Mortality and causes of death after hip fractures in The Netherlands.

The mortality rate and causes of death after a hip fracture were studied in 493 consecutive patients with a hip fracture. All patients were treated in three hospitals in Utrecht, The Netherlands. The mortality rate following hip fractures is high and age dependent. Forty-five patients, 38 women and 7 men, died during the period of hospitalization (9.1%). One year after the date of hip fracture 23.6% of the women had died and 33.0% of the men. Four years after the date of hip fracture the mortality rates in women and men were 44.4% and 55.3%, respectively. Male sex, concomitant illnesses and in-hospital complications are negative determinants of survival. The in-hospital mortality was due to: cerebrovascular accident (n = 7), cardiac decompensation (n = 12), myocardial infarction (n = 4), pulmonary infection (n = 6), intestinal bleeding (n = 1) and sepsis (n = 5). From the registration of death causes we learned that 54 deaths were directly due to the hip fracture, 4 due to bed sores, 34 due to infectious diseases, 62 due to cardiovascular disease, 22 due to cerebrovascular accidents, 14 due to diabetes mellitus, and 33 due to neoplasm. The high mortality rate within the first 8 weeks after the date of hip fracture was mainly attributed to the hip fracture.


Does baseline serum total calcium level influence the blood pressure response to calcium supplementation? A double-blind study.

This was a randomized and double-blind study to examine: (1) the effect of a 1500 mg/day calcium supplement vs a placebo for 8 wk in 42 adults with high normal or mildly elevated blood pressure (BP) and, (2) the relationship between baseline serum total calcium levels and BP response to calcium supplementation. Following the experimental protocol, mean pressures were lower in the treatment vs placebo group (95.7 mmHg and 102.1 mmHg, p = 0.002), but response was not related to initial serum total calcium levels. After 8 wk of calcium supplementation, serum total calcium was greater in the treatment group compared to the placebo group (p = 0.02). Within the treatment group only, the change in total serum calcium was related to the change in parathyroid hormone (r = -0.92, p = 0.0002); and the change in ionized calcium was related to the change in parathyroid hormone (r = -0.68, p = 0.03) in the subgroup with low baseline serum total calcium. This study provides further support for the hypotensive effect of supplemental calcium in some people. However, it fails to clarify or expand upon previous reports that a low serum total calcium level might be predictive of the blood pressure response to increased calcium.


Inhibitors of recombinant human erythropoietin in chronic renal failure.

This study investigates which factors influence the response of administered recombinant human erythropoietin (Re-HuEPO) with respect to the increase of haemoglobin in patients with end-stage renal disease. Pharmacokinetic parameters of administered Re-HuEPO in patients with end-stage renal disease and considerable differences in the amount of Re-HuEPO required ("Re-HuEPO-need") to obtain an increase of haemoglobin, revealed a pattern of dose-dependent first-order elimination without significant interindividual differences between the patients. As variable immunological inhibitors of erythropoietin are also absent, the administered Re-HuEPO seems to be equally available to the erythron in the various patients. In vitro incubation experiments with bone marrow cells show that the sera from patients with end-stage renal disease contain inhibitors of the erythropoietin-induced stimulation of bone marrow cells. As the patients' sera differ with regard to the degree of inhibition of erythropoietin bioactivity, this inhibition may also be responsible for the interindividual differences in amount of erythropoietin required. Besides a reduced endogenous production of erythropoietin, these inhibitors of the bioactivity of erythropoietin may also contribute to the pathogenesis of anaemia in patients with chronic renal failure.


Chronic lymphocytic leukaemia presenting as renal failure with lymphocytic infiltration of the kidneys.

A case of renal failure is reported in a 60-yr-old male as the first clinical manifestation of chronic lymphocytic leukaemia (CLL). It appeared to be due to a massive interstitial infiltration of both kidneys by small lymphocytes. Combination chemotherapy consisting of monthly courses of cyclophosphamide, vincristine and prednisone (COP), resulted in a rapid improvement of the renal function and in an apparent haematological and clinical remission of the CLL. After six courses, the COP therapy was stopped and replaced by a maintenance treatment with oral chlorambucil. During follow up, now lasting more than 3 years, no deterioration of renal function has been noted.


Pancreatitis induced by mesalamine.

Sulphasalazine is an active agent in the treatment of chronic inflammatory bowel disease, but there are a number of well-known side effects, including pancreatitis. The newer 5-ASA agents are thought to be equally effective but less toxic. Here we describe a patient who developed a pancreatitis due to mesalamine; this was confirmed at rechallenge.


Biological action of pancreatic amylin: relationship with glucose metabolism, diabetes, obesity and calcium metabolism.

Amylin, also called islet amyloid polypeptide (IAPP), or diabetes-associated peptide (DAP) is a recently discovered 37 amino acid polypeptide which has been shown to be co-secreted with insulin from the pancreatic beta-cell. The peptide turned out to be the major constituent of pancreatic amyloid deposits which are frequently found in the pancreas of type II diabetic patients. Therefore, a role for amylin in the aetiology of type II diabetes was hypothesized. To investigate this possibility, several studies have been performed to elucidate whether amylin is able to impair insulin secretion and action, two characteristic features of type II diabetes mellitus. These studies suggest that it is unlikely that amylin has a direct inhibitory effect on insulin secretion. Amyloid deposits, however, which are derived from the in situ polymerization and precipitation of amylin, may impair beta-cell function during type II diabetes by damaging and covering beta-cells. Furthermore, it has been shown that amylin has the potential to antagonize the action of insulin on glucose metabolism by increasing hepatic glucose production and by decreasing muscle, but not adipocyte glucose uptake. For these reasons, it has been suggested that amylin might be involved in the pathophysiology of type II diabetes and obesity, disease states which are characterized by abnormal beta-cell function and insulin resistance. In addition, amylin was shown to induce hypocalcaemia by inhibiting osteoclast-mediated bone resorption in a calcitonin-like manner. Therefore, amylin is likely to be involved in both the modulation of glucose and calcium metabolism.


Parkinson's disease in Taiwan: an analysis of 215 patients.

215 Chinese Parkinson's disease (PD) patients on levodopa therapy were followed up between 1982 and 1991. The ratio of males to females was 2.4 to 1. The mean durations from onset of the illness to stages I and II of Hoehn and Yahr (mild disability) were 4.0 and 6.5 years, to stage III (moderate) 7.9 years, and to stages IV and V (severe) 9.8 and 11.8 years. The mean duration of illness for living patients was 8.6 years. The mean duration of illness before death for the 46 patients who died was 8.9 years. The mean age at death was 68 years (4.4 years less than the normal life expectancy in Taiwan). The fate of this disease showed that patients with unilateral symptoms initially had a better prognosis than those with bilateral symptoms. The symptoms at onset were unilateral in 70% of the patients, of whom 91% had a spread of symptoms to the opposite side after a mean of 3.4 years. Familial PD occurred in 2.8% of our patients. The occurrence of blood ABO groups was not significantly different between the PD patients and the general population of Taiwan. Our findings differed from those in Western series by having a predominance of males, and a relatively shorter duration of unilateral symptoms before spread to the opposite side. In addition, the duration of illness and the survival time under levodopa treatment were shorter in Taiwanese and Japanese than in Western series.


Survival in presenile Alzheimer's and multi-infarct dementias.

Duration of survival in patients who had died of presenile Alzheimer's disease (AD) or presenile multi-infarct dementia (MID) in 13 mental hospitals in Scotland are described and contrasted. The duration of survival was significantly longer from symptom onset to death in AD (mean 7.4 years) than in MID (mean 5.8 years). Most of this difference was accounted for by a longer duration between symptom onset and presentation to hospital care in AD (mean 3.2 years) than in MID (mean 2.4 years). Age at onset and gender did not influence survival duration in AD or MID.


Studies on the incidence of dementia: the European perspective.

Dementing diseases, the most common of which are Alzheimer's disease and vascular dementia, are highly prevalent in Europe. To progress further in the search for the etiology of these diseases, incidence studies are needed. Comparison of the data of such studies will be important; the question of whether they produce comparable and interpretable data is therefore critical. We discuss the methodologic differences between earlier and more recent studies conducted in Europe that may account for some of the variation in the incidence rates of the dementia they report. Issues to be explored in the current European studies on the incidence of dementing diseases are also described.


Epidemiology of myasthenia gravis in the province of Trento (northern Italy).

The epidemiology of myasthenia gravis (MG) was studied in the province of Trento (northern Italy) among 444,879 inhabitants. On prevalence day (December 31, 1990) the crude rate was 82.9 per million population: 113 for females and 50.7 for males. The incidence rate was 7.4 per million per year: 10.8 for females and 4.6 for males. Over the same observation period (1981-1990), we calculated a death rate of 1.12 per million population per year. MG predominates in females. Nevertheless, we observed some differences related to age and to presence of thymoma, and our data supports the recognition of three types of MG: (1) predominating in females with a peak frequency at about 20-29 years; (2) affecting both males and females, with a frequency increasing with age, and (3) associated with thymoma.


Factors influencing long-term survival and disability among three-month stroke survivors.

216 survivors of acute stroke were studied 3 months postictus to determine predictors of long-term survival and disability 20 months after the initial stroke. Factors predicting mortality were, in order of importance, old age, a history of ischaemic heart disease, low mental-test score, low serum cholesterol concentration, low Glasgow Coma Score on admission, and the presence of left ventricular hypertrophy. 73% of subjects were correctly classified by discriminant function analysis using these variables. Factors predicting poor functional outcome (Barthel Index 15) were a low Barthel Index at 3 months, old age, low mental-test score at 3 months and a low Glasgow Coma Score on admission. 70% of subjects were correctly classified into 3 functional-outcome groups using these variables. Stroke subtype and size, position, and the territory of the lesion on brain CT did not influence long-term outcome. We conclude that factors affecting long-term survival and disability are different from those affecting outcome immediately after stroke.


A social and epidemiologic approach to use of technology in neurologic practice.

There is a consensus that technology is not always used appropriately in many medical care situations. In this article, a social and epidemiologic approach looks beyond biomedical issues to examine short- and long-term social consequences of using newer technology, particularly as related to neurologic disease. The prevailing belief that noninvasive neurodiagnostic testing is harmless for the patient often overlooks important physical and behavioral effects. High-technology subspecialization within neurology affects the matrix of patient care as well as the character of the specialty. The principles of clinical epidemiology and social medicine can help practitioners use neurotechnology more rationally.


Practice patterns in neurology in India.

Sixteen Indian neurologists saw 1,850 patients over a sample 6-day working week. The average daily workload comprised 19 patients including 11 new cases. Epilepsy (27.0%), headache (19.0%) and cerebrovascular disorders (7.8%) were the commonest problems. Only 2.5% fell in the ICD-9-CM categories 780-799 consisting of symptoms, signs and ill-defined conditions. In 43% it was felt that the neurologic consult was not necessary. In the Indian setting this would suggest that emphasis should be on neurologic education of primary care physicians and internists for the appropriate utilization of limited resources.


[Psychological impact of periodic hemodialysis in the adult].

End stage renal failure and its therapeutic procedures disorganize patient's world through the important modifications concerning his body and his personal, familial and socio-professional life. In proportion as the different stages of his psychological adjustment appear, the patient must mobilize several adaptive mechanisms to face fears, deterioration of body-image and numerous restrictions due to illness and its treatment. The quality of his personal response and of the family, society and medical staff responses will determine his compliance to the uremic status with its therapeutic pressures, and so the results of the treatment and the quality of his rehabilitation.


[Thrombosis and disorders of hemostasis in nephrotic syndrome].

Thromboses and disorders of hemostasis in nephrotic syndrome. Thromboembolic complications are common in nephrotic syndrome (NS). This article reviews the factors of thrombogenesis in NS, including: 1) a hypercoagulable state with platelet hyperaggregability, hyperfibrinogenemia and elevated factor VIII, decrease in plasma levels of coagulation inhibitors antithrombin III and free protein S, reduced fibrinolytic activity; 2) excessive intravascular thrombin formation marked by increased plasma levels of fibrinopeptide A. The intensity of hemostasis disorders coincides with that of NS. Most disorders are related to hypoalbuminemia and proteinuria. In agreement with experimental data, the role of intraglomerular activation of coagulation during active phases of glomerulopathies has to be considered. This could explain the predominance of renal vein thrombosis in several glomerulopathies with NS. Several coagulation disorders in SN have implications for therapy.


[Acute renal insufficiency associated with lymphoma. A new case].

We report on a case of acute renal failure secondary to relapse of a centrocytocentroblastic non-Hodgkin's lymphoma. Twenty-seven cases of acute renal failure due to lymphomatous infiltration of the kidneys have been so far reported. The clinical presentation is non-specific; the size of the kidneys appears normal or enlarged; diagnosis is confirmed by renal biopsy and/or CT scan examination. Chemotherapy and/or radiotherapy sometimes lead to dramatic improvement of renal function. However, prognosis is poor, mostly due to lymphomatous evolution.


[Crescentic Glomerulonephritis associated with gastric adenocarcinoma].

The association of membranous glomerulonephritis with carcinoma and minimal change disease with Hogkin's disease are well established. In contrast cancer and crescentic glomerulonephritis is an uncommon association. We report a patient with gastric carcinoma who developed synchronously acute renal failure due to crescentic glomerulonephritis. Corticosteroid therapy, plasma exchanges and tumor resection was associated with a regression of renal failure. Carcinoma must be considered as a possible cause of crescentic glomerulonephritis.


Peritonitis prevention in continuous ambulatory peritoneal dialysis.

Although peritonitis remains the major cause of morbidity in CAPD, peritonitis rates are declining in European and other countries. This article reviews approaches that are both decisive and promising concerning the prevention of peritonitis in CAPD. Clinical results with both reusable and single-use Y sets are discussed. These systems appear to have a significant impact on the reduction of intraluminal contamination, particularly Staphylococcus epidermidis. The importance of the flush-before-fill technique is reviewed in the context of the new disposable Y sets. In vitro studies confirm that 100 mls of fresh dialysate flushed from the new bag to the drainage bag at the appropriate time during the exchange can eliminate microorganisms that do not possess adherence factors, providing long periods of incubation are not encountered. Future prevention measures for the reduction of Staphylococcus aureus peritonitis are discussed in light of evidence identifying pre-CAPD nasal carriers as high risk patients for subsequent exit-site infection and S. aureus peritonitis. These measures include methods such as the application of antibiotics such as mupirocin to the anterior nares before and during CAPD. The roles of intraperitoneal IgG therapY and staphylococcal vaccination as additional therapeutic approaches to infection control in peritoneal dialysis are also discussed.


The effect of age on protein composition of rat cerebral microvessels.

The effect of age on protein composition of cerebral microvessels was investigated by examining the content of glycosylation endproducts in cerebral microvessels isolated from young (3-6 month old), intermediate age (18 month) and aged (24-26 month old) Fischer 344 male rats and by quantitating various protein spots identified with two dimensional (2D) electrophoresis. The results indicate that aging in rats is not associated with significant increase in glycosylation of microvessel proteins. Of the 26 proteins in cerebral microvessels identified on the 2-D gel, ten showed significant age-related changes (p less than 0.0004) and in two of these the changes were significant as early as 18-months of age. A large acidic protein with a molecular weight of 144,000 and isoelectric point (pI) of 5.4 (Spot #1) was found only in aged rats. The results indicate that aging is associated with significant quantitative changes in protein composition of cerebral microvessels. It is possible that Spot #1 may be a novel biochemical marker of aging blood-brain barrier.


Acetyl-L-carnitine influences the fluidity of brain microsomes and of liposomes made of rat brain microsomal lipid extracts.

The fluorescence anisotropy (r) of diphenylhexatriene (DPH) was measured in different preparations (bovine spinal cord phosphatidylserine liposomes, rat brain microsomes, liposomes made with rat brain microsomal lipid having different phospholipid:cholesterol ratios) at temperatures ranging from 10 degrees to 55 degrees C. Phosphatidylserine liposomes exhibited an exponential relationship of r versus temperature, whereas the relationship shown by microsomes and liposomes prepared with microsomal lipid extracts was a linear one. The removal of protein and high phospholipid:cholesterol ratios decreased the slope of the lines (fluidity increased), although the intercept was unaffected. This means that differences were better appreciated at high temperatures and were well evident at 37 degrees C. Acetyl-L-carnitine decreased r in rat brain microsomes and in liposomes made with microsomal lipids with different phospholipid:cholesterol ratios. The fluidifying effect of acetyl-L-carnitine was mild but statistically significant and could explain, at least in part, the data reported in the literature of acetyl-L-carnitine acting on some parameters affected by ageing. Besides, acetyl-L-carnitine seemed to oppose the changes of viscosity due to lipid peroxidation, which has been reported to increase in ageing and dementia. L-carnitine shares the properties of its acetyl ester, but only in part.


Free radical scavenging systems of rat astroglial cells in primary culture: effects of anoxia and drug treatment.

Hypoxic injury of rat astroglial cells in primary culture initiates several modifications of their functional integrity. A significant decrease of the cellular oxygen consumption was observed in astrocytes submitted to a 15 h low oxygen pressure. The addition of almitrine (dialylamino-4',6'-triazinyl 2')-1-(bis-parafluorobenzydryl)-4-piperazine, a chemoreceptor agonist, restored almost completely the respiratory activity of the hypoxia treated cells. In order to test the hypothesis that oxygen free radical formation may contribute to the cellular damage resulting from ischemia, the activities of the following antioxidant enzymatic systems have been determined in the cultured astrocytes: Cu,Zn- and Mn-superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), glutathione reductase (GSH-RED), and catalase (CAT). Only a significant and specific decrease of the Mn-SOD activity was observed after the hypoxia-normoxia exposure. The other oxygen radical scavenging systems were not modified. The addition of almitrine antagonized the decrease of the Mn-SOD activity observed in the low oxygen pressure treated cells, but results clearly point-out the importance of oxygen radical production in the astroglial response after hypoxic injury. A beneficial effect of almitrine toward the observed alteration has been underlined. It is suggested that some mitochondrial alterations could be related to some aspects of the astroglial hypoxic stress.


Effects of chronic bifemelane hydrochloride administration on receptors for N-methyl-D-aspartate in the aged-rat brain.

We assayed N-methyl-D-aspartate (NMDA) receptors [3H]3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid ([3H]CPP) bindings) and evaluated their distribution in the brain by quantitative autoradiography in young adult and aged rats. In the young adult rats, NMDA receptors were present at relatively high concentrations in the cerebral cortex and hippocampus. In the aged rats, NMDA receptors were decreased in the nealy all areas of the brain, especially in the cerebral cortex and hippocampus. Chronic administration of bifemelane hydrochloride, a drug for sequela of cerebrovascular diseased, at a dose of 15 mg/kg/day for 14 days, markedly attenuated these decrease in NMDA receptors. Since NMDA receptors are considered to be involved in memory and learning processes, our results suggest that bifemelane hydrochloride may be applicable to the treatment of disturbed memory and learning.


Regional distribution of tyrosine, tryptophan, and their metabolites in the brain of epileptic El mice.

Tyrosine, tryptophan, and their metabolites in the brain of ddY, non-stimulated El (El (-)), and stimulated El (El (+)) mice were measured using the three dimensional HPLC. The tryptophan content was lower in El (+) than ddY and El (-) mice. The 5-hydroxytryptophan content was much higher in both El groups. The serotonin content of El (+) was higher than that of ddY and El (-) mice. The kynurenine content was remarkably high in the El mice. The dopamine content was lower in El (-) than in ddY mice, whereas it was greater in El (+) than in El (-) mice. The norepinephrine showed higher levels in El (+) mice. These facts suggest that El mice possess congenital metabolic abnormalities of tryptophan and tyrosine and that kynurenine may play an important role as convulsant in El mice seizures along with changes in serotonin, dopamine, and norepinephrine that are inhibitory agents and responded to the repetitive convulsions.


Secretion of immunoreactive endothelin-1 by capillary and microvascular endothelium of human brain.

Modulation of immunoreactive endothelin-1 (IR-ET-1) production by vasoactive substances was investigated in cultured endothelial cells (EC) derived from capillaries and microvessels of human brain. Peptides, catecholamines, thrombin, protein kinase C-activating phorbol ester, and calcium ionophore enhanced the secretion of IR-ET-1. The known vasoconstrictive peptides, angiotensin II (Ang II) and arginine-vasopressin (AVP) dose-dependently stimulated the endothelial secretion of IR-ET-1. The angiotensin and vasopressin-inducible production of IR-ET-1 was completely inhibited by their respective receptor antagonists [Sar1, Ala8]-angiotensin II and [1-6 (beta-mercapto-beta,beta-cyclopentamethylene propionic acid), 2-O-methyl-tyrosine]. The results indicate that the peptide-stimulated secretion of IR-ET-1 is receptor-mediated in EC which have specific angiotensin II and arginine-vasopressin receptors. These findings represent the first demonstration of IR-ET-1 production by capillary and microvascular endothelium of human brain.


Comparative study between 4-aminobutyrate-2-oxoglutarate aminotransferase (GABA-T) from rat forebrain and cerebellum.

In this study differences in the biochemical properties of 4-aminobutyric acid aminotransferase (GABA-T) from forebrain and cerebellum were detected. These differences may be related to: a) the characteristics of the catalytic site, b) the substrate affinities and c) their pyridoxal-phosphate requirements which suggests that PLP could be a physiological regulator of these forms of brain GABA-T.


Differential effects of ethanol on membrane-bound and soluble acetylcholinesterase from sarcoplasmic reticulum membranes.

The action of ethanol on the activity of membrane-bound and soluble acetylcholinesterase (AChE) in sarcoplasmic reticulum of skeletal muscle has been studied. Treatment of membranes with 2.5-12.5% v/v ethanol produced a slight stimulation of the AChE activity and inhibition at higher concentration. The enzyme remained associated with the membranes after these treatments. The enzyme solubilized with Triton X-100 was inhibited by ethanol in a time-independent manner. Isolated 16 S (A12), 10.5 S (G4) and 4.5 S (G1) forms of AChE were inhibited by ethanol to a similar extent. Samples were reversibly inhibited by ethanol, up to 12.5% v/v, and irreversibly at higher concentrations. Kinetic studies performed with isolated forms in the presence of 5-12.5% v/v ethanol showed that the solvent behaved as a competitive inhibitor of the asymmetric form but as a mixed inhibitor of the tetrameric and monomeric forms. The results show that the solvent interacts with active and/or regulatory sites of AChE from muscle microsomes.


2-Guanidinoethanol increased dopamine release and 3,4-dihydroxyphenylacetic acid content, but not homovanillic acid content in the rat brain: electroneurochemical and enzymological studies.

The effects of 2-guanidinoethanol (GEt) on the release of monoamines and on the activity of their degrading enzymes were studied in order to investigate why 3,4-dihydroxyphenylacetic acid (DO-PAC) increased to a much greater extent than homovanillic acid (HVA) after GEt injection into rat brain. In differential pulse voltammograms recorded using an electrochemically treated carbon fiber electrode, two distinct oxidation peaks, one at 130mV (DOPAC peak) and the other at 300 mV (5-hydroxyindoleacetic acid (5-HIAA) peak), were observed. In the hippocampus, the DOPAC peak increased markedly compared to the peak height recorded prior to the intracerebroventricular injection of GEt (6 mumol). Although the DOPAC peak height increased to 350% 4 hours after GEt injection, the 5-HIAA peak showed no change. In the striatum, the DOPAC peak increased to 150% 3 hours after GEt injection. Serial changes in the extracellular levels of DOPAC, HVA, and 5-HIAA were monitored in the striatum after GEt injection, using an in vivo brain micro-dialysis technique. Although the DOPAC levels strated to increase 80 minutes after GEt injection, HVA and 5-HIAA levels showed no change. On the other hand, monoamineoxidase, which metabolizes dopamine to DOPAC, was not activated and catechol-O-methyltransferase, which metabolizes DOPAC to HVA, were not inhibited by 5 mM of GEt in vitro. These data suggested that GEt increased the release of dopamine, but not of serotonin, and that GEt might restrict the DOPAC transport system.


Effect of 2,5-hexanedione and 3,4-dimethyl-2,5-hexanedione on retrograde axonal transport in sciatic nerve.

The effects of systemically introduced neurotoxic solvents 2,5-hexanedione (2,5-HD) and 3,4-dimethyl-2,5-hexanedione (DMHD) on retrograde axonal transport (RT) of 125I-labeled tetanus toxin (TT) was studied in rat and mouse sciatic nerves. The rate of retrograde transport of TT in control rat sciatic nerves was slightly higher (6.8 +/- 0.4 mm/h) than in mouse sciatic nerves (5.4 +/- 0.5 mm/h). A single high dose of 2,5-HD (1,000 mg/kg, i.p.) produced a time-dependent effect on RT in mouse sciatic nerves. 2,5-HD caused a gradual decrease in the velocity of RT (approximately 65% inhibition between 2.0-2.5 h) with a reversal to normal rate 3-5 h after the toxin administration. The effect of DMHD on RT was examined following semi-chronic treatment in rats. DMHD caused a significant decrease (approximately 50%) in the rate of TT transport, in addition, it produced weight loss and hind-limb paralysis.


Neurochemical changes in rats chronically treated with a high concentration of manganese chloride.

Several neurochemical parameters were studied in brain regions of rats chronically treated with a high concentration of manganese chloride (20 mg MnCl2.4H2O per ml. of drinking water) throughout development until adulthood. Large increases in Mn accumulation were found in all brain regions (hypothalamus, +530%; striatum, +479%; other regions, +152 to +250%) of Mn-treated adult rats. In these animals, Ca levels were decreased (-20 to -46%) in cerebellum, hypothalamus, and cerebral cortex but were increased (+186%) in midbrain. Mg levels were decreased (-12 to -32%) in pons and medulla, midbrain, and cerebellum. Fe levels were increased (+95%) in striatum but were decreased (-28%) in cerebral cortex. Cu levels were increased (+43 to +100%) in pons and medulla and striatum but Zn levels were decreased (-30%) in pons and medulla. Na levels were increased (+22%) in striatum but those of K and Cl remained unchanged. Type A monoamine oxidase activities were decreased (-13 to -16%) in midbrain, striatum, and cerebral cortex, but type B monoamine oxidase activities decreased (-13%) only in hypothalamus. Acetylcholinesterase activities were increased (+20 to +22%) in striatum and cerebellum. The results are consistent with our hypothesis that chronic manganese encephalopathy not only affects brain metabolism of Mn but also that of other metals.


Structure and regulation of the MinK potassium channel.

MinK is a novel protein which induces an extremely slowly activating potassium channel when expressed in Xenopus oocytes. We discuss the properties and regulation of the current and localization and possible physiological roles of the MinK protein.


Quantitative aspects of reactive gliosis: a review.

Recent studies of gliosis in a variety of animal models are reviewed. The models include brain injury, neurotoxic damage, genetic diseases and inflammatory demyelination. These studies show that reactive gliosis is not a stereotypic response, but varies widely in duration, degree of hyperplasia, and time course of expression of GFAP immunostaining, content and mRNA. We conclude that there are different biological mechanisms for induction and maintenance of reactive gliosis, which, depending on the kind of tissue damage, result in different expressions of the gliotic response.


The properties of cultured fetal human and rat brain tissue and its use as grafts for the relief of the parkinsonian syndrome.

Primary cultures were derived from human fetal ventral mesencephalon and cerebral cortex at 7-11 weeks gestation, and from fetal rat mesencephalon and cortex at embryonic day 14-15. Immunohistochemical analysis of the mesencephalic cultures using antibodies to tyrosine hydroxylase (TH) showed between 0.1-0.5% of human cells to be TH positive and 0.1-1% of rat cells to be TH positive. HPLC analysis of extracts from the cultures showed that they had the ability to synthesise and store dopamine. Implantation of the cultured human and rat mesencephalic tissue into a 6-hydroxydopamine rat model of Parkinson's disease produced marked recovery from amphetamine induced rotational asymmetry in the recipient rats, but no such recovery was observed following implantation of cortical cultures. Histological examination demonstrated the presence of surviving human mesencephalic and cortical grafts at least 6 months after implantation. Implants of cultured fetal rat tissue were less obviously but still significantly effective in these experiments. These rat tissue grafts were detectable for periods of at least 6-8 weeks by histological staining.


Fluids of the brain and the pathogenesis of MS.

The plaques of multiple sclerosis are generally thought to spread outwards from central veins. We propose that periventricular plaques in the cerebral hemispheres, and superficial plaques in the brain stem and spinal cord, point to the importance of demyelinating factors in the cerebrospinal fluid.


Novel brain-specific bovine cDNA for a developmentally regulated mRNA encoding a putative new member of the leucine-rich glycoprotein (LRG) family.

We have isolated a bovine cDNA which hybridized to a 2 kb mRNA specifically expressed in the rat and human brain. The mRNA was abundantly expressed in adult but not 21-week old human brain. In the rat brain, there was very little of the transcript in 15-day old fetus but it increased in abundance with development, being most abundant in the adult and expressed in all brain regions. Genomic analysis showed that the sequence is single copy and conserved in all vertebrates examined, including chicken. The 702 bp partial cDNA encoded an amino acid sequence for a putative member of the leucine-rich glycoprotein (LRG) family known to be involved in cell adhesion/recognition. The predicted polypeptide displayed sequence identity with that recently reported for the human oligodendrocyte-myelin glycoprotein. This cDNA should prove useful in further investigations on brain-specific cell-cell interactions.


Monoclonal antibody 14E recognizes an antigen common to human oligodendrocytes, Schwann cells, Bergmann glia, and a subpopulation of reactive glia.

The monoclonal antibody 14E immunocytochemically stains the nuclear membrane of oligodendrocytes but not myelin in tissue sections of adult normal human white matter. The nuclear membranes of Schwann cells in human peripheral nerve and cerebellar Bergmann glia were also visualized with this antibody. In actively demyelinating multiple sclerosis plaques the 14E antibody stained increased numbers of oligodendrocytes and the nuclei, perikarya and cell processes of hypertrophic glia, which were often multinucleate. Scattered small groups of these hypertrophic glia were present in areas of dense astrogliosis in acute plaques. The 14E-positive hypertrophic cells could be either a subpopulation of reactive astrocytes or bipotential glial precursors.


Energy metabolism and selective neuronal vulnerability following global cerebral ischemia.

A short period of global ischemia results in the death of selected subpopulations of neurons. Some advances have been made in understanding events which might contribute to the selectivity of this damage but the cellular changes which culminate in neuronal death remain poorly defined. This overview examines the metabolic state of tissue in the post-ischemic period and the relationship of changes to the development of damage in areas containing ischemia-susceptible neurons. During early recirculation there is substantial recovery of ATP, phosphocreatine and related metabolites in all brain regions. However, this recovery does not signal restitution of normal energy metabolism as reductions of the oxidative metabolism of glucose are seen in many areas and may persist for several days. Furthermore, decreases in pyruvate-supported respiration develop in mitochondria from at least one ischemia-susceptible region at times coincident with the earliest histological evidence of ischemia-induced degeneration. These mitochondrial changes could simply be an early marker of irreversible damage but the available evidence is equally consistent with these contributing to the degenerative process and offering a potential site for therapeutic intervention.


[Indications for the shunt treatment of children with cerebellar astrocytoma].

In the years 1980-1987 the number of children aged from 11 months to 15 years treated for cerebellar astrocytoma was 113, the mean age was 5.4 years. Shunt insertion preceding the main surgical treatment was done in 10 cases (9%). After the operation shunt was necessary in 15 cases, that is 15% of cases not undergoing shunt insertion before the operation. In all, shunting was necessary in 22% of patients with cerebellar astrocytoma. In the conclusions the authors suggest indications to shunting in various age groups in cases of cerebellar astrocytoma.


[Brain tumors in the records of the Department of Neurosurgery in Rzeszów 1976-1989].

The authors present the results of surgical treatment of 232 patients with brain tumours operated on in the neurosurgery centre in Rzeszów. In 84% of cases it was possible to remove the tumor radically, 44% of the patients were subjected to postoperative radiotherapy. The relationship is discussed between the operative results and the location of tumor, its microscopic structure and patient's age.


[Colloid cysts of the III ventricle. Report on our 8 cases operated on by the interhemispheric approach].

Between 1984 and 1990, 12 patients with colloid cysts of the third ventricle were operated on. 8 of them underwent surgery by an anterior transcallosal approach with very good result. The authors discuss the different methods of surgical treatment using the microsurgical technique and present the advantages of the midline approach.


[Diagnosis and treatment of recurrent brain glioma].

In the period from Jan 1 1984 to Dec 31 1990 clinical and radiological evidence of brain glioma was found in 120 cases treated previously surgically. The group comprised 55 women (46%) and 65 men (54%). At the time of tumour diagnosis their age was ranged 40 to 60 years. All patients received non-radical surgical treatment, supplemented with Co60 radiation in 104 cases, in 3 cases Co60 treatment was given together with chemotherapy (CCNU) and 12 patients received no complementary treatment. Thirty four patients (28%) had reoperations, in two cases even twice. In 86 cases (72%) treatment was palliative. Three types of secondary tumour regrowth were discerned. Reoperation prolonged survival and its effectiveness was greatest in regrowth type I. The shortest survival till the appearance of regrowth signs and the shortest survival after recurrence were in type II of regrowth.


[Factors affecting the quality of life of patients treated by a combined method for poorly differentiated supratentorial glioma].

The quality of life of patients treated for brain tumours and the length of survival are important factors making possible the evaluation of treatment effectiveness. Changes of life quality evaluated by the Karnofsky scale were analysed in a group of 56 patients who have received combined treatment for poorly differentiated supratentorial gliomas. Life quality changes were evaluated after completion of surgical and radiological treatment in relation to preoperative status. The influence of various clinical factors on life quality changes was evaluated. Surgical treatment and tumour site had a significant effect on the stabilization or slight improvement of life quality. The direction and extent of life quality changes were related to surgery, with further change after radiotherapy.


[Transplantation of fetal dopaminergic cells in Parkinson disease].

Four patients with severe form of Parkinson's disease received transplantation of fetal dopaminergic cells into the caput of the caudate nucleus. The operation was done by an original method using a device designed specially for this purpose. In all cases the duration of the disease was 10 to 15 years, and the predominating signs were tremor, bradykinesia, and markedly pronounced side effects of the treatment (on-off syndrome and involuntary movements). One patients died 5 weeks after the operation. Autopsy demonstrated good survival of the transplanted cells with good integration with the brain of the recipient and traces of positive immunocytochemical reaction for tyrosine hydroxylase. In the other patients a significant clinical improvement was noted after the operation, with reduced intensity of parkinsonian symptomatology, shortening of the duration of the off phase, improved motor ability and reduced intensity of the involuntary movements. The longest follow-up was 24 months.


[Brachytherapy of brain gliomas].

Radiotherapy is considered presently the most advantageous supplementary method after surgical treatment for gliomas. The limitations of classical teletherapy cause that interstitial radiation may become preferable. The authors present the theoretical principles and practical application of brachytherapy in 10 cases of glioma. Closed radioactive sources were used in form of I125 implanted stereotactically into brain tumours for a period sufficient for providing therapeutic radiation dose to the border of the tumour. The doses received by tumour borders ranged from 812 to 4560 cGy, and the mean dose was 2064 cGy. Five patients were given additionally 6000 cGy by teleradiotherapy.


[Use of a stereotaxic method in the diagnosis and treatment of brain neoplasms in children].

The paper presents the possibility of application of the stereotactic method in the diagnosis and treatment of pediatric brain tumours, based on the material of the Dept. of Stereotactic Neurosurgery of the University Clinic in Homburg-Saar (Germany). The basic theoretical principles and diagnostic potential of serial biopsy and intraoperative diagnosis are presented. Shown are new therapeutic possibilities created by interstitial brachytherapy. The results obtained in stereotactic treatment of brain tumours are deemed satisfactory, as the method enables a cause-oriented treatment in cases hitherto inoperable because of localisation and resistant to megavolt radiotherapy because of radiobiological characteristics of the given neoplasm.


[Clinical analysis of 27 cases of primary lymphoma of the central nervous system].

Clinical analysis of 27 patients with primary central nervous system lymphoma--Out of 4397 patients with intracranial neoplasms treated in the Department of Neurosurgery Medical Academy in Poznań between years 1956-1990, 27 patients i.e. 0.6% had primary central nervous system lymphoma. The patients age ranged from 15 to 63 years. In most patients the tumour was located in the temporo-parietal region. All patients were treated surgically, and then some received radio and/or chemotherapy. In spite of combined therapy the results of treatment are unsatisfactory, the median survival time is between 2 and 4 months.


[Early results of surgical treatment of discopathy at the Neurosurgical Clinic, Medical Academy, in Białystok].

The author discusses 876 cases of discopathy treated surgically at the Neurosurgery Department in 1987. Better results were obtained in patients operated on within 6 months after the development of the first symptoms of disc prolapse.


[Reoperations in lumbar discopathies].

In the years 1976-1990 at the Neurosurgery Centre in Rzeszów 938 patients were treated surgically for lumbar discopathy. Reoperation was necessary in 5.4% of cases. In 0.6% of them purulent wound infection was the cause, in the remaining 4.8% lacking improvement or recurrence of sciatic pain after 1 month to 12 years. In 2.2% of cases the cause of pain recurrence was recurrent hernia at the same or other level, and after its removal sciatic pain disappeared. Root compression by cicatricial tissue or osteophyte caused reoperation in 1% and surgical decompression of the root gave only minor improvement. Lacking improvement after the first operation was due in 0.7% of cases to a fragment of the nucleus pulposus left in the vertebral canal and in 0.6% the cause was failure to recognize two-level discopathy. After reoperation in such cases all pains regressed. The analysis showed that the frequency of repeated interventions would be diminished by careful excochleation of the intervertebral space, operative revision of the space with comparison with the results of radiculography and clinical examination, and not too late decision of operation.


[Usefulness of computerized myelotomography in the diagnosis of discopathy of the cervical spine].

The authors compared the results of preoperative computer-assisted myelography (CAM) with surgical findings in 45 patients with suspected cervical disc disease. In 98% CAM gave full and proper diagnosis confirmed by surgery. Only in one patient, the preoperative diagnosis was extraspinal tumour, and surgery revealed prolapsed nucleus pulposus lying freely on the anterior wall of the dural sac. In authors's opinion, CAM is sufficient for planning of surgical treatment in cervical disc disease, and other radiological studies, myelography or nuclear magnetic resonance tomography are usually not necessary.


[Evaluation of work capacity in cases of discopathy of the lumbosacral segment of the spine].

The ability to resume occupational work in cases of lumbar discopathy was assessed in an analysis of 1104 cases treated in a period of 25 years. The assessment was analysed in relation to the following factors: 1. disease duration, 2. discopathy type, 3. patient's age, 4. occupation type, 5. treatment. The paper contains a number of observations concerning the management of lumbar discopathy, and suggestions related to working ability expertise in such cases.


[Prognostic value of evoked potentials of the spinal cord in surgical treatment of lumbar intervertebral disk prolapse].

Spinal potentials were evoked stimulating the peripheral nerves of lower extremities in healthy people and in patients with manifestations of lumbar disc prolapse. The patients were studied before and early after the operation. In healthy subjects the velocity of impulse conduction was nearly identical when both extremities were compared. In the patients the test before the operation revealed a significant prolongation of the latency of the potentials on the side of the damaged nerve root. After the operation a significant difference between the healthy and the affected side was still present early after the operation but it was significantly smaller than before the operation since the conduction velocity was improved on the side of the operation. The study of spinal evoked potentials makes possible recognition of disturbed function of nerve roots, and after the operation the rate of changes of potential latency is an important prognostic sign.


[Brain mapping in atonic epileptic attacks with consciousness disorders at school age].

The paper presents the results of the analysis of atonic epileptic seizures with application of brain mapping eeg. The views to date on the pathogenesis of atonic seizures could be based on the assumptions of centrencephalic epilepsy voiced by Penfield and Jasper. The present investigations and electrophysiological-clinical observations support, however, contrary to the concept of Penfield and Jasper, the cortical origin of these seizures. The discussion on the clinical forms of atonic seizures in epilepsy, confirmed by analysis of brain mapping in the domain of frequencies and amplitude distribution, in the form of brain topograms, allows for the concept of cortical origin of these seizures with the probability of localisation of the epileptic focus, as in here presented case, in the anterior right paramedial frontal region of the brain.


[Brain mapping in Parkinson disease treated by cryothalamotomy].

Brain mapping of the cerebral bioelectric activity was done by the BEAM method in 20 patients with Parkinson's disease treated by cryothalamotomy. Conventional egg examinations demonstrating relatively small changes of the type of local asymmetry of frequencies and/or amplitudes, sporadic focal changes, and sporadic generalized and disseminated generalized changes were analysed in a computer system in the domain of frequency and time. Brain mapping demonstrated very distinctly the asymmetry in the frequency bands alpha and beta. On the operated side a regular alpha rhythm of lower frequency but higher amplitude dominated in the brain hemisphere. On the intact side a quick beta rhythm prevailed and an irregular alpha rhythm was noticeable. This phenomenon described by analysis in the domain of frequency confirms the unilateral synchronizing influence of thalamotomy on the bioelectric activity of the operated brain hemisphere and may correlate with the functional motor improvement noted in the operated subjects. In three cases with a longer course of the disease analysis in the frequency domain demonstrated the presence of generalized diffused slow waves in both frontal regions. These changes correlated with mental insufficiency of the examined patients.


[Results of surgical treatment of 35 giant aneurysms].

Results of surgical treatment of 35 giant aneurysms. Over the last 4 years (1988-1991) 35 large aneurysms were operated on in the Department of Neurosurgery Medical Academy in Gdańsk. This material is divided in two groups: to group I belong these aneurysms of diameter 2 to 2.5 cm and to group II those above the diameter of 2.5 cm. Surgery in group I was always performed by means of direct attack, while in group II sometimes STA-MTA by-pass, combined with carotid ligation was applied. The by-pass procedure is particularly advocated in the aneurysms of the infraclinoid portion of ICA and those originating from the junction of the ophthalmic and ICA (carotid-ophthalmic). With the progress of operative technique and routine application of temporary clipping of the vessels adjacent to and supplying the aneurysm, the number of by-pass operations has been limited to those of the infraclinoid portion of ICA only. Only in 1 case the result was unfavourable, in 2 cases it was fair and in 2 other cases it was excellent.


[Results of the treatment of idiopathic hydrocephalus by shunt implantation after computerized cisternography].

A retrospective study was reported of 19 patients (10 males and 9 females aged from 11 to 65 years) with idiopathic hydrocephalus treated by shunt implantation after qualification for this treatment based on computed tomocisternography. Clinical improvement was noted in 16 patients (84%), and after 2 months the therapeutic results by Black's scale were good in 13 patients (65%).


[Changes in CSF resorption resistance. Experimental studies].

Lumbar infusion tests (IT) with different infusion rates (0.06 ml/min-1.2 ml/min) were used in order to investigate the intracranial pressure (ICP) and CSF outflow resistance (R) changes. Two groups of animals were studied: control group and animals with an 0.8 ml epidural balloon. In control group (without balloon) significant differences in ICP and R values between the increasing and decreasing IT curve were found. The most pronounced changes were noticed right after the highest infusion rate (40% for ICP value and 49% for R value). The results in the balloon group were very similar and the only difference were delayed ICP and R changes. The results obtained suggest that the determined R values are specific for the applied infusion rate and this phenomenon has to be taken into account in all human studies.


[Metabolic effects of experimental thermal damage of the brain in rats--cold lesion].

Experimental thermal brain injury leads to significant reduction of glucose utilization in the damaged hemisphere particularly evident in the cortex 3 days after the injury. The rate of development of these changes is not parallel with the observed damage to the blood-brain barrier, coexistent brain oedema and slight disturbances of cerebral blood flow. In a series of experiments it was possible to demonstrate significant accumulation of glucose, high-energy phosphate compounds and their metabolites in the areas of the brain near the damaged part. The authors think that this is an evidence of reduced glucose uptake by the brain resulting from reduced energy needs of the damaged brain tissue despite sufficient supply of energy-yielding substances. Since cerebral metabolism and functions are in close interrelationship reduced glucose metabolism in the damaged tissue leads to reduced activity of the cortex, which contributes to transient (or permanent) functional neurological deficits observed after cranio-cerebral trauma in humans. The knowledge and understanding of these processes regulating the development of local depression of cerebral metabolic processes may help in better results of treatment in such cases.


[Our experience with microsurgical methods of the treatment of injuries of the radial nerve caused by humeral fracture].

Experiences are presented with the surgical treatment of 33 patients with traumatic radial nerve injuries after humerus fracture. Diagnostic and surgical difficulties of primary orthopaedic humerus fragment union by osteosynthesis with simultaneous evaluation of the damaged nerve. In the group of patients who had been given primary orthopaedic treatment the causes were analysed of reinnervation failure. In another group of patients undergoing metal plate removal after full bone union had been achieved the own experiences are presented related to an improved method of operative approach and delayed reconstruction of the damaged nerve. The authors suggest reconstruction of radial nerve injury after humerus fracture by specialized teams of orthopaedic surgeons and neurosurgeons.


[Late results of the treatment of trigeminal neuralgia by the method of thermocoagulation of the gasserian ganglion].

The authors reviewed a series of 38 consecutive patients with trigeminal neuralgia treated by percutaneous thermocoagulation in 1984-90. In 10 patients in whom the result of the treatment was unsatisfactory the coagulation was repeated (in 2 out of 10 twice). The analysis of the results showed that good outcome was connected with permanent anaesthesia in the area innervated by the coagulated branch. If anaesthesia was not present 24 hours after the treatment, it suggested that an insufficient lesion was done and consequently unsatisfactory result was likely. In patients in whom there was a sensory impairment after either thermocoagulation or other form of treatment (injection of alcohol or rhizotomy) repeated thermocoagulation not only did not give good results but could lead to worsening of the pain.


[Use of the Nd:YAG laser in surgical treatment of intracranial tumors].

The Nd:YAG laser was used between January 1989 and March 1991 in 63 cases of intracranial tumours, including 32 meningiomas, 16 gliomas (including 11 glioblastomas), 8 acoustic neurinomas, 11 metastatic brain tumours. In 76.2% of cases very good results were obtained. The Nd:YAG laser was found to be particular value in the treatment of vascular intracranial tumours, especially meningiomas and metastatic tumours. The ability of the Nd:YAG laser to shrink and devascularize these tumours, was useful in neurosurgical operations. The no-touch technique, minimal or no thermal effect on surrounding tissues, better haemostasis and precision allow for easier removal of acoustic nerve tumours. The Nd:YAG laser is very useful in the operations close to the very important for life areas of the brain. The major advantages of laser include reduction of mechanical trauma, reduction of blood loss, and more radical removal of intracranial tumours.


[Evaluation of the usefulness of cerebral perfusion pressure in threatened cerebral ischemia].

The Cushing response was produced using the lumbar infusions in cats. The following parameters were recorded and computed: arterial blood pressure (ABP), central venous pressure (CVP), intracranial pressure (ICP), heart rate and ECG. The lactate concentration was studied in brain stem and brain cortex. The analysis of ABP and ICP recordings showed in some cases that the Cushing response was obtained at CPP over 60 mmHg. The role of adrenergic reaction in Cushing phenomenon was confirmed by the increase in blood catecholamine concentration and typical adrenergic changes in ECG pattern.


[Analysis of selected prognostic factors in patients with ruptured cerebral aneurysms operated-on in the early period].

An analysis of certain clinical and laboratory findings of 80 patients with ruptured intracranial aneurysms was done. All of them underwent an operation in acute stage. The following prognostic factors were analysed: age of patient, sex, number of previous subarachnoid hemorrhages (SAH), clinical status according to the Hunt-Hess scale, CT finding according to Fisher scale, location and number of aneurysms, time of operation, Nimodipine treatment, body temperature, serum sodium level, white blood count just before operation, mean blood pressure, coexistence of heart and kidney disease. A special computer programme was used to analyse the value of the above factors on follow-up and the final results of the ruptured intracranial aneurysms treated surgically in acute stage.


[Late results of surgical treatment of chronic subdural hematoma at the Department of Neurosurgery of the Merged District Hospital in Rzeszów 1976-1987].

Late results of the surgical treatment of chronic subdural haematomas in 117 patients after 1-13 years of follow-up are reported. Sporadic headaches were the complaint in 24% of cases, sporadic dizziness in 17.5%, and weak recent memory in 7.2%. Neurological deficit was found in 6.6% of cases. The complaints and neurological deficit present late after the operation caused no limitation of self-dependence and no help of others was necessary. EEG changes were present in 13.7% of cases late after the operation and had a decreasing tendency. The number of patients quitting work and receiving disability pension was greater than the number of those voicing complaints or showing neurological deficit. The wide range of works done by these "disabled" shows that the criteria of recognizing working disability are very imperfect. In 90 patients in whom the brain failed to expand spontaneously after haematoma evacuation 0.9% NaCl was given intrathecally and brain expansion was achieved. In this group complaints and deficits were much less frequent than in those in whom brain expansion was not aided. In the group with slower development of haematoma complaints and deficits were less frequent than in those with haematoma developing before one month after trauma.


[Traumatic and spontaneous cerebral hematoma].

The authors analyzed 231 patients--14% of all intracranial haematomas treated in the Department of Neurosurgery in Poznań between 1962 and 1990. The patients were divided into 3 following subgroups: I--cases of spontaneous haematomas (identified and unidentified)--30%, II--haematomas of unknown aetiology, but after mild head trauma--27%, III--traumatic haematomas--43%. Increased risk of mortality was observed in cases with intracerebral posttraumatic haematomas. These patients demonstrated diffuse cerebral oedema and multifocal contusions. In the subgroup of patients with spontaneous cerebral haematomas vascular malformation was present during operation or/and in histopathological study--65%.


[Surgical treatment of cerebral hematoma using an endoscopic method].

In the period from January 1990 to March 1991 in the Neurosurgery Department, Mining Industry Health Service Hospital in Sosnowiec 21 operations of evacuation of supratentorial intracranial haematomas were carried out by the endoscopic method using a neuroendoscope produced by K. Storz. The indication to this operation was a serious condition of the patients up to 10 points of the Glasgow scale, strictly limited extent of haematoma and ventricular system shifting over 5 mm in computed tomography. The mass of the haematoma could be evacuated in 70-90% and the patients were spared extensive craniotomy. Two patients had reoperations due to renewed haematoma formation. 48% of the patients left the hospital in good condition without neurological deficits and 42.5% had focal neurological signs.


[Remarks on conservative treatment of cerebral hematoma].

Authors present 38 patients treated non-operatively because of intracerebral haematomas since 1988 till 1990 in ++Neuro-traumatological Ward Medical Academy of Lódź. The aforementioned data revealed that patients could be treated non-invasively if: 1. On admittance to the ward they were in good general condition they were conscious or their awareness was uptuned a bit. 2. Compression of ventricular system and even slight replacement of media line structures was not an indication to operative treatment if the consciousness of the patients had been good, had not deteriorated during the treatment and on CT scan control haematomas and mass effect vanished. 3. It seemed that if general and neurological condition of patients was good or improved the control could be performed in week or even longer periods of time.


[Evaluation of the results of the treatment of cerebral hematoma in relation to its volume using the "best fit" method].

A method is described in which the volumes of intracerebral haematomas were retrospectively measured by a method of best-fitting circles, in 173 consecutive patients. 173 patients were operated on and 41 were treated conservatively. Prognosis in supratentorial haematomas of the volume up to 65 ml is better by 20% when they are treated conservatively. It seems that surgical treatment should be reserved for patients with haematomas over 65 ml presenting progressive deterioration of neurological condition. On the other hand, patients with infratentorial haematoma over 14 ml of volume should be operated on as quickly as possible.


[Acute subdural hematoma treated at the Department of Neurosurgery of the District Hospital No. 2 in Rzeszów 1976-1990].

The results of the treatment of 95 patients with acute subdural haematoma with discussion of the diagnostic difficulties and method of surgical treatment are presented. The relationship between trauma severity and therapeutic results, and between alcohol abuse and higher mortality is analysed.


[Results of surgical treatment of intracranial aneurysms].

In the years 1986-1990 in the Department of Neurosurgery Military Hospital in Bydgoszcz 61 patients were treated surgically for intracranial aneurysms. Good results were obtained in 60.7% of cases and bad in 21.3%. Death from extracranial causes occurred in 6 cases. The number of past bleedings from the aneurysms, the clinical state of the patients, the timing of the operation, intraoperative rupture of the aneurysms were factors having a significant unfavourable influence on the early postoperative results.


[Immediate and late results of the treatment of cerebrospinal rhinorrhea at the Department of Neurosurgery of the District Hospital in Rzeszów].

In the period 1976-1989 in the Neurosurgery Department, Province Hospital in Rzeszów 130 patients were treated for CSF rhinorrhoea and 104 of them were treated surgically. Out of these 104 patients 6 died after the operation because of purulent complications and severe brain injury following extensive open fractures of the anterior cranial fossa. The follow-up examinations are performed 1 to 13 years after the operation and conservative treatment. From the surgical group 77 (79%) came for the examination: 75 led active life, 50 resumed occupational work, 25 had disability pensions, 2 died, the cause of death was not established. From the group treated conservatively 15 patients responded (71%). Seven resumed occupation, 8 received disability pension, one died of cerebral abscess 3 years after head trauma.


[Cranioplasty of extensive defects of the cranial vault bones using a "Codubix" prosthesis].

In the years 1980-1987 in the Neurosurgery Department, Medical Academy in Lódź in 21 patients aged 12 to 59 years covering of cranial vault bone defects over 100 cm2 of area was done using of cranioplasty polypropylene-polyester knitted fabric Codubix. The size of the implanted prostheses was from 100 to 430 cm2. The time from bone defect occurrence to cranioplasty was from 4 weeks to 18 years. Cranial defects resulted from treatment of trauma complications in 10 cases, treatment of intracranial tumours in 7, aneurysms in 2 and intracranial infections in 2 cases. The follow-up after cranioplasty was from 3 to 10 years. In 18 cases (85.7%) good and very good therapeutic results were obtained. Three patients required removal of prosthesis because of purulent complication, in 2 of these cases high risk of infection was present before the operation. Codubix prosthesis was particularly useful for filling giant of cranial bones.


[Cranial bone prosthesis made of acrylic resins and prepared before surgical operation--description of the method].

The authors present a method of cranioplasty using super-acrylate type "O". Two approaches are used to this problem--copying of the own bone of the patient and use of an appropriate prosthesis made of plastic material used in maxillofacial surgery. The obtained results were favourable with respect to cosmetic effect and clinical outcome.


[Treatment of skull defects by using plastic material "Codubix"].

Early and late results of surgical treatment of cranial vault defects with Codubix prosthesis in 46 cases are presented. Early after the operation purulent complications were not observed. The main problem of normal healing-in of the prostheses was at that time accumulation of subgaleal haematoma which was observed in five patients (10.8%). Late complications necessitating removal of Codubix prosthesis occurred in four cases (8.7%). In one patient Codubix treatment led to meningitis due to late cerebrospinal fluid rhinorrhoea and in the second case staphylococcal infection was diagnosed 4 month after the operation. In 2 remaining cases prosthesis became movable 5 and 21 months after operation and became depressed by several millimeters. The inquiry sent to the patients for obtaining information on their present health was answered by 70% of them, and four reported slight, stable depression of the plate. The remaining ones reported no complications. In 91% of cases the patients regarded the cosmetic effect of the operation as good and 9% as unsatisfactory. Codubix is good material for filling of bone defects. It heals in quickly, produces rarely purulent complications, but requires very careful fixation.


[Use of biological vicarious biofeedback in the rehabilitation of patients with brain damage].

The mechanisms of feedback not controlled by our consciousness play an essential role in the functions of the central nervous system in the process of programming of activities, behaviour and control of these functions. In case of deviations or errors of activities the possibility of their immediate correction exists. Brain damage after trauma or caused by tumour disturbs these normal feedback mechanisms producing very varying symptom complexes. In such cases it is advantageous to introduce vicarious feedback based mainly on visual and auditory afferentation. The authors present own original methods used in the rehabilitation of such patients using vicarious feedback with elbow crutch with light and sound signalling in walk learning, and platform for attitude stability exercises. The earlier obtained results of rehabilitation by this method in a large group of patients after stroke, and preliminary observations of patients after trauma and after tumour operations justify recommendation of the method.


[Extensive arterial anomaly in the spinal canal (Th5-S5) in a 3-year-old boy].

A case of an extensive arterial anomaly in the vertebral canal (Th5-S5) in a boy aged 3 years is described. Sudden onset of the disease with massive subarachnoid haemorrhage, loss of consciousness and signs of raised intracranial pressure suggested rather a lesion in the cranial cavity. The final diagnosis was made after myelography and spinal arteriography. In view of the extent of the lesion its radical removal was not possible. Embolization was done twice of the greatest vessels feeding the anomaly followed by decompression laminectomy. The patient is without neurological defects and pains. The case is reported in view of its rarity and atypical character of the lesion as well as its extent.


[Effect of partial kyphectomy on the improvement of the results of reconstructive surgery in open meningomyelocele].

The authors present the results of reconstructive surgery on an open myelomeningocele in the lumbar region, the defect being accompanied by a large skin defect and the vertebrae malformed in form of bone hump. During the surgery two vertebral bodies were removed from the top of the hump, resulting in a proper closure of the myelomeningocele.


[A case of heterotopic ossification in the parapharyngeal region connected with the C2 vertebra in a 9-year-old girl].

A rare case of extraskeletal ossification in the parapharyngeal region related to C2 cervical vertebra was observed in a child, without any history of trauma, inflammation or endocrinological disease. One-step surgical intervention was carried out from the side of the neck and pharynx making possible complete removal of the lesion. The girl was admitted to the hospital with dysphagia and breathing difficulties increasing in the last 6 months. During that time the child was observed in laryngological hospital departments. After the operation Horner syndrome and hypoglossal paresis developed, but presently the child is without symptoms.


[Extensive bifocal location of ependymoma of the spinal cord].

Spinal cord ependymomas belong to rare tumours of the central nervous system. Their malignancy is usually low although anaplastic forms are known also to occur. Surgical treatment is the method of choice supplemented often with radiotherapy. An exceptionally rare form of ependymoma with two foci of origin in the spinal cord is reported. The large extent of the tumour caused that laminectomy at 15 levels was necessary. The mechanism of ependymoma development at two levels is discussed.


[Epidural hematoma with unilateral exophthalmos].

A case of epidural haematoma in the fronto-temporo-parietal region with ipsilateral exophthalmus is presented. In the light of 10 cases reported in literature and one own case, and on the basis of neuroanatomical data the possible causes of this rare sign are discussed. The aetiology of this exophthalmus is still unclear and subject to discussion.


[Diagnosis and treatment of aneurysms of the lower segment of the vertebrobasilar system].

The authors present 20 patients with aneurysms of the vertebral artery and its branches, treated operatively. The symptomatology and the diagnostic methods in this group of rare vascular abnormalities are discussed. The authors are of the opinion, that there are no specific symptoms typical of this localization. All aneurysms of this group can be treated by suboccipital craniectomy. The results of the operation were good; in 75% the results were good or very good. 20% patients died.


[Computerized tomography in aneurysms of the posterior cranial fossa].

The authors discuss the clinical usefulness of CT scan in patients with ruptured posterior fossa aneurysms. Among 164 patients after SAH, in 17 the bleeding was caused by aneurysms located in posterior fossa. The exact diagnosis of the bleeding during 5 days after SAH was possible in 94% of the patients, that is similar as in supratentorial aneurysms. The characteristic symptoms of SAH in these aneurysms was the symmetric presence of blood in basal cisterns, intraventricular haemorrhage and, in consequence,--hydrocephalus. Aneurysms of bifurcation of BA were characterized by presence of blood in interpeduncular cistern; this phenomenon was not observed in PICA aneurysms. The aneurysms of BA were more often seen in direct CT-Scan.


[Spontaneous subarachnoid hemorrhage in pregnancy].

Subarachnoid haemorrhage from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. The authors analyzed 11 cases of verified subarachnoid haemorrhage during pregnancy from 10 identified and 1 unidentified cerebral vascular malformation. The aneurysms were responsible for subarachnoid haemorrhage in 6, and arteriovenous malformation in 4 patients. We conclude that the decision to operate after subarachnoid haemorrhage during pregnancy should be based upon neurosurgical principles, whereas cesarean delivery should be done in every pregnant patient with subarachnoid haemorrhage.


[[Microsurgical treatment of cerebral hemangioma].

The authors present the results of microsurgical treatment of 16 patients with intracranial arteriovenous malformations. The applied technique made possible considerable sparing of healthy brain tissue and closing feeders closely to haemangioma. The patients in I to III degree according to Spetzler's scale left the hospital in good condition. The patients in IV and V degree in 4 cases were operated on twice and in control examination have presented mild neurological dysfunction. Severe disability was observed only in 1 patient. Control angiography revealed in 3 of these patients the presence of small parts of haemangioma.


[Our method of creating experimental aneurysms and its use in the training in microsurgical operations].

An original method is presented used for production of experimental aneurysms in rats. The method may be useful in training for microneurosurgical treatment of aneurysms.


[Anatomy of the middle cerebral artery and the angiographic image of its aneurysms].

The study is based on conclusions drawn from the microanatomical analysis of 200 middle cerebral arteries and angiographic findings in 40 aneurysms of the artery. The angiograms were analysed considering the site of the aneurysm with respect to the division of the artery at the limen insulae and presence of early temporal arteries. Correlating these data with the anatomical observations, especially with regard to the site of origin of the perforating arteries it was tried to define more strictly the facts relevant to the operation which can be obtained by angiography.


[Cerebral ischemia in young patients].

The clinical, angiographic and computed tomography (CT) examinations of 19 patients aged from 12 to 30 years with signs of ischaemic brain syndrome are presented. On the basis of these examinations and data obtained from literature it is supposed that in a majority of patients the disease is caused by basal arteriopathies + i.e. pathological changes in the wall of cerebral arteries, mainly of the circulus Willis. The features distinguishing this syndrome from ischaemic disease in adults are presented and discussed. These are first of all: sudden onset connected with physical effort, deep neurological deficit, narrowing or occlusion of basal cerebral arteries seen in angiography and signs of ischaemia within deep cerebral structures visible in CT. The methods of treatment are discussed, mainly STA-MCA anastomosis used in most cases. The results of treatment are discussed. Finally the problem of the cerebral ischaemic syndrome in young people is presented from the point of view of haemodynamics, principally in the aspect of haemodynamic reserve of cerebral blood flow.


[Transfontanellar USG examination using a color Doppler method in the diagnosis and differentiation of vascular changes in the CNS (preliminary report)].

In the light of own experiences the diagnostic possibilities are presented of using Doppler ultrasonography with transfontanellar projection in the diagnosis and differentiation of vascular changes. Colour Doppler USG makes possible recording and measurement of blood flow in the vessels and may be specially useful in cases of central nervous lesions. The paper is supplemented with a videographic record of Galen's vein aneurysm imaged by Doppler USG.


[Results of combined treatment of neoplasms of the posterior cranial fossa in children].

The effectiveness of combined treatment of posterior fossa tumours was analysed using the clinical material of a neurosurgery department. The material comprised 242 patients treated in the years 1980-1987 with 211 suboccipital craniotomies performed. In cases of cerebellar astrocytoma one-year survival rate was 9% and five year survival in 89% of cases. In the group of medulloblastoma treated in the period 1980-1982 the one-year survival rate was 75%, three-year 39% and five-year 25%. In the group treated in the years 1985-1987 the one-year survival rate was 95% and three-year was 60%. In ependymoma cases the one-year rate was 90%, three-year was 40% and five-year--33%. The use of combined treatment in cases of ependymoma and medulloblastoma improved significantly the therapeutic results.


[Clinical application of phase contrast angiography].

"Phase Contrast Angiography" is a new technique of Magnetic Resonance Angiography as reported by Dumoulin CL et al. Using this technique, we can obtain images of vessels (angiograms) without injection of contrast medium. We present the results of phase contrast angiography on cerebral and spinal vascular disease. We utilized the General Electric SIGNA, 1.5 tesla NMR. One hundred and ninety-one cases of cerebral and spinal vascular diseases were scanned using phase contrast angiography. Included were 90 cases of occlusive vascular disease, 16 cases of moyamoya disease, 39 cases of arteriovenous malformation, and 28 aneurysms. The phase contrast angiography uses flow encoding gradient pulses, which impart a velocity-dependent phase shift to the transverse magnetization of moving spins. The resulting image contains only information from the moving spins; while information from stationary tissue remains suppressed. In cases using 3-D angiogram, we made 32 images 6 degrees apart in their projection direction and displayed them on a video terminal. We were able to visualize occlusions of vessels, aneurysms, bypassed vessels, and abnormal vessels of arteriovenous malformations. Retrospective evaluation comparing phase contrast angiography with conventional angiography of the stenotic findings on the horizontal portion of middle cerebral arteries (64 vessels of 32 patients), resulted in a false positive ratio of 39.1%. We obtained clinically valuable results regarding the hydrodynamics of patients using "phase contrast angiography" non-invasively. These results reveal not only "anatomical" images of vessels, but also "functional" images, which are sensitive to the pattern of the blood flow. This study would strongly suggest that phase contrast angiography presents a valuable tool for the clinical diagnosis of cerebral and spinal vascular diseases.


[New surgical technique for anterior cervical fusion; surgical technique for anterior cervical fusion utilizing autogenous bone graft from the cervical vertebrae].

Since April, 1990, the authors have been reporting a surgical technique for anterior cervical fusion utilizing autogenous bone graft from the cervical vertebrae. This series included 53 patients (40 males and 13 females). The age ranged from 24 to 72 years with a mean of 49 years. There were 42 cases of cervical disc disease, and 11 cases of cervical disc disease with ossification of the posterior longitudinal ligament (OPLL). The patient was out of bed within two days and treated in a soft collar for 3 months. In all patients, the symptoms improved postoperatively. Postoperative X-ray showed slight anterior angulation deformity in 3 out of 53 cases (6%). The advantages of our surgical technique are as follows: 1) There are no problems related to the iliac donor site 2) The removal of posterior spur and localized OPLL is safely and easily performed.


[The dura mater adjacent to the attachment of meningiomas: its enhanced MR imaging and histological findings].

The dura mater adjacent to the attachment of meningiomas was enhanced on MR imaging with intravenous Gd-DTPA infusion. It was examined histologically in four patients with intracranial globoid meningiomas. Histological examination revealed that there was no tumor cell invasion within the dura mater enhanced on MR imaging, except at the point of their attachment. A layer of tumor cells was occasionally observed on the surface of the dura mater, but this was limited to within 5 mm of the tumor margin. Our electronmicroscopic observation indicated that enhancement of the dura mater adjacent to the attachment of meningiomas was caused by increased vascular permeability of the dural vessels and extended extravascular space.


[Quantitative analysis of glutathione and glutathione S-transferase in human brain tumors, C6 rat glioma cells and drug resistant C6 cells].

Glutathione (GSH) and Glutathione S-transferase (GST) plays an important role in the protection of cells against damage from free radicals and also influences cytotoxicity to some kinds of chemotherapeutic agents. GST comprises a group of abundant and widely distributed catalytic and binding proteins that facilitate the conjugation of GSH with the electrophilic center of a large spectrum of hydrophilic molecules. Multiple GST isozymes in mammalian tissues arise from dimeric combination of a number of distinct subunits grouped into three major classes: alpha (alpha), mu (mu), and pi (p). We report the total GST, GST-p activity and GSH content of human brain tumors, C6 rat glioma cells and drug resistant C6 cells. The values of total GST activity in 42 normal brain and brain tumors were quantitatively analyzed. Total GST activity was 92.6 +/- 25.1 units (mean +/- standard deviation) in 8 samples of normal brain tissues, 126 +/- 58.8 units in five grade II or III astrocytomas (154 +/- 63.3 units in grade II astrocytomas, 84.4 +/- 2.7 units in 2 grade III astrocytoma), 66.2 +/- 29.3 in 5 glioblastoma cases, 94.7 +/- 47.7 units in 3 metastatic tumors, 302 +/- 114 unit in 8 meningiomas and 213 +/- 90.4 units in 3 neurinomas. Differences of GST activity between glioblastomas and meningiomas, grade II or III astrocytomas and meningioma, in normal brain tissues and meningioma were statistically significant (p < 0.01). The difference between normal brain tissues and benign tumors (meningiomas and neurinomas), gliomas and benign tumors were also statistically significant (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)


[An adult case of intradural lumbo-sacral lipoma].

A rare case of lumbo-sacral lipoma in an adult case is reported. A 55-year-old male was admitted to the Department of Neurosurgery, Mazda Hospital, after a history of one year of urinary incontinence. Neurologically, no motor or sensory disturbance of the lower extremities was found in this patient. MRI showed a mass with high signal intensity on T2-weighted image, located between L3 to S2 vertebral segments. Metrizamide-CT scan demonstrated the outline of this hypodense mass at the same location as shown on MRI image. A L3 through L5 laminectomy was performed and the tumor was subtotally removed. Microscopic examination revealed that the tumor mass was made up of mature lipoma cells. Postoperative course of the patient was uneventful. The urinary incontinence was improved slightly. No motor or sensory deficit was found. We thought that MRI was useful for the correct diagnosis of lumbosacral lipoma. And it is best managed by operative removal of the tumor as early as possible after it is diagnosed.


[Recurrent fusiform aneurysm of the internal carotid artery; a case report].

A 61-year-old woman was referred to our department on February 12, 1991, due to a fusiform aneurysm of her left internal carotid artery (ICA). She had received aneurysm surgery twice in other hospitals in the past. The first operation, in June, 1980, was for an unruptured, symptomatic left internal carotid-posterior communicating aneurysm and the aneurysm disappeared completely after the neck clipping procedure was carried out by one of the authors. In November, 1990, she suffered from subarachnoid hemorrhage with a hematoma in the left frontal lobe. A ruptured anterior communicating aneurysm was clipped in another hospital, where abnormal dilatation of the left ICA was pointed out. She was referred to our department after a ventricular peritoneal shunt operation. Though the postoperative angiogram performed in 1980 had shown complete disappearance of the left IC-PC aneurysm, it was presumed that the fusiform aneurysm which she presented at our department was recurrent because it existed in almost the same place as the aneurysm which had been clipped. It was also in contact with a clip applied in 1980. In accord with the patient's desire to receive surgery, the fusiform aneurysm was operated on directly, and it was remarkably reduced in size by dome clipping. During a clip, a Sugita booster clip was useful for preventing a slip-out of the clip applied on the aneurysmal dome. The patient was discharged about 20 days after the operation and returned to her usual life. A recurrent fusiform aneurysm of the ICA arising after the neck clipping of IC-PC aneurysm has rarely been encountered.(ABSTRACT TRUNCATED AT 250 WORDS)


[Spinal extradural angiolipoma: a case report].

This 60-year-old man had been well until four years prior to admission, when he developed slowly progressive weakness of the lower extremities. On admission he was found to have a spastic paraparesis, sensory disturbance below the level of T10 and mild sphincter dysfunction. Conventional myelography and CT myelography demonstrated an epidural mass located from T5 to T8 vertebral level. MRI revealed that the epidural mass was fusiform and markedly enhanced by the contrast medium. Laminectomy was performed and a fibrous tumor red in color was subtotally removed. Histological findings were consistent with those of angiolipoma. Angiolipoma is a rare tumor in the central nervous system and is regarded as a clinical entity different from a spinal lipoma. Occurrence of angiolipoma in the central nervous system has been reported in 40 cases in the world literature. Thirty nine cases of them occurred in the spinal canal, especially in the dorsal epidural space of the thoracic region. The fusiform shape demonstrated in this case might also be characteristic of angiolipoma in this region.


[A case of prolactinoma presenting with CSF rhinorrhea and CSF otorrhea during bromocriptine therapy].

Cerebrospinal fluid (CSF) leakage is a rare complication of prolactinoma treated with bromocriptine (BC). BC is known to be effective for reducing the volume of a prolactinoma and for decreasing the serum level of prolactin (PRL). In cases of pituitary tumors, CSF leakage is thought to be caused by shunting between the subarachnoid and extradural spaces. We had a case presenting with CSF rhinorrhea and CSF otorrhea during BC therapy which was treated successfully. The mechanism and treatment of CSF leakage were studied. A 55-year-old woman complaining of nasal obstruction and headache was admitted to our hospital on Nov. 22, 1988. CT scan showed a huge intracranial mass lesion involving the sella and the supra-sellar region and invading the sphenoid sinus and ethmoid sinus. Serum PRL level was 18,000 ng/ml. The patient was diagnosed as having an invasive prolactinoma, and BC therapy (5.0 mg per day) was instituted. Three days later, CSF rhinorrhea developed, and BC treatment discontinued; radiation therapy was started. After 36 Gy irradiation the size of the tumor was same on CT, and serum level of PRL was still high. The patient underwent trans-sphenoidal operation. The tumor was removed partially and the presumed CSF fistula was repaired. The sella and sphenoid sinus were packed with fat. BC treatment was reinstituted, and the serum PRL level decreased gradually without recurrent CSF rhinorrhea. Two weeks later the patient returned complaining of bilateral hearing disturbance. With a diagnosis of exudative otitis media she underwent bilateral tympanostomy. Immediately after tympanostomy, pulsating discharge from the middle ear was observed.(ABSTRACT TRUNCATED AT 250 WORDS)


[Holoprosencephaly accompanied with dysgenesis of the cerebellum].

We have encountered 9 cases of holoprosencephaly, four of them with abnormalities of the posterior fossa. Three cases of semilobar type had severe cerebellar hypoplasia and a large cyst continuing to the fourth ventricle. They were diagnosed as Dandy-Walker syndrome. A case of lobar type had a relatively mild form of cerebellar hypoplasia and it was thought to be a Dandy-Walker variant. MRI was able to clarify the anatomical relationship of the intracranial construction, for example monoventricle, dorsal sac or large cyst in the posterior fossa, and it was very useful for the diagnosis of these congenital anomalies. All of them showed hydrocephalus and required treatment with ventriculoperitoneal or cyst-peritoneal shunt. With the availability of MRI, easy diagnosis of the mild forms of holoprosencephaly has been facilitated, and accompanying anomalies are also able to be diagnosed. Up to now, the structure of the posterior fossa in holoprosencephaly was thought to be normal. However, several cases of holoprosencephaly accompanied with cerebellar hypoplasia and cystic lesion of the posterior fossa, revealed by MRI or autopsy, have been reported. It was suggested that holoprosencephaly with anomalies of the posterior fossa may be less rare than has been thought, so far.


[A case of asymptomatic Dandy-Walker syndrome with cerebellar hemorrhage].

A case of asymptomatic Dandy-Walker syndrome (DWS) complicated by cerebellar hemorrhage is reported. A 65 year-old man was hospitalized for investigation and treatment of disturbance of consciousness. CT scan and MRI showed a large hematoma in the posterior fossa cyst. Postoperative CT scan and MRI revealed the DWS and cerebellar hemorrhage on the left side. This patient had no symptom until 65 years of age, in spite of having DWS. There has been no such case reported in the literature to our knowledge. Derangement of secretion and absorption of cerebrospinal fluid seem to have been the cause of late-onset symptoms after a long well balanced symptom-free period.


[Suprasellar arachnoid cyst associated with precocious puberty: report of an operated case and review of the literature].

The pathogenesis remains unknown in the majority of patients with precocious puberty, and yet infrequently such causative cerebral lesions as hypothalamic hamartomas are associated with sexual precocity. We reported a rare case of suprasellar arachnoid cyst in an infant presenting with precocious puberty, which eventually disappeared after a cyst-peritoneal shunt. It was believed that the mass effect of the arachnoid cyst upon the hypothalamus was, at least in part, responsible for development of precocious puberty. The role of surgical decompression of the cyst was also discussed. A one-year-old girl was admitted to the hospital for evaluation of genital bleeding which had persisted on and off for two months. The height, 80cm, and the weight, 12.4kg, exceeded by far the two standard deviations from the mean level of the normal population. In addition she had the development of breast tissue as classified Tanner's Stage II, and both pubic and axillary hair. The bone age by skeletal survey of the hand was rated as 3 years. Endocrinological examination showed that serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol had increased for her age, to levels equivalent to those for females at puberty. An LH-RH test revealed an excessive LH reaction. There were no definite neurological deficits. CT and MRI demonstrated the presence of a large arachnoid cyst involving the suprasellar region as well as the right middle and posterior fossa. After the patient underwent a cyst-peritoneal shunt, the cyst decreased in size and such symptoms as genital bleeding and breast growth disappeared. Serum levels of her LH and FSH also significantly decreased.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of multiple myeloma with intracerebral metastasis].

Compared to leukemia, malignant lymphoma and other hematogenous tumors, multiple myeloma rarely metastasizes to the central nervous system. Intracerebral metastasis without involvement of the cranium itself is rarer. We report a case of Ig-G k-type multiple myeloma with metastasis to the left frontal lobe extending to the right basal ganglia without involvement of the cranium. A 71-year-old male complained of exertional dyspnea and lumbago. His laboratory data revealed hyperproteinemia and an abnormal increase in Ig-G (6117mg/dl) in his serum. Serum protein immunoelectrophoresis revealed an IgG k-type band, and Bence-Jones protein was detected in his urine. MMPP, VMCP, VIPP and MP chemotherapy was given, and serum IgG level decreased to a normal range. 21 months after his first admission, incontinence, disorientation, gait disturbance and apathy developed. CT-scan showed an isodense lesion with massive edema in the left frontal lobe and right basal ganglia. On MRI, a Gd-DTPA enhancing lesion was detected extending from the left frontal to the opposite frontal lobe through the splenium. No abnormal skull punched out lesions were noted. Left frontal lobectomy was performed. Histopathology revealed plasmablastic myeloma cells with clear nucleole and eccentric nucleus in the cerebrum. He was diagnosed as having intracerebral metastasis of multiple myeloma without involvement of the cranium. Unfortunately, he died of pancytopenia and pneumonia. Our case suggests the possibility of metastasis via blood into the cerebrum.


[A case of traumatic spinal subarachnoid hematoma causing compression of the cauda equina].

A case of traumatic spinal subarachnoid hematoma causing compression of the cauda equina is reported here. The patient, a 76 year-old woman, who had fallen down by accident 1 month before, was admitted to our hospital presenting lumbar pain radiating into her right thigh, monoplegia of the right leg and urinary incontinence. Myelography and metrizamide CT demonstrated a filling defect mimicking intradural extramedullary tumor at the level of L1 and L2. Magnetic resonance imagings (MRI) revealed a subacute or chronic hematoma compressing the conus medullaris and the cauda equina. Operation was performed and an old hematoma, which occupied most of the spinal subarachnoid space and compressed the conus and cauda equina from right to left, was removed. No definite bleeding point was detected and no traumatic change was seen on the cord. Neither tumor nor abnormal vessel was detected. After surgery, the symptoms improved partially. On a review of the literature, we found only 4 cases of traumatic spinal subarachnoid hematoma, all of which occupied the cervical or thoracic portion of the spine. Our case is the first report, except for the cases following lumbar spinal tap, of traumatic spinal subarachnoid hematoma causing compression of the cauda equina. Though usually blood in CSF diffuses immediately, a clot may be formed when a large amount of bleeding obstructs the spinal canal. In our case, furthermore, deformity and narrowing of the spinal canal had preceded for many years, following lumbar vertebral compressed fracture related with osteoporosis. This might have promoted the process of canal obstruction and clot formation.(ABSTRACT TRUNCATED AT 250 WORDS)


[Cerebral salt wasting syndrome secondary to head injury: a case report].

A case of cerebral salt wasting syndrome secondary to head injury is reported here. A 4-year-old boy was admitted to our hospital with head injury. Neurological examination revealed no abnormal findings other than consciousness disturbance. Plain skull X-ray demonstrated a linear fracture of the bilateral parietal bones, and CT scan demonstrated subarachnoid hemorrhage of the tentorium of the cerebellum. He gradually improved, but on the 6th day deterioration of consciousness developed. At that time CT scan demonstrated no abnormal findings. Biochemical analysis showed hyponatremia (116mEq/L) with increased natriuresis. Although a high dose of NaCl was supplied, serum sodium levels did not normalize. So we suspected that SIADH might be causing the hyponatremia, and water restriction was started. He lost 1 kg in body weight over 3 days, but serum sodium levels remained low (118mEq/L) with increased natriuresis. We found that the hyponatremia was caused by cerebral salt wasting syndrome, so we treated the patient with fludrocortisone acetate. Consciousness disturbance improved two days after the medication with fludrocortisone acetate, and serum sodium levels became normal (137mEq/L) on the 27th day. The administration of fludrocortisone acetate was able to be stopped two months after admission, and then the patient was discharged without any neurological deficits. We discussed in detail the diagnosis and the treatment of cerebral salt wasting syndrome.


[Two cases of recurrent brain tumor during GH replacement therapy].

Two cases of patients with recurrent brain tumor are presented. Each of them received growth hormone (GH) replacement therapy for growth failure secondary to cranial irradiation. The first case is that of a 10-year-old girl who was treated with a combination of surgical resection, radiotherapy and chemotherapy for cerebellar medulloblastoma at 1 y.o. At the age of 9, 10 month after the beginning of GH replacement therapy, she complained of headache. This was due to shunt malfunction when CSF cytology was class V. It revealed that there was recurrence of medulloblastoma. The second case is that of a 14-year-old girl who was treated with a combination of surgical resection, radiotherapy and chemotherapy for suprasellar germinoma at the age of 10. This tumor completely disappeared after these procedures. For her growth failure, we started GH replacement therapy and after 1 year, she complained of lt. leg pain due to tibial and pelvic bone metastasis. In medical literature, we found 15 recurrent brain tumors during GH replacement therapy. These include our 2 cases, and 9 cases in which there was recurrence within 1 year. Recently, receptors for some somatomedins have been found in brain tumors. Although these numbers are too small for us to arrive at conclusions, we think it is possible that there are some mechanisms connecting GH replacement therapy and recurrence of certain brain tumors.