bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxyhemoglobin stimulation of endothelin production in cultured endothelial cells
Authors: Ohlstein Eliot H. , Storer Barbara L.
Published: May 2009

✓ Oxyhemoglobin and endothelin have both been linked to the development of the severe and sustained cerebral vasospasm associated with subarachnoid hemorrhage. The effects of oxyhemoglobin on endothelin biosynthesis in cultured endothelial cells were evaluated. Oxyhemoglobin (0.01 to 100 µM) produced concentration-dependent increases in immunoreactive endothelin levels in bovine pulmonary artery endothelial cell-conditioned medium. The median effective concentration for oxyhemoglobin-induced increases in immunoreactive endothelin levels was approximately 0.5 µM, and the maximum stimulation of immunoreactive endothelin levels was approximately 5.5-fold over basal conditions. In addition to directly stimulating basal production of immunoreactive endothelin, oxyhemoglobin significantly augmented immunoreactive endothelin production following platelet-mediated stimulation of endothelin production. An l-arginine analog inhibitor of nitric oxide synthase, L-NG-monomethyl arginine (L-NMMA, 200 µM), did not significantly affect basal immunoreactive endothelin levels. However, L-NMMA significantly augmented platelet-induced immunoreactive endothelin production. Methylene blue (10 µM), an inhibitor of soluble guanylate cyclase, did not significantly affect basal immunoreactive endothelin levels, nor did it significantly affect the platelet-mediated stimulation of immunoreactive endothelin production in cultured endothelial cells.

The present results reveal that oxyhemoglobin can directly stimulate endothelin biosynthesis in cultured endothelial cells. This newly identified property of oxyhemoglobin suggests a potential mechanism for the sustained and severe cerebral vasospasm associated with subarachnoid hemorrhage.
Presence of dopamine D1 receptors and absence of dopamine D2 receptors in human cerebral meningioma tissue
Authors: Schrell Uwe M. H. , Nomikos Panos , Fahlbusch Rudolf
Published: May 2009

✓ Preliminary studies have shown that the dopamine D1receptor is expressed in cerebral meningioma tissue. The current study presents evidence that the iodinated dopamine D1antagonist [125I]SCH-23982 bound to dopamine binding sites in 33 of the 45 human cerebral meningiomas examined for this. Saturation curves and the linearity of the Scatchard analysis indicate that [125I]SCH-23982 binds to a homogeneous population of binding sites. Competition curves reveal the presence of a dopamine D1receptor by rank order of various dopaminergic and nondopaminergic antagonists ((+)-SCH-23390 > (±)-SKF-83566 > (cis)-flupentixol > (+)-butaclamol > chlorpromazine > 1-sulpiride > mianserin > (−)-butaclamol). Stereoselectivity was evaluated by (+)- and (−)-butaclamol. The mean (± standard deviation) dissociation rate constant was 369 ± 196 pM with a density of 31.9 ± 12.5 fmol/mg membrane protein among 33 meningiomas.

The dopamine D2receptor was not present in the 30 meningiomas examined for this. These findings indicate that the dopamine D1receptor identified is expressed alone and is therefore regulated independent of a D2receptor in cerebral meningioma tissue. Although the function of the dopamine D1receptor in cerebral meningiomas has not so far been defined, previous studies have suggested that the D1receptor might be involved in the control of proliferative growth of meningiomatous tissue.
Chiari malformation with compression of the medulla oblongata by the vertebral arteries
Authors: Kobayashi Tomoko , Ogawa Akira , Kameyama Motonobu , Uenohara Hiroshi , Yoshimoto Takashi
Published: May 2009

✓ A unique case is reported of Chiari malformation and compression of the medulla oblongata by both vertebral arteries. A 39-year-old woman complained of unsteady gait and motor weakness of the legs, and magnetic resonance imaging revealed the malformation and compression. Vascular decompression of the vertebral arteries was performed using synthetic (Gore-tex) vascular strips following posterior fossa decompression.
Two fluid-blood density levels in chronic subdural hematoma
Authors: Hashimoto Naoya , Sakakibara Takehiko , Yamamoto Kazuaki , Fujimoto Masahito , Yamaki Tarumi
Published: May 2009

✓ The case of a chronic subdural hematoma is presented in which the computerized tomography scan showed two parallel fluid-blood density levels. The authors emphasize the importance of this finding in the management of such cases.
Adult intramedullary astrocytomas of the spinal cord
Authors: Epstein Fred J. , Farmer Jean-Pierre , Freed Diana
Published: May 2009

✓ In this series, 25 adult patients with intramedullary astrocytomas were treated by radical excision alone. Six patients proved to have anaplastic astrocytoma; five of them died within approximately 2 years and the sixth has demonstrated disease progression. The other 19 patients were diagnosed as having low-grade astrocytoma (16 cases) or ganglioglioma (three cases); two of these had advanced preoperative neurological disability and died of medical complications. Fifteen of the remaining 17 patients have no clinical evidence of tumor recurrence after a mean follow-up period of 50.2 months; the other two have a small residual neoplasm that demonstrates no progression. Of these 17 patients, seven had previously received radiation therapy, but had clear evidence of tumor growth subsequently.

This experience suggests that surgery is not beneficial for anaplastic spinal astrocytoma. However, in cases of low-grade tumor, radical excision is associated with minimal morbidity and an excellent long-term prognosis when carried out before significant disability occurs.
Ultra-early evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced computerized tomography
Authors: Bouma Gerrit J. , Muizelaar J. Paul , Stringer Warren A. , Choi Sung C. , Fatouros Panos , Young Harold F.
Published: May 2009

✓ The role of cerebral ischemia in the pathophysiology of traumatic brain injury is unclear. Cerebral blood flow (CBF) measurements with 133Xe have thus far revealed ischemia in a substantial number of patients only when performed between 4 and 12 hours postinjury. But these studies cannot be performed sooner after injury, they cannot be done in patients with intracranial hematomas still in place, and they cannot detect focal ischemia. Therefore, the authors performed CBF measurements in 35 comatose head-injured patients using stable xenon-enhanced computerized tomography (CT), simultaneously with the initial CT scan (at a mean (± standard error of the mean) interval of 3.1 ± 2.1 hours after injury). Seven patients with diffuse cerebral swelling had significantly lower flows in all brain regions measured as compared to patients without swelling or with focal contusions; in four of the seven, cerebral ischemia (CBF ≤ 18 ml/100 gm · min−1) was present. Acute intracranial hematomas were associated with decreased CBF and regional ischemia in the ipsilateral hemisphere, but did not disproportionately impair brain-stem blood flow. Overall, global or regional ischemia was found in 11 patients (31.4%). There was no correlation between the presence of hypoxia or hypertension before resuscitation and the occurrence of ischemia, neither could ischemia be attributed to low pCO2. Ischemia was significantly associated with early mortality (p < 0.02), whereas normal or high CBF values were not predictive of favorable short-term outcome. These data support the hypothesis that ischemia is an important secondary injury mechanism after traumatic brain injury, and that trauma may share pathophysiological mechanisms with stroke in a large number of cases; this may have important implications for the use of hyperventilation and antihypertensive drugs in the acute management of severely head-injured patients, and may lead to testing of drugs that are effective or have shown promise in the treatment of ischemic stroke.
The effect of 5-lipoxygenase inhibition on blood-brain barrier permeability in experimental brain tumors
Authors: Baba Takehiko , Chio Chung-Ching , Black Keith L.
Published: May 2009

✓ To determine if leukotrienes are important mediators of vascular permeability in brain tumors, the effect of 5-lipoxygenase inhibitors on blood-tumor barrier permeability in rats harboring HK Walker 256 brain tumors was examined using quantitative autoradiography with α-14C-aminoisobutyric acid. The 5-lipoxygenase enzyme converts arachidonic acid to leukotrienes. Three 5-lipoxygenase inhibitors were utilized: BW755C, nordihydroguaiaretic acid, and AA-861. All three 5-lipoxygenase inhibitors significantly decreased vascular permeability both within the tumors and in brain adjacent to tumor. This suggests that capillary permeability in and adjacent to tumors is influenced by endogenous leukotrienes and that leukotrienes play an important role in brain tumor edema.
Antiproliferative cytokines secreted by lymphokineactivated killer cells stimulated with tumor cells
Authors: Naganuma Hirofumi , Sasaki Atsushi , Nukui Hideaki , Tasaka Kachio
Published: May 2009

✓ Antiproliferative cytokine secretion by lymphokine-activated killer (LAK) cells during coculture with glioblastoma cell lines, autologous glioma cells, and nongliomatous tumor cell lines (Daudi and K562 cells) was assessed, as was the antiproliferative activity of the culture supernatants against the T98G (glioblastoma) cell line. A neutralization test using agents against interferon-γ (IFN-γ), tumor necrosis factor (TNF), and lymphotoxin (LT) showed that antiproliferative activity was due to IFN-γ, but not to TNF or LT. Nongliomatous tumor cells stimulated LAK cells to secrete cytokines, but gliomatous tumor cells did not.

It was found that there is a discrepancy between the LAK cell capability to lyse malignant glioma cells and the ability to secrete cytokines. This may be due to the factors secreted by glioblastoma cells.
Effects of vasopressin and oxytocin on canine cerebral circulation in vivo
Authors: Suzuki Yoshio , Satoh Shin-ichi , Kimura Masaaki , Oyama Hirofumi , Asano Toshio , Shibuya Masato , Sugita Kenichiro
Published: May 2009

✓In vivoexperiments on the vasoactive effects of vasopressin and oxytocin on cerebral circulation were carried out in anesthetized dogs, using an electromagnetic flowmeter to measure vertebral blood flow and angiography to measure the internal diameter of the basilar artery. Direct bolus infusion of 1 pmol to 1 nmol of vasopressin or 10 pmol to 10 nmol of oxytocin into a femoral-vertebral artery shunt produced a dose-dependent decrease in vertebral artery blood flow without significantly affecting mean arterial blood pressure. Vasopressin was more potent than endothelin and neuropeptide Y, which have also been demonstrated to induce long-lasting decreases in vertebral artery blood flow. However, direct bolus infusion of vasopressin (100 pmol and 1 nmol) or oxytocin (1 nmol and 10 nmol) into the vertebral artery dilated major vessels including the vertebral, anterior spinal, and basilar arteries, as well as the circle of Willis and its main branches, while endothelin (1 nmol) and neuropeptide Y (5 nmol) caused no change in the diameters of major cerebral arteries. The V1antagonist d(CH2)5tyrosine(methyl) arginine vasopressin suppressed the effects of both vasopressin and oxytocin. Vasopressin was over 10 times as potent as oxytocin in both assays. The vasodilatory effect of vasopressin, which may be mediated by an endothelium-dependent mechanism, was functionally damaged in dogs after experimental subarachnoid hemorrhage. These data suggest regional differences in the sensitivity and responsiveness of vasculature to vasopressin and oxytocin, and specifically that both peptides act through V1receptors to decrease the resistance of large vessels and increase the resistance of small vessels.
Reduction by delayed hypothermia of cerebral infarction following middle cerebral artery occlusion in the rat: a time-course study
Authors: Baker Christopher J. , Onesti Stephen T. , Solomon Robert A.
Published: May 2009

✓ The effect of hypothermia on neuronal injury following permanent middle cerebral artery (MCA) occlusion in the rat was examined. Moderate hypothermia (body temperature 24°C) was induced before MCA occlusion (0-minute delay group) in six rats, at 30 minutes in eight rats, and at 1 (seven rats), 2 (seven rats), and 3 (nine rats) hours after occlusion. The rats were kept at a 24°C body temperature for 1 hour, then allowed to rewarm over 90 minutes. The animals were sacrificed 24 hours after MCA occlusion, and infarction was visualized by staining of coronal sections with 2,3,5-triphenyltetrazolium chloride. Infarct volumes were compared to matched normothermic control rats (body temperature 36°C). Additional groups of 0-minute delay hypothermic (10 rats) and control animals (nine rats) were sacrificed 72 hours after MCA occlusion to examine the effects of prolonged survival.

A significant reduction in the percentage of infarcted right hemisphere was seen in the animals sacrificed after 24 hours with 0-minute, 30-minute, and 1-hour delays in inducing hypothermia (mean ± standard error of the mean: 2.2% ± 0.7%, 4.4% ± 0.9%, and 3.6% ± 1.1%, respectively) as compared to normothermic control rats (10.8% ± 1.5%, p < 0.01 by Student's t-test). In the 2- and 3-hour delay groups, the percentage of infarcted right hemisphere was 17.1% ± 2.4% and 12.0% ± 2.7%, respectively, and no decrease in infarct volume was observed. The 0-minute delay hypothermia group sacrificed after 72 hours also displayed a significant reduction in right hemisphere infarct compared to their respective controls (4.8% vs. 11.7%, p < 0.05). These findings indicate that, in the setting of permanent MCA occlusion, hypothermia markedly decreases brain injury even when its induction is delayed for up to 1 hour after the onset of ischemia. Ischemic damage does not appear to be merely retarded but permanently averted.
Rebleeding from vertebral artery dissection after proximal clipping
Authors: Kitanaka Chifumi , Morimoto Tadashi , Sasaki Tomio , Takakura Kintomo
Published: May 2009

✓ The authors present the case of a patient with vertebral artery dissection that rebled after being treated by proximal clipping. This is the second report of such a case. The results indicated that proximal clipping is not free from the risk of rebleeding, and a better alternative surgical technique should always be sought when treating vertebral artery dissections.
Treatment of fusiform intracranial aneurysms by circumferential wrapping with clip reinforcement
Authors: Bederson Joshua B. , Zabramski Joseph M. , Spetzler Robert F.
Published: May 2009

✓ The authors describe a new technique for treating unclippable aneurysms. The method involves a modification of the traditional wrapping technique, including a clip-reinforced cotton sling. The results of this method in four patients are presented.
The significance for postoperative hearing of preserving the labyrinth in acoustic neurinoma surgery
Authors: Tatagiba Marcos , Samii Madjid , Matthies Cordula , El Azm Mowaffak , Schonmayr Robert
Published: May 2009

✓ Among 186 patients with preoperative hearing, a total of 189 acoustic neurinomas were removed through a lateral suboccipital approach with anatomical preservation of the cochlear nerve. Functional hearing was preserved in 92 (49%) of these patients; despite anatomical preservation of the cochlear nerve, deafness was the result in 51 % of the series. Many factors have been considered to cause hearing loss in patients whose cochlear nerve was intact after surgery; these include nerve retraction, nerve or cochlear ischemia, overheating and vibration damage to the nerve, and opening of the labyrinth.

To evaluate the significance of injury to the labyrinth in postoperative hearing loss, a prospective study was undertaken. High-resolution computerized tomography studies through the inner ear with bone algorithm were performed pre- and postoperatively. The postoperative status of the labyrinth was classified into three patterns: intact, fenestrated, and widely opened. Injury to the labyrinth occurred in 30% of the cases. The most frequently injured labyrinth structures were the crus commune of the posterior and superior semicircular canals (52%), the posterior semicircular canal (23%). the vestibule (21%), and the superior semicircular canal (4%).

A statistically significant relationship was found between injury to the labyrinth and deafness, elevated thresholds, and lower discrimination values at pure-tone audiograms and speech audiometry (p < 0.0001). The degree of the injury (comparison between fenestration and wide opening of the labyrinth) was also significantly related to postoperative deafness (p < 0.0001). Disturbance of the inner-ear fluids was considered to be the cause of the hearing loss. In 12 patients labyrinth injury was not associated with deafness. This finding may support the existence of mechanisms of cochlear protection. The homeostatic function of the endolymphatic sac was considered to play an important role in recovery of damaged hearing in these 12 cases.
Pediatric spinal injury: review of 61 deaths
Authors: Hamilton Mark G. , Myles S. Terence
Published: May 2009

✓ Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. The authors present a unique review of 61 pediatric deaths associated with spinal injury. This group represented 28% of the total pediatric spine-injured population and 45% of the total pediatric spinal cord-injured group studied. The ratio of pediatric to adult spinal injury mortality was 2.5:1. Of the 61 children, 54 (89%) died at the accident scene. Thirty patients underwent a complete autopsy, 19 of whom had an Abbreviated Injury Scale Grade 6 injury (maximum score, untreatable). Spinal cord injury was found to be the cause of death in only eight children and was associated with injury to the high cervical cord and cardiorespiratory arrest. These children typically sustained severe multiple trauma. In this population, there appears to be little room for improved outcome through changes in treatment strategy.
The subtemporal, transcavernous, anterior transpetrosal approach to the upper brain stem and clivus
Authors: Harsh Griffith R. , Sekhar Laligam N.
Published: May 2009

✓ The temporal lobe, posterolateral cavernous sinus, tentorium, and petrous apex restrict anterolateral surgical access to lesions of the upper brain stem and clivus. The authors describe a modified transpetrosal approach that enhances the exposure of clival chordomas and aneurysms of the basilar artery bifurcation. An intradural and extradural subtemporal approach is combined with division of the tentorium and superior petrosal sinus, posterolateral dissection of the cavernous sinus, and intradural removal of the petrous bone from its apex to the cochlea. The indications, advantages, and disadvantages of this subtemporal, transcavernous, anterior transpetrosal approach are described in detail, along with its use in six patients.
Usefulness of β2-transferrin assay in the detection of cerebrospinal fluid leaks following head injury
Authors: Ryali Richard G. , Peacock Michael K. , Simpson Donald A.
Published: May 2009

✓ The clinical value of analyzing various fluids and exudates for β2-transferrin (β2-Tfn) to detect cerebrospinal fluid (CSF) leakage following head trauma was reviewed in a series of 11 cases. Qualitative detection of β2-Tfn was performed by agarose gel electrophoresis of tears, ear and nose exudates, cerebral cyst fluid, and wound discharge fluid in different cases. In each instance the presence of β2-Tfn in the analyzed fluid supported the diagnosis of a CSF leak. Equally, the demonstration of the absence of β2-Tfn in the fluid excluded the diagnosis of such a leak. Neither false-positive nor false-negative results were found, as indicated by separate radiological investigations and/or subsequent clinical assessment of patients. The detection of β2-Tfn in suspect fluids thus provides a highly sensitive and selective, rapid, and noninvasive test for the detection of CSF leakage in cases of head trauma.
Intrathecal chemotherapy with ACNU in a meningeal gliomatosis rat model
Authors: Yoshida T. Ken , Shimizu Keiji , Koulousakis Athanasios , sturm volker
Published: May 2009

✓ Intrathecal administration of ACNU ((1-4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride) had a remarkable chemotherapeutic effect in a rat model of meningeal gliomatosis. This effect was evaluated in rats with meningeal gliomatosis induced by an intracisternal inoculation of rat C6 glioma cells. The median survival time of the rats treated with a single dose of intrathecal ACNU (1 mg/kg) on Day 1 or Day 3 after tumor inoculation was significantly prolonged by 35.7% to 42.9% or 25.0% to 28.6%, respectively, as compared with that of the control animals. Meningeal gliomatosis rat models treated intrathecally with ACNU (1 mg/kg) 5 days after tumor inoculation or intravenously with ACNU (15 mg/kg) both failed to prolong the survival time of the animals. These findings suggest that intrathecal chemotherapy with a low dose of ACNU is effective in the early stages of meningeal gliomatosis, whereas intravenous chemotherapy with a high dose of ACNU is always ineffective.
Posttraumatic cervical spondyloptosis at C6–7 with late-onset cord compression: a new clinical entity
Authors: Bhojraj Shekhar Y. , Shahane Sunil M.
Published: May 2009

✓ An unusual case of total spondyloptosis of the cervical spine at the C6-7 level with late-onset cord compression is described in an 8-year-old girl. The patient was treated by anterior decompression and in situ fusion as it was thought hazardous to try an anatomical reduction. The patient's excellent neurological recovery postoperatively strongly supports the use of this treatment protocol. The authors believe this is the first report of a posttraumatic spondyloptosis of the cervical spine, presenting with a late-onset cord compression. A brief summary of the clinical presentation, the surgical technique, and a review of the relevant literature is presented.
Remote recurrence of craniopharyngioma in the epidural space
Authors: Malik Jacek M. , Cosgrove G. Rees , VandenBerg Scott R.
Published: May 2009

✓ The case is reported of a 28-year-old man with “ectopic” craniopharyngioma recurring in the epidural space 21 years after the original tumor was resected. Previously described cases of similar remote recurrences as well as some features of the biological behavior of craniopharyngioma are discussed. The rarity of this postoperative complication is addressed.
Saphenous vein graft to the distal vertebral artery between C-1 and C-2 using a lateral-anterior approach
Authors: Miyamoto Susumu , Kikuchi Haruhiko , Nagata Izumi , Akiyama Yoshinori , Itoh Kenjiro , Yamagiwa Osamu , Asahi Shigeki
Published: May 2009

✓ The authors present a modified surgical procedure for extracranial vertebral artery reconstruction. The use of the proposed technique results in access to the V3 segment of the vertebral artery between the C-1 and C-2 vertebrae through the retrojugular space without requiring bone rongeuring. A saphenous vein bypass graft was placed between the common carotid artery and the V3 segment of the vertebral artery in three patients with bilateral occlusive lesions of the proximal vertebral arteries.
Linear accelerator radiosurgery for arteriovenous malformations
Authors: Friedman William A. , Bova Frank J.
Published: May 2009

✓ Between May, 1988, and August, 1991, 80 patients with arteriovenous malformations (AVM's) were treated radiosurgically at the University of Florida. A mean dose of 1650 cGy was directed to the periphery of the lesion, which almost always corresponded to the 80% isodose line. The mean lesion diameter was 23 mm. Seventy-six patients were treated with one isocenter. Angiography, performed at 1 year after radiosurgery in 41 of the 48 eligible patients, revealed an overall complete thrombosis rate of 39%. The 1-year thrombosis rate was highest in those patients with relatively small AVM's. Angiography was performed at 2 years posttreatment in 21 of the 25 eligible patients, demonstrating an overall complete thrombosis rate of 81%. This incidence did not correlate with lesion size: that is, large lesions (up to 35 mm in diameter) seemed just as likely to thrombose. Two patients (2.5%) experienced hemorrhage at some time after radiosurgical treatment, and both recovered. Two patients (2.5%) have sustained mild, but permanent, radiation-induced neurological complications.
Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage
Authors: Kaku Yasuhiko , Yonekawa Yasuhiro , Tsukahara Tetsuya , Kazekawa Kiyoshi
Published: May 2009

✓ This report describes the successful treatment of cerebral vasospasm after subarachnoid hemorrhage with superselective intra-arterial infusion of papaverine hydrochloride. Thirty-seven vascular territories in 10 patients with symptomatic vasospasm were treated according to the following protocol. Percutaneous transluminal angioplasty was performed in two steps. First, a silicone balloon was used for dilation of the internal carotid artery and the proximal portions of the middle cerebral artery. A silicone leak balloon or Tracker-18 catheter was then introduced into or just proximal to the site of vasospasm not accessible to the angioplasty balloon catheter for superselective infusion of 0.2% papaverine. Thirty-four of 37 vascular territories were successfully dilated, and eight of 10 patients showed improvement in neurological function after the procedure. There were no serious side effects due to infusion of papaverine. It is essential to infuse the papaverine just proximal to the spastic vessels in order to deliver sufficient concentration of drug, and infusion should be carried out as early as possible before the artery loses its ability to return to a normal luminal size. Superselective intra-arterial infusion of papaverine is an alternative method of treatment for symptomatic vasospasm.
The treatment of associated intracranial aneurysms and arteriovenous malformations
Authors: Cunha e Sa Manuel J. , Stein Bennett M. , Solomon Robert A. , McCormick Paul C.
Published: May 2009

✓ Cerebral arterial aneurysm associated with arteriovenous malformation (AVM) has been described with a variable incidence, averaging 10% of AVM cases. The present series includes 39 patients with this association, derived from a total of 400 patients with AVM's evaluated and treated since 1970. The aneurysms are classified into four major groups, each carrying particular therapeutic implications. Optimum treatment of these lesions is based in part on a knowledge of the hemodynamic alterations associated with the AVM's. In most of these cases, the symptomatic lesion was treated first; occasionally, when feasible, both lesions were treated during the same operation. All patients had some form of treatment, either surgical or endovascular, directed to at least one of the two types of lesions. All symptomatic lesions were treated and all ruptured aneurysms were obliterated. There were no deaths in this series.
Shunt implantation: reducing the incidence of shunt infection
Authors: Choux Maurice , Genitori Lorenzo , Lang Dorothy , Lena Gabriel
Published: May 2009

✓ Shunt infection remains the foremost problem of shunt implantation after mechanical malfunctions. Diversionary cerebrospinal fluid shunt implantation has a high complication rate, with 5% to 15% of such shunts becoming infected. Of these infections, 70% are diagnosed within 1 month after surgery and more than 90% within 6 months. Shunt infection in the vast majority of cases is therefore a complication of shunt surgery. The authors review their experience with shunt implantation during two time periods. From January, 1978, to December, 1982, 302 children with hydrocephalus underwent 606 operations. Among these children, 47 (15.56%) developed a proven shunt infection, with an incidence of infection per procedure of 7.75%. As a result of this study, a new protocol for shunt procedures involving modifications in the immediate pre-, intra-, and postoperative management of children undergoing shunt implantation was initiated. With this new protocol, 600 children underwent a total of 1197 procedures between January, 1983, and December, 1990. The incidence of shunt infection decreased dramatically, with two infections (0.33%) in 600 patients and a per-procedure rate of 0.17%. The overall annual risk of a shunt infection in the pediatric neurosurgical unit is currently 1.04%.
Surgical management of symptomatic pineal cysts
Authors: Wisoff Jeffrey H. , Epstein Fred
Published: May 2009

✓ The authors present a series of six patients with large symptomatic benign pineal cysts and review the 27 patients previously reported in the literature. Patients with symptomatic pineal cysts most often present with one of three syndromes: 1) paroxysmal headache with gaze paresis; 2) chronic headache, gaze paresis, papilledema, and hydrocephalus; or 3) pineal apoplexy with acute hydrocephalus. Surgical intervention with radical cyst removal is the treatment of choice for all symptomatic pineal cysts. Complete cyst removal is desirable; however, radical subtotal resection is appropriate if the cyst cannot be easily separated from the quadrigeminal plate. Ventricular shunting should be reserved for patients with persistent hydrocephalus after cyst resection.
Extracranial complications of severe head injury
Authors: Piek Jürgen , Chesnut Randall M. , Marshall Lawrence F. , Berkum-Clark Marjan van , Klauber Melville R. , Blunt Barbara A. , Eisenberg Howard M. , Jane John A. , Marmarou Anthony , Foulkes Mary A.
Published: May 2009

✓ In order to define the role of intracranial and extracranial complications in determining outcome from severe head injury, 734 patients from the Traumatic Coma Data Bank were analyzed. Nine classes of intracranial and 13 classes of extracranial complications occurring within the first 14 days after admission were analyzed, while controlling for age, admission Glasgow Coma Scale motor score, early hypoxia or hypotension, and severe extracranial trauma. Outcome for survivors was based on the last recorded Glasgow Outcome Scale score, obtained a median of 521 days after injury. Intracranial complications did not significantly alter outcome for the study group. Of the extracranial complications, pulmonary, cardiovascular, coagulation, and electrolyte disorders occurred most frequently at 2 to 4 days. Infections developed later, peaking at 5 to 11 days. Gastrointestinal, renal, and hepatic complications followed no specific time course. Electrolyte abnormalities were the most frequent occurrence (59% of patients) but did not alter outcome. Pulmonary infections (41%), shock (29%, systemic blood pressure ≤ 90 mm Hg for 30 minutes or more), coagulopathy (19%), and septicemia (10%) were significant independent predictors of an unfavorable outcome. Backward-elimination, stepwise logistic regression modeling indicated that the estimated reduction of unfavorable outcome was 2.9% for the elimination of pneumonia, 3.1% for coagulation disturbances, 1.5% for septicemia, and 9.3% for shock. These data suggest that extracranial complications are highly influential in determining the outcome from severe head injury and that significant improvements in outcome in a sizeable proportion of patients could be accomplished by improving the ability to prevent or reverse pneumonia, hypotension, coagulopathy, and sepsis.
Variability of the territories of the major cerebral arteries
Authors: van der Zwan Albert , Hillen Berend , Tulleken Cornelis A. F. , Dujovny Manuel , Dragovic Ljubisa
Published: May 2009

✓ Recent morphological and functional studies on the circle of Willis suggest that the areas of supply of the six major cerebral arteries show a considerable variation in distribution, in contrast to the relatively consistent pattern generally accepted; therefore, the cortical and intracerebral distribution of the territories of these arteries was investigated in 25 unfixed human brains obtained at routine autopsy. The six major cerebral arteries were simultaneously injected under the same pressure with different-colored Araldite F mixtures under standardized conditions to obtain the most realistic territorial distribution. The cortical boundaries were examined and recorded in relation to the cerebral gyri and sulci, and the territories of the anterior, middle, and posterior cerebral arteries were analyzed and compared. The intracerebral distribution of these territories was investigated after the injected brains were cut in parallel slices. The variability of the territories of these arteries was much larger than generally described in the literature. Twenty-six variations in the territory of the anterior cerebral artery, 17 variations in the area of the middle cerebral artery, and 22 variations in the area of the posterior cerebral artery were found in the cortex of 50 hemispheres. Intracerebrally. the anterior, middle, and posterior cerebral arteries contributed in varying degrees to the blood supply of the lobar white matter, the internal capsule, the caudate nucleus, and the lentiform nucleus. The large variation in the area in which the cortical and intracerebral boundaries between these territories was located was demonstrated by illustrating the minimum and maximum extent of each. The results are compared with prior findings, and their implications for both experimental model studies and clinical practice are discussed.
Acute cauda equina syndrome from a ruptured aneurysm in the sacral canal
Authors: Schmidt Richard H. , Grady M. Sean , Cohen Wendy , Wright Sanford , Winn H. Richard
Published: May 2009

✓ The case is presented of a young woman with acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. The lesion was associated with pathological enlargement of the lateral sacral arteries bilaterally, which presumably occurred to provide cross-pelvic collateral flow in response to the diversion of the right internal iliac artery for renal transplantation. The patient presented with signs and symptoms of spontaneous spinal epidural hemorrhage. The radiographic features of this lesion are described. In addition to angiography and partial embolization of the vascular supply, contrast-enhanced high-resolution computerized tomography was essential in the diagnosis and treatment of this unique aneurysm.
Tenosynovial giant-cell tumor of the cervical spine
Authors: Mahmood Asim , Caccamo Dario V. , Morgan Jay K.
Published: May 2009

✓ A case of tenosynovial giant-cell tumor affecting the cervical spine is reported. The lesion is seen primarily in the fingers, knee, or ankle, and there are no previous reports of it occurring in the spine. The histological and radiological features of this tumor are discussed along with a brief description of the disease entity.
A two-step supraorbital approach to lesions of the orbital apex
Authors: Delfini Roberto , Raco Antonino , Aritco Marco , Salvati Maurizio , Ciappetta Pasquale
Published: May 2009

✓ A two-step supraorbital approach to lesions of the orbital apex is described. This technique is easy and allows a satisfactory exposure of the region. In addition, the reconstruction resulting from the procedure is anatomically perfect. The authors report the operative results obtained in 20 patients and compare this two-step supraorbital procedure with similar surgical techniques described previously.
The death of Henry II of France
Authors: Faria Miguel A.
Published: May 2009

✓ On June 30, 1559, King Henry II of France (1519–1559), against the advice of his court ministers, participated in a fateful joust. The wooden lance of his younger opponent pierced the King's headgear, shattered into fragments, and penetrated his right orbit and temple. The King survived for 11 days following the mortal wound and was treated by two of the most distinguished physicians of the Renaissance: Ambroise Paré (1510–1590), the master surgeon, and Andreas Vesalius (1514–1564), the great anatomist. The unfortunate event, the nature of the injury, and the medical consultation between these eminent physicians should all be of interest to neurosurgeons. The historical consequences of this event are briefly reviewed.
An approach to improve early detection of sternal wound infection
Authors: Howlader Mohammad H. , Smith John S. , Madden Brendan
Published: May 2009

We developed a reproducible and reliable method of using a rubber stamp prospectively to document appearances of the sternal wound. 395 consecutive patients undergoing median sternotomy for cardiac procedures were studied over a period of four months. Data were collected by the Senior House Officer during the ward round for all patients at Day 3 and Day 7 post-operatively. Data were entered for 303 patients using the rubber stamp. 78 patients had no stamp entered in their case notes. 21 patients were recorded as having abnormal wounds, 11 of whom confirmed positive microbiological growth.Â  On the other hand, 282 patients were recorded to have normal wounds, 10 of which had positive bacterial growth. Our initial results have been encouraging with almost 80% compliance and 96% specificity. A simple recording system consisting of proven signs of infection known to medical practitioners was our tool. Keywords: Detection; Infection; Sternal woundOnline: 21 May 2009DOI: 10.3329/bmrcb.v35i1.1815Bangladesh Med Res Counc Bull 2009; 35: 11-14
Prevalence and antibiotic susceptibility pattern of methicillin resistant Staphylococcus aureus at Armed Forces Hospital in Saudi Arabia
Authors: Ahmad Shamweel , Alenzi Faris Q. , Al-Juaid Nami Fawazan , Ahmed Shad
Published: May 2009

Keywords: Antibiotic; Armed Forces Hospital; Methicillin resistant; Saudi Arabia; Staphylococcus aureusOnline:Â 22 May 2009DOI: 10.3329/bmrcb.v35i1.1983Bangladesh Med Res Counc Bull 2009; 35: 28-30
Association of Helicobacter pylori infection with gastric carcinoma
Authors: Majid M.A. , Faruq T.I.M.A. , Hossain A.B.M. Bayezid
Published: May 2009

This is a cross-sectional study on 140 gastric neoplasm subjects diagnosed by upper gastrointestinal endoscopy. The commonest site of cancer was the antrum of stomach (52.86%), followed by the antrum and body (32.86%) and only body region (12.14%). Histology revealed adenocarcinoma in all patients. The associations of Helicobacter pylori with gastric cancer were studied by rapid urease test, serology and histology by Giemsa stain. The positivity of H. pylori determined by serology in 70 patients (50%) was significantly higher than those determined by histology 22 patients (15.71%). No significant association between H. pylori infection and gastric cancer was observed.Keywords: Gastric cancer; Helicobacter pylori; InfectionOnline: 20 May 2009DOI: 10.3329/bmrcb.v35i1.2315Bangladesh Med Res Counc Bull 2009; 35: 7-10
Evaluation of the effects of shortwave diathermy in patients with chronic low back pain
Authors: Ahmed Md. Shaik , Shakoor Md. Abdus , Khan Aminuddin A.
Published: May 2009

A prospective experimental study on 97 patients of chronic low back pain was conducted to find out the effects of shortwave diathermy. They were divided randomly into two groups and treated with non-steroidal anti-inflammatory drugs, exercises, activities of daily living instructions and with or without shortwave diathermy. After six weeks of treatment, improvements were observed in both the groups. But significant difference in improvement was found in shortwave diathermy group than in placebo group. The present study suggests that shortwave diathermy is effective for the treatment of patients with chronic low back pain.Keywords: Back pain; NSAID; Shortwave diathermyOnline:Â 22 May 2009DOI: 10.3329/bmrcb.v35i1.2320Bangladesh Med Res Counc Bull 2009; 35: 18-20Â
Corn extracts lower tissue arsenic level in rat
Authors: Chowdhury Noor Jahan Alam , Misbahudddin Mir , Rahman Md. Sayedur
Published: May 2009

This study was carried out to see whether corn extracts could reduce the accumulation of arsenic in different tissues of rat. Exposure to arsenic (700Âµg/rat/day) orally for 15 days led to significant accumulation of arsenic and significant reduction in the concentration of reduced glutathione (GSH) in different tissues. While water, salt, ethanol and alkali extracts of corn were co-administered at a dose of 0.5 mL/rat/day orally by stomach tube during last 8 days, arsenic concentration decreased significantly in all tissues and reduced glutathione (GSH) concentration increased significantly in tissues except heart and skin. Among the extracts, water extract produced maximum reduction of arsenic (69.07% in liver, 64.98% in kidney, 63.47% in lung, 57.55% in heart and 69.30% in skin) and elevation of reduced glutathione level in all tissues (17.03% in liver, 46.73% in lung, 32.67% in heart and 55.38% in skin) except kidney, in which maximum elevation of reduced glutathione was attained by ethanol extract (23.14%). This study suggests that corn extracts might protect rats from accumulation of arsenic in different tissues and oxidative stress, which is reflected by the increasing reduced glutathione concentration in those tissues.Keywords: Arsenic; Corn; RatOnline: 23 May 2009Bangladesh Med Res Counc 2009; 35: 21-25Â Â DOI: 10.3329/bmrcb.v35i1.2533
SDPhound, a Mutual Information-Based Method to Investigate Specificity-Determining Positions
Authors: Bonella Sara , Rocchia Walter , Amat Pietro , Nifosí Riccardo , Tozzini Valentina
Published: May 2009

Considerable importance in molecular biophysics is attached to influencing by mutagenesis the specific properties of a protein family. The working hypothesis is that mutating residues at few selected positions can affect specificity. Statistical analysis of homologue sequences can identify putative specificity determining positions (SDPs) and help to shed some light on the peculiarities underlying their functional role. In this work, we present an approach to identify such positions inspired by state of the art mutual information-based SDP prediction methods. The algorithm based on this approach provides a systematic procedure to point at the relevant physical characteristics of putative SPDs and can investigate the effects of correlated mutations. The method is tested on two standard benchmarks in the field and further validated in the context of a biologically interesting problem: the multimerization of the Intrinsically Fluorescent Proteins (IFP).
Global Assessment of High-Altitude Wind Power
Authors: Archer Cristina  L. , Caldeira Ken
Published: May 2009

The available wind power resource worldwide at altitudes between 500 and 12,000 m above ground is assessed for the first time. Twenty-eight years of wind data from the reanalyses by the National Centers for Environmental Prediction and the Department of Energy are analyzed and interpolated to study geographical distributions and persistency of winds at all altitudes. Furthermore, intermittency issues and global climate effects of large-scale extraction of energy from high-altitude winds are investigated.
The Built Environment and Health: Introducing Individual Space-Time Behavior
Authors: Saarloos Dick , Kim Jae-Eun , Timmermans Harry
Published: May 2009

Many studies have examined the relationship between the built environment and health. Yet, the question of how and why the environment influences health behavior remains largely unexplored. As health promotion interventions work through the individuals in a targeted population, an explicit understanding of individual behavior is required to formulate and evaluate intervention strategies. Bringing in concepts from various fields, this paper proposes the use of an activity-based modeling approach for understanding and predicting, from the bottom up, how individuals interact with their environment and each other in space and time, and how their behaviors aggregate to population-level health outcomes.
Informational Stories: A Complementary Strategy for Patients and Caregivers with Brain Metastases
Authors: Chung A. D. , Ng D. , Wang L. , Garraway C. , Bezjak A. , Nyhof–Young J. , Wong Rebecca K. S.
Published: May 2009

Objective: We compared the efficacy of a story-based writing style with that of a fact-based writing style for educational material on brain metastases. Methods: Identical informational content on four topics—radiation therapy, side effects, steroid tapering, and palliative care—was constructed into equivalent story-based and fact-based materials. The content and reader preference for style were evaluated using a questionnaire of 20 + 1 items. Cancer patients and caregivers were invited to evaluate the materials. Results: A total of 47 participants completed the questionnaire. The recorded preferences for facts, stories, or both were 42%, 7%, and 51% respectively (p = 0.0004). The fact-based materials were rated superior in providing factual information (for example, discussion of treatment, side effects) and selected general characteristics (clarity of information, for instance). A rating trend suggested that story-based materials were superior in describing “how it feels to have brain metastases” (21/40 fact-based vs. 26/43 story-based) and “how brain metastases affected a spouse” (17/41 fact-based vs. 21/47 story-based), and in being “sensitive to the frustrations of a patient with brain metastases” (25/40 fact-based vs. 30/44 story-based). Conclusions: Half the participants preferred to read both fact-based and story-based materials. A combined story-based and fact-based educational resource may be more effective in conveying sensitive information and should be further investigated.
Novel Developments in Angiogenesis Cancer Therapy
Authors: Hirte Hal W.
Published: May 2009

A greater understanding of the factors and pathways controlling angiogenesis in tumours has allowed the development of a number of agents that selectively inhibit the pathways mediating that activity. The results to date of clinical trials with such agents and future research opportunities are reviewed.
A Mexican kaolin deposit: XANES characterization, mineralogical phase analysis and applications
Authors: Vázquez F. , Torres L. M. , Garza L. L. , Martínez A. , López W.
Published: May 2009

A kaolin obtained from Villa de Reyes, a region near to San Luis Potosí (México) was characterized by means of X-ray powder diffraction (XRD, optical microscopy (OM), scanning electron microscopy (SEM), X-ray fluorescence (XRF), X-Ray Absorption Near Edge Spectroscopy (XANES), thermal analysis (DTA/TGA), dilatometry (DIL), and chemical analysis. Mineralogical and morphological characteristics of the mineral are presented. The kaolin sample was formed mainly by kaolinite, but other minor phases were also detected such as quartz, cristobalite, tridymite, and dolomite. The high content of volcanic glass detected, by optical microscopy, revealed an incomplete kaolinization process of the raw material. The reddish color of the kaolin was associated with the free iron content in the form of limonite [FeO(OH)], which was determined by XANES. The influence of the particle size on the whiteness of kaolin was evaluated. Dilatometric analysis revealed a strong thermal expansion between 110 y 240 °C, which would difficult the use of this material in traditional ceramic applications. On the other hand the presence of glass and high temperature phases of SiO2, such as cristobalite and tridymite will favor its use in the cement industry.