bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined effect of respirator-induced ventilation and superoxide dismutase in experimental brain injury
Authors: Levasseur Joseph E. , Patterson John L. , Ghatak Nitya R. , Kontos Hermes A. , Choi Surg C.
Published: May 2009

✓ The function-specific enzyme superoxide dismutase (SOD) was tested for its protective effect in severe experimental fluid-percussion brain injury (4.45 ± 0.10 atm) in 30 of 60 randomly selected male Sprague-Dawley rats. A respirator was used only in the event of need. The number of animals with permanent resumption of spontaneous breathing (Type I respiratory response) remained essentially the same in each group. However, when Type II apnea (cannot maintain recovery) and Type III apnea (never recovers from the initial apnea) were terminated with a respirator, all rats with Type II responses from each group were successfully converted to a state of sustained spontaneous breathing. In contrast, only five (41.7%) of the 12 rats with Type III response were salvaged in the control group while five (83.3%) of six Type III rats in the SOD-treated group were saved. The results reveal the nature of the therapeutic effectiveness of superoxide radical scavengers in the overall outcome of head injury in this animal model. While SOD alone did not increase the number of spontaneous survivors, the drug shifted a number of animals from the critically injured rats with Type III respiratory response to the less critical Type II condition. Whereas induced respiration as the sole therapy in the control group lowered the mortality rate to 23.3%, respiratory assistance together with SOD treatment reduced the “mortality” to a single animal with Type III apnea (3.3%) which was alive but still required the respirator after 2 hours (p < 0.001). The results show that respiratory assistance alone accounted for a 33% decrease in mortality rate and that SOD, given in addition to induced ventilation, further decreased mortality by 20%. Since SOD enzymes are reactively specific for superoxide, the increased survival rate of the brain-injured rat must have been due either to preventing or to minimizing pathophysiological changes, probably in the brain stem, caused by oxygen free radicals.
The influence of fat tissue on neuroma formation
Authors: Weis Joachim , Schröder J. Michael
Published: May 2009

✓ The proximal stumps of transected sciatic nerves were implanted into an abdominal pedicle flap of fat tissue in rats. Nerve stumps that had been transected without implantation into fat tissue served as control experiments. At 4, 8, or 24 weeks postoperatively, the rats were sacrificed and the neuromas at the transected nerve ends together with the adjacent fat tissue were studied after intra-aortal perfusion fixation. Light microscopy revealed no significant difference in neuroma size between the two groups. In most animals with fat implantation, however, infiltration of fat tissue beyond the margins of the solid neuromatous bulb by regenerating nerve fibers was limited to rare axons growing along blood vessels and connective tissue strands. In only a few instances was the fat tissue itself invaded by minifascicles as was usually seen in the connective tissue surrounding control neuromas. It is concluded that diffuse outgrowth of nerve fibers is limited to some extent by fat tissue, which, however, is not an impermeable barrier for regenerating nerve fibers. Nevertheless, in a fat tissue flap, the neuroma is placed in a “soft pressure-free bed” which might be a prerequisite for permanent diminution of pain sensitivity.
Control of extraneural metastasis of a primary intracranial nongerminomatous germ-cell tumor
Authors: Watterson Jan , Priest John R.
Published: May 2009

✓ Primary intracranial germ-cell tumors are infrequently occurring neoplasms which most often arise in the pineal or sellar regions. Germinomas are seen more frequently than nongerminomatous germ-cell tumors; they are often curable with radiotherapeutic approaches, or with chemotherapy in the rare instance of extraneural metastasis. Nongerminomatous germ-cell tumors are relatively radioresistant and when extraneural metastasis has occurred, they have been fatal in all of the 32 previously reported cases.

The case of a 14-year-old girl with a mixed malignant germ-cell tumor arising in the pineal region is reported. Extraneural metastasis to the lung developed 12 months after whole-brain radiotherapy was completed. She was treated with etoposide (VP-16), high-dose cisplatin, vinblastine, and bleomycin and is currently without evidence of disease 46 months postmetastasis.
Surgical removal of giant acoustic neurinomas involving the skull base
Authors: Sawamura Yutaka , Nakagawa Yoku , Ikota Toshio , Abe Hiroshi
Published: May 2009

✓ Neurinomas arising from the peripheral branch of the acoustic nerve distal to the internal auditory canal in the temporal bone are rare. Two advanced skull-base neurinomas are described which were situated mainly in the temporal petrous bone, and extended to the parapharyngeal space anteriorly, to the lateral cervical portion inferiorly, into the sphenoidal sinus medially, and into the middle and posterior cranial fossae compressing the brain stem. Both patients had been deaf for several years without other neurological deficits. The operative findings revealed that the fifth, seventh, and caudal cranial nerves were intact; therefore, it was suspected that these neurinomas originated primarily within the cochlea or the vestibule in the temporal bone. The tumors were completely removed via an extradural approach, with good results. Since the surgical treatment of such advanced skull-base neurinomas is difficult, the operative infratemporal fossa approach is described in detail.
Syringomyelia extending to the basal ganglia
Authors: Okada Satoshi , Nakagawa Yoshio , Hirakawa Kimiyoshi
Published: May 2009

✓ A 10-year-old girl was admitted to the hospital with complaints of progressive right hemiparesis and sensory disturbance. Magnetic resonance imaging revealed a Chiari Type I malformation and syringomyelia from T-10 to C-1. The syrinx extended from the medulla to the right putamen along the pyramidal tract.
Vacuum-stiffened beanbag for cranial remodeling procedures in modified prone position
Authors: Park T. S. , Broaddus William C. , Harris Mark , Persing John A. , Jane John A.
Published: May 2009

✓ In surgical correction of multiple-suture synostosis, placing the patient in the modified prone position permits access to the calvarium from the supraorbital ridge to the occipital bone below the transverse sinus. The modified prone position thereby enables surgeons to perform cranial remodeling procedures at one stage under direct vision, contributing to improved surgical results. However, no satisfactory head-frame for this position has been available.

The authors report the successful use of a vinyl bag filled with styrofoam beads to achieve the modified prone position in young children. This widely available, economical device provides a safe, reliable means of positioning the child's head for cranial remodeling procedures.
A century of change in neurosurgery at Johns Hopkins: 1889–1989
Authors: Long Donlin M.
Published: May 2009

✓ Neurosurgical admissions to The Johns Hopkins Hospital during the first year of its existence, the first and last years of Harvey Cushing's practice, the last years of Walter Dandy's practice, the last years of Earl Walker's tenure, and the current neurosurgical case load are reviewed. Sixteen patients with neurosurgical problems were admitted during the first year of the hospital's existence. In the first year of Harvey Cushing's staff appointment, 38 neurosurgical patients were admitted. Infection, trauma, and trigeminal neuralgia were the most common neurosurgical problems at that time. When Harvey Cushing retired in 1912, his practice had grown to 100 operations per year. By the end of Walter Dandy's tenure, the surgical volume was much larger, more than 500 major operations per year.

The development of neurosurgery virtually can be mirrored in the practice of neurosurgery under Harvey Cushing and Walter Dandy. From its humble beginnings in the treatment of trauma and infection, neurosurgery has expanded to cover all forms of intracranial disease, virtually every aspect of spinal disease, vascular disease (both intracranial and extracranial), and peripheral nerve injury. The centennial celebration at Johns Hopkins may be considered a centennial for neurosurgery. As we reflect upon our foundations, it is worthwhile to ask what changes we will contribute to the further development of neurosurgery in the next century.
Systemic beta-interferon therapy for recurrent gliomas: a brief report
Authors: Mahaley M. Stephen , Dropcho Edward J. , Bertsch Linda , Tirey Tammy , Gillespie G. Yancey
Published: May 2009

✓ Recombinant beta-interferon in escalating dosages was administered intravenously three times weekly to seven patients with recurrent gliomas. No evidence of response was seen in any patient, either on neurological examination or by computerized tomography (CT). However, stabilization of tumor volume, assessed from contrast-enhanced CT scans, occurred for 8 to 26 weeks in three patients. Immediate progression of disease despite treatment occurred in four patients.
Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage
Authors: Newell David W. , Eskridge Joseph M. , Mayberg Marc R. , Grady M. Sean , Winn H. Richard
Published: May 2009

✓ Angioplasty of narrowed cerebral arteries was performed in 10 patients who became symptomatic from vasospasm following subarachnoid hemorrhage. This procedure was accomplished with a microballoon catheter via percutaneous transfemoral insertion. Patients were selected for treatment if they had delayed neurological deficits due to vasospasm which were not responsive to hypervolemic hypertensive therapy. Eight patients (80%) showed sustained improvement in neurological function following the procedure. In two patients transcranial Doppler ultrasound recordings were obtained which revealed decreased mean blood flow velocities following angioplasty. Two patients died, one from an aneurysmal rebleed, and one secondary to diffuse vasospasm. There was one case of delayed stroke 6 weeks following the procedure. The overall results of this series indicate that in selected cases percutaneous balloon angioplasty can offer marked improvement to patients with ischemic deficits due to vasospasm following subarachnoid hemorrhage.
Clinical experience with a continuous monitor of intracranial compliance
Authors: Robertson Claudia S. , Narayan Raj K. , Contant Charles F. , Grossman Robert G. , Gokaslan Ziya L. , Pahwa Rajesh , Caram Pedro , Bray Robert S. , Sherwood Arthur M.
Published: May 2009

✓ Intracranial compliance, as estimated from a computerized frequency analysis of the intracranial pressure (ICP) waveform, was continuously monitored during the acute postinjury phase in 55 head-injured patients. In previous studies, the high-frequency centroid (HFC), which was defined as the power-weighted average frequency within the 4- to 15-Hz band of the ICP power density spectrum, was found to inversely correlate with the pressure-volume index (PVI). An HFC of 6.5 to 7.0 Hz was normal, while an increase in the HFC to 9.0 Hz coincided with a reduction in the PVI to 13 ml and indicated exhaustion of intracranial volume-buffering capacity. The mean HFC for individual patients in the present study ranged from 6.8 to 9.0 Hz, and the length of time that the HFC was greater than 9.0 Hz ranged from 0 to 104.8 hours. The mortality rate increased concomitantly with the mean HFC, from 7% when the mean HFC was less than 7.5 Hz to 46% when the mean HFC was 8.5 Hz or greater. The length of time that the HFC was 9.0 Hz or greater was also associated with an increased mortality rate, which ranged from 16% if the HFC was never above 9.0 Hz to 60% if the HFC was 9.0 Hz or greater for more than 12 hours. In 12 patients who developed uncontrollable intracranial hypertension or clinical signs of tentorial herniation during the monitoring period, 75% were observed to have had an increase in the HFC to 9.0 Hz or more 1 to 36 hours prior to the clinical decompensation. The more rapid the increase in the HFC, the more likely the deterioration was to be caused by an intracranial hematoma. Continuous monitoring of intracranial compliance by computerized analysis of the ICP waveform may provide an earlier warning of neurological decompensation than ICP per se and, unlike PVI, does not require volumetric manipulation of intracranial volume.
The effect of somatostatin analogue on chiasmal dysfunction from pituitary macroadenomas
Authors: Warnet André , Timsit José , Chanson Philippe , Guillausseau Pierre-Jean , Zamfirescu Françoise , Harris Alan G. , Derome Patrick , Cophignon Jean , Lubetzki Jean
Published: May 2009

✓ The long-acting somatostatin analogue SMS 201-995 has been shown to be efficient in the treatment of somatotropic and thyrotropic adenomas. In some cases, it can suppress adenoma secretion and lead to tumor shrinkage. Pituitary macroadenomas are often associated with a vision-threatening chiasmal syndrome. In this series, SMS 201-995 was administered subcutaneously to eight patients with pituitary macroadenomas of various types responsible for severe long-lasting visual defects. An obvious improvement of both visual fields and acuity occurred in six patients, in two of these during the first 4 to 6 hours of treatment; in two patients, gonadotropic adenomas were unresponsive. Maximal improvement (normalization of visual fields in three cases) occurred within 6 to 45 days and was sustained during the 1- to 12-month follow-up period. This effect seems independent of the type of adenoma since the adenomas secreting growth hormone (GH) and thyroidstimulating hormone and silent corticotropic-secreting adenomas responded as well as did two of the non-functioning adenomas. In one acromegalic patient visual improvement was obtained while the abnormal GH secretion remained unaltered. In all cases but one, no tumor shrinkage could be demonstrated. These data demonstrate that SMS 201-995 can rapidly improve the chiasmal syndrome due to pituitary macroadenoma, and suggest that this effect might be independent of a reduction in tumor volume.
Murine intracerebral interleukin-2 injection: pathological and immunological effects
Authors: Yamasaki Toshiki , Kikuchi Haruhiko , Paine Jonathan T. , Yamashita Junkoh , Miyatake Shin-ichi , Iwasaki Kouichi , Kobayashi Hiroshi , Namba Yuziro , Hanaoka Masao
Published: May 2009

✓ The authors have investigated whether specific pathological changes and antibodies against interleukin-2 (IL-2) are induced after intracerebral administration of recombinant IL-2 (rIL-2). In addition, IL-2 receptor (IL-2R) expression was checked on the cell surface of normal brain tissues before and after the intracerebral infusion. Reconstituted rIL-2 (specific activity 1.2 × 107 U/mg protein) was injected into the right cerebral hemisphere of normal adult C57BL/6 mice in three different dose groups, each receiving single or multiple infusions of 8, 32, or 80 U. In sham control experiments, mouse albumin purified by gel filtration and ion exchange chromatography and adjusted to the same concentration of protein as rIL-2 was injected into mice at various doses. Anti-IL-2 antibodies were measured by an enzyme-linked immunosorbent assay concurrently with assessment of IL-2 activity in serum. The IL-2R expression was determined by using immunofluorescence techniques with monoclonal antibodies against mouse IL-2R. Since histological alteration after rIL-2 injection did not differ from that in the sham control preparations, it seems that there is no direct toxic action of rIL-2 on normal brain tissues. Interleukin-2 antibodies were produced at low levels only in mice injected repeatedly at the maximum dose, and levels were insignificant in other groups. Serum levels of IL-2 activity remained low. The IL-2R expression within the brain was not enhanced within 8 weeks following the intracerebral administration of rIL-2, suggesting that direct intracerebral infusion of rIL-2 may be safely used in the immunotherapy of brain tumors.
Posttraumatic narcolepsy: the complete syndrome with tissue typing
Authors: Good Janine L. , Barry Elizabeth , Fishman Paul S.
Published: May 2009

✓ Although sleep disturbances following head injury are common, well-documented posttraumatic narcolepsy has rarely been reported. A patient with all four major features of narcolepsy following significant head injury is presented. Tissue typing revealed the presence of the human lymphocyte antigen DR2, which is strongly associated with idiopathic narcolepsy. Interaction between the brain injury and a genetic predisposition appears to be involved in the development of posttraumatic narcolepsy.
Sacral lipoma of the filum terminate with dural arteriovenous fistula
Authors: Djindjian Michel , Ayache Patrick , Brugieres Pierre , Poirier Jacques
Published: May 2009

✓ A patient presenting with progressive paraparesis was found to have a dural sacral arteriovenous (AV) fistula. His condition deteriorated abruptly after thoracolumbar angiography. Embolization of the fistula improved the patient's status so that he was able to walk with crutches. One year later his neurological condition worsened. He was treated via an enlarged laminectomy because of uncertainty concerning a lipoma noted on the initial computerized tomography scan. The lesion consisted of an intradural filum terminale lipoma associated with an AV fistula, both of which were excised. The patient's condition was unchanged 6 months later. The different types of spinal lipomas and spinal AV malformations are reviewed, and mechanisms are proposed to explain the clinical deterioration in this patient. Venous hypertension seems to be the most likely possibility. The lipoma may have produced local hypervascularization of the dura mater with a subsequently acquired AV fistula.
Subependymoma of the thoracolumbar cord
Authors: Guha Abhijit , Resch Lothar , Tator Charles H.
Published: May 2009

✓ Subependymomas are benign, usually asymptomatic, intraventricular tumors, the origin of which remains controversial. Spinal cord subependymomas are rare; a literature review yields 10 previous cases which are critically appraised in this report. A case of thoracolumbar intramedullary subependymoma is reported, and the histology, ultrastructure, and pre- and postoperative management are reviewed. Awareness that subependymomas may occur as a separate entity in the spinal cord should lead to increased frequency of diagnosis and a better understanding of the biological behavior of these tumors.
Surgery of spinal nerve schwannoma
Authors: Kim Phyo , Ebersold Michael J. , Onofrio Burton M. , Quast Lynn M.
Published: May 2009

✓ When surgically removing a spinal nerve schwannoma, preservation of the involved root is attempted and may be feasible. However, in large tumors, sacrifice of the nerve root is often required to achieve total removal of the tumor, and the resection does not always result in postoperative neurological deficit. The present study was designed to determine the incidence and extent of neurological deficit as correlated with resection of the root, performed between 1976 and 1987 in 86 cases at the time of total removal of spinal schwannoma. Thirty-one patients underwent sacrifice of a root critical for the function of the upper (C5–T1, 14 cases) or the lower extremities (L3–S1, 17 cases). This report is limited to these 31 cases. Only seven patients (23%) developed detachable motor or sensory deficits postoperatively. All deficits were no more than partial loss of strength or sensation. Fifteen of the 31 patients had large tumors with extradural components, which necessitated sacrifice of the entire motor and sensory radix; however, 11 (76%) of these 15 did not develop any deficits referrable to the involved myotome or dermatome. Six cases showed histological characteristics of “neurofibroma,” with axons intermingled in the tumor, and none developed a postoperative deficit. Preoperative electromyography was performed in 23 cases. Of 13 patients with findings of denervation, five developed deficits after surgery; the other 10 patients showed no evidence of denervation, and none had deficits after surgery.

These results indicate that the spinal roots giving origin to schwannoma are frequently nonfunctional at the time of surgery, and risks of causing disabling neurological deficit after sacrificing these roots are small.
Pre-irradiation chemotherapy for infants and children with medulloblastoma: a preliminary report
Authors: Kretschmar Cynthia S. , Tarbell Nancy J. , Kupsky William , Lavally Beverly L. , Loeffler Jay S. , Wolfe Lawrence , Strand Roy , Scott R. Michael , Sallan Stephen E.
Published: May 2009

✓ From March, 1984, through June, 1987, 21 newly diagnosed children with high-risk medulloblastoma (Chang Stage T3 to T4) were treated on a 9-week postoperative, pre-irradiation chemotherapy regimen consisting of vincristine and cisplatin. The children over 2 years old then received radiation therapy. Six infants (aged 6 to 18 months) were maintained on chemotherapy consisting of MOP (nitrogen mustard, vincristine, and procarbazine) until the age of 2 years, at which time they were referred for irradiation. Of 13 children with measurable disease following surgery, five showed a definite response on computerized tomography scans to vincristine and cisplatin (one complete response and four partial responses) and five others showed clear marginal responses. Four of the six infants were disease-free at 19, 32, 35, and 57 months from diagnosis. One infant developed progressive disease at the completion of the vincristine and cisplatin course, and a second infant had progression during MOP administration. Three of the 21 children developed hearing loss within the speech frequencies during cisplatin treatments, but there were no other major toxicities. Fifteen children remained disease-free with a median follow-up period of 35 months (range 19 to 57 months). Chemotherapy given between surgery and radiotherapy may allow for the direct evaluation of a specific drug regimen and permit the postponement of radiation therapy in infants. Pre-irradiation vincristine and cisplatin was well tolerated and effective in shrinking the tumor in most children with medulloblastoma. Such chemotherapy regimens have the potential for extending long-term survival in high-risk children.
Primary intraspinal neoplasms in Norway, 1955 to 1986
Authors: Helseth Are , Mørk Sverre J.
Published: May 2009

✓ A survey of all patients (173 males and 294 females) registered with primary intraspinal neoplasms in the Norwegian Cancer Registry from 1955 through 1986 is presented. Annual age-adjusted incidence rates of new tumors per one million population were three for males and five for females. Altogether, 89% of the tumors were verified histologically. Meningioma was the most common tumor type, followed by ependymoma and neurilemoma. Intraspinal ependymomas accounted for 34.5% of all 223 ependymomas of the central nervous system, whereas only 0.2% of the 3046 glioblastomas were found intraspinally. Patients with intraspinal meningioma had a better life expectancy than those with intracranial meningioma. The 5-year relative survival rate for patients with intraspinal ependymoma was 88.9% in contrast to 24.4% for patients with intracranial ependymoma.
Surgical alternatives in the treatment of cavernous sinus aneurysms
Authors: Diaz Fernando G. , Ohaegbulam Sam , Dujovny Manuel , Ausman James I.
Published: May 2009

✓ Direct surgery on aneurysms in the cavernous sinus is a formidable technical procedure. The intimate relationship of the intracavernous carotid artery to the venous structures and to the cranial nerves make surgical access difficult at best. Thirty-two of 356 aneurysm patients presented with symptomatic aneurysms originating from the intracavernous internal carotid artery. Twenty-one patients had aneurysms contained entirely within the cavernous sinus, and in 11 others the aneurysms arose within the cavernous sinus and extended into the subarachnoid space. Of the purely intracavernous aneurysms there were five small aneurysms (< 25 mm) and 16 giant (≥ 25 mm) aneurysms. Fifteen patients with purely intracavernous lesions had a superior orbital fissure syndrome, and six had a variety of other symptoms. Of 11 patients with subarachnoid extension, five had a subarachnoid hemorrhage (Grade I or II), five had ipsilateral visual loss, and one had periorbital pain. The aneurysms were treated as follows: Group 1 received progressive ligation of the internal carotid artery in the neck with a Selverstone clamp and a surface superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (purely intracavernous in nine, and with subarachnoid extension in one); Group 2 underwent trapping of the internal carotid artery and a deep STA-MCA anastomosis (purely intracavernous in seven); and Group 3 had direct clipping of the aneurysm (purely intracavernous in five, and with subarachnoid extension in 10).

The cavernous sinus was entered directly through its roof by a pterional craniotomy with radical removal of the optic canal, lesser sphenoid wing, and lateral and superior orbital walls. Proximal control of the internal carotid artery was obtained through a cervical incision. Two patients in Group 1 developed transient neurological deficits, which resolved. Two patients in Group 2 developed a cerebral infarction, one of whom died; in both of these patients, the anastomosis was completed after the internal carotid artery occlusion. Two patients in Group 3 progressed from marked visual loss to blindness of the same side, and one developed an intraventricular hemorrhage during induction of anesthesia and died without surgery. It is proposed that a direct approach to symptomatic aneurysms in the cavernous sinus is the best initial alternative. When this approach is not feasible, a trapping procedure preceded by a high-flow extracranial-intracranial anastomosis may be considered. Although the authors have been able to clip aneurysms of various sizes, this has not been possible in all patients. Further work is needed in this area.
Effects of ML-9 on experimental delayed cerebral vasospasm
Authors: Kokubu Kiyokazu , Tani Eiichi , Nakano Masaru , Minami Nobutaka , Shindo Hideki
Published: May 2009

✓ Experimental delayed cerebral vasospasm was produced in a two-hemorrhage canine model. The spastic basilar artery was exposed via the transclival route under a surgical microscope, and was dilated by the topical application of 1-(5-chloronaphthalenesulfonyl)-1H-hexa-hydro-1,4-diazepine(ML-9), a selective antagonist of myosin light chain kinase. Dilation was dose-dependent, with a median effective dose (± standard deviation) of 51.4 ± 6.9 µM. In addition, 50 µM of ML-9 was injected into the cisterna magna until the intracranial pressure (ICP) reached 200 mm H2O for 30 minutes, including a complete reversal of angiographic delayed vasospasm in three of seven dogs; in contrast, 150 µM of ML-9 was infused at 1.52 ml/min into the vertebral artery for 30 minutes, producing little dilation of the spastic basilar artery. In another study, the intracisternal perfusion of 50 µM of ML-9 at 1.48 ml/min for 30 minutes in dogs with an ICP of less than 200 mm H2O produced no serious electroencephalographic abnormalities, and the mean arterial blood pressure and pulse rate remained normal; no neurological deficits or significant histological abnormalities ascribable to the intracisternal ML-9 were found.
Multiple dural arteriovenous malformations
Authors: Kuwayama Naoya , Takaku Akira , Nishijima Michiharu , Endo Shunro , Hirao Masato
Published: May 2009

✓ Two cases of multiple dural arteriovenous malformations (AVM's) in different locations are reported. One patient was diagnosed as having a dural AVM involving the right cavernous sinus that disappeared spontaneously 4 months after onset of symptoms. After an interval of 4 months, another dural AVM appeared involving the right lateral sinuses (transverse and sigmoid sinuses) with occlusion of the right sigmoid sinus. In the other patient, multiple dural AVM's were demonstrated on angiography, one involving the cavernous sinus and the other the left lateral sinus. The frequency of multiple occurrence and possible mechanisms of sinus occlusion are discussed.
The “thousand-hands Kannon” universal headframe
Authors: Tamaki Norihiko , Ehara Kazumasa , Matsumoto Satoshi
Published: May 2009

✓ The authors describe a new headframe system, by which a variety of instruments, such as brain retractors, suction tubes, mirrors, forks, armrests, and cotton-sheet trays, can be simultaneously supported. This frame enables neurosurgeons to perform operations with greater ease and fewer problems.
Clinical analysis and prognostic study of ossified ligamentum flavum of the thoracic spine
Authors: Shiokawa Kazuhiko , Hanakita Junya , Suwa Hideyuki , Saiki Masaaki , Oda Masashi , Kajiwara Motohiro
Published: May 2009

Object. A variety of factors may affect surgery-related outcome in patients with ossification of the ligamentum flavum (OLF) of the thoracic spine. The aim of this study was to determine these factors on the basis of preoperative clinical and radiological findings.

Methods. The authors treated 31 cases of symptomatic thoracic OLF between 1988 and 1999. The following factors were retrospectively studied: patient age, sex, morbidity level, initial symptoms, chief complaint, duration of symptoms, patellar reflex, Achilles reflex, computerized tomography (CT) finding, presence of intramedullary change determined by magnetic resonance imaging, coexistent spinal lesions, preoperative grade, and postoperative grade.

A decompressive laminectomy was performed in all cases. In 29 patients (94%) improved symptoms were demonstrated postoperatively. In terms of functional prognosis, the preoperative duration of symptoms was significantly shorter in the group of patients with excellent outcomes than in those with fair outcomes (p < 0.05).

No significant difference was observed in the correlation between other factors. To evaluate the degree of preoperative thoracic stenosis and the severity/extent of OLF-induced spinal compression, we used an original OLF CT scoring system. A score of excellent on the CT scale tended to indicate an excellent prognosis (p < 0.01).

Conclusions. Thoracic OLF frequently develops in the lower-thoracic spine in middle-aged men, and it is complicated by various spinal lesions in many cases. Early diagnosis and treatment are important for understanding the clinical symptoms and imaging diagnosis because the present findings suggest that a delay in diagnosis and treatment correlates with the functional prognosis postoperatively.
Autotransfusion by cell saver technique in surgery of lumbar and thoracic spinal fusion with instrumentation
Authors: Chanda Amitabha , Smith Donald R. , Nanda Anil
Published: May 2009

Object. The authors used a modern cell saver technique to perform autotransfusion in patients undergoing instrument-assisted lumbar and/or thoracic spinal fusion, in whom significant blood loss was anticipated. The safety and benefits of this procedure as well as its cost effectiveness were analyzed.

Methods. The authors studied 50 patients who underwent lumbar and/or thoracic spinal fusion in which instrumentation was placed between January 1998 and June 2000 and in whom an estimated blood loss of 500 ml or more was expected. All surgeries were conducted by a single neurosurgeon (D.R.S.). During surgery, the Brat 2 cell saver system was used to salvage the autologous blood. The anesthesiologist and surgeon jointly decided, on the basis of hematocrit and clinical stability, whether transfusion was necessary in each patient. Various parameters (hematocrit, plasma and urine hemoglobin, platelet counts, coagulation profile, and serum bilirubin) were measured pre-, intra-, and postoperatively.

Thirty-three patients (66%) required transfusion. The mean blood loss in these patients was 1046 ml. The most important factor affecting blood loss was the number of levels fused (p < 0.0001). Only two patients required postoperative homologous transfusion. The mean decrease in hematocrit was 7.82%. The maximum reduction of platelet count was limited to 80,000/mm3. Major complications such as hemoglobinuria, coagulopathy, cardiopulmonary problems, air embolism, and major sepsis were not observed in this study.

Conclusions. Autotransfusion performed using a modern cell saver technique is safe and has many advantages over homologous transfusion. It conserves the homologous blood resources. The costs of the two modes are statistically comparable when greater than 500 ml of red blood cell transfusion is necessary.
Improved accuracy of computer-assisted cervical pedicle screw insertion
Authors: Kotani Yoshihisa , Abumi Kuniyoshi , Ito Manabu , Minami Akio
Published: May 2009

Object. The authors introduce a unique computer-assisted cervical pedicle screw (CPS) insertion technique used in conjunction with specially modified original pedicle screw insertion instruments. The accuracy of screw placement as well as surgery-related outcome and complication rates were compared between two groups of patients: those in whom a computer-assisted and those in whom a conventional manual insertion technique was used.

Methods. The screw insertion guiding system consisted of a modified awl, probe, tap and a screwdriver specially designed for a computer-assisted CPS insertion. Using this system, real-time instrument/screw tip information was three dimensionally identified in each step of screw insertion. Seventeen patients underwent CPS fixation in which a computer-assisted surgical navigation system was used. The cervical disorders consisted of spondylotic myelopathy with segmental instability or kyphosis, metastatic spinal tumor, rheumatoid spine, and postlaminectomy kyphosis. The rate of pedicle wall perforation was significantly lower in the computer-assisted group than that in the other group (1.2 and 6.7%, respectively; p < 0.05). The screw trajectory in the horizontal plane was significantly closer to the anatomical pedicle axis in the computer-assisted group compared with the manual insertion group (p < 0.05). This factor significantly reduced the incidence of screw perforation laterally. Complications such as neural damage or vascular injury were not demonstrated in the computer-assisted group (compared with 2% in the manual insertion treatment group). The overall surgery-related outcome was satisfactory.

Conclusions. In contrast to the previously reported computer-assisted technique, our CPS insertion technique provides real-time three-dimensional instrument/screw tip information. This serves as a powerful tool for safe and accurate pedicle screw placement in the cervical spine.
Lumbar stenosis: a personal record
Authors: Jane John A. , Sherman Jonathan H. , Boulos Paul T. , Luce Craig , Dumont Aaron S.
Published: May 2009

✓ Although its management continues to evolve, lumbar stenosis remains a common societal problem. The present article is based on an invited lecture at the 2004 Annual Meeting of the Congress of Neurological Surgeons/American Association of Neurological Surgeons Joint Section on Disorders of the Spine and Peripheral Nerves. In it the authors provide a historical overview of lumbar stenosis and describe how the senior author's treatment of this condition has evolved over the past four decades. Within each era of treatment, the reasons for modification of treatment methods and relevant outcome measures are outlined. Additionally, specific subsets of patients with lumbar stenosis are also discussed to emphasize unique characteristics that affect treatment strategies. The authors' present technique for management of lumbar stenosis is also illustrated.
Adult paravertebral pleomorphic rhabdomyosarcoma infiltrating diffusely the whole spinal axis
Authors: Fountas Kostas N. , Donner Robert S. , Nikolakakos Leonidas G. , Feltes Carlos H. , Karampelas Ioannis , Robinson Joe Sam
Published: May 2009

✓ The authors report a unique case of diffuse spinal metastatic disease due to a pleomorphic rhabdomyosarcoma (RMS) in an adult. In additon to its overall rarity, peculiar characteristics of the particular tumor included its site of origin, demonstrated radiologically as the lumbar paravertebral musculature (psoas muscle) and the transcanalicular spread into the vertebral canal, resulting in thecal compression at multiple levels. The salient clinicopathological characteristics of RMS, as they related particularly to the spine, are subsequently discussed and a short review of the major therapeutic modalities for these tumors is offered.
The Effect of Composite Pig Islet-Human Endothelial Cell Grafts on the Instant Blood-Mediated Inflammatory Reaction
Authors: Kim Hyoung-Il , Yu Jae Eun , Lee Song Yi , Sul A. Young , Jang Min Seok , Rashid M. A. , Park Sang Gyu , Kim Sang Jun , Park Chung-Gyu , Kim Jae Hyeon , Park Kyong Soo
Published: May 2009

Instant blood-mediated inflammatory reaction (IBMIR) causes rapid islet loss in portal vein islet transplantation. Endothelial cells are known to protect against complement-mediated lysis and activation of coagulation. We tested composite pig islet–human endothelial cell grafts as a strategy to overcome IBMIR. Porcine islets were cocultured with human endothelial cells in specially modified culture medium composed of M199 and M200 for 1–9 days. A positive control group, negative control group, and the endothelial cell-coated group were examined with an in vitro tubing loop assay using human blood. The endothelial cell-coated group was subdivided and analyzed by degree of surface coverage by endothelial cells (≤50% vs. >50%) or coculture time (<5 days vs. ≥ 5 days). Platelet consumption and complement and coagulation activation were assessed by platelet count, C3a, and thrombin–antithrombin complex (TAT), respectively. After 60-min incubation in human blood, the endothelial cell-coated group showed platelet consumption inhibition and low C3a and TAT assay results compared to uncoated controls. When the endothelial cell-coated group was subdivided by degree of surface coverage, the ≤50% coated group showed less platelet consumption and less activation of complement and coagulation compared with the positive control (uncoated) group. On analysis by coculture time, only the subgroup cocultured for <5 days showed the same protective effect. Human endothelial cell-coated pig islets, especially the partially coated and short-term cocultured pig islet–human endothelial cell composites, reduced all components of IBMIR. If the optimal endothelial cell–islet coculture method could be identified, human endothelial cell coating of pig islets would offer new strategies to improve xenogenic islet transplantation outcomes.
Suppression of Carbon Tetrachloride-Induced Liver Fibrosis by Transplantation of a Clonal Mesenchymal Stem Cell Line Derived from Rat Bone Marrow
Authors: Hardjo Marhaen , Miyazaki Masahiro , Sakaguchi Masakiyo , Masaka Takuro , Ibrahim Sukaeni , Kataoka Ken , Huh Nam-Ho
Published: May 2009

Transplantation of hepatocytes or bone marrow-derived cells has been shown to ameliorate liver fibrosis in animal models, but no direct comparison of relative efficiency has been made. The aim of this study was to compare the efficiency of a bone marrow-derived clonal mesenchymal stem cell line established by us (rBM25/S3) with that of its adipogenic or hepatogenic differentiation derivative for suppression of rat liver fibrosis. After induction of differentiation of rBM25/S3 cells into adipogenic or hepatogenic cells in culture, we intrasplenically transplanted the three types of cells into rats (3 × 107 cells/rat) before and 4 weeks after initiation of carbon tetrachloride treatment (1 ml/kg body weight twice a week for 8 weeks) to induce liver fibrosis. Undifferentiated rBM25/S3 cells were the most effective for suppression of liver fibrosis, followed by the adipogenic cells and hepatogenic cells. Expression levels of MMP-2 and MMP-9 were also highest in undifferentiated rBM25/S3 cells. These results indicate that bone marrow-derived clonal mesenchymal stem cell lines are useful for further mechanistic studies on cell-mediated suppression of liver fibrosis and that such cell lines will provide information on an appropriate cell source for transplantation therapy for cirrhosis.
Improved Survival of Fulminant Liver Failure by Transplantation of Microencapsulated Cryopreserved Porcine Hepatocytes in Mice
Authors: Mei Jie , Sgroi Antonino , Mai Gang , Baertschiger Reto , Gonelle-Gispert Carmen , Serre-Beinier Véronique , Morel Philippe , Bühler Leo H.
Published: May 2009

The aim of this study was to establish hepatocyte isolation in pigs, and to evaluate function of isolated hepatocytes after encapsulation, cryopreservation, and transplantation (Tx) in a mouse model of fulminant liver failure (FLF). After isolation, porcine hepatocytes were microencapsulated with alginate-poly-L-Lysine-alginate membranes and cryopreserved. In vitro, albumin production of free and encapsulated hepatocytes were measured by enzyme linked-immunoadsorbent assay. In vivo, encapsulated hepatocytes were transplanted into different groups of mice with FLF and the following experimental groups were performed: group 1, Tx of empty capsules; group 2, Tx of free primary porcine hepatocytes; group 3, Tx of fresh encapsulated porcine hepatocytes; group 4, Tx of cryopreserved encapsulated porcine hepatocytes. In vitro, fresh or cryopreserved encapsulated porcine hepatocytes showed a continuous decreasing metabolic function over 1 week (albumin and urea synthesis, drug catabolism). In vivo, groups 1 and 2 showed similar survival (18% and 25%, respectively, p > 0.05). In groups 3 and 4, Tx of fresh or cryopreserved encapsulated porcine hepatocytes significantly increased survival rate to 75% and 68%, respectively ( p < 0.05). Primary porcine hepatocytes maintained metabolic functions after encapsulation and cryopreservation. In mice with FLF, Tx of encapsulated xenogeneic hepatocytes significantly improved survival. These results indicate that porcine hepatocytes can successfully be isolated, encapsulated, stored using cryopreservation, and transplanted into xenogeneic recipients with liver failure and sustain liver metabolic functions.
Extracellular Matrix in Pancreatic Islets: Relevance to Scaffold Design and Transplantation
Authors: Stendahl John C. , Kaufman Dixon B. , Stupp Samuel I.
Published: May 2009

Intrahepatic islet transplantation provides a potentially more benign alternative to pancreatic transplantation. However, islet transplants are associated with limited engraftment potential. This inefficiency is likely at least partially attributable to the isolation process, which removes islets from their native environment. Isolation not only disrupts the internal vascularization and innervation of islets, but also fundamentally changes interactions between islet cells and macromolecules of the extracellular matrix (ECM). Signaling interactions between islet cells and ECM are known to regulate multiple aspects of islet physiology, including survival, proliferation, and insulin secretion. Although it is highly likely that disruptions to these interactions during isolation significantly affect transplant outcomes, the true implications of these conditions are not well understood. The following article reviews current understandings and uncertainties in islet–ECM interactions and explains their potential impact on posttransplant engraftment. Topics covered include matrix and receptor compositions in native islets, effects of isolation and culture on islet–ECM interactions, and potential for postisolation restoration of islet–ECM interactions. Greater understanding in these areas may help to reduce isolation and transplantation stresses and improve islet engraftment.
Local adaptation in European populations of Arabidopsis lyrata (Brassicaceae)
Authors: Leinonen Päivi H. , Sandring Saskia , Quilot Bénédicte , Clauss Maria J. , Mitchell‐Olds Thomas , Ågren Jon , Savolainen Outi
Published: May 2009

We studied local adaptation to contrasting environments using an organism that is emerging as a model for evolutionary plant biology—the outcrossing, perennial herb Arabidopsis lyrata subsp. petraea (Brassicaceae). With reciprocal transplant experiments, we found variation in cumulative fitness, indicating adaptive differentiation among populations. Nonlocal populations did not have significantly higher fitness than the local population. Experimental sites were located in Norway (alpine), Sweden (coastal), and Germany (continental). At all sites after one year, the local population had higher cumulative fitness, as quantified by survival combined with rosette area, than at least one of the nonlocal populations. At the Norwegian site, measurements were done for two additional years, and fitness differences persisted. The fitness components that contributed most to differences in cumulative fitness varied among sites. Relatively small rosette area combined with a large number of inflorescences produced by German plants may reflect differentiation in life history. The results of the current study demonstrate adaptive population differentiation in A. lyrata along a climatic gradient in Europe. The studied populations harbor considerable variation in several characters contributing to adaptive population differentiation. The wealth of genetic information available makes A. lyrata a highly attractive system also for examining the functional and genetic basis of local adaptation in plants.
A FINITE DIFFERENCE METHOD FOR PIECEWISE DETERMINISTIC PROCESSES WITH MEMORY. II
Authors: Annunziato Mario
Published: May 2009

We deal with the numerical scheme for the Liouville Master Equation (LME) of a kind of Piecewise Deterministic Processes (PDP) with memory, analysed in [2]. The LME is a linear system of hyperbolic PDEs, written in non‐conservative form, with non‐local boundary conditions. The solutions of that equation are time dependent marginal distribution functions whose sum satisfies the total probability conservation law. In [2] the convergence of the numerical scheme, based on the Courant‐Isaacson‐Rees jointly with a direct quadrature, has been proved under a Courant‐Friedrichs‐Lewy like (CFL) condition. Here we show that the numerical solution is monotonic under a similar CFL condition. Moreover, we evaluate the conservativity of the total probability for the calculated solution. Finally, an implementation of a parallel algorithm by using the MPI library is described and the results of some performance tests are presented.
ON SMOOTHING PROBLEMS WITH ONE ADDITIONAL EQUALITY CONDITION
Authors: Asmuss Svetlana , Budkina Natalia
Published: May 2009

Two problems of approximation in Hilbert spaces are considered with one additional equality condition: the smoothing problem with a weight and the smoothing problem with an obstacle. This condition is a generalization of the equality, which appears in the problem of approximation of a histogram in a natural way. We characterize the solutions of these smoothing problems and investigate the connection between them.
NUMERICAL INVESTIGATIONS OF SINGLE MODE GYROTRON EQUATION
Authors: Cepitis Janis , Kalis Harijs , Reinfelds Andrejs
Published: May 2009

A stationary problem with the integral boundary condition arising in the mathematical modelling of a gyrotron is numerically investigated. The Chebyshev's polynomials of the second kind are used as the tool of calculations. The main result with physical meaning is the possibility to determine the maximal value of electrons efficiency.