Search

Summary ¶Background. Cell apoptosis in solid tumours has been related to immunological attack by NK-cells. The purpose of the present study is to verify in the tissue of brain metastases a possible relationship among the degree of NK-cell infiltration and the number of apoptotic tumour cells. Methods. Twenty brain metastases whose tumour cells expressed CD95 (Fas/APO1) have been studied. NK-cells were identified by using the monoclonal antibody to CD57, and apoptotic tumour cells by means of the immunostain with the anti-ssDNA monoclonal antibody F7-26. The Spearman rank correlation test was used to study the relationship between the degree of CD57-NK-cell infiltration and the apoptosis labelling-index. Findings. Positivity to F7-26 was present in all tumour samples, but the number of immunostained cells showed a wide variability, with a mean apoptosis labelling-index of 11.48%. All the studied tumours showed CD57 immunostained cells, with a number that ranged between 4 and 20 per microscopical field at 200× (mean±standard deviation: 8.4±3.7). Statistical studies showed that there was no correlation between the number of CD57 immunostained NK-cells and the apoptosis labelling-index (p>0.05). Interpretation. These findings suggest that in brain metastases, apoptosis related to immune r esponse is mainly mediated by activated tumour-infiltrating mononuclear cells other than CD57+ NK-cells. [ABSTRACT FROM AUTHOR]

Summary. Background: Vascular Endothelial Growth/Permeability Factor (VEG/PF) has been correlated with angiogenesis and vascular leakage in diverse pathological conditions of the brain. On the other hand, neoformation of capillaries and vascular hyperpermeability have been related to progressive enlargement of chronic subdural haematomas (CSDH). The purpose of the present study is to verify the presence of VEG/PF in tissue of CSDH, with the hypothesis that neovascularization and vascular hyperpermeabitity in CSDH can be related to the presence of this cytokine. Methods: Immunohistochemical studies and Reverse Transcription Polymerase Chain Reaction (RT-PCR) analysis were performed in the neomembranes of 12 CSDH to verify presence of VEG/PF in this tissue. Findings: Strong expression of VEG/PF was immunohistochemically disclosed in neomembranes of CSDH, as well as in inflammatory cells currently infiltrating this tissue. Furthermore, RT-PCR studies showed the presence of VEG/PF in all the studied samples. Interpretation: These findings suggest a role for inflammatory cells, currently present in the granulation tissue of CSDH, in the release of VEG/PF and in the enlargement of these lesions, stating the possibility of a new therapeutic approach to CSDH, based on blocking the physiological effects of VEG/PF. [ABSTRACT FROM AUTHOR]

Summary. Background: Cell proliferation and cell death are opposing processes in tumour growth, with tumour progression reflecting the balance between proliferating and apoptotic cells. The purpose of the present study is to verify the hypothesis that an imbalance between apoptosis and proliferation can predict survival in patients with primary glioblastoma. Methods: After the immunohistochemical study of Apostain and MIB-1 expression, the index of apoptosis (AI), the index of proliferation (PI), and the ratio AI/PI was recorded for each tumour specimen, in a series of 32 primary glioblastomas. Studies of correlation between AI and PI, between AI and survival, between PI and survival, and between the ratio AI/PI and survival, were performed using the Spearman rank correlation test. Furthermore, a comparative study of survival was performed for subgroups of patients with ratio AI/PI greater or lesser than 1, using the log rank test. Findings: In the present series, values of AI and PI showed a wide distribution, with a mean±SD of 8.16±7.2, and of 12.69±21.1, respectively. The values for the ratio AI/PI ranged between 0.01 and 6.03 (mean±SD: 1.44±1.60). Statistical study failed to obtain correlation between AI and PI. Survival of patients not correlated with AI neither with PI. The ratio between AI and PI did not correlate with survival either. Nevertheless, when survival for the subgroups of patients showing a ratio AI/PI greater or lesser than 1 was compared, a significant difference was found (p: 0.02). Survival ranged between 50 and 81 weeks (mean of 58.5±11.05 weeks) for the 12 cases showing a ratio AI/PI greater than 1, and it ranged between 8 and 85 weeks (mean: 38.20±25.37 weeks) for the 20 cases showing a ratio AI/PI lesser than 1. Interpretation: Our present results suggest that a clear imbalance between cell proliferation and apoptosis can predict outcome in patients operated on for a primary glioblastoma. [ABSTRACT FROM AUTHOR]

An isocentered system for functional stereotactic procedures with the Cosman-Roberts-Wells frame and a CT localizer that allows extrapolation of target data directly from the CT slice is presented. Based on anatomical landmarks and on the scaled corresponding transverse plates of the Schaltenbrand and Wahren atlas, we delineate the thalamic and cerebellar nuclei. Twenty three image-directed functional procedures were performed in one year on 18 patients (7 with Parkinson's disease, 4 with dystonia, 3 persons with essential tremor, 2 patients with choreo-athetosis and 2 with de-afferentiation pain). The 23 procedures included 19 thalamotomies, two dentatotomies and two stereotactic implantations of deep seated brain electrodes. Successful targeting was verified by intra-operative electrical stimulation and postoperative CT scan. Complete reduction of symptoms was observed in 4 persons with Parkinson's disease and in 2 patients with essential tremor with significant improvement observed in the rest of the patients with the exception of the individual with choreo-athetosis. There were no operation-related complications. The reported technique is safer and less distressing for patients than previous radiological procedures and it makes image-directed stereotactic functional neurosurgery available to many units with the CRW frame. [ABSTRACT FROM AUTHOR]

It is known that natural killer (NK) cells are involved in immunosurveillance against tumours. This study examines the NK activity of mononuclear cells (MNC) from the peripheral blood of patients with gliobalstoma. The cytotoxic inducer effect of interferonalpha (IFN-α) upon these MNC has also been studied. A marked decrease in NK activity mediated by MNC from these patients was found. This functional defected in MNC is not due to a decrease in phenotypically defined NK cells. After long-term (5-day) incubation with IFN-α, MNC from 5 out of 14 patients showed strong lytic activity against NK-sensitive target cells. In this system, IFN-α failed to induce cytotoxic activity against NK-resistant target cells in MNC from all the patients studied. This in vitro induction of cytotoxic activity in MNC from some patients with glioblastoma by IFN-α suggests a potential immunotherapeutic use of the lymphokine in these subjects. [ABSTRACT FROM AUTHOR]

A series often patients with glioblastoma multiforme were treated with human lymphoblastoid alpha interferon (HLBI) as a single therapy after partial surgical resection (5 cases) or stereotactic biopsy (5 cases). Treatment consisted of intratumoural administration of HLBI (15 × 16IU) every month (8 cases) or in the continuous intraventricular infusion of HLBI (1.8 × 10IU daily) in 15-day cycles (2 cases) until rapid growing of the tumour and important neurological deterioration. The treatments were well tolerated. As judged from data from control groups, the patients demonstrated no improvement in mean survival time and follow-up CT-scan showed rapid progression of the tumour in all cases. [ABSTRACT FROM AUTHOR]

Preliminary experience with a clinical trial of immunotherapy for glioblastoma, by means of intratumoural injection of autologous lymphocytes (AL) mixed with low doses of human lymphoblastoid interferon (HLI) is presented. In two of twelve patients, a transient reduction of tumoural volume was obtained. Morphological studies showed that injected lymphocytes remain within the tumour, and suggest tumoural lysis due to activity of natural killer (NK) cells. Clinically no significant prolongation of survival time could be achieved and, as in other series, patients with additional radiation therapy survived longer. But the morphological findings suggest that immunotherapy carrying NK-cells to contact with tumoural cells might be useful in some patients with glioblastoma. Actually no explanation can be given why only two of our cases responded positively. Regarding the otherwise poor prognosis it seems justified to continue these studies. [ABSTRACT FROM AUTHOR]

In Part I of this report, the CSF circulatory dynamics of autologous leucocytes labelled with indium-111 and injected in the subarachnoid space, in patients operated on for glioblastoma, were studied. In the Part II, a series of 11 patients with recurrent glioblastoma was studied for evaluating the efficacy of intrathecal injection of autologous leucocytes. Six patients previously had radiotherapy. The results in Part I show that after intrathecal injection of autologous leucocytes, these cells follow throughout the subarachnoid space and pass to the systemic blood circulation, showing no evidence of colonization of the tumour or deposit in the tumoural region. The mean survival of the patients studied in Part II was 8 months. Those six patients who received radiotherapy had a mean survival of 11.4 months, and those five who received only intrathecal injection of autologous leucocytes after surgery, had a mean survival of 4 months. This results seem to demonstrate that immunotherapy, as used in this study, is ineffective in patients with glioblastoma. [ABSTRACT FROM AUTHOR]

The authors present their clinical and surgical experience with 18 posterior fossa cholesteatomas, including three cases with atypical CT scan appearances that corresponded to calcification, haemorrhage or malignant change into an epidermoid carcinoma, respectively. [ABSTRACT FROM AUTHOR]

We present our clinical experience and the results of surgical management with 25 cavernomas of the CNS, treated in our hospital in the last 10 years. The location of the lesion assessed by clinical and CT scan examinations, proved to be the most significative factor determining the prognosis of cavernomas of the CNS, after surgical removal. The symptoms started in most of the cases in the third decade of life. 19 cases were located in the cerebral hemispheres and produced three well defined clinical syndromes: The remaining six cases were located within the basal ganglia, brainstem, pineal region, cerebellum and spinal cord, showing a progressive course. CT scan studies were performed on 24 cases. The characteristic image of a cavernoma is represented by a moderately hyperdense nodule with discreet contrast uptake. Calcification was observed in and around the lesions in 33% of the cases. Perilesional hypodensities suggestive of brain tissue atrophy were noted in 22% of the CT scans. On the other hand, 12% of cerebral hemisphere cavernomas showed atypical CT scan images that suggested an erroneous diagnosis of cystic gliomas. Radical surgical removal was performed in all cases. The postoperative results varied according to the location of the lesions. Complete recovery was obtained with cerebral hemisphere cavernomas presenting with a progressive history suggesting tumour or a haemorrhagic syndrome. 85% of the cases presenting with seizures, were symptom-free and taking no anticonvulsants 1 year after surgery. In deeply placed cavernomas (basal ganglia and brainstem) the surgical results were poor. In the latter cases surgery has to be carefully evaluated when a mode of treatment is to be considered in patients whose CT scan data strongly suggest a diagnosis of cavernoma. [ABSTRACT FROM AUTHOR]

We have studied 15 cases of spontaneous intracerebellar haematomas in 9 males and 6 females. A significant correlation between the clinical presentation and the CT scan features of benign and fatal haemorrhages of the cerebellum is presented. Diagnostic computerized tomographic studies were performed in a mean interval of 31 hours after the initial symptoms. 60% were diagnosed and treated in less than 24 hours; 11 patients had haematomas larger than 3 cm, and 5 (45%) of these cases died with evidence of irreversible brain-stem damage. Twelve (80%) showed compression of the fourth ventricle, 9 (60%) obliteration of the brainstem cisterns and 8 (53%) ventricular dilatation. 8 cases were treated with surgery; 50% of them showed neurological improvement, including two cases with signs of brain-stem compression. 7 patients who were treated conservatively were followed closely with repeated CT scans, which showed that resolution of the mass effect and isodensity of the haematomas occurred within 9 to 15 days, with a mean of 11 days, after the initial CT scan. An increased mortality was observed with haematomas larger than 3cm (73%), hydrocephalus (45%) and intraventricular haemorrhage (40%). Smaller haematomas without CT scan evidence of obliteration of the brain-stem cisterns or hydrocephalus had a better outcome. [ABSTRACT FROM AUTHOR]

The experiences with a series of 9 patients with syringomyelia treated by syringosubarachnoid shunt (SSS) are presented. All of the cases were evaluated by myelography, CT scan or MNR. The cases showed satisfactory results which consisted in stabilization of the symptoms (55%) or clinical improvement (44%). These results should be continously evaluated, due to the short follow-up period and to the variable natural history of the illness. Treatment by SSS is a technique of low morbidity. It is recommended for patients with syringomyelia without significant descent of the tonsils or in those cases where posterior fossa operations have failed to obtain good results. [ABSTRACT FROM AUTHOR]

A new case of hypothalamic hamartoma associated with precocious puberty is presented. After reviewing the literature, 23 other cases appeared. The ultrastructural study of the present case revealed common features with other hamartomatous lesions of the central nervous system and with the gangliogliomas. The data suggest that these lesions are morphologically organized in a very similar manner despite their very different growing potential. [ABSTRACT FROM AUTHOR]

Five cases of intracranial gangliomas in their clinical, diagnostic and surgical aspects are presented. In four cases we arrived at the diagnosis by CT-scan, which showed in all of them, calcified lesions without a mass effect. Total surgical resection was performed in four cases, and there is no evidence of recurrence either clinically or in the CT-scan after different follow-up periods. Although infrequent, these kinds of tumours should enter the differential diagnosis at any time when there a calcified mass exists in children or young patients with a long history of seizures. In our experience, seizures were the most important sign in all cases with supratentorial gangliogliomas. [ABSTRACT FROM AUTHOR]

Two cases of cystic cavernous haemangioma of the brain are reported. In both cases, an erroneous diagnosis of cystic glioma was made, because of the unusual CT scan findings. Cavernous haemangiomas should be included in the differential diagnosis of intracranial cystic lesions. [ABSTRACT FROM AUTHOR]

A retrospective study of operative results after a minimum follow-up period of five years was carried out in a series of 34 patients operated upon for cervical spondylotic myelopathy (CSM). In all the cases, myelography showed involvement of two or more intervertebral spaces. Constitutional spinal canal narrowing was not present, and only one operation was performed in each patient. Of the 34 patients, 16 also had symptoms of cervical spondylotic radiculopathy (CSR). Seventy-four percent of the patients thought that operation resulted in overall improvement of the preoperative clinical picture. This subjective improvement was similar whether the operative procedure consisted of anterior intersomatic fusion or of laminectomy. Amelioration of CSM symptoms occurred in only 8 of the 20 patients subjected to anterior fusion (40%), in contrast to 10 of the 14 patients subjected to laminectomy (71%). In the 16 patients with CSR symptoms associated with CSM, amelioration of CSR symptoms occurred in 6 of the 11 patients subjected to anterior fusion (55%), and in 4 of the 5 patients subjected to laminectomy (80%). It is suggested that laminectomy offers the best results for CSM, associated or not with CSR, when two or more intervertebral spaces are affected. [ABSTRACT FROM AUTHOR]

A case of suprasellar granular-cell tumour is presented. Only 27 other similar tumours in this location have been reported to date. These cases have been studied, and some clinical and radiological characteristics that are useful preoperatively are discussed. Regarding the pathological aspects, we have reviewed the various theories about the origin of these tumours and accept as the most plausible an origin from the granular pituicytes that can normally be found in the neurohypophysis and in the pituitary stalk. [ABSTRACT FROM AUTHOR]

A case is presented of Acute Intermittent Porphyria and aneurysm of the posterior communicating artery, an association not previously described in the literature. The problems posed by the acute intermittent porphyria in the neurosurgical management are discussed. Finally, the drugs that do not cause induction of the enzyme δ-Ammolaevulinic Synthetase are indicated. [ABSTRACT FROM AUTHOR]

A case of intrasphenoidal meningoencephalocele in an adult, with CSF leak through the nose and pneumocephalus after removal of a parasagittal meningioma, is presented. The clinical and pathogenic factors of this case are discussed. [ABSTRACT FROM AUTHOR]

A case of rhinorrhoea due to direct communication between the ventricular system and the frontal sinus in a case of adult aqueductal stenosis is reported. The mechanism of production is discussed. After reviewing the literature, the treatment of this condition is outlined. [ABSTRACT FROM AUTHOR]

Two spastic patients undergoing chronic cerebellar stimulation are studied. Biopsies taken after three months of stimulation showed various tissue changes when compared with those taken at the moment of electrode implantation. The most important alterations in the cerebellar cortex were adhesions round the electrodes, with a scarring reaction, gliosis, and loss of Purkinje cells. These findings resemble those described in various experimental reports of chronic cerebellar stimulation. [ABSTRACT FROM AUTHOR]

The authors report the clinical features, radiological findings, and surgical management in a case of meningioma of the anterior part of the third ventricle in a 59-year-old woman. The unusual fact in our patient compared with the other reported cases is that she never developed symptoms or signs of increased intracranial pressure. A review of the literature is presented. Ours is the second case in which CT scan has been used in the diagnosis. [ABSTRACT FROM AUTHOR]

Images of ependymal cell proliferation after experimental spinal cord injury in the rabbit are presented. This finding suggests that segmental central canal obliteration after injury could be considered in the pathogenesis of posttraumatic syringomyelia. [ABSTRACT FROM AUTHOR]

A case of unilateral association of a neurinoma of the VIII nerve and a neurinoma of the temporal fossa in a 33-year-old woman without von Recklinghausen disease stigmata is presented. This uncommon association can mimic the picture of a trigeminal neurinoma with a dumb-bell extension into the posterior fossa. [ABSTRACT FROM AUTHOR]

A morphological study of an experimental epileptogenic focus in the cat, eighteen months after intracerebral injection of alumina cream, is presented. The most significant histological findings were cortical atrophy and reactive gliosis enclosing the implanted particles. Subpial sclerosis and evidence of ischaemic neuronal lesions were also found. These findings confirm a close morphological relation between the alumina cream experimental focus obtained after a certain period of evolution and the human epileptogenic focus. [ABSTRACT FROM AUTHOR]

An unusual case of damage to the cervical spinal cord due to a non-missile penetrating injury through an anterior route in a nine-year-old boy who fell from a bicycle is reported. There was a cerebrospinal fluid leak that lasted for two days. Clinical picture was that of incomplete Brown-Séquard syndrome and flaccid paresis of the extensor muscles of the left elbow and wrist. Treatment was conservative, with a very good functional recovery. To our best knowledge there is no myelographically documented case report of such a lesion in the literature. [ABSTRACT FROM AUTHOR]

A case of symptomatic subependymoma of the lateral ventricle in a 64-year-old-woman is presented. We have found only 12 cases of symptomatic subependymoma of the lateral ventricle reported in the literature. We think that this location denotes a specific anatomoclinical entity, with a histological picture and a surgical prognosis that are different from those of the symptomatic subependymomas located in other sites of the ventricular system. [ABSTRACT FROM AUTHOR]

A case of primary osteogenic sarcoma of the skull with intracranial involvement is presented. The rarity of a skull location for osteogenic sarcoma is stressed. The clinical, diagnostic, and therapeutic aspects of this entity are discussed. [ABSTRACT FROM AUTHOR]

The authors present a case of primary carcinoma of the choroid plexus in a 26-years-old female, localized in the left lateral ventricle. Four years after total removal plus local radiotherapy, the patient presented with an intraparenchymatous metastasis in the right cerebellar hemisphere and intraspinal metastatic seeding. With this kind of malignant growth, a therapeutic approach consisting of radical removal of the tumour plus radiotherapy to the whole neuraxis is proposed. [ABSTRACT FROM AUTHOR]

The authors have studied the histological, histochemical, and ultrastructural aspects of eight corticectomies of epileptogenic foci in the medial surfaces of frontal lobes. In all cases they were able to see more gliosis and fewer neurons than normal. The shape and number of dendritic spines were thought to be normal with the Golgi-Cox method. The histochemical study showed an increment of activity of Glucose-6-Phosphatase, Glucose-6-Phosphatedehydrogenase, adenosintriphosphatase, and acid phosphatase. The electron microscope showed, in every case, a variety of changes, among which the authors can point to perivascular lipid accumulation, and an increase of lipofuscin bodies in the cytoplasm of pyramidal cells. [ABSTRACT FROM AUTHOR]

The morphological modifications of the cerebellar cortex have been evaluated in eight cats with chronic electrodes implanted in the anterior vermis. In a control animal a silastic lamina without electrodes was implanted. Four animals received intermittent stimulations up to 11 hours in one case and 100 hours in the other 3. The stimulation was carried out with pulses of 0.5 msc, 200 cps, and a charge per phase of 0.68 μc. Microscopic examination of the cerebellum showed that the experimental implanting of prostheses on the cerebellar vermis produces tissue lesions consisting of fibrous reaction, imprinting of the cortex, gliosis, and loss of Purkinje cells. These lesions are independent of the electric stimulation, and seem to be related to the pressure of foreign material against the cortex. [ABSTRACT FROM AUTHOR]

The cellular changes in the neighbourhood of an alumina cream epileptogenic focus and in the mirror focus in chronic experiments in cats have been studied. According the neuroglial morphology, four layers are described around the alumina cream lesion. At an ultrastructural level, an increase in gap junctions with a great amount of gliofilaments in astroglial processes are observed. There is a decrease in the number of neurons in the vicinity of the alumina cream. Some are coated by glial processes filled with gliofilaments. The dendrites of the pyramidal neurons in the mirror focus show long mitochondria. The possible significance of these data, in relation with the current theories about epileptogenicity, are discussed. [ABSTRACT FROM AUTHOR]

A case of tension pneumocephalus within the cavity of a brain abscess after simple puncture-drainage is reported. This possibility has to be taken into consideration when a worsening in the clinical situation of the patient occurs after this procedure. [ABSTRACT FROM AUTHOR]

Background: Cell apoptosis in solid tumours has been related to immunological attack by NK-cells. The purpose of the present study is to verify in the tissue of brain metastases a possible relationship among the degree of NK-cell infiltration and the number of apoptotic tumour cells., Methods: Twenty brain metastases whose tumour cells expressed CD95 (Fas/APO1) have been studied. NK-cells were identified by using the monoclonal antibody to CD57, and apoptotic tumour cells by means of the immunostain with the anti-ssDNA monoclonal antibody F7-26. The Spearman rank correlation test was used to study the relationship between the degree of CD57-NK-cell infiltration and the apoptosis labelling-index., Findings: Positivity to F7-26 was present in all tumour samples, but the number of immunostained cells showed a wide variability, with a mean apoptosis labelling-index of 11.48%. All the studied tumours showed CD57 immunostained cells, with a number that ranged between 4 and 20 per microscopical field at 200x (mean+/-standard deviation: 8.4+/-3.7). Statistical studies showed that there was no correlation between the number of CD57 immunostained NK-cells and the apoptosis labelling-index (p>0.05)., Interpretation: These findings suggest that in brain metastases, apoptosis related to immune response is mainly mediated by activated tumour-infiltrating mononuclear cells other than CD57(+) NK-cells.