bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Diagnosis of a Congenital Postaxial Longitudinal Limb Defect: A Case Report
Authors: Pauleta Joana , Melo Maria Antonieta , Graça Luís Mendes
Published: May 2010

Introduction. Although congenital longitudinal fibular deficiency is one of the most common long bone deficiencies, there are few published cases of its prenatal diagnosis. Case report. A right longitudinal deficiency of the fibula associated with tibial shortening, foot equinovalgus, and absence of the fourth and fifth foot rays diagnosed at 22 weeks gestation is described. Sequential ultrasonographic surveillance was performed without obstetric complications. The anomaly was confirmed after birth, and conservative orthopaedic management was decided. Conclusion. Though rarely seen, postaxial longitudinal limb defect may be detected by ultrasound. The correct approach can only be decided after birth, when the functional impact of the anomaly can be fully evaluated.
Single Incision Laparoscopic Colectomy: Technical Aspects, Feasibility, and Expected Benefits
Authors: Leblanc F. , Champagne B. J. , Augestad K. M. , Stein S. L. , Marderstein E. , Reynolds H. L. , Delaney C. P.
Published: May 2010

Background. This paper studied technical aspects and feasibility of single incision laparoscopic colectomy (SILC).
Methods. Bibliographic search was carried out up to October 2009 including original articles, case reports, and technical notes. Assessed criteria were techniques, operative time, scar length, conversion, complications, and hospitalization duration.
Results. The review analyzed seventeen SILCs by seven surgical teams. A single port system was used by four teams. No team used the same laparoscope. Two teams used two laparoscopes. All teams used curved instruments. SILC time was 116 34 minutes. Final scar was longer than port incision (31 7 versus 24 8 mm; ). No conversion was reported. The only complication was a bacteremia. Hospitalization was 5 2 days.
Conclusion. SILC is feasible. A single incision around the umbilical scar represents cosmetic progress. Comparative studies are needed to assess potential abdominal wall and recovery benefits to justify the increased cost of SILC.
Differential vulnerability of Physalaemus pustulosus tadpole size classes to predation by the water spider Thaumasia sp. (Physauridae)
Authors: Jara Fabián Gastón
Published: May 2010

The effect of predatory water spiders on the tadpole size-structure is poorly understood. Here I present a study of the effect of the spider Thaumasia sp. on the survivorship of Physalaemus pustulosus tadpoles in a tropical system. Under experimental conditions, tadpoles of one or two sizes were offered to juvenile spiders. Two experiments were conducted, one during the day and another during the night. The spiders consumed a greater number of large tadpoles in all treatments, and more tadpoles of both sizes were eaten during the day. This suggests that larger tadpoles are more susceptible to predation by Thaumasia sp. and that tadpoles are more vulnerable during the day.
A new species of Phasmahyla Cruz, 1990 (Anura: Hylidae) from the Atlantic Rain Forest of the States of Minas Gerais and Bahia, Brazil
Authors: Cruz Carlos Alberto , Feio Renato , Nascimento Luciana
Published: May 2010

A new species of the genus Phasmahyla is described from Atlantic Rain Forest fragments at the Fazenda Duas Barras, Municipality of Santa Maria do Salto, northeastern State of Minas Gerais, at the Reserva Particular do Patrimônio Natural (RPPN) Serra do Teimoso, Municipality of Jussari, and at the Fazenda Santa Cruz, Municipality of Arataca, southern State of Bahia, Brazil. The new species is recognized by its medium size for the genus (SVL 33.3 to 38.0 mm in males, 42.8 to 48.6 mm in females); purple drops on flanks and concealed surfaces of forearm, thigh, and digits; male with moderate nuptial pad of minuscule horny asperities on finger I; tympanum distinct only on ventral half; supratympanic fold weakly developed and visible only behind the tympanum; loreal region slightly obtuse; larval oral disc with distinct upper and second lower series of horny teeth; and second lower series of horny teeth slightly shorter than the upper one.
Home ranges and movements of the Chinese stripe-necked turtle (Ocadia sinensis) in the Keelung River, northern Taiwan
Authors: Lue Kuang-Yang , Chen Tien-Hsi
Published: May 2010

We investigated home ranges and movements of 13 adult Ocadia sinensis by radio-tracking in a narrow and disturbed riverine habitat of the Keelung River, northern Taiwan from January 2001 to April 2002. Our results indicated that individuals of this turtle were sedentary, with home range length averaging 703 m (range 170-1460 m). Home range length did not differ between the sexes. Movement patterns of radio-tracked turtles were highly variable, with no apparent seasonal patterns. The daily movement distances ranged from 5-245 m, equalling 0.3 to 47.1% of their home range length. Usually, O. sinensis moved into a new pool during flooding or after a longer period of low water level. This turtle was seldom relocated terrestrially, showing its highly aquatic nature. Ocadia sinensis used the riverine habitat unevenly, preferring the deep and slow-current pools and avoiding highly modified river sections. Our results raise conservation concern about loss of deeper, slow-current pools in many river management projects, which was important habitat for O. sinensis in their home ranges.
The large invasive population of Xenopus laevis in Sicily, Italy
Authors: Giacalone Gabriele , Valvo Mario Lo , Faraone Francesco Paolo , Lillo Francesco
Published: May 2010

The worldwide spread of invasive species is considered to be one of the main causes of global amphibian declines and the loss of biodiversity in general. The African Clawed Frog, Xenopus laevis, shows a strong ability to establish populations and invade various geographic regions. In 2004 X. laevis was found in Sicily for the first time. The Sicilian population is probably the largest in Europe with a range of about 225 km2 in an area characterized by numerous agricultural ponds. This high density of ponds has potentially facilitated the dispersal of X. laevis. The frogs can move far from rivers or watercourses by utilizing the ponds as suitable "islands". The analysis of their diet shows that the aquatic larvae of nektonic insects comprise the major portion in terms of mass while small planktonic crustaceans are the most numerous component. There is a significant difference between the diet of adults and juveniles.
Sexual size dimorphism and microhabitat use of the orange-tail skink (Gongylomorphus spp.) on Flat Island, Mauritius: conservation implications
Authors: Ross Toby , Bell Diana , Jones Carl , Pernetta Angelo
Published: May 2010

The Gongylomorphus skinks are an endemic genus of Mauritius and comprise two described species. Following the recent discovery of a third putative species, endemic to Flat Island, 11 km off the coast of Mauritius, this study was conducted to examine morphometrics and the pattern of microhabitat use by the species in an effort to provide effective conservation recommendations. There was a clear sexual size dimorphism with males significantly larger than females in terms of; snout-vent length, head length, head width, snout-mouth length, snout-ear length, upper and lower fore- and hind-limb lengths and fourth toe length. There was no sexual dimorphism in other measures including pelvic width, width at the base of the tail, head depth or body weight. Microhabitat use was found to be non-random with lizards occurring in areas with high humidity, high numbers of natural refugia, increased leaf litter coverage and plant species diversity, and low grass cover. We found no evidence that microhabitat use varied in relation to sex or age of lizards. The implications of these results for the conservation management of Flat Island for the orange-tail skink are discussed.
Molecular phylogeny and geographic variation of Malagasy iguanas (Oplurus and Chalarodon)
Authors: Vences Miguel , Glaw Frank , Wollenberg Katharina , Münchenberg Tobias
Published: May 2010

The iguanid subfamily Oplurinae consists of seven species of small to medium-sized, arboreal, sand-dwelling or rock-dwelling lizards endemic to Madagascar and the Comoros, belonging to the genera Oplurus and Chalarodon. We here present the first complete molecular species-level phylogeny for Oplurinae based on DNA sequences (865 bp) of the mitochondrial 16S rRNA gene and the nuclear c-mos gene. Our study is based on 52 specimens sampled from different populations in Madagascar and includes the geographically isolated population from Grande Comore, hitherto considered as subspecies Oplurus cuvieri comorensis or even as a separate species O. comorensis. Our results confirm that, within the genus Oplurus, the largely arboreal O. cuvieri and O. cyclurus form the sister clade to the remaining, more rock-dwelling species. Within the latter lineage, Oplurus quadrimaculatus is placed most basal, O. fierinensis and O. grandidieri are closely related sister species with high support, and O. saxicola is sister to the fierinensis/grandidieri lineage. Within the arboreal Oplurus, the Comoran sample shows no genetic differentiation relative to O. cuvieri populations from the North West and Sambirano regions of Madagascar, indicating that this population should not be considered as a separate species. In the monotypic genus Chalarodon, we discovered deep genetic divergences among populations of C. madagascariensis indicating the presence of a previously unrecognized cryptic species and the need for taxonomic revision.
Dietary strategy of a Pyrenean lizard, Iberolacerta aurelioi, living in a poor resources alpine environment
Authors: Díez Teresa García , Hernández-Estévez José Ángel , Pérez-Mellado Valentín , Amat Fèlix
Published: May 2010

We report the first study of diet composition of a Pyrenean lizard of the genus Iberolacerta, the Aurelio's lizard, I. aurelioi, living in an alpine rocky slope at 2300 m of altitude in Andorra. Diet composition was studied during two years from 289 faecal pellets containing 966 prey items. Number of prey per pellet shows annual, seasonal and sexual differences. Diet of the species is poorly diverse, mainly dominated by insects, but we find clear evidences of opportunistic cannibalism based on the presence of toes and scales in feces. In addition, we detected minor sexual, annual and month differences in prey presence and abundance. Low amplitude of trophic niche width and prey diversity, as well as predation on clumped prey and cannibalistic behaviour suggest that Iberolacerta aurelioi has a remarkable dietary strategy in response to strong thermal and food availability constraints at high mountain habitats.
New haplotypes of Cyclura nubila nubila from Cuba changed the phylogenetic tree of rock-iguanas: a challenge for conservation strategies?
Authors: Frynta Daniel , Rehák Ivan , Starostová Zuzana
Published: May 2010

Rock-iguanas of the genus Cyclura are the largest native terrestrial herbivores of the West Indies. Most species are currently under a high risk of extinction. In order to assess genetic variation in Cuban rock iguanas (Cyclura nubila nubila), we sequenced a fragment of mitochondrial DNA (894 bp long region including a part of the ND4 subunit of the NADH gene and the tRNA genes histidine, serin and leucin (partial)) in 21 iguanas from European Zoos and private breeders. The animals sampled represent founders and important representatives of the studbook population. The data was combined with published sequences of other species/subspecies of the genus and outgroups. We used neighbour joining, maximum likelihood, maximum parsimony and Bayesian methods to reconstruct the phylogenetic tree. The results are congruent with the previously reported paraphyletic relationship of C. nubila with respect to C. cychlura from the Bahamas. Surprisingly, within C. n. nubila, we found previously undescribed haplotypes phylogenetically closer to those of the subspecies C. nubila caymanensis from Little Cayman Island, or C. nubila lewisi from Grand Cayman Island. Thus, our results show that C. n. nubila as currently defined represents more distinct lineages and is therefore a composite taxon. Nevertheless, as rapidly evolving isolates these taxa are still worthy of conservation efforts. We hypothesize that the basal divergence of the C. nubila–C. cychlura clade occurred in Cuba and the above mentioned taxa from the neighbouring islands are a result of relatively recent over-water dispersal. In conclusion, our data suggest that special attention should be devoted to conserving Cuban rock-iguanas.
Forceps delivery of a new treefrog species of the genus Boophis from eastern Madagascar (Amphibia: Mantellidae)
Authors: Glaw Frank , Vallan Denis , Vences Miguel
Published: May 2010

We describe a new treefrog species of the genus Boophis (subgenus Sahona) from eastern Madagascar. Boophis calcaratus sp. nov. is distinguished from other species of the group by the presence of distinct dermal heel tubercles which are especially well developed in females. We also re-examined the type specimens of Boophis hillenii, a species that has not been rediscovered after its description in 1979. According to our analysis this taxon shows no consistent morphological differences to Boophis idae and supposed bioacoustic differences may be explained by two distinct call types in this species, and we thus suggest to consider hillenii as junior synonym of idae.
A quantitative reassessment of morphology-based taxonomic schemes for Turkish tortoises (Testudo graeca)
Authors: Kiremit Ferhat , Taşkavak Ertan , Parham James , Türkozan Oğuz , Olgun Kurtuluş
Published: May 2010

In the last decade, Asian populations of Testudo graeca were split into as many as 10 species based on morphology and morphometry and then subsequently synonymized based on genetic evidence. We generate new morphometric data for six of these disputed species from Turkey, a major center of morphological and genetic diversity for Asian T. graeca. We test the concordance of our data with previous morphological assignments. Our morphometric data and analyses do not support all of the results of previous morphometric studies. Instead we find that putatively named taxa from the Mediterranean coast (“antakyensis”, “anamurensis”, and “terrestris”) are not morphometrically distinct. On the other hand, some inland populations from eastern Turkey (“armeniaca” and “perses”) are morphometrically distinct as previously claimed. Tortoise populations from northern and southern Turkey, which may correspond to the ibera and terrestris mt clades, also appear to be morphometrically distinct. In this respect, the morphometric data reflects the emerging genetic pattern, although the picture is complicated by a lack of genetic sampling within Turkey and morphometric studies outside of Turkey.
Reproduction in neotropical Tropidurus lizards (Tropiduridae): evaluating the effect of environmental factors on T. torquatus
Authors: Martelotte Sandra , Rocha Carlos , Kiefer Mara Cíntia , Van Sluys Monique
Published: May 2010

Lizards exhibit a wide array of reproductive strategies. For tropical lizards, a single reproductive pattern is not evident, and the actual determinants of seasonality in reproduction remain unclear. Tropidurus torquatus is the most widely distributed species of the genus in Brazil and occurs in coastal and inland areas, and in islands off the Brazilian shore. In this study, we examine the reproductive cycle of T. torquatus at a coastal area in Rio de Janeiro State, southeastern Brazil. We analysed the reproductive cycle of T. torquatus from one coastal population to evaluate how reproduction is affected by local environmental factors (rainfall), and we also compared reproductive parameters of T. torquatus between two time periods (15 years apart) at the same locality. Tropidurus torquatus reproduces from the beginning of the dry season to the middle of the rainy season, even considering the two time periods. Reproductive season was similar between the coastal and inland populations suggesting that local environmental factors play a less important role in regulating the duration of the reproductive cycle of these lizards.
Phylogeography of Rhinella spinulosa (Anura: Bufonidae) in northern Chile
Authors: Pastenes Luis , Sallaberry Michel , Correa Claudio , Veloso Alberto , Méndez Marco
Published: May 2010

The southern part of the Altiplano of the Andes Range is characterized by a complex hydrography, due to an intense geologic activity and the effects of the Pleistocene glaciations. This has produced a high degree of diversity at the species level in some aquatic taxa (e.g., fish and amphibians), which suggests that these same processes have produced divergence at the intraspecific level in co-distributed taxa. We investigated the genetic variation in populations of the anuran Rhinella spinulosa which represent its entire distribution in the extreme north of Chile (17°44′S-23°47′S). Haplotype networks of the mitochondrial control region recognized two main lineages, one of which is distributed from the northern boundary of Chile to the Salar de Alconcha and the other from the Salar de Carcote to the locality of Tilomonte. The northern lineage showed little phylogeographic structure; a few very frequent haplotypes are widely distributed. The southern lineage had greater structure, due principally to the high divergence of the populations from the eastern springs of the Salar de Atacama. Fu's Fs test and the mismatch distributions suggested that most of the populations of both lineages are in the process of demographic expansion. The spatial distribution of the genetic variability was correlated with the hydrography and the paleoclimatological data available for the region, which suggested that geographic expansions followed by periods of contraction of population ranges, together with sporadic floods may explain the observed phylogeographic patterns.
The Determination of Speech Organization in a Patient with an Arteriovenous Malformation
Authors: Close Richard A. , O'Keefe Anne Marie , Buchheit William A.
Published: May 2010

A case is reported of an arteriovenous malformation in the left motor speech area which was successfully excised without aphasia in a right-handed man. Preoperative sodium amobarbital carotid infusion testing demonstrated that the patient had right hemisphere dominance for speech. A review of the literature suggests that this is not an uncommon occurrence in individuals with congenital lesions of the left cerebral hemisphere. Lateralization of speech dominance should be established through definitive testing in these cases, especially if surgical removal of the malformation is contemplated.
A Technical Modification of Cloward's Posterior Lumbar Interbody Fusion
Authors: Lin Paul M.
Published: May 2010

The concept of interbody (intercorporal) fusion as a useful treatment for intervertebral disc disease in the cervical area has been well received. Thirty-two years have passed since Cloward first introduced his technique of posterior lumbar intervertebral fusion. The author believes that the delayed acceptance of this procedure is due to fear of technical difficulties. A technical modification of Cloward's posterior lumbar interbody fusion is introduced. It entails better technique in controlling epidural bleeding by careful positioning of the patient and the use of oxidized cellulose as a tampon in the epidural space. The integrity of the facet is preserved through a more limited interlaminal approach. Osteosynthesis of the grafts is assured by multiple perforations of the cortical plate in accordance with Robinson's principle utilized in cervical interbody fusion. The author believes that the modification simplifies the Cloward posterior lumbar interbody fusion. It also assures better stability after surgery by retention of the facet and lessening the dangers of settlement of the graft by preservation of the cortical plate. In a series of 75 cases, tomograms made 4 months after operation have shown a viable graft with active osteosynthesis between the graft and the adjoining vertebral bodies in 94%.
Chronic Ventricular Cerebrospinal Fluid Sampling, Drug Injections, and Pressure Monitoring Using Subcutaneous Reservoirs in Monkeys
Authors: Wood James H. , Poplack David G. , Flor William J. , Gunby Neal E. , Ommaya Ayub K.
Published: May 2010

Animal models enabling reliable access to ventricular cerebrospinal fluid (CSF) are crucial to the study of neuropharmacological and neurotoxicological effects of cytotoxic agents used to treat central nervous system neoplasms. This investigation concludes that 4th ventricular catheterization using subcutaneous CSF reservoirs in rhesus monkeys: (a) provides chronic access to sterile CSF without chronic immobilization, (b) enables mixing of injected drugs with lateral ventricular CSF, (c) permits sensitive monitoring of intraventricular pressure and (d) does not produce tissue damage during cannula implantation or breakdown of the blood-brain barrier.
The Intracranial Pressure-monitoring Cup Catheter
Authors: Wilkinson Harold A.
Published: May 2010

The author describes a simple catheter designed for use in the measurement of intracranial pressure, especially during the initial stage following craniotomy. The device has been studied in experimental animals, and has been used in 40 neurosurgical patients for periods up to 15 days.
Saccular Aneurysm of Infancy and Early Childhood
Authors: Becker Dennis H. , Silverberg Gerald D. , Nelson Denver H. , Hanbery John W.
Published: May 2010

A case of intracranial saccular aneurysm occurring in early childhood and presenting with sudden dysphasia and hemiplegia is reported. A review of the literature emphasizes the rarity of this lesion. Despite a significant preoperative neurological deficit, the patient tolerated ancurysm clipping and recovered well. The majority of reported cases involve males under 2 years old. Aneurysms in infants have a distribution different from that seen in adults. Microscopic examination of these lesions fails to show any evidence of inflammation or atherosclerosis. The data suggest that the pathogenesis of these rare childhood lesions differs from that of adult saccular aneurysms.
Spinal Dysraphism
Authors: James Hector E. , Oliff Michael , Mulcahy John
Published: May 2010

Twelve patients with the clinical findings of spinal dysraphism form the basis for this report. In eight patients, physical findings, plain x-rays, and unenhanced spinal computed tomography allowed for precise diagnosis and subsequent therapy, without contrast myelography. All patients in the study had intravenous pyelography, and this revealed evidence of renal deterioration in two. The other 10 patients had radiographically normal upper urinary tracts. Urodynamic assessment was performed in seven; three were abnorma. The pattern of the abnormal studies (three “flaccid type” with an adequate urethral pressure profile and one with detrusor-sphincter dyssynergia) allowed for appropriate therapy to be employed for bladder emptying and continence. Both spinal computed tomography and urodynamic testing serve as noninvasive studies that can be employed in the follow-up and management of patients with spinal dysraphism.
Measurement of Spinal Cord Blood Flow by the Microsphere Technique
Authors: Smith Donald R. , Smith Howard J. , Rajjoub Rodwan K.
Published: May 2010

Differential spinal cord blood flow was measured in dogs by the radioactive microsphere injection method. The mean spinal cord blood flow was 10.8 ± 0.53 (SE) ml/100 g/minute. The flow values for the white and gray matter were 7.1 ± 0.65 (SE) and 26.3 ± 2.2 (SE) ml/100 g/minute, respectively.
Air Embolism during Trans-sphenoidal Pituitary Operations
Authors: Newfield Philippa , Albin Maurice S. , Chestnut Julian S. , Maroon Joseph
Published: May 2010

Doppler ultrasonic cardiac monitoring of patients undergoing trans-sphenoidal pituitary operations in the semisitting position has revealed the occurrence of venous air embolism in 3 of 31 consecutive cases. One such case is presented. Air may be drawn into the venous system whenever a gradient exists between the site of operation and the right heart. During trans-sphenoidal operations the most likely portals of venous air entry include the intercavernous connections within the sella, venous channels through nonpneumatized bone, inadequately sealed subnasal vessels, and vascularized metastatic tissue in the pituitary. Because the potential for morbidity and mortality from air embolism is so great, rapid diagnosis with the Doppler unit and prompt treatment, including aspiration of air from the right atrial catheter, administration of 100% oxygen, performance of the Valsalva maneuver, saline irrigation of the wound, and hemostasis of open vessels, are essential. Technetium-macroaggregated albumin (T EMAA) lung scans are helpful in postoperative verification of venous air embolism.
Melanotic Schwannoma
Authors: McGavran William L. , Sypert George W. , Ballinger William E.
Published: May 2010

Reports of melanotic nerve sheath tumors of Schwann cell origin are rare, only three having been found in the literature. Two new cases of spinal intradural melanotic nerve sheath tumors are reported and the literature is reviewed. Controversy has arisen in regard to the origin of melanin within these tumors. Electron microscopic study of one of our cases indicates that the Schwann cell is capable of producing melanin. The available evidence suggests that ultrastructural identification of the cell type in these pigmented tumors is essential in plotting the therapy and prognosis of patients with melanotic nerve sheath tumors.
Ring Formation on Computerized Tomography in the Postoperative Patient
Authors: Grand Walter , Kinkel William R. , Glasauer Franz E. , Hopkins L.N.
Published: May 2010

Ring formation with contrast infusion in computerized tomography has been described with various entities. The current report demonstrates its appearance in three postoperative patients from whom cerebral tumors had been removed. These examples of postoperative ring formation are compared with the ring formation in the scan of an unoperated patient with an intracerebral hematoma.
Anterior Approach for Removal of a Cervical Intradural Tumor
Authors: Giroux J.-Cartier , Nohra Chaouky
Published: May 2010

A case of an intradural extramedullary meningioma of the cervical spine excised through an anterior approach is reported. This permitted a complete excision without manipulation of the cord followed by a rapid and complete recovery. The technique of excision and bone grafting is described.
Cerebral Herniation from Ventricular Dilatation after Craniectomy
Authors: Kaufman Howard H. , Miller Mark H.
Published: May 2010

Local cerebral herniation due to ventricular dilatation was observed in a patient who had had removal of a bone flap and whose dura had previously been left open. The explanation of this problem was suggested by experimental and clinical evidence relating the development of ventricular enlargement to loss of support of the brain. Such an explanation also suggested that head wrapping to buttress the brain and promote transependymal absorption of cerebrospinal fluid could reverse the condition. This treatment was employed with apparent success.
Intracranial Teratocarcinoma in a Child with Anterior Sacral and Intrasacral Meningocele
Authors: Holness Renn O. , Hoffman Harold J. , Mancer Kent , Armstrong Dawna
Published: May 2010

A very rare combination of two rare entities is reported. The patient had anterior sacral and intrasacral meningoceles, which were repaired at age 3 years, and 7 years later he presented with hypopituitarism due to a suprasellar teratocarcinoma. There has been no evidence of tumor recurrence in the 2.5 years since subtotal excision and radiotherapy (patient was last seen in 1977). Two aspects of the case are reviewed; the unusual nature of the spinal defect and the implications of its association with an intracranial tumor of developmental origin.
Cerebral Arterial Revascularization: The Value of Repeated Angiography in Selection of Patients for Operation
Authors: Fox John L.
Published: May 2010

Three patients with occlusive cerebrovascular disease were evaluated for possible extracranial-intracranial arterial anastomosis. Cerebral angiography repeated at a later date revealed disappearance of the initial vascular stenosis or occlusion and development of extensive collateral circulation. It was concluded in these cases that surgical revascularization would not improve upon natural revascularization. Repeated angiography provides information of value to the physician who must make a decision about such surgical treatment.
Infrequent Aneurysm Surgery
Authors: Helme William B.
Published: May 2010

A study of 18 consecutive surgically treated intracranial aneurysms, with no mortality, is presented. The study extended over a period of 6 years, and this relatively infrequent surgery with acceptable results is the main feature of the study.
Preliminary Experience with Ultrasonic Aspiration in Neurosurgery
Authors: Flamm Eugene S. , Ransohoff Joseph , Wuchinich David , Broadwin Alan
Published: May 2010

A new instrument utilizing ultrasonic energy to fragment and aspirate normal and pathological tissue has been evaluated for neurosurgical use. The instrument has been tested in several animal models to assess its efficacy and safety. The instrument has been used clinically in 38 cases for removal of meningiomas, acoustic neurinomas, and other tumors. Future modifications and applications are discussed.
Carcinoembryonic Antigen in a Metastatic Brain Tumor
Authors: Feinberg Stephen Brent , Hoffman Joseph F.
Published: May 2010

A case is presented in which 10 ml of cystic fluid from a metastatic brain tumor contained a high concentration of carcinoembryonic antigen (CEA). The use of CEA as a prognostic indicator and adjunctive therapeutic monitor in tumors is reviewed.
Revascularization of the Scalp by Microsurgical Techniques after Complete Avulsion
Authors: Chater Norman L. , Buncke Harry , Brownstein Michael
Published: May 2010

A total scalp replantation was performed after a complete traumatic avulsion of the scalp with skull fracture. Multiple arterial and venous anastomoses were required. Satisfactory healing occurred, and the patient has had a subsequent uneventful cranioplasty to fill a bony defect, with normal scalp healing.
CT Scan in Intraventricular Hemorrhage
Authors: McCallum J.E. , LoDolce Dolores , Boehnke Manfred
Published: May 2010

Twenty-three adults who had evidence of intraventricular hemorrhage were identified, and their charts were reviewed. Thirteen patients died and 10 survived. Eleven of the 13 who died were hypertensive. All had severe neurological deficit and evidence of brain stem dysfunction at the time of admission and progressed rapidly to coma and death. Two of the survivors had periventricular arteriovenous malformations. They presented neurologically intact and remained so. The other eight survivors had a distinct clinical course. They presented with focal deficits and abnormalities of mental status. These persisted, and at follow-up 3 to 20 months later they all had profound deficits of recent memory and intellect, and none was capable of daily self-care. Computerized tomographic (CT) scans were not useful in predicting outcome. The presence of parenchymal clot, multiple chamber involvement, 3rd ventricular involvement, ventriculomegaly, and midline shift were seen in all groups. Illustrative examples are presented.
The Lumbar Shield
Authors: Feild James Rodney , McHenry Hugh
Published: May 2010

Postoperative perineural adhesions between the lumbar nerve root and the partially removed intervertebral disc are thought to be a cause of failure of the standard operative procedure for the removal of a ruptured lumbar intervertebral disc. Attempts have been made to reduce postoperative perineural adhesions by the use of epidural muscle, fat, gelatin sponge, silicone, and steroids. The present communication introduces a new implantable silicone device, a lumbar shield. designed to: (a) provide a radiopaque marker on the dorsal perimeter of the excavated lumbar disc so that the presence or absence of a recurrent disc herniation can easily be determined on plain postoperative x-ray films, (b) provide ready access to the operative site in the event of a recurrent disc herniation. (c) prevent postoperative perineural adhesions between the lumbar dura and the nerve root and the partially removed intervertebral disc, and (d) prevent postoperative adhesions between the lumbar dura and the nerve root and the paraspinal muscles. Satisfactory results of lumbar disc surgery over the past 44 years have occurred in about 90% of routine patients. The value of the lumbar shield in 82 patients (59 routine and 23 workmen's compensation/medicolegal patients) followed for 6 months is described. A satisfactory result, i.e., relief of pain or the presence of occasional postoperative pain, occurred in 85% of routine patients at 1 month, 97% at 3 months. and 95% at 6 months.
Neural and Vascular Tissue Reaction to Aneurysm-coating Adhesive (Ethyl 2-Cyanoacrylate)
Authors: Diaz Fernando G. , Mastri Angeline R. , Chou Shelley N.
Published: May 2010

The effect of ethyl 2-cyanoacrylate (Aaron-2-Alpha) obtained from two different manufacturers was evaluated in 37 cats divided into two groups. The first group (n = 28) received a 9-year-old preparation. The second group (n = 9) received recently acquired adhesive. Aaron-2-Alpha was applied to the left cruciate cortex and left femoral neurovascular bundle under barbiturate anesthesia. Normal saline was applied on the right side for control. Survival was allowed for 2, 4, 7, and 14 days after application of the adhesive. The 2-day survival was excluded in the second group. Neuropathological examination revealed meningeal necrosis, neuronal and axonal degeneration, vascular wall degeneration, thrombosis, and inflammatory reaction in both groups of cats. The compounds tested are far from satisfying the ideal requirements for their safe use. Chemical degradation may take place in the adhesives stored for prolonged periods of time. Adhesives obtained from two different sources may contain adjuvants of different toxicity. Severe local tissue reaction could produce marked neurological deficits when adhesives are applied in critical areas.
Recovery from Acute Subdural Hematoma and Uncal Herniation Due to Ruptured Intracranial Aneurysm
Authors: Sachs Ernest , Bernat James L.
Published: May 2010

A case of acute subdural hematoma due to a ruptured carotid aneurysm with decerebrate rigidity and complete recovery is reported.
Bilateral Optic Canal Meningiomas
Authors: Trobe Jonathan D. , Glaser Joel S. , Post Judith D. , Page Larry K.
Published: May 2010

In the case presented, bilateral optic canal meningiomas produced binocular visual loss. Correct diagnosis was delayed because of inadequate and misinterpreted radiological studies. Careful radiological and surgical examination of the planum sphenoidale later suggested this as the source of both canalicular masses. The pertinent aspects of this case are reviewed in relation to information from similar cases reported previously. In the future, increased clinical suspicion and more accurate neuroradiological studies should improve the detection and afford earlier surgical treatment of meningiomas of the optic canal.
Extracranial-Intracranial (EC-IC) Arterial Bypass
Authors: Samson Duke S. , Boone Stephen
Published: May 2010

The authors present a review of published experience with intracranial-extracranial arterial bypass grafting. The procedure is technically feasible and has a relatively low morbidity and mortality when performed by experienced microvascular surgeons. However, its therapeutic value is still unproven.
Microsurgical Evaluation of the Pterional Approach to Aneurysms of the Distal Basilar Circulation
Authors: Samson Duke S. , Hodosh Richard M. , Clark Kemp W.
Published: May 2010

The microsurgical correlates of the pterional approach to the distal basilar circulation were evaluated in 20 cases of posterior circulation aneurysms, 50 human cadaver dissections, and a variety of other intracranial surgical lesions. The pterional approach permitted successful clipping of the aneurysm in 13 of 15 basilar bifurcation aneurysms, 1 of 2 basilarposterior cerebral aneurysms, and 2 of 3 basilar-superior cerebellar aneurysms. In each of the failed attempts via the pterional approach, the subtemporal route ultimately resulted in proper clip application. The interposition of the posterior clinoid process was the impediment to successful clipping in three of the four cases that could not be managed via the pterional approach. All 3 of these patients had a basilar bifurcation that was below the level of the posterior clinoid on angiography, whereas none of the remaining 17 aneurysm patients demonstrated a low-lying bifurcation. Posterior displacement of the basilar artery away from the posterior clinoid exceeded 1 cm in only 13% of our cases and was not an impediment to successful clipping of the aneurysm via the pterional route. We conclude that, when the anatomical situation is appropriate, the pterional approach offers the advantages of less brain retraction and better visualization of the parent arteries and important perforating branches when compared to the subtemporal approach.
Shunt-associated Glomerulonephritis
Authors: Wald Steven L. , McLaurin Robert L.
Published: May 2010

Six patients with glomerulonephritis in association with a ventriculovascular shunt were treated with three basic modes of therapy. Direct intraventricular instillation of antibiotic was used on seven occasions in five patients either as the definitive mode of therapy or as an adjunct to shunt removal. Ventricular fluid antibiotic concentrations were monitored in two patients and demonstrate that effective levels as compared to the specific minimal inhibitory concentration can only be achieved by this method. With resolution of the shunt infection, improvement in the clinical and laboratory parameters of renal function was noted. A recommended treatment protocol is outlined, including specific dosages for intraventricular antibiotics. The need for detailed and frequent post-treatment examination including serum immunoglobulin profile is stressed.
Stereotactic Surgery with Image Processing of Computerized Tomographic Scans
Authors: Penn Richard D. , Whisler Walter W. , Smith Charles A. , Yasnoff William A.
Published: May 2010

The three-dimensional information from computerized tomographic scans has been transformed by image processing for use in stereotactic surgery. A lateral image of the target and calvarium can be superimposed on the lateral x-ray film taken at operation. Computer processing also eliminates extraneous data on the scan and gives the precise distance of the target from the midline. Testing the technique on a phantom shows it to be accurate to better than 0.5 cm. Application of the method for the stereotactic biopsy of a deep tumor is illustrated.
Posterior Fossa Subdural Hematoma in a Hemophiliac
Authors: Raggio John F. , Fleischer Alan S. , Corley Charles C.
Published: May 2010

A successfully managed case of posterior fossa subdural hematoma occurring in a hemophiliac is reported, and the rarity of this lesion is mentioned. The management of the hemophiliac who is a victim of craniocerebral trauma is discussed, with emphasis on the use of computerized tomographic scanning to obtain rapid diagnosis. The importance of prophylactic Factor VIII replacement is emphasized, and appropriate methods of Factor VIII administration are outlined.
Sarcoidosis of the Cervical Spinal Canal
Authors: Baruah Jitendra K. , Glasauer Franz E. , Sil Ranajit , Smith Bernard H.
Published: May 2010

A patient with sarcoidosis presenting as an intradural extramedullary space-occupying lesion in the cervical spinal canal is described.
Cerebellar Infarction
Authors: Feely Michael P.
Published: May 2010

Cerebellar infarction has been inadequately recognized by clinicians. A review of 75 cases showed that in 55 of them the infarct acted as an expanding mass lesion and compressed the brain stem. Once this occurred, the mortality without operation was very high. With surgical treatment, the mortality was reduced considerably. The computerized tomographic scan is the diagnostic test of choice.
A Reticulothalamic System Mediating Proprioceptive Attention and Tremor in Man
Authors: Velasco Francisco , Velasco Marcos
Published: May 2010

This report describes the electrophysiological characteristics of thalamic and subthalamic targets used to control tremor. In these targets exploratory electrodes recorded one or more of the following events. Electrical stimulation produced enhancement of tremor or other complex motor responses. Somatic evoked potentials (SEPs) induced by proprioceptive stimulation showed only late components, the amplitudes of which changed in various attentive situations. Multiunit activity showed spontaneous 3- to 6-Hz rhythmic bursts. And a lesion produced neglect of contralateral extremities and an ipsilateral decrease of scalp-recorded SEP late components. In contrast, in the areas located immediately posterior and dorsal, electrical stimulation produced contralateral paresthesias. Early components of SEPs could be recorded, as were rhythmic bursts of multiunit activity after the occurrence of peripheral tremor. Lesions produced sensory deficits in the contralateral extremities and ipsilateral blocking of all components of scalp SEPs. The latter areas are identified as the lemniscal system, but the former seem to be extralemniscal. Their electrophysiological characteristics suggest that they are probably involved in the process of selective attention and motor control
Effect of Furosemide on Experimental Traumatic Cerebral Edema
Authors: Tornheim Patricia A. , McLaurin Robert L. , Sawaya Raymond
Published: May 2010

The present study was designed to test the effectiveness of furosemide in reducing cerebral edema due to closed head trauma. A Remington Humane Stunner was used to deliver blows to the heads of anesthetized cats. Impacted animals were divided into three groups: (a) trauma, no drug, and ad lib. fluid intake after head injury; (b) trauma, no drug, and standardized fluid intake (0.9% NaCl; 10 ml/Ib/day); and (c) trauma, furosemide (3 mg/lb/day), and standardized fluid intake. For the treated cats, we began furosemide therapy 1 hour after head injury and used three intramuscular injections/day. The animals were killed 48 hours after head trauma. From animals with unilateral contusion, we took bilateral white matter samples from five points along the centrum semiovale and tested for edema using density determinations with an organic density gradient. Serum electrolytes, blood urea nitrogen, and weight were determined before the cats were impacted and before they were killed. All impacted animals demonstrated weight loss. Density data showed a normal water content for white matter in the uncontused hemispheres of all impacted cats. Contused hemispheres showed a significant decrease in density (increase in brain water content) for both treated and untreated cats. In the furosemidetreated animals, however, the brain edema was significantly less than that found in the untreated groups. Analysis of data from individual brain sections of furosemide-treated animals suggested a reduction in the spread of edema fluid 48 hours after head injury.
Chronic Extradural Hematoma
Authors: Burres Kenneth P. , Hamilton Richard D.
Published: May 2010

A recent experience with a chronic extradural hematoma found unexpectedly during an evaluation for an enlarged sella turcica is reported. This case, as well as pertinent literature, demonstrates the variability of the classical signs in the chronic lesion. Our experience suggests that the diagnosis of patients with persistent symptoms after head injury may be clarified by computerized tomographic scanning, which in the present case revealed chronic extradural hematoma.
Traumatically Induced Brain Stem Hemorrhage and the Computerized Tomographic Scan
Authors: Cooper Paul R. , Maravilla Kenneth , Kirkpatrick Joel , Moody Sarah F. , Sklar Frederick H. , Diehl Jan , Clark Kemp W.
Published: May 2010

The computerized tomographic (CT) scan has revolutionized the management of cerebral trauma. Nevertheless, visualization of traumatically induced lesions of the brain stem by the CT scanner remains difficult. Seven patients with autopsy or CT evidence of brain stem hemorrhage were identified over a 1-year period. In six of these patients, brain stem hemorrhage could be defined by CT scan. As part of a prospective study of CT changes after head injury, we performed serial CT scans on six of the seven patients. Clinical experience shows that timing is important for identification of these lesions and that inability to visualize brain stem hematomas may occur because of the development of hematomas after CT scanning, evolution of hemorrhagic lesions that makes them isodense with the surrounding brain stem, patient movement, and technical factors such as the partial volume effect. Experimental injection of fresh blood into the pons and midbrain of cadavers shows that lesions as small as 0.1 ml in volume may be visualized by ex vivo thin section CT scanning techniques. However, the character and anatomical configuration of the hemorrhage may be as important in determining CT visualization as is the volume of the hemorrhage. For example, a hematoma displacing the brain parenchyma was visualized, but a similar-sized small hemorrhage that had diffused through the brain stem tissues was not. Although many of the experimentally placed lesions extended over a rostral-caudal length of 15 mm or more in the brain stem, no lesion was seen on more than three thin section scans. This is explained by the presence of lesions that, although extensive in a rostral-caudal direction, had relatively small cross sectional areas available for identification by the CT scanner. The small size of traumatic lesions of the brain stem and their proximity to bony structures at the base of the skull are not insurmountable obstacles to visualization of brain stem hemorrhages. Serial scanning and the application of thin section computed tomography will lead to identification of most of these lesions.
Total Morbidity and Mortality Rates of Patients with Surgically Treated Intracranial Aneurysms
Authors: Giannotta Steven L. , Kindt Glenn W.
Published: May 2010

The authors report their recent experience in treating 80 patients with intracranial aneurysms. A total of 83 surgical procedures were performed with a surgical mortality of 4.8%. Fifty-six patients had suffered a subarachnoid hemorrhage. Total mortality for this group was 14.2% regardless of clinical grade. Early surgical intervention, meticulous preoperative monitoring, and control of circulatory dynamics were used to improve the perioperative morbidity and mortality rates. We believe that any major improvements in the outcome of patients with aneurysms will come from advances in perioperative management.
Personality Factors and Results of Lumbar Disc Surgery
Authors: Cashion Ernest L. , Lynch William J.
Published: May 2010

Patients undergoing surgery for herniated lumbar discs were evaluated prospectively with a battery of psychological tests. Personality factors in patients having a good outcome were compared to those in patients having a bad outcome. Both groups had similar surgical findings. Patients with a good outcome were more stable, cautious, efficiently defensive, selfconfident, realistically concerned with their illness, mildly depressed, generally optimistic regarding outcome, and able to withstand setbacks without resorting to emergency reactions. Patients with a bad outcome were less stable, were unpredictable, had inefficient defenses, were more obviously depressed, and were less able to withstand stress and breakdown. However, even the degree of psychological testing used in this study does not definitely predict outcome.