Methylnitrosourea, dimethylbenzanthracene and benzoapyrene differentially affect redox pathways, apoptosis and immunity in zebrafish.

Cancer continues to be a major cause of mortality globally. Zebrafish present suitable models for studying the mechanisms of genotoxic carcinogens. The aim of this study was to investigate the interaction between oxidant-antioxidant status, apoptosis and immunity in zebrafish that were exposed to three different genotoxic carcinogens methylnitrosourea, dimethylbenzanthracene, benzoapyrene and methylnitrosourea + dimethylbenzanthracene starting from early embryogenesis for 30 days. Lipid peroxidation, nitric oxide levels, superoxide dismutase and glutathione-S-transferase activities and mRNA levels of apoptosis genes p53, bax, casp3a, casp2 and immunity genes fas, tnfα and ifnγ1 were evaluated. The disruption of the oxidant-antioxidant balance accompanied by altered expressions of apoptotic and immunity related genes were observed in different levels according to the carcinogen applied. Noteworthy, ifnγ expressions decreased in all carcinogen-exposed groups. Our results will provide basic data for further carcinogenesis research in zebrafish models.

Rabies virus vaccine as an immune adjuvant against cancers and glioblastoma: new studies may resurrect a neglected potential.

To review the literature about the use of Rabies Virus-Vaccine (RV-V) as an anticancer immunotherapeutic modality in the light of recent findings. The literature search in relevant databases with the following key words: Rabies virus, cancer, remission. Remissions occured following RV-V injections in patients with cervical cancer and melanoma. Pilot clinical studies showed that RV-V injections enhanced survival in glioblastoma patients, which is supported by findings in GL261 mouse glioma model. If public health studies demonstrate protective role of RV-V against certain types of cancers, it can be benefitted as a novel immune adjuvant in clinic.

Angiotensin-converting enzyme insertion/deletion gene polymorphism in patients with familial multiple cerebral cavernous malformations.

Cavernous malformations can occur in both sporadic and autosomal dominant forms. The aim of this study was to investigate the potential role of insertion/deletion (I/D) polymorphisms of the angiotensin-converting enzyme (ACE) gene in the development of cerebral cavernous malformations (CCM). Forty-one members of two families affected by familial CCM were included in this study. DNA was isolated from peripheral venous blood, and polymerase chain reaction analysis was used to detect I/D polymorphisms of the ACE gene, using HACE3s and HACE3as as primers. Only 10 participants had MRI-confirmed CCM. Of these 10 subjects, seven had the I/D, two had the D/D, and one had the I/I genotype. Of the remaining 31 subjects, 14 had the I/I, 13 had the I/D, and four had the D/D genotype. There was a greater proportion of subjects with the D allele among those with MRI-confirmed CCM than among those without (p<0.05). These results suggest that the D polymorphism of the ACE gene may be involved in the pathogenesis of familial CCM.

Intracranial cholesteatoma - case report and critical review.

OBJECTIVE: Chronic otitis media is a potentially serious disease because of its complications, most of which are common in conjunction with cholesteatomas. There is variance in the terminology used by neurosurgeons, otorhinolaryngologists and neuropathologists. Synonyms for cholesteatoma found in the literature include epidermoid tumor, epidermoid cysts and epithelial inclusion cyst. Intracranial extension of an acquired cholesteatoma is a rarely documented occurrence. PATIENTS/MATERIAL AND METHODS: A 47-year-old woman who had undergone a right tympanomastoidectomy 20 years previously, presented with a long history of mild headaches that had become progressively more severe over the last 3 years. Clinical and radiological evaluation of the patient raised the suspicion of an intracranial cholesteatoma. RESULTS: A right temporal craniotomy was performed. The mass was completely excised and histopathological study revealed the tumor to be a cholesteatoma. The patient's post-operative recovery was uneventful. CONCLUSIONS: Cholesteatomas possess the capacity for eroding bone and can have an insidious onset, but once established, grows relentlessly and destroys neighboring structures. Since a gradual intracranial involvement does not usually cause acute symptoms of increased intracranial pressure, the correct diagnosis may be difficult. Detailed clinical and radiographic studies in particular are diagnostically helpful. Because of the high incidence of delayed recurrence, life-long follow-up is required. The inconsistency in the histopathological classification of intracranial cholesteatomas should be clarified.

Chiari malformation type III and results of surgery: a clinical study: report of eight surgically treated cases and review of the literature.

BACKGROUND: The characteristics of Chiari malformation type III and its treatment are evaluated in this study. Radiological and surgical findings were correlated and the benefits of the therapy are discussed. METHODS: Eight patients (6 males, 2 females) with Chiari malformation type III were studied. All patients underwent surgery to remove encephalocele along with neural tissue and to repair the dura and the skin. Associated pathologies such as hydrocephalus, tethered cord syndrome and syringomyelia were also surgically treated. Follow-up was based on the evaluation of postoperative motor and mental development, as well as on magnetic resonance imaging findings. RESULTS: Ventriculoperitoneal shunt malfunction in 2 patients was the only surgical complication. One patient died 10 days after the operation, 7 patients survived, and the outcome of 2 patients was quite poor because of severe mental retardation and neurological deficits at the beginning. In the remaining patients, motor and mental development was normal, and the neurological outcome was satisfactory. CONCLUSION: Surgery in the newborn period, initial severity of neurological deficits, the presence of intermittent apnoea, delayed treatment of hydrocephalus and the amount of neuronal tissue within the excised encephalocele were determined as unfavourable prognostic factors for the outcome. If the appropriate surgical procedure is done at the right time, the outcome of the Chiari malformation type III patient can be satisfactory with a low mortality rate.

[Making the differential diagnosis between pituitary apoplexy and craniopharyngioma]. / Difficulté du diagnostic différentiel entre l'apoplexie hypophysaire et le craniopharyngiome.

Pituitary apoplexy is characterized by an abrupt neurological deteriorating condition associated with rapid expansion of the pituitary gland, caused by ischemic necrosis and hemorrhage. Craniopharyngioma may be difficult to distinguish from pituitary apoplexy. In this study, we discuss a case of pituitary apoplexy in a 19-year-old male patient. In our patient, the tumor was confused with a craniopharyngioma because of the suprasellar extension of the tumor on magnetic resonance (MR) images and the hyperintensity in T1-weighted images, the young age of the patient, and the gradually progressive onset of the symptoms. In conclusion, even without a known history of pituitary adenoma or an abrupt onset of the clinical symptoms, the diagnosis of pituitary apoplexy should be considered in a patient with a suprasellar mass hyperintensity in T1-weighted MR images, which may mimic craniopharyngioma.

Pediatric intramedullary teratomas.

Teratomas account for 3% of all childhood tumors, with the majority occurring in the sacrococcygeal region and in the ovary. Intradural spinal teratomas are extremely rare dysembryogenetic tumors. Spinal cord teratomas may be extradural, intradural or intramedullary. Intramedullary ones are the least frequently seen. We have extensively reviewed the literature for intramedullary spinal cord teratomas in children. Although an intramedullary teratoma of the conus medullaris in children is a rare entity, it should be considered in the differential diagnosis of masses involving the conus medullaris.

A pioneering female neurosurgeon: Dr. Aysima Altinok.

This article will look at how one female neurosurgeon in Turkey made her mark in the field. In 1954, Dr. Aysima Altinok began her residency training in neurosurgery at Haydarpasa Numune Hospital where the first official department of neurosurgery in Turkey had been founded five years earlier. On November 22, 1959, she successfully completed her training and was certified officially as a neurosurgeon. Hence, Dr. Altinok was a leader in neurosurgery. Dr. Altinok was the chief of the department of neurosurgery from 1968 to 1992 at Bakirköy Mental and Psychological Health Hospital in Istanbul. She was among the founders of the Turkish Neurosurgical Society in 1968 and was awarded the honour of "Medical Doctor of the Year in Turkey" by the Ministry of Health in 1990. On May 15, 1996, she was accepted as an honorary member of Turkish Society of Neurosurgery for her contributions to neurosurgery. For proving the capability of a woman as a neurosurgeon, her contribution to the world history of neurosurgery should be respected.

Cerebral alveolar echinococcosis. A case report with MRI and review of the literature.

Alveolar echinococcosis is an important zoonotic infection caused by the larval stage of the Echinococcus multilocularis. It is endemic to North America, Central Europa, Russia, China and Turkey. The liver and the lung are the organs most commonly involved. Cerebral alveolar echinococcosis is rare accounting for only 1% of cases. We present a 55-year-old patient with a right frontal mass. T2-weighted MRI series revealed a grape like multilobular, heterogeneous mass with low density. A diagnosis of glial tumor was made. The mass was totally removed. The histopathological examination showed a diffuse growth composed of compartments that are filled with a gelatinous matrix and many brood capsules and protoscolices filled with necrotic tissue. Histopathological findings were consistent with the diagnosis of alveolar echinococcosis. No postoperative complications were observed. There were no lesions in the liver and lungs. The patient was started on albendazole (ABZ) at a daily dosage of 800 mg for 3 months. The patient has remained free of any mass lesion for 5 years. Hypointense grape-like mass with calcification and surrounding white matter edema in T2-weighted MRI should suggest cerebral alveolar echinococcosis. Radical surgery and an adjuvant therapy with ABZ provides useful prolongation of life.

Ectopic pituitary adenoma located at the pituitary stalk. Case report.

Suprasellar located ectopic pituitary adenomas are unusual tumors. We report a rare case of suprasellar prolactinoma arising from the pars tuberalis in a 37-year-old woman. Menstrual disregulation and bitemporal hemianopsia were the main complaints. Blood tests revealed hyperprolactinemia. In magnetic resonance the tumor was totally supradiaphragmatic. Pterional craniotomy and total tumor excision was performed. The pituitary stalk was preserved. Histopathologic diagnosis was a pituitary adenoma immunoreactive for prolactin. Pituitary hormonal functions returned to normal at 6 months postoperatively. No complications were seen in the postoperative period. An ectopic adenoma should be suspected in a patient with suprasellar tumor and hyperprolactinemia. Surgical excision of this tumor may result with normal pituitary functions and normal visual acuity.

The effects of quantum energy surgical device and of bipolar coagulation: a comparative experimental study.

OBJECTIVE: The quantum energy surgical device (QESD) employs an innovative, "no-touch" thermal coagulation, incision and evaporation technique in which thermal energy is delivered to tissue in the format of high-energy neutral argon gas atoms. The aim of this study is to compare QESD and bipolar coagulation (BC) through assessment of both haemostasis and histological damage to isolated femoral arteries of rats. METHODS: Sixty rats were randomly divided into acute and short-term experimental groups. In the acute group (n=20) histopathological evaluation was performed immediately following coagulation, whereas in the short-term experimental group (n=20) the evaluation was performed 10 days later. Each sham group consisted of ten rats. Viewed under the surgical microscope, only normal-appearing, freshly sectioned, and bleeding femoral arteries were studied. Right femoral arteries subject to QESD coagulation, and left femoral arteries to BC. Haemorrhaging was controlled using the minimal coagulation time necessary to stop it. All vascular layers, including endothelium, internal elastic lamina, media and adventitia were examined histologically and ultrastructurally in a "blind" fashion to critically compare morphological damage due to QESD and BC. RESULTS: Surgical haemostasis induced by QESD was found to be as safe as BC. Light microscopy revealed more marked histopathological changes in the BC than in the QESD group. These involved mainly the endothelial and medial compartments and, at the ultrastructural level, consisted of endothelial degeneration and exfoliation, irregularity of internal elastic lamina, degeneration, and loss of medial smooth muscle. CONCLUSION: The results indicate that QESD coagulation induces significantly less histological damage than does BC. Thus QESD coagulation is a safe, less tissue destructive, and equally effective method of haemostasis.

Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours postsurgery provides reliable information.

There is no agreed-upon schedule for MRI follow-up after pituitary adenoma removal via the transsphenoidal approach. Our aim was to establish a plan for MRI follow-up after pituitary surgery. Eighty pituitary adenoma cases (25 microadenomas, 30 macroadenomas that did not infiltrate the cavernous sinus, and 25 macroadenomas with cavernous sinus infiltration) were prospectively studied with MRI following tumor resection via the transsphenoidal approach. Each patient was imaged at 24 hours, at 3, 6 and 9 months, and at 1 year or more postsurgery. The parameters studied were residual tumor, synthetic packing material (Gelfoam) versus fat graft, and normal pituitary, hypophyseal stalk and optic chiasma. The size of the pituitary structure as a whole was also measured. The latter was studied quantitatively, and the findings for the rest of the parameters were evaluated qualitatively, based on the examiners' confidence in their assessment. The final MRI study, done at least 1 year postsurgery in all cases, was considered the reference MRI for all scans. MRI performed 24 hours after surgery was diagnostically accurate for residual tumor and valuable for visualizing normal sellar structures. The findings also showed that fat packing takes longer to resorb than Gelfoam, but produces no potentially confounding contrast enhancement. An algorithm based on the results is presented for postsurgical MRI assessment of pituitary adenoma patients in which the scan at 24 hours postsurgery is the major factor that determines the timing of later rechecks.

Giant pericallosal artery aneurysm: case report and review of the literature.

Pericallosal artery aneurysms comprise 5% of all intracranial saccular aneurysms and are usually small. Giant cerebral aneurysms mostly occur in major arteries. To date, 12 cases of giant pericallosal artery aneurysm have been reported in the literature. An unusual giant thrombosed pericallosal artery aneurysm is reported here. A 65-year-old female presented with headache and personality changes. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a right-sided giant thrombosed pericallosal artery aneurysm. The patient was operated via an anterior interhemispheric approach and the neck of the aneurysm was successfully clipped. The postoperative period was uneventful. This rare lesion is one of few cases presented in the literature in which neuroradiologic and neuropathologic evaluation was completely performed and the neck of the aneurysm was clipped.

The nature and fate of punctate (type IV) cavernous malformations.

OBJECTIVE: Four types of cavernous malformations (Types I-IV) have been described on the basis of their magnetic resonance imaging (MRI) appearance. The nature of the Type IV cavernous malformation is unclear. It has been suggested that these small lesions, which are well observed only on gradient echo MRI scans, are capillary telangiectasias. We sought to understand the relationship of Type IV cavernous malformations to the other cavernous malformation subtypes. METHODS: We examined serial MRI scans obtained between 1987 and 2000 from 68 patients with more than 228 cavernous malformations. Sixteen patients harbored Type IV cavernous malformations (total, >114 Type IV lesions). Spin echo T1-weighted, T2-weighted, proton density, and (when available) gradient echo MRI scans were reviewed. Cavernous malformations that met the Zabramski criteria for Type IV (poorly observed on T1- and T2-weighted images) were reviewed in serial scans from individual patients to characterize their radiographic behavior over time. RESULTS: Type IV cavernous malformations were best observed on gradient echo images and have an MRI appearance distinct from capillary telangiectasias. Proton density images demonstrate more Type IV lesions than T1- and T2-weighted images, but far fewer Type IV lesions than gradient echo images. When observed on T1- and T2-weighted images, Type IV cavernous malformations are generally punctate and hypointense. These lesions rarely enhance with gadolinium. Four of the Type IV cavernous malformations observed serially evolved into Type I and Type II cavernous malformations, for an approximate rate of progression of 0.05 per patient year. CONCLUSION: Although most Type IV cavernous malformations remain stable over time, a small subset of these lesions progress into Types I and II cavernous malformations.

Solid-calcified colloid cyst of the third ventricle.

We report a 65-year-old female with a solid-calcified colloid cyst in the third ventricle that was demonstrated on computed tomography scan and magnetic resonance images. The lesion was surgically excised using the anterior transcallosal-transforaminal approach. Complete preservation of the surrounding neural and vascular structures was achieved.

Spinal solitary fibrous tumor: seventh reported case and review of the literature.

We present the clinical, radiological, and pathological features of a solitary fibrous tumor in the spinal cord. This case is the seventh spinal solitary fibrous tumor in the literature. The tumor caused clinical symptoms in a 70-year-old female, which indicated compression of the spinal cord. Magnetic resonance imaging showed an intradural extramedullary mass at T3 vertebral level. Surgically, the tumor was firm, in an intradural extramedullary location and attached to the dura. Histologically, the tumor was composed of spindle cells in a collagen-rich matrix but exhibited regional variations. CD34 and vimentin were diffusely positive during immunohistochemical stain testing. The tumor displayed no positive staining for epithelial membrane antigen, cytokeratin, S-100 protein, smooth muscle actin or desmin. The Ki-67 labeling index was low. Solitary fibrous tumors have been found in a variety of locations suggesting that a solitary fibrous tumor has a mesenchymal origin. This rare tumor should be considered in the differential diagnosis of spinal tumors.

Value of transcranial Doppler ultrasonography in the diagnosis and follow-up of carotid-cavernous fistulae.

The introduction of transcranial Doppler ultrasonography (TCD) has made it possible to examine blood flow characteristics in carotid-cavernous sinus fistulae (CCSF) in a noninvasive, relatively simple, and reliable way. This study investigated the usefulness of TCD in the diagnosis and follow-up of various CCSF subtypes. We found characteristic TCD findings associated with high-flow CCSF, but perhaps more importantly, found this technique to be an excellent tool also for detecting and following treatment results in low-flow CCSF. The low-flow fistulae exhibit less specific clinical signs and are harder to distinguish using the noninvasive radiological methods of computed tomography (CT) and magnetic resonance imaging (MRI). The impact of our findings on future approaches to the diagnosis and follow-up of these different types of acquired vascular shunts is also discussed. The conclusions were as follows: a) TCD parameters (blood flow velocity and pulsatility index) for CCSF are specific, and are thus valuable in the hemodynamic assessment of these lesions. b) Since dural CCSF feature more subtle hemodynamic changes and CT and MRI findings may be normal, these cases pose diagnostic challenges. In these situations, TCD reveals specific diagnostic findings and allows the examiner to determine whether cerebral angiography is indicated.

The juxtaposition of a capillary telangiectasia, cavernous malformation, and developmental venous anomaly in the brainstem of a single patient: case report.

OBJECTIVE AND IMPORTANCE: Capillary telangiectasias, cavernous malformations, and developmental venous anomalies are all vascular malformations that occur on the capillary-venous side of the cerebral circulation. The associations of capillary telangiectasias with venous malformations, cavernous malformations with venous malformations, and capillary telangiectasias with cavernous malformations have all been described; however, the association of all three lesions in a single patient is extremely rare. CLINICAL PRESENTATION: A 52 year-old Caucasian woman presented to our clinic with an extended history of confusion, distorted visual perceptions, photophobia, neck pain, swallowing problems, and poor balance. The patient's examination was remarkable for difficulty concentrating, mild rotatory nystagmus, subtle decreased sensation over the left side of the face and body, and brisk reflexes. Review of the patient's magnetic resonance imaging examination demonstrated a cavernous malformation, a capillary telangiectasia, and a developmental venous anomaly located adjacent to one another in the brainstem. INTERVENTION: Given the patient's complex constellation of symptoms and relatively mild neurological findings, it was difficult to ascribe any one of them to a specific vascular malformation. Conservative management of this patient's vascular malformations was decided upon. CONCLUSION: Juxtaposition of these three different vascular lesions in the brainstem of an otherwise normal individual suggests a relationship among them. Although there are several theories that link similar associations through physiological mechanisms such as venous hypertension, we propose that a developmental event disrupting local capillary-venous pattern formation is a plausible alternative.