in the presence of 100 µg/ml trapidil and 1 µg/ml ACNU, the proliferation of U251MG cells was 18% of the control preparation. These findings suggest that trapidil interrupts the autocrine loop at the PDGF and PDGF-receptor level and that combination therapy with trapidil and ACNU may be useful in the treatment of glioma.
Spontaneous resolution of multiple hemangiomas of the brain
Authors: Abe Masamitsu , Tabuchi Kazuo , Takagi Masashi , Matsumoto Shunichi , Shimokama Tatsuro , Kishikawa Takashi
Published: May 2009

✓ A case of multiple intracerebral hemangiomas is reported. The lesions were angiographically hypervascular and accompanied by marked perifocal brain edema. After removal of the main lesion and postoperative steroid administration, the rest of the lesions resolved spontaneously. Histologically, the lesion was composed of capillaries and fibromyxoid stroma. The distinctive clinical, radiological and histological features of this lesion are discussed in contrast to several other types of intracranial vascular tumors.
Anosmia and isolated ACTH deficiency following a road traffic accident
Authors: Scoble J. E. , Havard C. W. H.
Published: May 2009

✓ A 42-year-old man suffered a head injury in a road traffic accident and subsequently developed anosmia and isolated adrenocorticotropic hormone (ACTH) deficiency. There was no other evidence of pituitary dysfunction. No previous case of isolated ACTH deficiency following head injury has been reported.
Paraganglioma of the cauda equina
Authors: Pigott Timothy J. D. , Lowe James S. , Morrell Ken , Kerslake Robert W.
Published: May 2009

✓ The authors report the clinical, radiological, and pathological findings in three cases of paraganglioma of the cauda equina. In one case, magnetic resonance imaging and neurochemical study results are described. No specific identifying features were encountered either clinically or radiologically that were helpful in making a distinction between this and other more common tumors at this site such as ependymoma or neurofibroma. At surgery, these neoplasms were well-circumscribed red fleshy tumors. Histological examination of one paraganglioma showed a superficial resemblance to ependymoma, and this may be particularly true on initial assessment by frozen section or smear. The use of electron microscopy and immunohistochemical demonstration of synaptophysin in these tumors allowed a confident diagnosis to be made. Neurochemical assessment in one case showed very high levels of serotonin and a turnover of dopamine similar to that of human cerebral cortex. Paraganglioma of the cauda equina is an uncommon tumor with just over 50 cases reported in the world literature. The clinical course of these tumors is benign and they should be completely removed at surgery to prevent later recurrence.
Giant gangliocytic paraganglioma of the filum terminale
Authors: Djindjian Michel , Ayache Patrick , Brugières Pierre , Malapert Denis , Baudrimont Marielle , Poirier Jacques
Published: May 2009

✓ The clinical and pathological features of a giant cauda equina paraganglioma arising from the intradural filum terminale is described. Scattered mature large neurons characterized the tumor as a gangliocytic paraganglioma. Histologically, these neoplasms have considerable similarity with ependymoma and the diagnosis can be easily missed unless special techniques are employed.
AANS Presidential Address, 1990: Neurosurgery in the Decade of the Brain
Authors: Rhoton Albert L.
Published: May 2009

✓ The decade of the 1990's has provided neurosurgery with multiple challenges and opportunities. Numerous developments hold a promise for making the 1990's the most rewarding decade of the 20th century for neurosurgery. The “Decade of the Brain” resolution, adopted by the United States House and Senate and signed into law by President Bush in 1989, has provided the specialty with staggering opportunities. Neurosurgery and the basic and clinical neurosciences would be strengthened by the development of a major new philanthropic organization called the “American Brain Association” that would carry the activities of the Decade of the Brain into the 21st century. Major efforts are being made to improve organized neurosurgery's responsiveness to member needs. These include the strategic planning project undertaken by the Board of Directors of the American Association of Neurological Surgeons (AANS) and efforts to strengthen the Joint Council of State Neurosurgical Societies. The AANS has been extremely active in representing the specialty in legislative matters in Washington and in multiple other forums. This Association has joined The American Board of Neurological Surgery and the Residency Review Committee in responding to orthopedic surgery's proposal for spine fellowships. It is proposed that the logo of the state, regional, and national neurosurgical societies be changed to depict our involvement in spinal surgery (as well as brain surgery) because spinal surgery represents more than half of the total effort of this specialty. The standards of worth and value that provide the driving force behind our work emphasize the need to grow in compassion as manifested by our kindness, sincerity, and concern as we grow in professional competence as reflected by our training, knowledge, and skill.
Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, tumor, and occlusive cerebrovascular disease
Authors: Spetzler Robert F. , Fukushima Takanori , Martin Neil , Zabramski Joseph M.
Published: May 2009

✓ In the management of cavernous sinus aneurysms, cavernous sinus tumor, and cavernous internal carotid artery (ICA) stenosis, a direct arterial bypass around the pathology may be required. A series of 18 patients is presented in whom a petrous ICA to subarachnoid ICA saphenous vein bypass procedure was performed. The advantages of a short large-caliber venous graft entirely within the skull account for the high patency rate (17 of 18 patients) in this series. This vascular bypass can be recommended in the management of patients whose intracavernous ICA must be sacrificed.
The long-term side effects of radiation therapy for benign brain tumors in adults
Authors: Al-Mefty Ossama , Kersh Jane E. , Routh Anupam , Smith Robert R.
Published: May 2009

✓ Radiation therapy plays an integral part in managing intracranial tumors. While the risk:benefit ratio is considered acceptable for treating malignant tumors, risks of long-term complications of radiotherapy need thorough assessment in adults treated for benign tumors. Many previously reported delayed complications of radiotherapy can be attributed to inappropriate treatment or to the sensitivity of a developing child's brain to radiation.

Medical records, radiological studies, autopsy findings, and follow-up information were reviewed for 58 adult patients (31 men and 27 women) treated between 1958 and 1987 with radiotherapy for benign intracranial tumors. Patient ages at the time of irradiation ranged from 21 to 87 years (mean 47.7 years). The pathology included 46 pituitary adenomas, five meningiomas, four glomus jugulare tumors, two pineal area tumors, and one craniopharyngioma. Average radiation dosage was 4984 cGy (range 3100 to 7012 cGy), given in an average of 27.2 fractions (range 15 to 45 fractions), over a period averaging 46.6 days. The follow-up period ranged from 3 to 31 years (mean 8.1 years). Findings related to tumor recurrence or surgery were excluded.

Twenty-two patients had complications considered to be delayed side effects of radiotherapy. Two patients had visual deterioration developing 3 and 6 years after treatment; six had pituitary dysfunction; and 17 had varying degrees of parenchymal changes of the brain, occurring mostly in the temporal lobes and relating to the frequent presentation of pituitary tumors (two of these also had pituitary dysfunction). One clival tumor, with the radiographic appearance of a meningioma, developed 30 years post-irradiation for acromegaly. This study unveils considerable delayed sequelae of radiotherapy in a series of adult patients receiving what is considered “safe” treatment for benign brain tumors.
Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations
Authors: Martin Neil A. , Bentson John , Viñuela Fernando , Hieshima Grant , Reicher Murray , Black Keith , Dion Jacques , Becker Donald
Published: May 2009

✓ Intraoperative digital subtraction angiography using commercially available equipment was employed to confirm the precision of the surgical result in 105 procedures for intracranial aneurysms or arteriovenous malformations (AVM's). Transfemoral selective arterial catheterization was performed in most of these cases. A radiolucent operating table was used in all cases, and a radiolucent head-holder in most. In five of the 57 aneurysm procedures, clip repositioning was required after intraoperative angiography demonstrated an inadequate result. In five of the 48 AVM procedures, intraoperative angiography demonstrated residual AVM nidus which was then located and resected. In two cases intraoperative angiography failed to identify residual filling of an aneurysm which was seen later on postoperative angiography, and in one case the intraoperative study failed to demonstrate a tiny residual fragment of AVM which was seen on conventional postoperative angiography. Two complications resulted from intraoperative angiography: one patient developed aphasia from cerebral embolization and one patient developed leg ischemia from femoral artery thrombosis. This technique appears to be of particular value in the treatment of complex intracranial aneurysms and vascular malformations.
Impact of vessel distortion on transcranial Doppler velocity measurements: correlation with magnetic resonance imaging
Authors: Finn John Paul , Quinn Michael William , Hall-Craggs Margaret Anne , Kendall Brian E.
Published: May 2009

✓ Because transcranial Doppler ultrasound is a blind procedure, it is not possible to routinely correct for insonation angle errors, which are presumed to be small. In anatomically normal brains this is a valid assumption; however, in some patients with distorted vascular anatomy (as in hydrocephalus) a small insonation angle cannot be assumed, and measurements of flow velocity may be misleadingly low. The orientation of the middle cerebral arteries was studied on magnetic resonance images of 17 control patients and three patients with hydrocephalus, and estimates of insonation angle errors in velocity measurements were made. When asymmetrical vessel distortion is present, relative flow to each hemisphere may not be accurately reflected in the measured velocities. Under these circumstances, the resistivity index may be a more reliable hemodynamic parameter.
Comparison of crystalloids and colloids for hemodilution in a model of focal cerebral ischemia
Authors: Korosue Kazuyoshi , Heros Roberto C. , Ogilvy Christopher S. , Hyodo Akio , Tu Yong-Kwang , Graichen Robert
Published: May 2009

✓ Forty dogs were subjected to 6 hours of occlusion of the left internal carotid and middle cerebral arteries. They were divided into two “hemodilution groups” of 13 dogs each and a control “nonhemodiluted group” of 14 dogs. Thirty minutes after arterial occlusion, isovolemic hemodilution was performed by phlebotomy and infusions of low-molecular weight (MW) dextran in one group and of lactated Ringer's solution in the other group. The animals were sacrificed 1 week after temporary arterial occlusion.

Hemodilution reduced the hematocrit to a level of 33% to 34%, which lasted throughout the week in both groups. After hemodilution there was a very significant reduction in blood viscosity, plasma total protein content, and fibrinogen levels in both groups in the acute stage; these levels gradually returned to baseline by the end of the week. In the group with lactated Ringer's solution hemodilution, both osmotic and oncotic pressures were decreased by hemodilution in the acute stage. In the control and low-MW dextran groups, osmotic and oncotic pressure remained unaltered throughout the week. Hemodilution resulted in a slight decrease in mean arterial blood pressure in all groups in the acute stage, but there were no significant changes in central venous, pulmonary arterial, or pulmonary wedge pressures. During the week of study, there were no differences in the cardiac index and total blood volume between the groups, and no significant changes in hematological parameters with the exception of a slight increase in bleeding time immediately after hemodilution with low-MW dextran.

Daily neurological assessment showed consistently poorer condition during the first 5 days in the group with lactated Ringer's solution compared to either the control group or the group receiving low-MW dextran. Based on Mann-Whitney U-testing, the infarct volume of the lactated Ringer's solution recipients, expressed as a percentage of the total volume of that hemisphere (median 15.7%, range 6.6% to 25.2%) was significantly larger than that of the group receiving low-MW dextran (median 2.2%, range 0% to 15.8%) and that of the control group (median 11.9%, range 0% to 39.9%). The results indicate that, in this model, hemodilution with colloids was beneficial, whereas hemodilution with crystalloids was deleterious. It is likely that the decrease in oncotic pressure observed after hemodilution with lactated Ringer's solution is one of the most important reasons for its detrimental effect.
A new 1.9-µ wavelength laser for neurosurgery
Authors: Steichen John D. , Stewart Robert B. , Louis David N. , Choi Benjamin B. , Kung Robert , Martuza Robert L.
Published: May 2009

✓ The 1.9-µ wavelength component of a 1.9/1.06-µ two-wavelength laser with near-continuous wave properties was tested for its potential use in neurosurgery. The 1.9-µ wavelength has tissue-ablative capabilities, while the 1.06-µ wavelength (Nd:YAG) is suitable for achieving hemostasis. The advantages of the 1.9-µ wavelength over the CO2 laser include its ability to transmit through silica fiberoptic delivery systems and its deeper penetration in water (approximately 100 µ, a depth 10 times greater than for the CO2 laser), which is compatible with irrigation during ablation.

To test the effectiveness of the laser, bilateral craniotomies were performed in anesthetized rats immobilized in a stereotactic frame. Under an operating microscope, lesions were made on the cortex by delivering the 1.9-µ laser beam through a 400-µ fiber at an average power of 1 W over a range of fluences. Subjective intraoperative observations were notable for minimal bleeding, absence of charring when the tissue was irrigated with a thin stream of saline, and uniform lesion formation. For comparison, lesions were generated with a commercially available continuous-wave CO2 laser at equivalent power and fluences. Histological specimens were divided into three groups based on the study after laser application: acute (30 minutes), subacute (48 hours), and chronic (14 days). The extent of thermal injury for the 1.9-µ laser in the acute lesions was quantitatively and histologically similar to that generated by the CO2 laser. Regions of injury extended approximately from the apex of the lesion, and crater depths generated by both lasers were similar (250 to 750 µ) in the range of fluences investigated (1.25 to 10 kJ/sq cm). Subacute and chronic histological specimens demonstrated inflammatory and repair responses that correlated with the acute injury regions in both the 1.9-µ and CO2 laser-treated specimens.

This study demonstrates a neurosurgical potential for a new two-wavelength laser that ablates tissue effectively with limited thermal injury. The 1.9-µ laser is comparable to the widely used CO2 laser but offers several unique advantages, including the ability for delivery through a fiberoptic system and to irrigate tissue during use.
Functional PET scanning in the assessment of cerebral arteriovenous malformations
Authors: Leblanc Richard , Meyer Ernst
Published: May 2009

✓ A case is presented which represents the first instance of the use of functional positron emission tomography (PET) scanning to precisely localize a structural brain lesion to the precentral gyrus, and the first validation of functional PET scanning by intraoperative cortical mapping. The lesion was a 3-cm arteriovenous malformation (AVM) that had produced a generalized seizure in an otherwise asymptomatic young woman. A first, resting H215O PET scan identified the AVM. A second PET scan, performed during vibrotactile stimulation of the contralateral hand, identified the somatosensory area of the hand region and localized the AVM to that part of the precentral gyrus immediately in front of it. This relationship and localization were confirmed by cortical mapping at the time of craniotomy under local anesthesia. Functional PET scanning may prove to be useful to localize cortical lesions precisely and to help in determining preoperatively the best form of treatment for lesions, especially AVM's, in functionally important cortex.
Bilateral femoral nerve neuropathy following blunt trauma
Authors: D'Amelio Louis F. , Musser David J. , Rhodes Michael
Published: May 2009

✓ A unique case of bilateral compressive injury of the femoral nerves is reported in a 19-year-old man. Traumatic femoral nerve neuropathy following operative injury, penetrating injury, anticoagulant therapy with hemorrhage, and stretch injury has been described previously, and the literature concerning this unusual clinical problem is reviewed. Bilateral traumatic femoral nerve neuropathy resulting from compressive injury has not been previously reported.
Cerebral metastasis from angiosarcoma of the heart
Authors: Vaquero Jesús , Martínez Roberto , Coca Santiago , Oya Santiago , Burgos Raúl
Published: May 2009

✓ A case of secondary cerebral angiosarcoma in a 30-year-old man is presented. The patient had previously undergone heart transplantation for treatment of the primary tumor. Only a few cases of cerebral metastasis from angiosarcoma have been recorded in the literature; the present case is the first reported case diagnosed after heart transplantation.
Reconstruction of the temporalis muscle for the pterional craniotomy
Authors: Spetzler Robert F. , Lee K. Stuart
Published: May 2009

✓ Several techniques have been employed to incise the temporalis muscle for the pterional craniotomy. The authors describe a method which provides the advantage of a free bone flap, yet allows anatomical reapproximation of the temporalis muscle to its bone attachment.
Surgical management of exophytic chiasmatic-hypothalamic tumors of childhood
Authors: Wisoff Jeffrey H. , Abbott Rick , Epstein Fred
Published: May 2009

✓ Sixteen children underwent 18 operations for radical resection of chiasmatic-hypothalamic tumors. The clinical presentation correlated with age: infants under 1 year of age presented with macrocephaly, failure to thrive, and severe visual failure; children aged 1 to 5 years predominantly had precocious puberty with mild visual deficits; and older children (> 5 years old) had slowly progressive loss of vision. All three infants had biologically aggressive tumors in spite of low-grade histology, and died from progressive tumor growth. Eleven of the 13 children aged 1 year or over are alive and well, without clinical or radiographic evidence of disease progression, 4 months to 4½ years following surgery. Six of these patients, with a follow-up period of 10 months to 4½ years (mean 27 months), have had no adjuvant therapy following radical surgical resection. The authors conclude that: 1) radical surgical resection of chiasmatic-hypothalamic tumors can be performed with minimal morbidity; 2) radical resection may delay the time to disease progression in older children and postpone the need for irradiation; 3) resection of postirradiation recurrent tumors may provide neurological improvement and long-lasting clinical remission; and 4) chiasmatic-hypothalamic tumors of infancy are aggressive neoplasms that require multimodality therapy.
Zygomatic approach to skull-base lesions
Authors: Al-Mefty Ossama , Anand Vinod K.
Published: May 2009

✓ A modification of the preauricular skull-base approach is described. After sectioning and downward displacement of the zygomatic arch, the coronoid process of the mandible is dissected and sectioned at its base. The temporal muscle, with its coronoid insertion, is then retracted upward. This approach provides direct and unobstructed access to the temporal and infratemporal fossae. Adequate vascularity of the temporal muscle is maintained. The exposure encompasses the internal carotid artery in the neck for vascular control. Extensive reconstruction is eliminated. The described technique was used in seven patients with lesions of the skull base. There was no operative mortality, and morbidity consisted of temporary restriction of mandibular opening in two patients.
Long-term follow-up review of 31 children with severe closed head trauma
Authors: Costeff Hanan , Groswasser Zeev , Goldstein Ruth
Published: May 2009

✓ Thirty-one children aged 3 to 15 years were followed for 5 to 11 years after suffering severe closed head trauma which caused coma for 1 week or more (median duration of coma 3 weeks). One patient remained in a persistent vegetative state until his death 9 years later. The other 30 recovered consciousness and were discharged. All suffered diminution of their abilities, and 24 of them had major permanent disability. The most common motor disabilities were pure spastic hemiparesis (seven cases), basal ganglia syndromes (four cases), ataxia (three cases), and a combination of hemiparesis and ataxia (five cases). Of the 30 patients, 26 regained independent ambulation, seven were epileptic, and 14 were dysarthric in various degrees. Only 10 had the cognitive ability to profit from the normal educational system, and none had attempted postsecondary education. Social problems were common.

The worst outcomes were associated with intracranial bleeding and/or brain contusion seen on computerized tomography (CT) scans at the acute stage; the best were associated with normal CT scans. The degree of residual disability in these children seems no less than that of adults with trauma of similar severity.
Meningiomas mimicking cerebral schwannoma
Authors: Louw Deon , Sutherland Garnette , Halliday William , Kaufmann John
Published: May 2009

✓ A brain tumor with histological features reminiscent of schwannoma with underlying meningioangiomatosis was subjected to electron microscopic and immunohistochemical analysis, which confirmed the neoplasm as a meningioma. This prompted reexamination of a similar tumor, described in a previous publication as a cerebral schwannoma, with identical immunohistochemical techniques. The results obtained favored alteration of this diagnosis to that of meningioma. This experience has led the authors to recommend the use of immunohistochemistry techniques when evaluating unusual intracranial neoplasms.
Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation
Authors: Cruz Julio , Miner Michael E. , Allen Steven J. , Alves Wayne M. , Gennarelli Thomas A.
Published: May 2009

✓ Global cerebral oxygenation, perfusion pressure, and expired pCO2 were continuously monitored in 10 adults with acute severe closed head trauma. Cerebral oxygenation was monitored by fiberoptic catheter oximetry, which allowed simultaneous measurements of arterial and jugular bulb oxyhemoglobin saturation. Intracranial pressure levels over 20 mm Hg were recorded several times in all patients, in spite of sedation, muscle paralysis, and profound hyperventilation. Intracranial hypertension was frequently associated with oligemic cerebral hypoxia, identified as abnormally low jugular oxygen saturation in the presence of normal arterial oxygenation. Intracranial hypertension was then managed with intravenous administration of mannitol boluses, which yielded simultaneous decreases in intracranial pressure and increases in cerebral oxygenation to highly statistically significant levels. Monitoring cerebral oxygenation was clinically useful because it allowed identification of impaired cerebral oxygenation even when cerebral perfusion pressure was normal. It is therefore proposed as a new monitoring technique, to supplement conventional monitoring of cerebral perfusion pressure.
Hormonal dependency of cerebral meningiomas
Authors: Schrell Uwe M. H. , Adams Eric F. , Fahlbusch Rudolf , Greb Robert , Jirikowski Gustav , Prior Reinhard , Ramalho-Ortigao Flavio J.
Published: May 2009

✓ Female sex steroid receptors were examined in 50 human cerebral meningiomas. For estrogen receptors, high-affinity binding sites (dissociation constant (Kd): 0.05 to 0.2 nM) were found in the cytosolic fraction with a capacity of less than 4 fmol/mg protein in 10 meningiomas using a dextran-coated charcoal (DCC) assay. In the same cytosolic fraction, the solid-phase enzyme immunoassay revealed only one cytosol with a positive colorimetric reaction equal to 5 fmol/mg protein. However, in the nuclear compartment, none of the tumors stained positively for estrogen receptors with immunohistochemical techniques. In addition, the most convincing evidence for the absence of estrogen receptors was obtained by in situ hybridization using an oligonucleotide probe complementary to a fraction of the human receptor messenger ribonucleic acid (mRNA). In none of the 50 meningiomas was the expression of estrogen mRNA coding for the estrogen receptor detected.

For progesterone receptors, high-affinity binding sites (Kd: 0.3 to 2.6 nM) were found in 49 of the 50 tumors using a DCC assay. In the same cytosols, solid-phase enzyme immunoassay revealed that each tumor was positive for progesterone receptors. However, in the nuclear compartment, only five tumors had partially positive staining for progesterone receptors with immunohistochemical techniques.

Within the confines of this study, it is concluded that: 1) the estrogen receptor is generally absent in meningioma tissue, and 2) the progesterone receptor is mainly absent in the nuclear compartment, leading to the conclusion that the cytosolic progesterone receptor may be an inactive form. This study suggests that female sex steroid receptors are not primarily involved in the proliferative rate of cerebral meningiomas and that they are of no current significance as markers for adjuvant medical therapy of most meningiomas.
Cholesterol uptake by human glioma cells via receptor-mediated endocytosis of low-density lipoprotein
Authors: Murakami Masaji , Ushio Yukitaka , Mihara Yosuke , Kuratsu Jun-Ichi , Horiuchi Seikoh , Morino Yoshimasa
Published: May 2009

✓ Low-density lipoprotein (LDL) is a carrier of the cholesterol found in human plasma. Cells utilize cholesterol for membrane synthesis by taking up LDL via receptor-mediated endocytosis. In the present study, interactions of LDL with human malignant glioma cell lines (U-251MG and KMG-5) were investigated biochemically and morphologically. The LDL, labeled with the fluorescent dyes 1, l′-dioctadecy1–3,3,3′,3′-tetramethylindocarbocyanine (DiI) and fluorescein isothiocyanate (FITC), was internalized by both cell processes and cell bodies. Reductive methylation of DiI-labeled LDL, which abolishes the ability of the cell to bind to the LDL receptor, prevented the internalization of the cholesterol moiety of LDL. Cellular binding of 125I-LDL to U-251MG cells at 4°C revealed the presence of a specific saturable-associated receptor (dissociation constant (Kd) approximately 38 µg/ml). Endocytic uptake of 125I-LDL or 3H-cholesterol oleate-labeled LDL (3H-LDL) at 37°C demonstrated the cell-associated 125I-LDL and 3H-LDL increase. The intracellular degradation of protein moiety increased linearly with time. Reductive methylation of 3H-LDL led to a remarkable decrease in the cell-associated cholesterol moiety of LDL. The difference in uptake of the cholesterol moiety of LDL between U-251MG cells and KMG-5 cells showed that the U-251MG cells, which proliferate more actively than KMG-5 cells, take up more of the cholesterol moiety of LDL than do the KMG-5 cells.

Thus, LDL cholesterol seems to be endocytosed predominantly via the LDL receptor present on the plasma membrane of malignant glioma cells. In addition, for growth, these cells may require large amounts of the cholesterol moiety of LDL.
Spinal cord arteriovenous malformation with an associated lymphatic anomaly
Authors: Kraus Gary E. , Bucholz Richard D. , Weber Thomas R.
Published: May 2009

✓ Spinal cord arteriovenous malformations (AVM's), like other vascular anomalies of the central nervous system, can be associated with similar vascular lesions of the skin and viscera. A 7-year-old girl, who presented with rapidly progressing paraplegia, was found to have a spinal cord AVM, cutaneous angioma, and a chylous malformation of the lymphatic system. She had previously undergone treatment for a posterior thoracic cutaneous angioma. At surgery, upon incision of the paravertebral muscle fascia, viscous pale fluid was encountered emanating from a foramen in the thoracic lamina. The spinal AVM was resected in spite of concern that the abnormality represented spinal osteomyelitis. Postoperatively, there was full return of function in the lower extremities, along with recurrent episodes of chylothorax, which slowly came under control with dietary manipulation. A review of the anatomy of the thoracic duct and nontraumatic causes of chylothorax is presented, and the association of cutaneous and central angiomas is discussed. Finally, the treatment of chylothorax is delineated.
Hemiparkinsonism as a complication of an Ommaya reservoir
Authors: Cheshire William P. , Ehle Albert L.
Published: May 2009

✓ The authors describe the case of a 28-year-old woman who developed the following symptoms in her right hand: a lasting resting tremor, transient focal rigidity, and paresthesia. These deficits occurred following treatment with intrathecal methotrexate via an Ommaya reservoir which was placed too deeply, resulting in trauma to the contralateral mesencephalon.
Fourth ventricular schwannoma
Authors: Redekop Gary , Elisevich Kost , Gilbert Joseph
Published: May 2009

✓ A schwannoma arising from the dorsum of the pontomedullary junction and presenting as an exophytic mass in the fourth ventricle is described. A ventricular schwannoma has not previously been reported in the literature. The presenting clinical and radiographic features and the pathology of this tumor are summarized, and an explanation is sought for its unusual location.
Intradural epithelial cyst at the craniovertebral junction
Authors: Breeze Robert E. , Nichols Peter , Segal Hervey , Apuzzo Michael L. J.
Published: May 2009

✓ A case of an intradural epithelial cyst at the craniovertebral junction is reported in a 37-year-old man. The classification of these rare lesions is discussed.
Stereotactic investigation of limbic epilepsy using a multimodal image analysis system
Authors: Lévesque Michel F. , Zhang Jingxi , Wilson Charles L. , Behnke Eric J. , Harper Ronald M. , Lufkin Robert B. , Engel Jerome , Crandall Paul H.
Published: May 2009

✓ A methodology has been developed for stereotactic investigation of limbic epilepsy using an image-analysis system that simultaneously displays different structural and functional images of the brain. The validity and accuracy of this system were established with phantom studies. Surgical planning and electrode implantation are guided by stereotactic magnetic resonance imaging, digital subtraction angiography, and positron emission tomography. This methodology provides the spatiotemporal relationship of cerebral structure and function necessary to identify seizure onset and propagation in human limbic system epilepsy.
A simple technique of posterior wiring in traumatic instability of the mid to lower cervical spine
Authors: Brandt Lennart , Nielsen Carsten Feldborg , Säveland Hans , Wingstrand Hans
Published: May 2009

✓ Wiring without bone fusion in the treatment of traumatic cervical instability is an uncommon procedure. The authors describe a semirigid wiring technique for stabilizing the acute injured movement segment in the mid and lower cervical spine. Results are briefly discussed.
Cushing Oration, 1990: Role of the United States in a changing world
Authors: Carter Jimmy
Published: May 2009

✓ In discussing the role of the United States in world politics, President Jimmy Carter described the changes in Europe as it prepares for unification into one economic bloc; the deteriorating conditions in the third world; the impact of the recent changes in communist countries; and the persistence of regional wars and civil disputes. He summarized the policies and activities of The Carter Center in Atlanta, Georgia. This nonprofit organization receives no government funds and can act as an independent agent in areas such as disease eradication and promotion of food production in the third world countries, and can intercede on behalf of peace in countries with civil unrest. He urged the members of the Association, as leaders of society, to use their influence in alleviating worldwide suffering.
Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction
Authors: Dickman Curtis A. , Hadley Mark N. , Pappas Conrad T. E. , Sonntag Volker K. H. , Geisler Fred H.
Published: May 2009

✓ Fourteen patients with superior cervical spinal cord injuries and the clinical signs and symptoms of cruciate paralysis are presented. This rare injury pattern is characterized by weakness of the upper extremities with little or no compromise of lower-extremity function following trauma to the superior spinal cord. Anatomically, cruciate paralysis is thought to represent selective injury to descending corticospinal tracts as they decussate at the cervicomedullary junction. The clinical and radiographic findings of each patient are outlined and the incidence and natural history of the injury syndrome, including a review of the literature, are presented.
Characterization of periventricular edema in normal-pressure hydrocephalus by measurement of water proton relaxation times
Authors: Tamaki Norihiko , Shirakuni Takayuki , Ehara Kazumasa , Matsumoto Satoshi
Published: May 2009

✓ The magnetic resonance longitudinal relaxation time (T1) and transverse relaxation time (T2) of the water proton of the periventricular white and cortical gray matter were measured for 17 control patients and 21 patients with suspected normal-pressure hydrocephalus (NPH). Of the latter group, 14 showed good response to shunting (true-NPH group) and seven showed no response (false-NPH group). In the true-NPH group, both the T1 and the T2 of the periventricular white matter were significantly prolonged compared to the control values, and slowly shortened after cerebrospinal fluid (CSF) shunting. The true-NPH group showed significantly longer T1 and T2 of the white matter than did the false-NPH group. The T1 and T2 of the white matter were longer than those of the gray matter in this group, which was the reverse of the relationship observed in the control patients. In the white matter of the false-NPH group, there was a significant prolongation of T1 only; no difference was seen in the T2 compared to control values. There was no change in either T1 or T2 of this region after CSF shunting. The false-NPH group showed no significant difference in either T1 or T2 between the white and the gray matter. There was no difference in either T1 or T2 of the gray matter between the false-NPH and control groups or between preshunt and postshunt measurements in each patient group. It is suggested that a distinction between true- and false-NPH, which cannot be made from the radiographic appearance alone, may be possible from measurement of relaxation times. The mechanism of varied relaxation behavior between two entities may be explained by a difference in properties of the biological water and its environment.
Systems analysis of cerebrovascular pressure transmission: an observational study in head-injured patients
Authors: Piper Ian R. , Miller J. Douglas , Dearden N. Mark , Leggate James R. S. , Robertson Ian
Published: May 2009

✓ In an observational study in head-injured patients, cerebrovascular pressure transmission was investigated using a systems analysis approach whereby the blood pressure (BP) waveform was used as a measure of an input stimulus to the cerebrovascular bed (CVB) and the intracranial pressure (ICP) waveform as the response to that stimulus. The transfer function is a measure of how much pressure is transmitted through the CVB at a given frequency and is calculated using Fourier analysis of the pressure waveforms. The transfer function allows quantification of the pressure transmission performance of the CVB, thus providing a basis for comparison between normal and abnormal function.

Fifteen hundred samples of ICP and BP waveforms were collected from 30 head-injured patients via microcomputer. Off-line spectral analysis of the waveform database revealed four main classes of transfer function: those with an overall flat transfer function (curve type 1); those with an elevated low-frequency response (curve type 2); those with an elevated high-frequency response (curve type 3); and those exhibiting both an elevated low- and high-frequency response (curve type 4). Curve types 2 and 4 were most often associated with raised ICP (> 20 mm Hg), whereas curve types 1 and 3 were most often affiliated with ICP less than 15 mm Hg. Studies of this type may provide insight into the pathophysiology of the CVB and ultimately aid in the prediction and treatment of raised ICP.
Antigen related to cell proliferation in malignant gliomas recognized by a human monoclonal antibody
Authors: Kokunai Takashi , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2009

✓ A human monoclonal antibody (CLN-IgG) was produced from a human-human hybridoma derived from lymphocytes of a patient with cervical carcinoma. The reactivities of this antibody with various human glioma tissues and cultured glioma cells and the characterization of the antigen recognized by CLN-IgG on malignant glioma cells were analyzed and reported. CLN-IgG reacted with various human glioma cells and glioma tissues, especially glioblastoma, but did not react with normal brain tissues or fetal brain tissues. A large amount of antigen recognized by CLN-IgG was expressed on cell membranes of undifferentiated glioma cells and of glioma cells at the G2/M tumor growth phase in cycling cells. Antigen recognized by CLN-IgG was detected in only one of seven samples of cyst fluid, and was not detected in 27 serum samples or 18 samples of cerebrospinal fluid from glioma patients. CLN-IgG exhibited antibody-dependent cell cytotoxicity against U-251MG glioma cells and primary cultured cells of glioblastomas and anaplastic astrocytomas. These data suggest that the antigen recognized by CLN-IgG might be related to cell proliferation in malignant gliomas. Thus, CLN-IgG might be useful for immunotherapy or immunoimaging of malignant gliomas.
Long-term evaluation of hemiparkinsonian monkeys after adrenal autografting or cavitation alone
Authors: Plunkett Robert J. , Bankiewicz Krysztof S. , Cummins Alex C. , Miletich Robert S. , Schwartz Joan P. , Oldfield Edward H.
Published: May 2009

✓ Autografts of adrenal medulla were implanted into preformed cavities in the caudate nuclei of four rhesus monkeys with hemiparkinsonism induced by l-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Five other hemiparkinsonian monkeys underwent caudate cavitation, but received no tissue implant. All of the animals had marked bradykinesia of the affected arm and stable apomorphine-induced turning before cavitation or implantation.

Moderate behavioral recovery was seen in all five monkeys with cavitation and two of the three monkeys with long-term adrenal autografts (the fourth adrenal recipient was sacrificed 10 days after grafting). The improvement occurred months after the procedure and was not as early or as complete as that seen after fetal dopaminergic grafts. Surviving adrenal tissue was found only in the animal that showed no behavioral recovery. The other two adrenal autograft recipients (with no surviving adrenal medulla) and all of the animals with cavitation had ingrowth of dopaminergic fibers from the area olfactoria and nucleus accumbens into the caudate, oriented toward the cavity.

These findings show that the mechanism of improvement after adrenal medullary implants for parkinsonism is not dopamine secretion by chromaffin cells, but may be related to the sprouted host fibers. The results also indicate that the limited recovery after adrenal implants in parkinsonian patients may be a result of the cavitation, and not necessarily the result of tissue implantation.
Evidence for a local immune activation in cystic brain tumors
Authors: Boethius Jörgen , Lefvert Ann Kari , Sidén Åke
Published: May 2009

✓ The fluid of cystic brain tumors was characterized with regard to the protein content. In most malignant tumors, the concentrations of immunoglobulins G and M (IgG and IgM) were higher relative to other proteins in the cyst fluid than in the serum of the same patient. A markedly elevated ratio of monomeric to pentameric IgM was detected in the cyst fluid of two patients with glioblastomas. The results indicate a local immunoglobulin synthesis in malignant cystic brain tumors. It is hypothesized that higher-than-expected concentrations of IgG and IgM in cyst fluid as compared to plasma are a sign of an ongoing immune response triggered by the tumor.
Biologically inert synthetic dural substitutes
Authors: Sakas Damianos E. , Charnvises Komporn , Borges Lawrence F. , Zervas Nicholas T.
Published: May 2009

✓ Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.
Epithelial cyst of the fourth ventricle
Authors: Yoshida Kenshi , Nakamura Saburo , Tsubokawa Takashi , Sasaki Jun , Shibuya Tadashi
Published: May 2009

✓ A case of epithelial cyst in the fourth ventricle of a 4-year-old child is described. A single epithelial layer with a clear basement membrane lining the cyst wall was observed. There were no prominent histological findings to suggest a pathogenesis for this cyst based on immunohistochemical or ultrastructural studies; however, the cyst fluid contained significant amounts of carcinoembryonic antigen. It is considered that the epithelial layer lining the cyst wall was possibly of endodermal origin.
Toxoplasmosis of the conus medullaris in a patient with hemophilia A-associated AIDS
Authors: Kayser Constance , Campbell Robert , Sartorious Carl , Bartlett Marilyn
Published: May 2009

✓ Toxoplasma gondii has been reported to be the most common cause of focal brain lesions in patients with acquired immunodeficiency syndrome (AIDS). A case of intramedullary toxoplasmosis of the conus medullaris is reported in a patient with hemophilia A-associated AIDS. The diagnosis is discussed, with particular emphasis on the magnetic resonance imaging appearance.