bluuebunny/crossref_metadata_2025 huggingface dataset:
Charcot-Marie-Tooth Disease due to Novel Myelin Protein Zero Mutation Presenting as Late-Onset Remitting Sensory Neuropathy
Authors: Simpson Benjamin S , Rajabally Yusuf A
Published: May 2010

We describe a previously asymptomatic patient who developed acute onset sensory symptoms which gradually resolved spontaneously. Neurologic examination revealed pes cavus, and motor nerve conduction studies were consistent with Charcot-Marie-Tooth disease type 1. Genetic testing later showed the presence of a novel frameshift mutation within the transmembrane domain of the myelin protein zero gene (Leu144fs). This case suggests that this novel myelin protein zero mutation, as others reported previously, also results in a mild phenotype with late-onset neurologic symptoms and may be accompanied by remitting sensory disturbances.
Recovery of Neurologic Dysfunction With Early Intervention of Vitamin B12
Authors: Ahmed Aiesha , Kothari Milind J
Published: May 2010

A patient developed numbness and tingling in distal extremities with subsequent weakness. Evaluation revealed B12 deficiency. She had evidence of myelopathy on imaging studies and polyneuropathy on electrodiagnostic testing. Treatment with B12 caused remittance of symptoms and resolution/improvement of abnormalities found on the imaging and electrodiagnostic studies. This case demonstrates that early intervention with B12 supplementation can cause reversal of both central and peripheral nervous system dysfunction.
A Female With Progressive Four-Limb Paresthesias and Gait Difficulty
Authors: Chai Yaohui , Bertorini Tulio E
Published: May 2010

Educational Objectives:

To discuss a case of progressive four-limb paresthesias and gait difficulty in a female who had previously undergone gastric bypass surgery.

Key Questions:

1) What is the differential diagnosis of progressive four-limb paresthesias and gait difficulty? 2) How would one approach diagnostic testing for such a patient? 3) What are the complications of gastric bypass surgery? 4) What is the treatment for this patient?
Paraspinal and Scapular Myopathy Associated With Scleroderma
Authors: Rojana-Udomsart Arada , Fabian Vicki , Hollingsworth Peter N , Walters Susan E , Zilko Paul J , Mastaglia Frank L
Published: May 2010

Objective:

To describe a form of inflammatory myopathy with prominent involvement of the paraspinal and scapular muscles in patients with scleroderma.

Methods:

Review of clinical records, laboratory investigations, and muscle biopsies.

Results:

Patients presented with a “dropped head” resulting from weakness of the posterior cervical muscles (three cases) or camptocormia (“bent spine”) resulting from weakness of the paraspinal muscles (two cases) and variable weakness and atrophy of shoulder girdle muscles with mild or absent pelvic girdle involvement. Biopsies from the deltoid or paraspinal muscles showed myositis of variable severity and scleroderma vasculopathy in all cases. The response to prednisolone and cytotoxic agents was poor, but there was a good response to intravenous immunoglobulin therapy in one case.

Conclusions:

Patients with scleroderma may develop a restricted form of immune-mediated inflammatory myopathy with a predilection for the paraspinal and scapular muscles, which is poorly responsive to treatment with glucocorticoids and immunosuppressive agents and may require consideration of other treatment modalities.
The effectiveness of helmet wear in skiers and snowboarders: a systematic review
Authors: Cusimano Michael D , Kwok Judith
Published: May 2010

Objective

To summarise the best available evidence to determine the impact of helmet use on head injuries, neck injuries and cervical spine injuries in skiers and snowboarders.

Data sources

Relevant publications were identified through electronic searches of MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library databases (1966–2009) in addition to manual reference checks of all included articles.

Review methods

45 articles were identified through our systematic literature search. Of these, 10 studies met the inclusion criteria after two levels of screening. Two independent reviewers critically appraised the studies. Data were extracted on the primary outcomes of interest: head injury, neck injury and cervical spine injury. Studies were assessed for quality by the criteria of Downs and Black.

Results

Studies reviewed indicate that helmet wear reduces the risk of head injuries in skiing and snowboarding. Four case-control studies reported a reduction in the risk of head injury with helmet use ranging from 15% to 60%. Another cohort study found a significantly lower incidence of head injuries involving loss of consciousness in helmet users (p<0.05). The five remaining studies suggested a major protective effect of helmets by indicating that none or few of the head-injured and deceased participants wore a helmet.

Conclusions

There is strong evidence to support the protective value of helmets in reducing the risk of head injuries in skiing and snowboarding. There is no good evidence to support the claim that the use of helmets leads to an increase risk of cervical spine injuries or neck injuries.
Fabrication of Mesostructured Silica and Titania Rods on Substrates by Using Polycarbonate Membranes
Authors: Suzuki Norihiro , Yamauchi Yusuke
Published: May 2010

By using the polycarbonate membrane a template, mesoporous silica rods are fabricated on a silicon substrate in one pot. From scanning electron microscope (SEM) images, the creation of fibrous morphology is confirmed over the entire area. The diameter of the obtained rods is consistent with that of the template. Transmission electron microscope (TEM) images revealed that the tubular mesochannels are uniaxially oriented parallel to the longitudinal axis of the silica rods. The mesoporous titania rods with anatase crystalline frameworks are also fabricated.
Leukocyte Counts, Myeloperoxidase, and Pregnancy-Associated Plasma Protein A as Biomarkers for Cardiovascular Disease: Towards a Multi-Biomarker Approach
Authors: Lobbes M. B. I. , Kooi M. E. , Lutgens E. , Ruiters A. W. , Lima Passos V. , Braat S. H. J. G. , Rousch M. , Ten Cate H. , van Engelshoven J. M. A. , Daemen M. J. A. P. , Heeneman S.
Published: May 2010

We evaluated leukocyte counts and levels of CRP, fibrinogen, MPO, and PAPP-A in patients with stable and unstable angina pectoris, acute myocardial infarction, and healthy controls. All biomarkers were analyzed again after 6 months. Leukocyte counts and concentrations of fibrinogen, CRP, MPO, and PAPP-A were significantly increased in patients with acute myocardial infarction. Leukocyte counts and concentrations of MPO were significantly increased in patients with unstable angina pectoris compared with controls. After 6 months, leukocyte counts and MPO concentrations were still increased in patients with acute myocardial infarction when compared to controls. Discriminant analysis showed that leukocyte counts, MPO, and PAPP-A concentrations classified study group designation for acute coronary events correctly in 83% of the cases. In conclusion, combined assessment of leukocyte counts, MPO, and PAPP-A was able to correctly classify acute coronary events, suggesting that this could be a promising panel for a multibiomarker approach to assess cardiovascular risk.
Dietary Intake and Physical Activity of Normal Weight and Overweight/Obese Adolescents
Authors: D'Addesa Dina , D'Addezio Laura , Martone Deborah , Censi Laura , Scanu Alessandra , Cairella Giulia , Spagnolo Amedeo , Menghetti Ettore
Published: May 2010

Purpose. To evaluate the relationship between overweight/obesity and dietary/lifestyle factors among Italian adolescents.Methods. On a total of 756 adolescents with mean age , body mass index, food consumption, and time dedicated to after school physical activities and to TV viewing were determined. The data were analysed according to age, nutritional status, and gender. The analysis of variance and multiple logistic regression analysis were performed to investigate the association between dietary/lifestyle factors and overweight/obesity.Results. The percentages of overweight and obesity were, respectively, 28% and 9% among boys, 24% and 7% among girls. The overweight/obesity condition in both genders was associated with parental overweight/obesity ( for mother), less time devoted to physical activity ( for boys and for girls) and being on a diet (). Direct associations were also observed between BMI and skipping breakfast and the lower number of meals a day (boys only).Conclusions. This pilot study reveals some important dietary and lifestyle behaviour trends among adolescents that assist with identification of specific preventive health actions.
Synthesis and Characterization of a Linear [Mn3(O2CMe)4(py)8]2+ Complex
Authors: Moushi Eleni E. , Kizas Christos , Nastopoulos Vassilios , Tasiopoulos Anastasios J.
Published: May 2010

Two new compounds that consist of the linear trinuclear manganese(II) cation [Mn3(O2CMe) 4(py) 8] 2+ cocrystallizing with different counteranions (, [1]; Cl, [2]) are reported. Complex 1 was prepared from the reaction of [Mn(O2CMe) 2]·4H2O with I2 in MeCO2H/py, whereas complex 2 was isolated from the reaction of [Mn3O(O2CMe) 6(py) 3]·py with [Mn(ClO4) 2]·6H2O in MeCN/py. The crystal structures of both compounds were determined by single crystal X‐ray crystallography. Magnetic susceptibility studies that were performed in microcrystalline powder of 1 in the 2–300 K range revealed the presence of antiferromagnetic exchange interactions that resulted in an S = 5/2 ground spin state.
Evaluating the effect of varying clutch frequency in nesting trend estimation of sea turtles
Authors: Matsinos Yiannis , Mazaris Antonios , Pantis John
Published: May 2010

In sea turtle studies, population trend assessments are primarily based on monitoring of beach nesting. Annual nesting abundances are usually estimated by dividing the total number of nests laid during a season by the mean number of clutches deposited annually by nesting turtles, termed clutch frequency. The estimated numbers of annual nester are used for drawing population trends. In the present study, we evaluate the potential effect of individual variability in clutch frequency and successful nest construction, in estimating annual nesting abundance and nesting population trends. We estimate annual nesting abundance and trends by using constant values of clutch frequency. We further develop a stochastic model that simulates breeding performance as an individual based process to produce estimates of annual female abundances. As the next step, we draw population trends by using abundance estimates produced by the model. Our results indicate that nesting abundance estimations are highly affected by stochasticity in nesting behavior. Long term nesting population trends followed annual fluctuations in nester abundance, leading to a great variability in the produced patterns. Our results indicate that population trend estimations which are based on observed numbers of females nesting annually and mean values of clutch frequency are unreliable due to the exclusion of stochastic events that increment nesting performance, thus should be viewed with increased caution. We conclude that more data are needed to be collected in order to produce accurate estimates of sea turtle nesting population tends.
Tandem evolution of diet and chemosensory responses in snakes
Authors: Cooper William
Published: May 2010

Adaptations to foraging requirements have molded sensory capacities of animals in intriguing and sometimes spectacular ways, including evolution of echolocation by bats and infrared detection by pitvipers, as well as of location of prey using lingually sampled chemical cues by actively foraging lizards. Among snakes, specialized diets and geographic differences in diets have evolved many times. Because snakes identify prey by vomerolfactory analysis of chemicals sampled by tongue-flicking, it may be predicted that responsiveness to lingually sampled chemical cues corresponds to diet: It should be much stronger to prey included in than excluded from specialized diets and should covary with geographic dietary differences in prey generalists. Breeding studies in Thamnophis elegans showed that greater responsiveness to local prey in populations having geographically variable diets has a heritable component. Whether strong chemosensory response evolves to match current diet has not been established for snakes using the comparative method. For all paired comparisons of dietary change now available, chemosensory behavior changed so that strongest responses were limited to cues from the current prey. Because diets were specialized and snakes were ingestively naive hatchlings in almost all comparisons, the basis for observed relationships is innate rather than experiential. Snake chemosensory responses have evolved to match current diets.
Habitat features affecting the small-scale distribution and longitudinal migration patterns of Calotriton asper in a Pre-Pyrenean population
Authors: Montori Albert , Llorente Gustavo , Richter-Boix Àlex
Published: May 2010

The longitudinal movements and abiotic factors that determine the distribution of Pyrenean mountain newts (males, females, amplexus and metamorphic newts) were examined in a 1500 meters segment of a Pre-Pyrenean stream. Migration of adult newts was studied by means of capture-recapture techniques in the course of one year. Our results indicate that the mean distance the newts migrated per year was less than 50 meters and the population could be considered sedentary. No significant differences in longitudinal movement patterns between the sexes were observed, and movement patterns were more or less constant over time. Habitat variables determining newt abundance was estimated by means of a GLM. Our results indicate that the number of refugia (wood debris, stones and fissures) determines the distribution of newts. Larval abundance was correlated with stream-bed structure.
Tupinambine teiids from the middle Miocene of north-western Patagonia (Argentina)
Authors: Brizuela Santiago , Albino Adriana María
Published: May 2010

Remains of teiids assignable to the Tupinambinae (Tupinambis sp. or Crocodilurus sp.) are here described from the middle Miocene Collón Curá Formation at Cañadón del Tordillo, in Neuquén province, Argentina. No tupinambine species presently inhabits the region of the fossil locality. The fossils represent the westernmost distribution of fossil tupinambine teiids in Patagonia, enlarging the known geographical distribution of the teiids through the Miocene in a longitudinal range. Also, they constitute the first record of lizards from the Colloncuran SALMA, partially filling the record of tupinambine teiids for the South American Miocene.
Modelling the distribution of the Boid snakes, Epicrates cenchria alvarezi and Boa constrictor occidentalis in the Gran Chaco (South America)
Authors: Di Cola Valeria , Cardozo Gabriela , Lanfri Mario , Scavuzzo Carlos Marcelo , Chiaraviglio Margarita
Published: May 2010

The viviparous snake species Epicrates cenchria alvarezi and Boa constrictor occidentalis inhabit the Gran Chaco region of South America. Ecological factors determining their distribution are poorly known. GIS-based modelling of a species' environmental requirements using occurrence records provides essential information of the species' distribution. We modelled the geographical distribution of E. c. alvarezi and B. c. occidentalis in the Gran Chaco and analyzed the degree to which their distribution is associated with different environmental variables (precipitation, normalized difference vegetation index (NDVI), land surface temperature and altitude) using Logistic Regression Analysis. We found that E. c. alvarezi and B. c. occidentalis would be more frequent in areas with high levels of NDVI (positive relationship with NDVI1), with low levels of precipitation (negative relationship with PRE1) and with lower altitude (negative relationship with ALT). However, the analysis also revealed specific differences in the environmental requirements of the snakes, showing that B. c. occidentalis is more frequent than E. c. alvarezi at sites with higher levels of NDVI. Additionally, E. c. alvarezi is more frequent at sites with lower temperatures in the dry season. The maps obtained show that both are highly likely to be present in the Dry subregion of the Gran Chaco. The results of the present study can be an important contribution to a better understanding of the ecological requirements of the species and of the impact of global environmental change on its distribution.
Habitat use by chameleons in a deciduous forest in western Madagascar
Authors: Soazandry Mathilde , Razafimahatratra Bertrand , Randrianantoandro Christian , Jenkins Richard , Ratsimbazafy Jonah
Published: May 2010

Information on the distribution and abundance of chameleons in Madagascar is required to develop conservation plans that integrate protected area management and sustainable use. We surveyed chameleons in eight sites in deciduous forest in Menabe, western Madagascar. Brookesia brygooi was the most frequently detected species, with a population density of 35 ha–1. Furcifer species were less common, with calculated densities of 7.2 ha–1 (F. labordi), 3.0 ha–1 (Furcifer sp.) and 1.3 ha–1 (F. oustaleti). Chameleon abundance varied according to altitude (B. brygooi) and no clear effect from logging was detected (all species). A lack of information on chameleon diurnal habitat requirements impedes a fuller assessment of the extent to which these species are tolerant to forest degradation. There were interspecific differences in the height of nocturnal perches and additional studies are needed to determine whether these are related to diurnal resource partitioning. Furcifer labordi and Furcifer sp. are of conservation concern because they are restricted to native forests in western Madagascar.
Movements of Alpine newts (Mesotriton alpestris) between small aquatic habitats (ruts) during the breeding season
Authors: Kopecký Oldřich , Denoël Mathieu , Vojar Jiří
Published: May 2010

Many species with complex life cycles, such as caudate amphibians, migrate from terrestrial to aquatic habitats for reproduction. However, movements between reproductive ponds within a breeding season have rarely been studied and are usually considered to be limited. Our aim was to determine whether this pattern occurs frequently in Alpine newts (Mesotriton alpestris) inhabiting complexes of small ruts on muddy forest tracks. We analysed capture-recapture data for individually marked newts as a function of locality, sex, body condition and hydroperiod throughout the breeding season. More than one third of the newts changed their ruts. Movements occurred more often towards ruts that did not dry during the breeding season. The body condition of males that changed ponds (but not that of females) was higher compared to that of resident newts in one of the studied populations. The relatively high frequency of movements between ruts can be seen as an adaptive strategy in unpredictable habitats which have a high probability of drying. The promiscuous pattern of newts also favours low site tenacity, because few sexual partners are available in each rut. Because of the broad occurrence of this kind of habitat, future studies should take into account these movements to better understand newt population dynamics and how to apply adequate conservation measures.
Discordance between ventral colour and mtDNA haplotype in the water frog Rana (ridibunda) caralitana, 1988 Arıkan
Authors: Akın Çiğdem , Bilgin C. Can , Bilgin Metin
Published: May 2010

The water frog form caralitana was first described as a subspecies of Rana ridibunda by Arıkan (1988) from southwestern Turkey. Its orange ventral colour has been used as a diagnostic character since its description. After testing for a correlation between body size and ventral colour, we compared mtDNA and venter colour of adult specimens from 27 localities to assess the validity of this character for systematics of Anatolian water frogs. We mapped the distribution of each category and tested whether there is concordance between mtDNA haplotype and ventral colour of sampled individuals at the watershed level. Furthermore, we analyzed relationships between ventral colour and altitude. Size and ventral colouration were found to be significantly correlated. The distribution of orange ventral colour exhibited a complex clinal variation especially west of the Lake District where different coloured individuals are seen syntopically. In other regions, there were abrupt changes, presumably because of geographic barriers such as mountains. Our results indicate that although there is significant concordance between caralitana-specific mtDNA and orange venter colour, there are certain watersheds where the majority of sampled individuals exhibits discordance in mtDNA and ventral colouration. In all periphery regions, some degree of genetic introgression is indicated. These patterns clearly indicate gene flow between the caralitana lineage and non-caralitana lineages and is supported by lack of evidence for habitat-specific selection, the assignment of individuals from the same population into distinct clades, and the occurrence of an intermediate character between different forms in transition zones.
Distribution and morphological variation of Vipera berus nikolskii Vedmederja, Grubant et Rudaeva, 1986 in Western Ukraine, The Republic of Moldova and Romania
Authors: Ţurcanu Vladimir , Zinenko Oleksandr , Strugariu Alexandru
Published: May 2010

Morphological variation of vipers of the Vipera berus complex in Eastern Romania, the Republic of Moldova and Western and Central Ukraine was studied using multivariate statistics. Discriminant analysis, based on ten meristic characters in 89.7% of cases (males) and in 92.0% cases (females), was able to separate reference samples of subspecies Vipera berus berus and Vipera berus nikolskii and was conducted to classify snakes from the studied territory. According to these results, V. b. nikolskii inhabits the broad-leaved forests in the forest-steppe zone in the Republic of Moldova, the hilly part of Eastern Romania and Central Ukraine. Specimens from a contact zone between V. b. berus and V. b. nikolskii have intermediate morphology and, thus, could represent the result of introgression. Populations of the Nikolsky's viper from the western part of its range combine high level of morphological differentiation from V. b. berus with the presence of non-black specimens and even include populations without melanistic specimens, previously thought not to occur in this taxon. A morphological description of the largest samples is given and determination of V. b. nikolskii is discussed.
Genetic characterization of loggerhead turtle (Caretta caretta) individuals stranded and caught as bycatch from the North-Central Adriatic Sea
Authors: Tinti Fausto , Caputo Vincenzo , Franzellitti Silvia , Cerioni Paola Nisi , Vallini Carola , Giovannotti Massimo , Fabbri Elena , Guccione Sergio
Published: May 2010

The North Adriatic Sea is considered a critical feeding and developmental area for Mediterranean loggerhead turtles. In this study, a comparative analysis of mitochondrial DNA control region sequences was carried out on sixty-five loggerhead individuals stranded and caught as bycatch in the Adriatic Sea from 1999 to 2002. We demonstrated the existence of genetic relationships between the North-Central Adriatic (NCA) aggregate and the Central-Eastern Mediterranean rookeries. Short-range and long-range migrations towards the Adriatic Sea were hypothesized by the finding of individuals bearing haplotypes endemic to the nesting populations of Greece and Turkey. The occurrence of individuals belonging to dimensional classes from juveniles to mature adults strongly support both the feeding and developmental role of the NCA.
Modelling suitable areas for Hyla meridionalis under current and future hypothetical expansion scenarios
Authors: Sillero Neftalí
Published: May 2010

New records of the frog Hyla meridionalis have been reported on the Iberian Central mountain range, although it is not clear if those records correspond to an expansion process or to a lack of sampling. The species' global distribution was modelled to identify possible areas of expansion in the current environment and in a near future environment. To verify the effects of modelling a dynamic situation, the hypothetical expansion process from south to north was simulated in the current scenario. The species records were partitioned in four different datasets and modelled iteratively over a study area enclosing all records: records only from North Africa, from North Africa and South Iberian Peninsula, from North Africa and all the Iberian Peninsula, and from the entire distribution. The complete dataset was also used to extrapolate the model to a current and future global environmental scenarios. The models were compared by subtraction per pairs and by Cohen's Kappa. No spatio-temporal trends were detected in species records; therefore, the hypothesis of a recent expansion is nor supported. The species spread only to the Mediterranean part of the Iberian Peninsula when modelling only with African records, and to Europe when modelling also with Iberian records. The extrapolation models were moderately similar: large suitable areas were predicted in all the continents. Temperature variables contributed more to models. The species can expand to new suitable areas, although it is not possible to know if it would expand outside the biogeographical regions where the species is present.
Intraoperative Intracranial Angiography
Authors: Smith Randall W.
Published: May 2010

Forty-one intraoperative angiograms were performed on 39 patients undergoing surgical therapy for aneurysms or excision of deep arteriovenous malformations. Good quality radiographs were produced in each case using commonly available equipment. One nonfatal stroke syndrome was the only serious complication possibly attributable to these angiograms. The techniques of opacifying the anterior and posterior intracranial circulations are described and the value of angiography in the intraoperative situation is discussed.
The Microsurgical Anatomy of the Basilar Artery Bifurcation
Authors: Grand Walter , Hopkins L.N.
Published: May 2010

The vascular microsurgical anatomy in the area of the basilar artery bifurcation is described in 30 autopsy dissections. Particular emphasis is placed on variations of the posterior thalamoperforators and their relation to the proximal posterior cerebral artery and basilar bifurcation.
Diaphragm Pacing as an Adjunct in Respiratory Insufficiency
Authors: Young Ronald F.
Published: May 2010

Most neurosurgical patients with permanent partial or complete respiratory insufficiency are managed with a mechanical ventilator and tracheostomy. This method presents many medical, technical, emotional, and social problems. A case report is presented that illustrates the potential usefulness of electrical stimulation of the phrenic nerve (“diaphragm pacing”) as an alternate method of therapy for respiratory insufficiency. This paper outlines the indications for, methods of, and problems with such a system and is intended to make its availability more widely appreciated among neurosurgeons.
Intracerebral Ewing's Sarcoma
Authors: Sonntag Volker K. H. , Stein Bennett M.
Published: May 2010

A case of intracerebral Ewing's sarcoma is reported. Neurosurgical intervention was required for treatment. The increasing incidence of central nervous system involvement by Ewing's sarcoma is discussed.
Surgical Management of Unilateral and Bilateral Coronal Craniosynostosis
Authors: Mohr Gerard , Hoffman Harold J. , Munro Ian R. , Hendrick E. Bruce , Humphreys Robin P.
Published: May 2010

From 1955 to 1975, 116 patients with unilateral and bilateral coronal synostosis, including 39 with craniofacial dysmorphism, were treated surgically. Five techniques were used: multiple linear craniectomies, linear craniectomies with supraorbital grafting, morcellation craniotomies, lateral canthal advancement of the supraorbital margin, and radical cranio-orbitofacial reconstruction. Analysis of clinical and radiological indices of the synostotic process, coupled with evaluation of the surgical results, indicates that the anterior skull base is the site of origin of the bony dysplasia. Therefore, early creation of artificial sutures in the skull base is recommended to provide adequate expansion of the frontal bones and consequently of the entire facial skeleton.
Fluorometric Monitoring of NADH Levels in Cerebral Cortex
Authors: Van Buren J.M. , Lewis D.V. , Schuette W.H. , Whitehouse W.C. , Marsan C. Ajmone
Published: May 2010

In 14 patients operated upon for focal cerebral seizures under local anesthesia, cortical electrical activity was compared with the levels of nicotinamide adenine dinucleotide (NADH) observed fluorometrically. NADH levels fell 3 to 15% in response to 5-second intervals of cortical stimulation in 42 of 70 observations. Although a rough correlation was seen between the quantity of current delivered (milliamperes × seconds) and the NADH decrease, this varied from case to case. The presence of cortical afterdischarge often, but not invariably, corresponded to a greater percentage of change in the NADH levels. Averaging the NADH response to sporadic interictal epileptiform discharges failed to demonstrate concomitant NADH reductions. A similar lack of change was seen in four patients in whom low frequency spike foci were induced by topically applied penicillin in cortex destined for excision. Preliminary studies of the topography of spread of NADH change after cortical stimulation indicate that this is usually asymmetrical in human epileptogenic cortex. Under experimental conditions in cats, it seemed possible to differentiate primary from projected epileptiform activity, in that the projected activity had little or no concomitant fall in the NADH level after the electrographic spike. Pathological examination of the excised sites of NADH recording showed, with one exception, fibrous astrocytic transformation of the central cortex layers.
Cerebral Revascularization
Authors: Story Jim L. , Brown Willis E. , Eidelberg Eduardo , Arom Kit V. , Stewart James R.
Published: May 2010

A right common carotid to distal middle cerebral artery bypass utilizing a saphenous vein graft was performed in a patient with episodic cerebral ischemia and reversible ischemic neurological deficit. The patient was relieved of his symptoms, and there was improved motor function in the left hand. Postoperative angiography revealed flow through the graft with excellent filling of the middle cerebral circulation, both retrograde and antegrade. This bypass procedure provided an immediate source of high volume blood flow and thereby provided immediate protection to the hemisphere.
Intracranial Vascular Complications of Choriocarcinoma
Authors: Weir Bryce , MacDonald Neil , Mielke Bruce
Published: May 2010

Choriocarcinoma is the most malignant of the tumors of chorionic tissue that (most commonly) arise from fetal tissues and invade the maternal vasculature. Two cases of choriocarcinoma are presented. One patient had a suprasellar mass in conjunction with a neoplastic carotid-cavernous fistula. The mass and the fistula disappeared after apparently successful radiation therapy and chemotherapy. The second patient had a ruptured arterial aneurysm associated with an intracerebral hematoma treated by evacuation of the hematoma and resection of the aneurysm. The vascular complications of this tumor are reviewed, and a management plan is suggested.
Comparison of the Infratentorial and Transtentorial Approaches to the Pineal Region
Authors: Reid William S. , Clark Kemp W.
Published: May 2010

During the past 10 years, two different operative approaches to the pineal region have been recommended by different authors. Numerous reports have appeared in the literature, indicating the safe use of one or the other of these two techniques for the excision of masses in the pineal region. This paper reports experience with both techniques in the treatment of 15 patients with mass lesions in this area. Four patients underwent a supracerebellar infratentorial approach and 11 patients underwent an occipital transtentorial approach to the pineal region. These two approaches are compared in terms of anatomical exposure, technical difficulties, and real or potential complications. The authors prefer the occipital transtentorial approach in dealing with lesions in the pineal region.
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Authors: Story Jim L. , Brown Willis E. , Eidelberg Eduardo , Arom Kit V. , Stewart James R.
Published: May 2010

A right proximal external carotid to distal middle cerebral artery bypass with a prosthetic tube graft was performed in a patient with intermittent cerebral ischemia due to middle cerebral artery stenosis. The patient was relieved of his symptoms, and he was neurologically normal 3 months after operation. Angiography 3 months postoperatively revealed flow through the graft and excellent filling of the middle cerebral circulation, both retrograde and antegrade. Early results suggest that an expanded polytetrafluoroethylene graft may be useful as a vascular conduit if suitable autogenous vessels are unavailable or have failed.
Anterior Pituitary Function before and after Trans-sphenoidal Microsurgical Resection of Pituitary Tumors
Authors: McLanahan Scott C. , Christy James H. , Tindall George T.
Published: May 2010

Anterior pituitary lobe function was measured pre- and postoperatively in 40 patients with pituitary tumors who were managed surgically by the trans-sphenoidal approach. Of 23 patients with normal anterior lobe function preoperatively, 21 (91%) were normal postoperatively. Of 17 preoperatively impaired patients, 7 (40%) regained normal function, 3 (18%) improved, 4 (24%) remained the same, and 3 (18%) were further impaired by the surgery. In this small series, the likelihood of recovery of pituitary function varied inversely with the degree of preoperative impairment and the size of the tumor, suggesting that more aggressive surgical management of small, minimally symptomatic pituitary tumors is justified.
Cerebral Cysticercosis
Authors: Schultz Thomas S. , Ascherl George F.
Published: May 2010

Six cases of cerebral cysticercosis have been diagnosed at the Neurological Institute of New York during the past 18 years. Three recent cases are discussed, with emphasis on the variability of signs and symptoms and the best available diagnostic techniques. One must have a high index of suspicion when evaluating patients who have immigrated to the United States from endemic areas, although the disease may be acquired through food contaminated by carriers in nonendemic areas. Conventional radiography (e.g., plain films and pneumography) and, more recently, computerized tomography are the most effective tests to confirm this diagnosis. Cerebrospinal fluid and serum eosinophilia and indirect hemagglutination titers are nonspecific but occasionally helpful. Therapy is currently confined to surgical excision of lesions where possible and symptomatic treatment otherwise.
Alterations in the Distribution of Water, Sodium, Potassium, and Chloride in Brain during the Evolution of Ischemic Cerebral Edema
Authors: Bremer Alfonso M. , West Charles R. , Kazuo Yamada
Published: May 2010

Experimental regional cerebral ischemia in the territory of the middle cerebral artery (MCA) in a primate (Macaca mulatta) was produced by selective embolization of the internal carotid artery bifurcation. Determinations of tissue dry weight (percentage) and tissue sodium, potassium, and chloride on samples from the affected and contralateral hemispheres were carried out periodically until 48 hours after the onset of focal cerebral ischemia. Samples from the cortex supplied by the occluded MCA showed excesses in water content, increases in sodium, and decreases in potassium as early as 3 to 4 hours after occlusion. Hemispheric swelling became apparent after 4 to 5 hours, with obvious “gray matter edema.” However, only minimal to moderate increases in the water content of the subcortical white matter (without change in electrolytes) were observed in the same brain sections. Subcortical white matter samples from the affected MCA territory showed gradual increases in water content at 12, 24, and 48 hours, but definite increases in sodium and decreases in potassium were not observed until 24 to 48 hours of ischemia. During this late phase, the “gray matter edema” remained unchanged or underwent partial resolution. Our results agree with data derived from morphological studies suggesting that ischemic cerebral edema develops in a diphasic fashion, with a primary phase of early “gray matter edema” evolving to a secondary phase of late “white matter edema.”
Transoral Exposure of the Atlantoaxial Region
Authors: Apuzzo Michael L. J. , Weiss Martin H. , Heiden James S.
Published: May 2010

A broad spectrum of disease entities affects the atlantoaxial-clival region. This area is readily accessible through a transoral approach, which offers capabilities for canal decompression and fusion. A case is reported that required transoral odontoidectomy with concurrent excision of an osteophyte from the base of an ununited odontoid fracture. Operative preparation, technique, and postoperative management are described in detail. The advantage and applications of the procedure are discussed.
Traumatic Anterior Atlanto-occipital Dislocation
Authors: Powers Barry , Miller Michael D. , Kramer Richard S. , Martinez Salutario , Gehweiler John A.
Published: May 2010

The five cases of atlanto-occipital dislocation reported in the world literature are reviewed, and four additional cases are presented, including two survivors. The pathological anatomy of this potentially catastrophic injury and its management are briefly discussed. Because immediate recognition of the atlanto-occipital dislocation is critical to proper treatment and because the neurological findings are extremely varied, a new radiographic criterion for its identification has been developed.
Autogenous Skull Cranioplasty
Authors: Prolo Donald J. , Burres Kenneth P. , McLaughlin William T. , Christensen Alexander H.
Published: May 2010

Every craniotomy requires immediate replacement of a fresh autograft of skull or, in the presence of cerebral swelling, delayed reimplantation of preserved autogenous skull. Resumption of osteogenesis, the index of viability, determines the effectiveness of these segments of calvaria in protecting the brain and restoring skull conformity. The cellular response in skull replaced either at the end of craniotomy or after frozen preservation was studied by light and fluorescence microscopy, skull roentgenograms, and radionuclide scintigraphy. In 5 patients eventual total remodeling of skull was found at the time of a second craniotomy performed from 1 to 19 years after the first. In 12 patients skull sections removed aseptically at craniotomy were frozen and stored for 1 to 35 months at −20°C in bacitracin. This cytotoxic preservative method fixed the tissue, which appeared unchanged on light microscopy and was sterile on bacteriological and fungal cultures. In 53 patients who underwent autogenous cranioplasty with skull stored frozen for 3 weeks to 19 months, 48 operations were totally successful. Complications included infections in 2 patients, resorption in 2 infants, and incomplete restoration in 1 adult. In 10 patients the sequential dynamics of skull revitalization were found to be: revascularization, resorption, and accretion. The repair of membranous skull is similar to that of endochondral bone of the skeleton. Skull is metabolically intensely active after reimplantation and is the ideal material for cranioplasty.
Cerebral Arterial Spasm
Authors: Allen George S. , Banghart Suzanne B.
Published: May 2010

We performed in vitro experiments with a small volume chamber to determine the inhibitory effect of nifedipine on serotonin-, phenylephrine-, and potassium-induced contractions of canine basilar and femoral arteries. Nifedipine, an inhibitor of the influx of extracellular calcium into smooth muscle cells, was found to be a sensitive inhibitor of contractions of the basilar artery induced by all three agents. In contrast, nifedipine did not significantly inhibit the serotonin- and phenylephrine-induced contractions of the femoral artery but did inhibit potassium-induced contractions of the femoral artery. Calcium-induced contractions of the basilar artery were also inhibited by nifedipine. These experiments demonstrate a relatively selective effect of nifedipine on the basilar artery, and a mechanism to explain this selective effect is postulated.
Cerebral Arterial Spasm
Authors: Allen George S. , Bahr Albert L.
Published: May 2010

In vivo experiments in dogs demonstrated angiographically that the subarachnoid injection of blood produced cerebral arterial spasm both immediately after the injection of blood and 2 days later. The sublingual administration of nifedipine reversed both the acute and the delayed cerebral arterial spasm. In addition, sublingual administration of nifedipine 20 minutes before the subarachnoid injection of blood prevented the acute spasm.
Neurogenic Tumors of the Brachial Plexus
Authors: Richardson Robert R. , Siqueira Edir B. , Oi Shizuo , Nunez Carlos
Published: May 2010

Two cases of solitary neurogenic tumors of the brachial plexus unassociated with von Recklinghausen's disease are presented. One patient had a malignant schwannoma. The lesion of the other patient was benign and was diagnosed pathologically as a plexiform neurofibroma. These uncommon neurogenic tumors of the brachial plexus unassociated with von Recklinghausen's disease pose diagnostic and surgical problems. The initial clinical presentation is usually that of a painless supraclavicular mass. At the time of surgical exploration, the exact site or nerve of origin cannot always be identified. If motor loss is caused by such a tumor of the brachial plexus, it usually indicates a malignant lesion and a poor prognosis. Although wide radical excision of a malignant neurogenic tumor is indicated surgically, one of our patients had an early malignant recurrence that necessitated immediate amputation.
Meningiomas of the Paranasal Sinuses, Benign and Malignant
Authors: Sadar Edward S. , Conomy John P. , Benjamin Sanford P. , Levine Howard L.
Published: May 2010

Three cases of paranasal sinus meningioma are presented. Their variable pathology, including angioblastic and sarcomatous changes in two of the cases, and their persistent course are emphasized.
Expanding Pneumocephalus Due to Nitrous Oxide Anesthesia
Authors: Raggio John F. , Fleischer Alan S. , Sung Yung Fong , Hoffman James C.
Published: May 2010

A patient who developed transtentorial herniation postoperatively was successfully treated by needle aspiration of the subdural space with removal of gas under pressure. This case demonstrates the diagnosis by CT scan and the successful management of expanding pneumocephalus due to the diffusion of nitrous oxide anesthetic into an intracranial air cavity.
Absence of Neurological and Behavioral Abnormalities after Anterior Transcallosal Operation for Third Ventricular Lesions
Authors: Winston K. R. , Cavazzuti V. , Arkins T.
Published: May 2010

abstract

Four children who had each undergone a transcallosal operation for a lesion in the anterior 3rd ventricle were studied extensively for behavioral abnormalities of the type that might follow a disruption of the corpus callosum. No such abnormalities were found. The operative technique used in these children is described.
Pituitary Adenoma Presenting as Post-traumatic Oculomotor Palsy
Authors: de Araujo Luiz Carlos , Zappulla Rosario A. , Quinonez Rafael O. , Noh Jae M.
Published: May 2010

abstract

Two cases of oculomotor palsy occurring after head injury in a patient with an unsuspected pituitary adenoma are presented. A possible explanation for the appearance of this sign is suggested. The literature on post-traumatic oculomotor palsy is briefly reviewed.
Intracranial Pressure Time Course in Primary Intracerebral Hemorrhage
Authors: Papo Isacco , Janny Pierre , Caruselli Giuseppe , Colnet Gilles , Luongo Antonio
Published: May 2010

abstract

The course of intracranial pressure (ICP) over time was studied in 66 hypertensive and/or atherosclerotic patients harboring intracerebral hematomas. Patients with no disturbance of consciousness showed normal or only slightly elevated pressure. Conversely, most patients in deep coma exhibited high pressure with a tendency to rise further no matter what treatment was used. In the remaining patients with intermediate disturbances of consciousness, no definite correlation was found between ICP, clinical condition, and outcome. In all of the patients who underwent operation, the postoperative course of ICP over time was also studied and seemed to depend to a certain extent on the timing of the operation.
Use of Anal Sphincter Electromyography during Operations on the Conus Medullaris and Sacral Nerve Roots
Authors: James Hector E. , Mulcahy John J. , Walsh John W. , Kaplan George W.
Published: May 2010

abstract

The mechanical activity of the anal sphincter can be translated into electrical activity and recorded on graph paper or an oscilloscope. The activity of the anal sphincter may be extrapolated to activity of the external urethral sphincter because both are striated muscles innervated by the pudendal nerve that arises from S-2, S-3, and S-4. Stimulation of these nerves causes contraction of the sphincter muscles, and a deflection of the recording device occurs. This technique was employed intraoperatively in monitoring operations on the conus medullaris and sacral nerve roots in 10 patients with spinal dysraphism (age range, 3 weeks to 15 years). Their diagnoses were tethered conus, 4; lipomeningocele, 3; spinal hamartoma, 1; syringocele, 1; and sacral arachnoiditis, 1. With general anesthesia, and the patient in the prone position, an electrode-containing anal plug was inserted or two needle electrodes were inserted into the anal sphincter muscle. The electrodes were connected to the electromyography recording stylus of the urodynamic bladder diagnostic unit. During the spinal operation, whenever a structure could not be identified clearly, it was stimulated with the disposable electrical stimulator and, if oscillations of the stylus occurred (indicating contraction of the anal sphincter), the structure was preserved. This technique permitted spinal operations in these 10 patients without changes in neurological or urological function.
Time Course of Serotonin-induced Vasoconstriction
Authors: Silverberg Gerald D. , Ross Gordon , Corbin Steven D. , New William
Published: May 2010

abstract

Canine cerebral arterial segments tested in a tissue bath were found to escape from the vasoconstrictor effects of serotonin, the basilar segments more rapidly than the middle cerebral segments. At low doses (10−9M), serotonin caused a small, prolonged contraction, whereas at higher doses (10−6M), a more forceful phasic response was seen. Verapamil blocked the phasic portion of the response but not the low amplitude sustained portion. Increasing the bath concentration of K+, Ba++, and tetraethylammonium markedly enhanced the constrictor response of low serotonin doses and significantly inhibited escape. Potentiation of the force and duration of vasoactive amine-induced arterial constriction by small increments of extracellular K+ might be important in the prolonged vascular narrowing associated with subarachnoid hemorrhage.