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UNLABELLED Thirty patients with pituitary adenomas were investigated: 20 with growth hormone producing acromegaly, 7 with prolactinoma and 3 with hormonal inactive adenoma. The correlation between the serum PRL, GH, TSH, levels, their response to 200 micrograms i.v. TRH, measured before the transsphenoidal adenomectomy and the size, the light microscopic (H.E. and Mallory staining), immunocytochemical and ultrastructural (performed in 17 cases) picture of the adenomas were evaluated. CONCLUSIONS (a) there is no close correlation between the hormone granules detected in the pituitary adenoma cells - by light microscopic, immunocytochemical and electron microscopic methods - and the serum hormone levels, their response to TRH; (b) in hormonally active adenomas the immunocytochemical as well as the ultrastructural findings could be negative; (c) in one disease more hormones could give an immunopositive reaction; (d) in any types of investigated adenomas the TSH immunopositivity was always accompanied by PRL immunopositivity (6 cases); (e) the size and the clinical (serum) or cytological hormone activity of the adenomas were independent of one another; (f) the basal serum hormone level shows the hormonal activity of the pituitary adenoma best of all.

The aim of this study was the formulation and examination of a novel thermoresponsive and bioadhesive, in situ gelling drug delivery system, which can be used in the treatment of oesophageal pain and inflammation. A bioadhesive cellulose derivative (Metolose ® 60SH) was used as a thermoresponsive material, because Metolose ® has thermal gelation properties at certain temperature. The thermal gelation temperature ( T 2 ) of Metolose ® 60SH 2 w/w% solution is above body temperature (65–66 °C), but by using different methods (Metolose ® 60SH concentration, auxiliary materials), it can be shifted near to body temperature. The pH alteration between pH = 2–10 and the application of different alcohols did not influence the gelation temperature, but using water-soluble salts and changing the concentration of Metolose ® 60SH solution between 2 and 3 w/w% the thermal gelation point could be decreased. Different NSAIDs were used as model drugs and which had not influence on thermal gelation temperature, but difference in in vitro liberation and penetration can be observed. In vitro adhesion test pointed out that the condition of investigated membrane can change the adhesion. Morphological test of oesophageal tissue showed that investigated materials had no irritative or tissue-damaging effect on the oesophageal mucosa even after 12 h.

36 consecutive years' experience in treating 104 cases of posterior fossa haemangioblastomas is described and discussed. The mortality was 24%, with a tendency to decrease, reaching 20% in the last 15 years. About half the patients returned to neurological normality and full working capacity. Dividing the lesions into solid and cystic tumours, cystic tumours were more frequent, their survival was longer, recurrence less and postoperative state somewhat better.

An in situ gelling liquid suppository is liquid at room temperature but forms a gel at body temperature. In our work, Metolose® SM-4000 (methylcellulose) is studied that basically shows thermal gelation at 68°C (2%, w/w).The objective was to study the potency of different factors (concentration, pH, additives) to change the value of thermal gelation temperature (T (t)) for Metolose® to form an in situ gelling liquid suppository.We studied the effect of Metolose® concentration, pH, and salts (sodium chloride, potassium chloride, sodium hydrogen carbonate, and sodium monohydrogen phosphate) on T (t) by viscosimetry. To choose the appropriate compound, in vitro drug release was examined. Rectal safety test was performed on rats in vivo after 12-hour application.Increasing the Metolose® concentrations (0.5-4%, w/w), T (t) can be decreased, but it also altered the consistency of gel. pH does not affect the T (t). The water-soluble salts allowed reducing the gelation temperature to 37°C. Sodium monohydrogen phosphate in 4.5% concentration was found to be the most appropriate. The impact of examined factors on in vitro drug release of piroxicam from the in situ-formed gel was characterized according to Fickian diffusion. Metolose® and the chosen salt did not cause any morphological damage on the rectal tissues.According to our study, Metolose® has the physical and chemical potential to be used as base for liquid suppositories.

The aim of this study is to prepare novel pH-sensitive beads to obtain a gastric mucosa protective formulation and to ensure drug delivery into the intestine. Diclofenac sodium was used as a model drug. Bead formation was achieved by ionotropic gelation method using three-component gel system containing sodium alginate (Na-Alg), hydroxyethylcellulose (HEC) and hydroxypropylmethylcellulose (HPMC). Factors influencing the characteristics of beads (exposure time, cross-linking agent concentration, polymer ratio) were investigated by swelling and erosion tests based on gravimetric method. Drug release was tested in distilled water and/or artificial digestive fluids and evaluated with Korsmeyer–Peppas equation and Baker–Lonsdale model. The encapsulation behaviour was qualitatively indicated by differential scanning calorimetry (DSC) method. In vivo experiments were conducted to test ulcerogenicity and intestinal absorption in rats. HPMC increased the encapsulation efficiency (EE) and HEC improved the drug release in the intestinal fluids. The equilibrium water uptake (EWU) was correlated with exposure time, calcium chloride concentration and HEC amounts. Bead erosion increased proportionately to exposure time, while it reduced when calcium chloride concentrations were increased. Higher amounts of HEC increased, while higher pH values reduced the encapsulation efficacy. The in vivo experiments demonstrated that the studied encapsulation technology markedly reduced the ulcerogenic effect of diclofenac. © 2009 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 98:4285–4295, 2009

Ten cases with cystic craniopharyngioma were investigated. Histologically, eight of them belonged to the adamantinomatous group and two were squamous epithelial type. Histochemical investigation revealed mucin secretion in microcysts, and electron microscopy demonstrated zymogen granules in the epithelial cells. When the protein content of the cyst fluid was analyzed by polyacrylamidegel electrophoresis, the electrophoretic pattern and immunological properties were found to be similar to the normal human serum control. The results of the morphological study suggest that cystic craniopharyngiomas have a secretory component in addition to the classical histological structures.

The histological, ultrastructural and immunocytochemical features are reported of an intrasellar neuronal and lipomatous hamartoma associated with pituitary growth hormone (GH) cell adenoma and acromegaly. Electron microscopy demonstrated a close contact between neurons and adenomatous GH cells. By immunohistochemistry the adenoma cells revealed a positive staining for GH and prolactin. The neurons of hamartoma showed neurosecretory activity which might have induced the development of pituitary GH cell adenoma.

Science is dealing with the nature, the human beings and the society, and aims to explore the laws of their existence. It uses universal scientific methods, by taking all known laws of nature into consideration. It is free of subjectivity and is guided by a high degree of consciousness. In the author's view, the goal of science is to create a balance between man and nature by exploring the rules of the universe. Art, on the other hand, carries a message about the man and the world, which originates in both emotion and intuition. It intends to impress our feelings and wishes to entertain, create pleasure or make us accept its message. One might wonder about the nature of relationship between art and science. Do we scientists waste our valuable time when dealing with art? Furthermore, is it of any use for artists to deal with science? Ever since the ancient times, scientists have been highly appreciated. Artists, however, used to belong to lower social classes up until the 18th century. Still, the commercial and political life of the Middle Ages were greatly influenced by the guildes, where artists as craftsmen belonged to. Art and science have always been interconnected, although their contents and messages kept changing during the centuries. In the 5th century, sciences were listed among the "septem artes liberales", the "seven free arts". When comparing the creative process of art and science, we might find similarities and differences, some of which will be discussed in the paper. Both research and clinical profession demands devoted work. One of the most valuable form of stress reduction and relaxation is the enjoyment or practice of art. Engagement in art as a form of hobby widens our horizon which in turn stimulates professional work. We might as well agree with the wise saying: Without hobby, one can neither relax nor concentrate.

Six GH adenomas and three prolactinomas were investigated by light- and electron-microscopic morphological and immunocytochemical methods and the effect of vasoactive intestinal polypeptide (VIP) on growth hormone (GH) and prolactin (PRL) secretion was tested in vitro. The tumour cells of the acromegalic patients revealed both GH and PRL immunoreactivity while prolactinomas showed only PRL activity. All the adenomas stained immunocytochemically also for VIP. By electron microscopy, the tumours included two densely and two sparsely granulated GH, two mixed GH/PRL, and three sparsely granulated PRL adenomas. The dissociated cells were explanted, and cultured in vitro. The cultures in micro test plates were treated with VIP at different concentrations between 10(-5)-10(-12) M. GH and PRL contents in the culture media were measured by radioimmunoassay. GH release was significantly stimulated by VIP in a dose-dependent manner over the whole concentration range, while VIP was effective on the PRL release only at 10(-6)-10(-7) M concentration. The cells of a mixed adenoma were grown in Petri dishes and used for ultrastructural and immunocytochemical studies. The cytoplasmic structure of the cells treated with VIP corresponded to that of active hormone-secreting cells with large ergastoplasmic fields and Golgi zones containing secretory granules. Massive exocytotic events were encountered mainly in the GH-type cells. GH and PRL double immunocytochemistry showed the predominance of GH cells, many of them containing low amounts of PRL as well. Cells predominantly containing PRL were spread among them, they also might contain GH as well. Some of the cells contained only a single immunoreactive hormone. The intensity of gold labelling of the secretory granules appeared higher in the VIP-treated cells than in the untreated control ones which showed a cytoplasmic structure characteristic of glandular cells with low secretory activity. As all the adenoma cells both contained and reacted to VIP, our results are in agreement with an autocrine or paracrine effect of this peptide. The fine structure of the cells in the cultures treated with VIP supply an additional argument to the assumption that VIP may serve as a growth factor for these cell types.

The spontaneous spinal epidural haematoma (SSEH) is a rarity, but the severe and permanent motor disability underlines its importance. From 1957 seven cases of SSEH have been diagnosed and operated on in the National Institute of Neurosurgery, Budapest. These cases are analysed and discussed. The clinical picture began with local pain of the spine and radicular signs but some hours or days later paraparesis or paraplegia and incontinence developed. In the discussed cases the neurological deficit progressed to complete para- or tetraplegia in 5 cases. Only 2 patients had partial spinal transverse lesions on admission. All patients underwent myelography to detect the spinal space occupying lesion and were operated on soon. Three patients recovered completely, 2 remained partly and 2 totally paralysed. The outcome depended mainly on the timing of neurological deficiency. If the neurological signs existed less than 8 hours the patients recovered completely or fairly well while the prognosis was poor if the transverse lesion persisted longer than 24 hours. The authors stress the importance of correct and fast decisions at the first medical examination for the outcome of this disease, because only immediate transfer to a neurosurgical department gives a chance of good recovery.

Two cases of rare, benignant gastric tumors are reported. The suggest that while in the diagnosis of tumors with a mucous membrane involvement endoscopy has doubtless a leading role, tumors not infiltrating the mucous membrane are usually better recognizable by radiological (ultrasonography, computer tomography and double contrast x-ray) methods. An appropriate diagnosis followed by surgical removal of the tumor might result in a complete healing of the patient.

Radiological diagnosis of Meckel diverticulum is a difficult task. Here we report a patient with hereditary sphaerocytosis who complained of a chronic periumbilical pain and in whom antegrade barium enema suggested Meckel diverticulum. The diagnosis had been proven both surgically and histologically. This observation indicates that so called traditional x-ray still has its role even in the era of modern (and expensive) radiology.

A child was operated 3 times because of a recurrent growth hormone- and prolactin-producing pituitary adenoma. Between the operations she was treated for five years with bromocriptine. The characteristics of the tumour cell population collected after the last operation was now examined by electron microscopy, immunocytochemistry, and in tissue culture and compared to those of the primary tumour cells reported earlier. A prominent change was the reversal of the proportion of the densely and sparsely granulated cells in favour of the GH-type, densely granulated cells. These cells, some of them coexpressing PRL, did not essentially change their characteristics either in vivo or in culture. On the other hand, pleomorphous cells with smaller cytoplasmic area and prominent lysosomal structures represented the sparsely granulated population containing PRL or both PRL and GH. The morphological alteration of the PRL-type cells was also reflected in vitro. Hence, while GH-type cells prevail, at least a sub-population of PRL-type cells survives long-term bromocriptine administration. A shift in the incidence of the two cell types in favour of the GH-type cells explains the change in the endocrine status of the patient.

A 40-year-old male patient with a 2 years history of recurring hyperthyroidism is presented with clinical hyperthyroidism and diffuse goiter. Despite thyreostatic treatment and surgical thyroid ablation the hyperthyroidism recurred. The patient had laboratory evidence of hyperthyroidism and his serum TSH was persistently and enormously elevated (T4:214 nmol/l, T3:6.9 nmol/l, TSH:218 mIU/l)Computed tomography and magnetic resonance imaging confirmed a pituitary mass of 7 cm in a-p diameter, with supra-, parasellar and sphenoidal extension. The pituitary adenoma was partially resected by transsphenoidal surgery, which failed to result in a substantial decrease in the serum thyrotropin level. Pituitary irradiation and a long-term somatostatin analog octreotide treatment (300-600 micrograms/die) combined with bromocriptine therapy resulted in a significant, but still incomplete suppression of thyrotropin secretion (TSH level about 15 mIU/l) and persisting mild hyperthyroidism. The size of the adenoma was unchanged during the two years of highdose octreotide treatment period. According to our best knowledge this is the first reported case of a thyrotropin-secreting pituitary adenoma in Hungary.

Temperature dependent spin-lattice relaxation time, T1, measurements were carried out on surgically removed pituitary adenoma tissues at low temperature. Differences were found between samples; the temperature dependence of T1 showed a broad minimum below freezing. The measured data were fitted by theoretical lines to determine various parameters such as activation energy, correlation time and intensity.

A pituitary adenoma was transsphenoidally removed from a 4.5-year-old girl suffering from gigantism. Prior to the operation both the growth hormone (GH) and the prolactin (PRL) levels in the serum were elevated. By light microscopy the tumor appeared to be an acidophilic adenoma. Two distinct cell types, the densely granulated and the sparsely granulated cells, could be distinguished by electron microscopy. Double immunolabeling revealed the presence of GH alone in some densely granulated cells and PRL alone in some sparsely granulated cells, as well as GH and PRL co-localized in both of the morphologically distinguished cell types. Both cell types were identified in the monolayer and the suspension cultures by electron microscopy. GH and PRL concentrations in the culture media were measured by radioimmunoassay. The basal secretion of growth hormone was almost uniform during the 3-week cell culture period. GH and PRL release was significantly inhibited by bromocriptine. Our studies revealed a bimorphous and bihormonal mixed adenoma in childhood.

Pathological specimens of 131 surgically removed craniopharyngiomas were obtained from the registry of the National Institute of Neurosurgery, Budapest between 1977 and 1991. The cases were reviewed statistically with reference to their gross and microscopic features and clinical characteristics. Macroscopically, 34% of the tumours were cystic, 23% solid and 43% mixed. Histologically, 38% of the cases belonged to the adamantinous group, 26% were squamous epithelial type, 15% were combined, that is expressing the characteristics of both. In 21% of the cases the surgically removed samples did not contain enough material for correct histopathologic classification. There was no recurrence in the group with the squamous epithelial type tumours, while 59% of the adamantinous, and 36% of the combined craniopharyngiomas recurred. The 5-year survival proportion was 73% at the squamous epithelial, 60% in the adamantinous, and 55% at the combined histological types.

The authors report of a case with a pituitary macroadenoma which was associated with a persistent trigeminal artery. The tumour was removed by transsphenoidal microsurgical approach to the sella turcica. To recognise the developmental anomaly is very important to avoid complications during operation.

According to Hommerich (1964) malignant tumors of paranasal sinuses account for 10%–13% of the otorhinolaryngologic malignancies and for 0.2% of malignancies overall. These tumors are usually diagnosed late, since in view of the mild symptoms patients tend to not see the physician early. Vollrath and Lasch (1988) detected stage III or IV tumors in 75% of his 61 patients. Since precise diagnosis of these tumors is not always easy, even given the case history and symptoms, a team including an ophthalmologist, a radiologist and a neurologist is needed.

CSF shunts are of primary importance in treatment of hydrocephalus of various aetiology. Neuroimaging techniques (CT, MR) do not provide ample information on the dynamics of hydrocephalus, CSF cysts, CSF shunt surgery indications and shunts’ patency. Based on the well-known dynamic advantages of radionuclide imaging, this method is routinely applied in our Institute for examination of CSF flow, resorption in hydrocephalus, as well as in CSF shunt patency. 100–200 MBq of 99-m-Tc-DTPA was injected by cisternal puncture in 656 cases of hydrocephalus and CSF cysts of different origins; CSF shunt patency control has been performed in 462 cases via ventricular or direct shunt puncture. The selection of tracer activity, the place of injection and the time interval of the taken pictures depended on the goal of the study (for ex. 10–20 MBq radiotracer was injected into the shunt valve due to insufficient patency of the distal tube of ventriculoperitoneal shunt). The serial scintigrams, apart from their morphological value, provide reliable information on the CSF flow and resorption, the extent of CSF communication of the cysts of various origins, hence being more advantageous than the CT and MR. The short time and in most cases the non-invasive character of the study, as well as the low radiation dose yields valuable information not only on the patency of the shunt, but also on localization of the blockage and its possible aetiology. The results suggest direct information and allows precise planning of surgical revision and differentiation with other non-surgical diseases (appendicitis, viral influenza, etc.) (Figure).

Dandy was the first to describe the successful removal of a colloid cyst in 192110. Initially a variety of open surgical approaches were described mainly through the frontal horn of the lateral ventricle or through the corpus callosum and although these were attended by considerable mortality and morbidity in the past12, 13, 23,24, 34, modern microsurgery has revolutionized the management of these conditions1, 27. The two series reported here by classical neurosurgical techniques, from Zurich and London, indicate that complete excision of these tumours may now be achieved with low mortality and morbidity. Since 1975, an increasing number of reports have described aspiration techniques avoiding craniotomy5, 11, 15, 17,29,30,31 and a series from Homburg/Saar is described using these techniques. The ventriculoscope has been employed stereotactically or freehand29 (Calliauw) and a brief description of the modern ventriculoscope is appended from Brussels.

Radiosurgery, using 90Y injected directly into the cavity of cystic craniopharyngiomas produces remarkable reduction of tumour size and diminishes cyst fluid production. The authors have studied the histology of biopsy and autopsy material obtained from seven patients presented with cystic craniopharyngiomas. Histological examination was carried out before and after 90Y silicate implantation. As an effect of 90Y irradiation, histology of samples taken from the cyst wall revealed that the lining epithelial cell layer became destroyed and the cyst wall shrunk. Large amount of collagen fibres with focal hyaline degeneration was present. Proliferation of intimal cells and subendothelial connective tissue narrowing small vessel lumina also occurred. Considering that fibrotic tissue is more susceptible to shrink, the fibrosis induced by irradiation together with destruction of the squamous epithelium and vascular changes, might explain the reduction of the cyst volume and diminished fluid secretion after 90Y treatment.

The role of the surface oxide layer in the outgassing process of hydrogen was studied. Different surfaces were prepared by heat treatment, 24Mg+ implantation and etching. We observed that hydrogen enrichment occurred in the surface oxide layer of the magnesium-implanted samples and in samples heat treated in air. During outgassing in the temperature range 648 – 823 K the surface oxide layers were changed but no continuous crystalline oxide layer was grown. From calcuulations of D0 and Q it was shown that the effect of the surface layer was eliminated to the largest extent in implanted surface layers because of their high permeability.

Pituitary adenomas of 120 patients were investigated in tissue and in cell cultures. Under different conditions of culture, the biopsies revealed different rates of growth. In tissue cultures 66% of the samples could be propagated while tumour specimens explanted in cell suspensions proliferated in 80% of the cases. Attempts to establish subcultures were also more successful when specimens were put into cell cultures primarily. Further differences of growth characteristics were observed in connection with the histological types of the parent tissues. According to the old terminology cells of mixed type adenomas had the longest life-span both in tissue and in cell cultures. Considering the proliferative activity, this type of tumour could be most frequently subcultured.

The authors describe the intracavital treatment with 90Y silicate colloid in 9 cases of cystic craniopharyngioma. The method has been applied since 1975 in the National Institute of Neurosurgery, Budapest. The intracavital treatment was only one among several applied treatment forms. In all patients a partial removal of the tumour has also been performed. The possibilities of evaluation of the effectiveness of the internal cyst irradiation are therefore limited. In most cases the intracavital treatment resulted in shrinkage of the cyst, or even was followed by its practical disappearence and the condition of the patients shows a decisive improvement. The growth of solid tumour parts is not influenced by this kind of treatment. Therefore the clinical improvement of the patient's condition depends also on the ratio between cyst and solid tumour volume. The optic nerve impairment did not improve in all cases. As a side-effect an oculomotor nerve paresis developed in several patients. Its possible explanations have been discussed, including lasting damage from tumour pressure.

The significance of superselective angiography in obtaining information concerning the haemodynamics of arteriovenous angiomas and certain saccular aneurysms in emphasized on the basis of evidence obtained in 17 cases.

15 patients presented with cervical spine dislocation and kyphotic spondylosis due to traumatic fracture and vertebral body tumour underwent surgical decompression and fixation via the anterior approach in one stage. Decompression was achieved by resection of the body of the vertebra while fixation meant implantation of iliac bone graft with metal plate fixation. Early reduction of the dislocation was impossible or insufficient in most of the cases. Therefore the majority of operations were "late decompression". Patients with root or partial cord lesions had the most significant improvement. In some selected cases, however, who suffered from a total cord lesion due to C6 or C7 fracture-dislocation, surgical decompression of the C7 and/or C8 roots by resection of the C6 or C7 vertebral bodies could lead to useful motor improvement in the hands and the fingers.

The authors report a case of EC/IC bypass with venous interposition between the external carotid artery and the middle cerebral artery cortical branch without function in the first eight months after surgery but, after the reopening of the graft, very good revascularization of the brain could be seen. The possible causes are discussed.

A spinal vasomotor reflex that resembles the Cushing response (CR) can be evoked also by isolated intraspinal hypertension. The intensity of the spinal vasomotor reflex (SVR) depends primarily on the length of the isolated spinal cord, i. e., on the total vegetative elements that participate in this mechanism. The vasopressor effect produced by isolated intraspinal hypertension may be the consequence of ischaemia of the spinal vegetative structures. Cur data suggest that in the case of increased intracranial pressure, when craniospinal connections are free and there is no impaction, the CR is due not only the vasomotor centre in the brain stem, but also to spinal vegetative structures.

This paper deals with experience gained in the study of patency of different types of shunt. Results of subsequent surgery are considered. Findings of 79 scintigraphic studies with radiotechnetium on 68 patients are presented. The method is simple, quick, easy to reproduce and means only moderate radiation load for the patient. Results obtained suggest that this study is a reliable diagnostic tool which can be used in a routine way.

The last few years have seen ion implantation become a widely used industrial method. This has resulted in increasing importance being attached to the reliability of implanters and to a satisfactory working time/maintenance relation and other factors which are in some way connected with reproducibility and homogeneity. With these viewpoints in mind, ion sources seem to be the most sensitive components of implanters. Besides the normal ion source operations such as changing feeding material or gas, etc., ion sources need care in the maintenance. Ion source lifetime and reliability problems are of special consequence in the case of heavy-current machines. The excellent, mechanically scanned target chambers have made possible the use of higher and higher currents, but at the same time these currents can cause lifetime problems which affect the profit of expensive high current machines.