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The preferred vascular access for hemodialysis recipients is an arteriovenous fistula in the nondominant arm. Prior placement of a peripheral intravenous (PIV) catheter can lead to vascular injury and limit options for arteriovenous fistula creation, a particular problem for children, who may need hemodialysis for their entire lifetime. We instituted an initiative to increase the frequency of PIV catheter placement in the dominant arm for hospitalized pediatric patients with advanced chronic kidney disease (CKD).Quality improvement initiative.Children with CKD stage 3-5, receiving dialysis, and/or following kidney transplantation who were hospitalized at one children's hospital between September 2018 and August 2020.Retrospective data on PIV catheter location for patients from January 1 to June 30, 2017, served as baseline data. Quality improvement activities consisted of: 1) education of the multidisciplinary treatment team, patients, and parents regarding importance of vein preservation; 2) placement of individualized notes in the electronic medical record identifying the preferred arm for PIV catheter placement; 3) use of "restricted extremity" arm bands; and 4) vascular access team participation to minimize attempts for PIV catheter placement.Monthly compliance with placement of PIV catheters in dominant arms.Location of PIV catheter placements were determined monthly and used to create run charts describing compliance.At baseline and before institution of this initiative, 34 of 72 (47%) PIV catheters were placed in patients' dominant arms, with only 2 of 8 (25%) PIV catheters placed in the dominant arm for children aged5 years. After instituting the initiative, 345 of 371 (93%) PIV catheters were placed in the dominant arm of 93 children; in children aged5 years, 58 of 62 (94%) PIV catheters were placed in the dominant arm. Only 38 of 371 (10%) PIV catheters were placed in the antecubital vein.Single-center study.Education regarding the importance of vein preservation, along with implementation of a standardized process for identifying children for whom vein preservation is important, can help direct PIV catheter placement and potentially preserve vasculature in pediatric patients with CKD.

Objective Activated (CD38HLA-DR) PD-1 CD4 T cells are strongly associated with virus replication and disease progression in untreated HIV-1 infection, and viral persistence in individuals on ART. Few studies have examined cell-associated viral load (CAVL) in different activated CD4 T-cell populations to measure relative contributions to viral reservoirs. Design Longitudinal assessment of HIV-1 chronically infected Ugandans initiating ART, to investigate activated CD4 T-cell populations and their contribution to viral reservoirs. Methods We followed 32 HIV-1 chronically infected individuals from Kampala, Uganda, and determined their CD4 T-cell counts and viral load at baseline, 6, and 12 months after the initiation of ART. T-cell populations were sorted based on activation profiles and gag DNA was measured to determine CAVL within these populations. Soluble factors associated with inflammation were measured in plasma using a multiplexed platform. Results Concomitant with viral load decline and CD4 T-cell count rebound, the activated PD-1 CD4 T-cell population contracted upon initiation of ART. Baseline levels of activated PD-1 CD4 T cells correlated with plasma levels of IP-10 and TNFRII. Interestingly, a higher baseline level of activated PD-1 CD4 T cells was associated with poorer CD4 T-cell recovery after 12 months of ART. This population contributed significantly to the cell-associated HIV DNA load at baseline, whereas their contribution declined on ART, indicating high turnover. Conclusion Activated PD-1 CD4 T cells are predictors of poor immunologic recovery on ART and may represent a short-lived component of HIV-1 reservoirs.

HIV DNA is a marker of HIV persistence that predicts HIV progression and remission, but its kinetics in early acute HIV infection (AHI) is poorly understood. We longitudinally measured the frequency of peripheral blood mononuclear cells harboring total and integrated HIV DNA in 19 untreated and 71 treated AHI participants, for whom 50 were in the earliest Fiebig I/II (HIV IgM −) stage, that is ≤ 2 weeks from infection. Without antiretroviral therapy (ART), HIV DNA peaked at 2 weeks after enrollment, reaching a set-point 2 weeks later with little change thereafter. There was a marked divergence of HIV DNA values between the untreated and treated groups that occurred within the first 2 weeks of ART and increased with time. ART reduced total HIV DNA levels by 20-fold after 2 weeks and 316-fold after 3 years. Therefore, very early ART offers the opportunity to significantly reduce the frequency of cells harboring HIV DNA., Highlights • The HIV DNA set-point is established early in acute HIV infection. • Over three years without antiretroviral therapy, persons with acute HIV infection have total HIV DNA in peripheral blood mononuclear cells that is 300-fold and integrated HIV DNA that is 100-fold higher than those on treatment. • Early antiretroviral therapy provides an opportunity to markedly reduce proviral HIV DNA burden, HIV is difficult to cure because it infects long-lived cells in the body, also called “reservoirs”. Having a small HIV reservoir size may benefit health. We show that HIV DNA in peripheral blood cells, a marker of the HIV reservoir size, establishes a set-point level during the first 6 weeks of infection and changes little over time without HIV medications. However, if HIV medications are started early, the reservoir size declines rapidly, and is 300-fold lower than that seen in untreated persons. Currently the most effective way to significantly lower the HIV reservoir size is with very early treatment.

OBJECTIVES To better understand the gene expression patterns in tumor-associated stroma, laser-capture-microdissections from clinical specimens were analyzed by genome-wide-expression microarray technology. The epithelial-stromal interaction plays a critical role in prostate development, reactive changes, and tumorigenesis. Diverse microarray technologies have been used to characterize the molecular changes in prostate cancer. Even though these gene expression studies are compromised by the heterogeneity of the tumor, as well as by the difficulty associated with collecting appropriate counterparts to represent normal prostate cells, the gene array data from tumors have shown promising results. Currently, little is known about the tumor-associated stromal gene expression profile in prostate cancer. METHODS Matching benign and malignant epithelial cell-related stroma cells were subjected to microarray platforms. RESULTS The prostatatic stroma expressed several osteogenic molecules. In particular, one of the genes, OSF2, was upregulated in tumor-associated stroma compared with benign epithelial cell associated stroma, which was further validated by immunohistochemical examination. CONCLUSIONS These data show that the combination of laser capture dissection with computational enhancement of epithelial and stromal microarray data is a useful tool to assess gene expression changes in prostate cancer stroma.

The high prevalence of TMPRSS2-ERG rearrangements ( approximately 60%) in prostate cancer (CaP) leads to androgenic induction of the ETS-related gene (ERG) expression. However, the biological functions of ERG overexpression in CaP remain to be understood. ERG knockdown in TMPRSS2-ERG expressing CaP cells induced striking morphological changes and inhibited cell growth both in cell culture and SCID mice. Evaluation of the transcriptome and specific gene promoters in ERG siRNA-treated cells and investigation of gene expression signatures of human prostate tumors revealed ERG-mediated activation of C-MYC oncogene and the repression of prostate epithelial differentiation genes (PSA and SLC45A3/Prostein). Taken together, these data combining cell culture and animal models and human prostate tumors reveal that ERG overexpression in prostate tumor cells may contribute to the neoplastic process by activating C-MYC and by abrogating prostate epithelial differentiation as indicated by prostate epithelial specific markers.

To assess the role of colour Doppler flow imaging (CDFI) in the diagnosis and management of lacrimal fossa lesions. Institutional ethical committee approval was obtained. Fifty-one patients with 62 lacrimal fossa lesions were retrospectively included from 2003–2015. All patients underwent conventional ultrasonography and CDFI, with a qualitative and quantitative analysis of the vascularization. All patients had lacrimal gland surgery. Definitive diagnosis was based on pathological examination. The study included 47 non-epithelial lesions (NEL) and 15 epithelial lesions (EL), with 24 (39 %) malignant lesions and 38 (61 %) benign lesions. NEL were significantly more likely to present with septa (p

Transcription factors encoded by the ETS family of genes are central in integrating signals that regulate cell growth and differentiation, stress responses, and tumorigenesis. This study, analysing laser microdissected paired benign and malignant prostate epithelial cells from prostate cancer (CaP) patients (n=114; 228 specimen) by GeneChip and quantitative real-time RT-PCR, identifies ETS-related gene (ERG), a member of the ETS transcription factor family, as the most frequently overexpressed proto-oncogene in the transcriptome of malignant prostate epithelial cells. Combined quantitative expression analysis of ERG with two other genes commonly overexpressed in CaP, AMACR and DD3, revealed overexpression of at least one of these three genes in virtually all CaP specimen (54 of 55). Comprehensive evaluation of quantitative ERG1 expression with clinicopathological features also suggested that ERG1 expression level in prostate tumor cells relative to benign epithelial cells is indicator of disease-free survival after radical prostatectomy.

Evaluations of androgen regulated gene (ARG) repertoire provide new insights into the androgen receptor (AR) mediated signaling at the transcriptional level. Definition of ARGs having critical functions in the biology of normal and malignant prostate should aid in identifying new bio-markers and therapeutic targets for prostate cancer (CaP). Using Affymetrix HuGene FL oligonucleotide arrays, temporal expression profiles of ARGs in widely used hormone responsive LNCaP cells, were analysed by hierarchical clustering methods and functional classification. ARGs in response to different androgen concentrations showed temporal co-regulation of genes involved in specific biochemical pathways. This study focuses on our new observations of the coordinated androgen induction of genes (NDRG1, PDIR, HERPUD1, ORP150) involved in the endoplasmic reticulum (ER) stress response pathway. Expression analysis of the two selected ER stress responsive genes, NDRG1 and HERPUD1 in primary CaPs revealed a significantly reduced tumor associated expression. Intriguing linkage of the androgen signaling to ER stress responsive genes, a protective response to protein unfolding or protein damage resulting from cellular stress signals, suggests that androgens may induce such stress signals in CaP cells. Decreased CaP associated expression of two ER stress responsive genes also suggests that possible abrogation of this pathway in prostate tumorigenesis.

Background Patterns of expressed genes in the peripheral blood mononuclear cells of persons who were receiving RTS,S/AS01 or RTS,S/AS02 malaria vaccine and were undergoing experimental challenge with mosquito-borne falciparum malaria were examined to identify markers associated with protection. Methods Thirty-nine vaccine recipients were assessed at study entry; on the day of the third vaccination; at 24 h, 72 h, and 2 weeks after vaccination; and on day 5 after challenge. Of 39 vaccine recipients, 13 were protected and 26 were not. Eleven vaccine recipients exhibited delayed onset of parasitemia. All infectivity control subjects developed parasitemia. Prediction analysis of microarrays identified genes corresponding with protection. Gene set enrichment analysis identified sets of genes associated with protection after the third vaccination and before challenge. Results After the third vaccination and before challenge, differential expression of genes in the immunoproteasome pathway distinguished protected and nonprotected persons. At 5 days after challenge, differential expression of genes associated with programmed cell death distinguished between subjects protected and not protected from malaria blood-stage infection. Conclusions The up-regulation of genes associated with the efficient processing of major histocompatibility complex peptides suggests a potential role of the vaccine in conferring major histocompatibility complex class 1-mediated protection and may represent a useful surrogate marker of vaccine efficacy without the need for challenge.

Patterns of expressed genes examined in cryopreserved peripheral blood mononuclear cells (PBMCs) of seropositive persons electing to stop antiretroviral therapy in the AIDS Clinical Trials Group Study A5170 were scrutinized to identify markers capable of predicting the likelihood of CD4+ T-cell depletion after cessation of antiretroviral therapy (ART). A5170 was a multicenter, 96-week, prospective study of HIV-infected patients with immunological preservation on ART who elected to interrupt therapy. Study entry required that the CD4 count was greater than 350 cells/mm(3) within 6 months of ART initiation. Median nadir CD4 count of enrollees was 436 cells/mm(3). Two cohorts, matched for clinical characteristics, were selected from A5170. Twenty-four patients with an absolute CD4 cell decline of less that 20% at week 24 (good outcome group) and 24 with a CD4 cell decline of20% (poor outcome group) were studied. The good outcome group had a decline in CD4+ Tcell count that was 50% less than the poor outcome group. Significance analysis of microarrays identified differential gene expression (DE) in the two groups in data obtained from Affymetrix Human FOCUS GeneChips. DE was significantly higher in the poor outcome group than in the good outcome group. Prediction analysis of microarrays (PAM-R) identified genes that classified persons as to progression with greater than 80% accuracy at therapy interruption (TI) as well as at 24 weeks after TI. Gene set enrichment analysis (GSEA) identified a set of genes in the Ras signaling pathway, associated with the downregulation of apoptosis, as significantly upregulated in the good outcome group at cessation of ART. These observations identify specific host cell processes associated with differential outcome in this cohort after TI.

Formalin-fixed paraffin-embedded (FFPE) prostate specimens are rich sources of molecular pathological information. However, FFPE-based microarray analysis of tissue samples may be hampered by the degradation and chemical alteration of RNA molecules due to the preservation procedure. In this report, we employed a probe analyses of Affymetrix oligonucleotide arrays at individual probe level to compensate for the potential loss of gene identifications associated with compromised mRNA quality in FFPE preparations. Furthermore, to increase the sample quality, we utilized laser capture microdissection of prostate tumor and benign epithelial cells. Remarkably, combination of these approaches recapitulated the common prostate cancer-associated gene expression alteration. Identification of prostate cancer associated-gene expression alterations such as AMACR, Kallikrein gene family and genes associated with androgen signaling such as PDEF and STEAP were consistent with previous findings reported in prostate cancer. These data suggest that combination of laser capture dissection with computational enhancement of microarray data may be useful for the assessment of gene expression changes in FFPE prostate cancer specimens.

Cancer cells gain selection advantages by the coordinated silencing of protective and by the activation of cell proliferation/cell survival genes. Evaluations of epithelial cell transcriptome of benign and malignant prostate glands by laser capture microdissection (LCM) identified Lactotransferrin (LTF) as the most significantly downregulated gene in prostate cancer (CaP) cells (p10(-6)). Frequent downregulation, significant association of LTF with PSA recurrence-free survival in CaP patients and the established anti-tumorigenic effects of LTF in experimental cancer models have provided impetus to evaluate LTF expression features and mechanisms in CaP specimens.LTF mRNA expression analysis was performed in LCM derived benign and malignant prostate epithelial cells by using Affymetrix GeneChip and QRT-PCR. LTF protein expression was assessed in tissue specimens by immunohistochemistry and in serum samples from CaP patients compared to healthy male control by using ELISA. Mechanism of LTF downregulation was analyzed in 5-azadeoxycytidine treated LNCaP and LAPC4 cells using MALDI-TOF MS. Proliferation and cell cycle analysis of CaP cells by FACS flow cytrometry was assessed in LNCaP cell cultures.Quantitative analysis of LTF mRNA expression in tumor cells revealed marked downregulation of LTF with significant associations to decreased PSA recurrence-free survival of CaP patients (n = 100, por = 0.0322). Moreover, low levels of LTF protein expression was observed in tumor tissues as well as in sera from CaP patients (por = 0.0001). LTF promoter downstream CpG island methylation was found in LNCaP and LAPC4 cells. Furthermore, replenishing of LTF by supplementing growth media with LTF protein resulted in reduced cell growth. Cell cycle analysis revealed robust increases in apoptosis in response to LTF treatment.This study highlights the potential for LTF in chemoprevention and to become a biologically relevant prognostic marker of CaP, suggesting that silencing of the LTF gene may be causally linked to CaP progression.

This study examined the fate of axon terminals of one of the major sources of hypoglossal afferents, the spinal V nucleus, after XIIth nerve resection in adult Sprague-Dawley rats. In order to anterogradely label trigemino-hypoglossal projections, small quantities of horse radish peroxidase were pressure-injected into the ipsilateral dorsal (mandibular) portion of the spinal V nucleus two days before the animals were killed. Survival periods ranged from 5 to 33 days after nerve injury (dpo). Axonal injury produced relative changes in the association of labelled axon terminals to structures in the hypoglossal nucleus on the injured side. The proportion of horse radish peroxidase-labelled spinal V nucleus terminals with spherical vesicles (S-terminals) that were unapposed to hypoglossal somata or dendrites increased rapidly and reached maximal levels by 11 dpo. By contrast, the isolation of labelled terminals with pleomorphic/flattened vesicles (P/F-terminals) from postsynaptic structures began later, advanced at a slower rate and did not attain maximal levels until 20 dpo. S-terminals not apposed to neuronal cell parts increased at a rate of 2.2 times greater than unapposed P/F-terminals. In addition, at peak levels, the proportion of labelled S-terminals that were detached from somata and dendrites was significantly greater than unapposed, labelled P/F-terminals. Axotomy did not alter the caliber of the labelled axon terminals. However, by 29 days after axotomy, the average diameter of dendrites remaining in contact with SPVN terminals was 1/3 the diameter of dendrites of uninjured neurons apposed to labelled axon terminals. These findings provide the morphological correlate for physiological and pharmacological evidence that the effectiveness of excitatory and inhibitory synapses are down-regulated in a coordinated manner after hypoglossal nerve injury.

Twenty-two patients suffering from syringomyelia were treated operatively. Different shunt procedures were performed. Most often syringo-subarachnoid shunt (seven cases) and syringopleural shunt (eight cases) were used. Operative findings and complications were discussed. Postoperative improvement was observed in five patients, twelve were stable-unchanged, four showed further deterioration and one died. Operative treatment should be performed before gross neurological deficit is established.

The odontogen brain abscess is a relatively rare, but very serious complication of an infection of the teeth. Frequently the bacteria found by aspiration of the brain abscess are the only indication of a dental focus. The diagnostic problems in confirming a covert dental infection as the cause of the brain abscess are illustrated.

A retrospective study was performed on 109 patients who died in the neurosurgical ICU. We investigated the problem of outcome prediction in relation to diagnosis, status at admission and several risk factors. We analysed the meaning of diagnostical and therapeutical treatment and compared the clinical diagnosis to the neuropathological findings.

In a neurosurgical intensive care unit 26 patients with unconsciousness and unresponsiveness were investigated by means of multimodality evoked potentials and electroencephalography in order to obtain information on the functional state of the nervous system. Multimodality evoked potential techniques allowed us to differentiate patients with EEG alterations due to drug treatment from those without therapy. The functional state and prognosis can be better evaluated by means of evoked potential techniques. Patients with raised intracranial pressure seem to undergo some characteristic alterations in FEP and far field potential derivations.

Cases of optic nerve lesions of various origins are described. These were seen in a systematic study of 59 autopsy cases with underlying neurological or neurosurgical diseases. The characteristic morphological signs of direct and indirect as well as primary and secondary lesions are discussed. Circulatory complications in cases with increased intracranial pressure are stressed.

18 patients with post-traumatic visual disease of the optic nerve are presented. In the post-traumatic stage, visual evoked potentials were monitored. In amaurosis there was a high incidence of midface or frontobasal fractures. The severity of the trauma is not correlated with the severity of visual deficits. Flash evoked potential (FEP) findings were different: In most cases there was a correlation of clinical and FEP findings. In some we found false positive potentials in the acute stage. In smaller visual field deficits the alterations of FEP could not be correlated with the clinical disorders. FEP alterations depended on time. The pathophysiological mechanisms are discussed in regard to the pathological findings in 51 unselected autopsies with an investigation of the visual pathway from the intraorbital optic nerve to the visual cortex. Because of the different morphological alterations the clinical, neurological and ophthalmological examination should be followed by standard CT scanning to evaluate intracranial haematomas and by CT scanning with thin slices of the optic nerves and the soft tissue of the orbit. Visual evoked potentials (VEP) and in the unconscious patient, flash evoked potentials (FEP) do not give much more security for therapeutic decisions in comparison with former times. The histological findings do not support the hypothesis that operative decompression is successful.

Injections of horseradish peroxidase (HRP) or wheat-germ agglutinin-horseradish peroxidase (WGA-HRP) into the nucleus reticularis parvocellularis (RPc) produced anterograde labeling of axon terminals within the hypoglossal nucleus. Based on morphological parameters of vesicle population, membrane specializations, and postsynaptic articulations, two types of axon terminals derived from neurons in RPc end on hypoglossal neurons. More than half of the terminals contained spherical vesicles (S-type), established asymmetrical membrane specializations and contacted proximal and medium-sized dendrites. The remaining labeled terminals had flattened vesicles (F-type), symmetrical membrane densities and apposed medium and small dendrites. The morphological differences expressed in the two types of terminals may reflect physiological and/or pharmacological differences in the action of RPc neurons on motoneurons in the hypoglossal nucleus.

Electroencephalographic (EEG) investigations were done in 36 patients with intracranial aneurysms, before and after surgery. Thirty five of them suffered from subarachnoid hemorrhage (SAH). Pre-operatively, there was no correlation between patients' age or sex and localisation of the aneurysm or degree of EEG disturbances. The most frequent finding was a generalised slowing, the degree of which depended on the time from bleeding to EEG. Focal abnormalities were due to spasms of the vessels or intracerebral haematomas. There was a high correlation with neurological deficits. Post-operatively, EEG disturbances became worse in 21 cases. Generalised and focal abnormalities increased. These were due to focal oedema and the operative approach. The EEG could be correlated very well with the findings from other investigative methods (CT scanning, angiography). The EEG, as a functional method, showed very well the whole state of the brain after bleeding and after operation.

Axon terminals projecting to the hypoglossal nucleus have been identified and characterized by electron microscopy following injections of horseradish peroxidase (HRP) into pars interpolaris of the spinal trigeminal nucleus (SPVN) in adult rats. Over 70% of the anterogradely labeled terminals contained spherical vesicles (S-terminals) and their synaptic densities were chiefly asymmetrical (Gray Type I). The rest (28%) of the labeled terminals had flattened vesicles (F-terminals) and predominantly established symmetrical (Gray Type II) synaptic contacts. The diameters of labeled terminals were 0.5-2.5 micron. Two-thirds of the S-terminals had diameters less than 1.25 micron, whereas, F-terminals were distributed equally in the higher (greater than 1.25) and lower (less than 1.25) diameter ranges. Most axon terminals ended on dendrites of hypoglossal neurons; some, chiefly F-terminals, formed axosomatic endings. Dendrites had diameters of 0.5-5 micron. The majority of S- and F-terminals ended on dendrites with diameters of less than 2.5 micron. However, more F-terminals (17%) than S-terminals (11%) were presynaptic to dendrites greater than 2.5 micron in diameter. Experiments in which anterograde HRP labeling of trigemino-hypoglossal projections was combined with retrograde WGA-HRP labeling of motoneurons projecting to the tongue, demonstrated that SPVN axons end on dendrites of these motoneurons. Whether some of the trigeminal fibers also terminate on intrinsic hypoglossal interneurons remains to be determined.

45 patients (55 hands) with carpal tunnel syndrome treated surgically have been studie Painful nocturnal paraesthesiae occurred in patients with short histories and was a good prognostic feature. Electromyography proved of value in assessing motor lesions and the degree of the process. The first sign of muscle involvement was fibrillation potential. In longer histories an increased amount of polyphasic potentials and reduced voluntary pattern was seen. The reduced pattern is reversible in cases of short duration and the absence of muscle wasting. In cases with marked alteration and signs of chronic muscle degeneration, the prognosis for pain is good, but not so for the neurological deficit. The nerve conduction velocity improve quickly after decompression of the median nerve in accordance with the complaints of the patient Electrophysiological methods proved their value in staging and follow-up.

Event-related potential recording and neuropsychologic testing were carried out on 18 severely head-injured patients and on a control group. At early stages of injury the patients had prolonged P3 latencies and reduced psychometric scores. In the assessment of individual patients the P3 latency proved to be a measure that diagnosed cognitive impairment with clinically acceptable levels of accurate classification. On retesting 4.6 +/- 1.6 months after trauma, normal values were found for the neuropsychologic measures and a residual latency prolongation for P3, indicating the P3 latency to be a sensitive index of subtle residual brain dysfunction due to head injury.

Tumours in the sellar region may still present diagnostic problems. We therefore compared encephalotomographic and CT findings in sellar tumours and 91 patients were examined by both methods. For clinical purposes and operative treatment the degree of compression of the hypothalamus is of great importance. Encephalotomographic and CT findings are analysed and demonstrated. In cases of density differences between tumour and brain tissue shown by contrast enhancement, more information on the inner structure of a tumour (cystic or solid) can be obtained by computerized tomography. But if these are no density differences or/and contrast enhancement, tumour diagnosis is made easier by encephalotomography because of the great efficiency of this method.

Sixty-six patients with tumours in the sellar region were examined. All were operated on either by the transfrontal or the transsphenoidal route. Pre- and postoperative longitudinal electroencephalographic investigations were performed. Preoperative electroencephalograms showed a normal frequency content in cases of intrasellar tumours or those reaching the chiasma. Nearly all cases had irregularities in the temporal regions. Tumours compressing the third ventricle had slower average frequencies and a general slowing in all cases. Besides these alterations unilateral delta waves or bitemporal dysrhythmic groups were sometimes found. A connection between extension of the tumour and its histological nature could not be found, but the operative approach influenced the electroencephalographic disturbances enormously. After a transfrontal approach and removal of the tumour the electroencephalogram was unchanged. Sometimes a mild transient bitemporal slowing was present. But after a transfrontal operative approach a general slowing was common, usually with focal marked slow activity in the right fronto-temporal area.

Reports of electroencephalographic changes in cases of the traumatic apallic syndrome in children and adolescents are very rare. We tried to correlate special electroencephalographic patterns with the three different stages that are usually seen. We found high voltage subdelta and delta activity in the initial symptom complex, an EEG with dominating delta-theta activity and voltage of medium height corresponding to the fully developed stage, and a flat theta EEG in the stage of remission. The difficulties in interpretation of the changes, especially in children, are discussed. Longitudinal electroencephalographic studies are recommended for diagnosing complications, such as haematomas or palsies, and for prognosis.

In 14 cases of diffuse astrocytoma, glioblastoma and cerebral lymphoma CT was compared to the gross anatomy and their histology at corresponding levels. Diffuse spread of tumor even in areas of considerable increase of cellular density are not recognizable in CT including application of contrast medium. Circumscribed and frequently multiple foci inside of diffuse areas of gliomatosis may have necrosis and extensive vascular changes including haemorrhage. These foci alone are demonstrable by pathological changes in CT and may suggest multiple metastatic growth or vascular lesions. True unconnected multiple lesions in gliomas are rare as can be demonstrated by intensive histological investigations but occur in cerebral lymphomas.

Two cases of long-standing multiple sclerosis (MS) are presented. During the course of this disease signs of a space-occupying lesion in the brain developed. An astrocytoma was diagnosed by biopsy in both patients. A later postmortem examination in one of them revealed a diffuse glioma with extension of tumor cells into the brain stem and cerebellum. Current opinions on the development of cerebral gliomatous tumors and of malignant lymphomas in patients with MS are discussed. Recent immunopathologic aspects are considered.

From all the available radiodiagnostic procedures for diagnosing spinal disorders (conventional tomography, myelography, CT), high-resolution, thin-slice computer tomography presents the highest radiation exposure as represented by the somatic dose index. It allows, however, the retrospective computer reformatting of axial slices into secondary slices of any projection desired. To obtain this extra information with conventional tomography would require further exposures in the desired projections and/or thinner slices. But there is a great amount of important diagnostic information that plays a decisive role in the choice of the form of therapy and the preoperative planning of surgical which cannot be obtained by conventional radiological procedures.

Between 1969 and 1979, seventy-nine patients suffering from a cerebrospinal fluid (CSF) leakage, were operated on in the neurosurgical department of the University Clinic Essen (West Germany). A modified classification, the onset of symptoms and the diagnostic procedures are described and some data are compared with the results of other investigators.

The clinical course and computed tomographic findings in two patients suffering from multiple sclerosis and coincidental gliomatous brain tumor are presented. Both diagnoses were proven by surgical biopsy; autopsy findings of one case are reported as well. Our results demonstrate that a differentiation of both diseases is not possible by computed tomography or by clinical data alone. Surgical biopsy to establish the diagnosis is indicated during the course of suspected multiple sclerosis when computed tomographic alterations and clinical signs of a space-occupying lesion last for some weeks.

Axon terminals were identified and characterized by electron microscopy after injections of horseradish peroxidase (HRP) into the spinal V nucleus (SPVN) or the medullary reticular formation adjacent to the XIIth nucleus. The synaptic organization and topology of these two different populations of hypoglossal afferents (T-XII and R-XII respectively) were determined by quantitative comparisons. Significant differences were obtained in the ratios of morphological types of terminals, sizes of axonal endings and their location on postsynaptic structures. Axon terminals containing spherical vesicles (S-terminals) and those with flattened/pleomorphic vesicles (F-terminals) were anterogradely labeled with HRP from both injection sites. However, the S/F ratio for R-XII terminals was 1.2:1 compared to 2.6:1 for T-XII afferents. Asymmetrical membrane densities (Gray Type I) were the predominant form of junctional specialization for S-terminal synapses. Asymmetrical densities with subjunctional dense bodies/bars (S-Taxi) were associated with a higher proportion of T-XII synapses than R-XII synapses. Almost all of the F-terminals from both sources had symmetrical densities (Gray Type II). The average diameter of R-XII terminals was greater than that of T-XII terminals. R-XII-F terminals were the largest terminals. The majority of axon terminals from both sources formed axodendritic synapses. However, R-XII terminals had a higher incidence (10% vs. 3%) of axosomatic contacts. The proportion of R-XII-F-terminals decreased from the central toward the distal dendrites, whereas the opposite was found for T-XII-F and T-XII-S-terminals. In contrast to these findings, R-XII-S-terminals were more uniformly distributed on dendrites of all sizes.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-eight children with medulloblastoma (19 boys and 9 girls) were treated at the Departments of Neurosurgery and Radiotherapy in Essen between 1969 and 1977, and were followed prospectively after surgical treatment and postoperative irradiation. Because different radiation techniques had been used, these patients were divided into two groups, one given a limited irradiation volume and the other irradiation of the entire central nervous system. The results obtained in the former group were inferior to those in the latter. All living patients in the second group are in good condition. Special attention is paid to the technique of irradiation and the factors which may influence prognosis. Even after the relatively short follow up period of one to five years, it may be concluded that high-dose irradiation of the entire central nervous system considerably improved the prognosis of medulloblastoma.

In the first six months of 1977 156 patients with craniocerebral injuries underwent computerized tomography. Twelve had severe deficits which led to neurosurgical interventions. Only five had space-occupying haematomas. CT was useful in detecting neurosurgical complications, whereas EEG was useful in staging the severity of the trauma. The two methods, the functional one of EEG and the morphological one of CT, are complementary, especially with regard to the posttraumatic course. The clinical symptoms are reflected by EEG better than by CT.

A 48-year-old man had a 3-year history of progressive sensory and motoric disturbance of the lower extremities. Computed tomography and magnetic resonance imaging revealed an extensive epidural lipoma reaching from T2 to T10 level. After hemilaminectomy the dorsally located epidural fat was removed. Ten months later the neurological deficit had greatly improved.

Thirty patients with histologically established medulloblastoma were postoperatively irradiated at the radiological center in Essen. The patients were divided into two groups. Treatment was nonuniform in the first group consisting of 12 patients irradiated between 1969 and 1973. The second group of 18 patients was treated uniformly as regards the combined neurosurgical and radiological concept, and a new irradiation technique at the 5.7-MeV linear accelerator was employed there. While none of the patients in the first group survived longer than three years, in the second group 12 of 18 patients are in a good general state after a follow-up period between 19 and 60 months.

Event related potential recording and psychometric evaluation of cognitive impairment were carried out on 21 patients with brain tumours, 21 patients with severe head injuries and 24 controls. The tumour and trauma patients who met the psychometric inclusion criteria for dementia, but not the non-demented patients, had significantly longer N2 and P3 latencies than the controls. In assessing individual patients P3 latency correctly differentiated between demented and non-demented patients in 81% of cases (for N2 latency 77%). Particularly P3 latency may provide a practical and objective measure of mental impairment in neurosurgical disorders producing dementia. Marked asymmetry in N2 and P3 amplitudes between hemispheres was observed in a number of cases. No significant relationship was found between diminution of N2 and P3 components and side of lesion.

We report a case of hydranencephaly with its clinical and morphological aspects. The origin of hydranencephaly is discussed. There is strong evidence of very early damage to the brain substance in this condition. Therefore this disease should not be regarded as a malformation. The diagnostic procedures are described and their values discussed.

The potential of computerized tomography (CT) in diagnosis and follow-up of intracerebral hemorrhage is demonstrated. The study is based on 37 patients suffering from medical diseases such as high blood pressure, diabetics, generalized arteriosclerosis, valvular heart disease and anticoagulation therapy. Ensuing complications, such as rupture into the ventricles and hydrocephalus, are being discussed. Special effort is made to explain the finding of the hyperdense ring structure occuring after contrast enhancement.

Eight cases of carotid cavernous fistulas are reported. Electroencephalograms were done before, during and after operative attack und during digital carotid compression. Preoperative, there was a mild general slowing, ipsilaterally marked in the parieto-temporal region. During digital carotid compression slowing may be found on the opposite side because of a steal syndrome. The degree of these physical changes and of those during hyperventilation depends on the individual cerebral blood flow and the corresponding situation of cerebral blood flow and the corresponding situation of cerebral metabolism. These changes are especially marked under anaesthetics. That is why derivations under anaesthetics seem to be most important for indicating the operation and to be correlated to the functional disturbances by the fistula. delta-activity is no contra-indication, when faster activity is superposed. Seizure potentials, only, seem to be a contra-indication. Pathogenetic mechanisms of electroencephalographic changes are being discussed. From that can be concluded that early operative treatment is necessary. Especially if the patient is young, there may be no need for compression training. Simultaneously, there is a possibility for curing neuro-ophthalmic disturbances.

Three clinically and histologically verified cases of "traumatic aneurysm" concerning the a. basilaris, a. communicans posterior, and a. lenticulostriata have been used to demonstrate that these acute and subacute lesions do not belong to the true aneurysms, as defined pathologically and anatomically. They can be considered as acute traumatic lesions of arteries with periarterial hematoma (aneursyma spurium) and should be designated as pseudoaneurysms. Such pseudoaneurysms must not only be differentiated from true aneurysms by radiological and clinical findings but also by histological investigation. An intracranial artery rupture with formation of an pseudoaneurysm due to a blunt injury can also exist without a fracture of the base of the skull. Since traumatic lesions of the striatum arteries are caused especially in children and young adults, the localization of an acute hemorrhage in the basal ganglia does not exclude a traumatic etiology. Early closure of the injury in the artery wall and surroundings by fibrin and thrombotic material with following repairing processes are important for latency between injury and rupture of the pseudoaneurysm.

Seventy-four patients with tumors in the sellar region were examined by means of encephalotomography and axial computerised tomography. In nearly all cases, the localisation and expansion of tumors could be exactly determined by encephalotomography. In addition, a graduation according to the degree of hypothalamic compression was possible. In cases of density differences between tumor and brain tissue and contrast enhancement more information of the inner structure of a tumor (cystic or solid) could be obtained by computerised tomography. But in cases of missing density differences or/and contrast enhancement tumor diagnosis is easier by encephalotomography because of the high efficiency of encephalotomography. The indication for the form of operative treatment, transsphenoidal or transcranial, depends on the exact knowledge of tumor growth, especially of the degree of hypothalamic compression. Therefore, in all uncertain computerised diagnosis encephalotomography has to be undertained.

Ventriculo-atrial shunt has proved to be an effective therapy for hydrocephalus. We report about two patients, in whom due to different causes this therapy was not possible. Both of them were treated with ventriculo-pyeloureterostomy for liquor drainage. The shunt functioned well and without renal damage for four weeks in one patient and for 1 1/2 year in the other patient. The reported method is an alternative procedure when the usual type of liquor drainage is impossible.