Back pain prevalence in adolescent athletes.

The research aimed to investigate back pain (BP) prevalence in a large cohort of young athletes with respect to age, gender, and sport discipline. BP (within the last 7 days) was assessed with a face scale (face 1-2 = no pain; face 3-5 = pain) in 2116 athletes (m/f 61%/39%; 13.3 ± 1.7 years; 163.0 ± 11.8 cm; 52.6 ± 13.9 kg; 4.9 ± 2.7 training years; 8.4 ± 5.7 training h/week). Four different sports categories were devised (a: combat sports, b: game sports; c: explosive strength sport; d: endurance sport). Analysis was described descriptively, regarding age, gender, and sport. In addition, 95% confidence intervals (CI) were calculated. About 168 (8%) athletes were allocated into the BP group. About 9% of females and 7% of males reported BP. Athletes, 11-13 years, showed a prevalence of 2-4%; while prevalence increased to 12-20% in 14- to 17-year olds. Considering sport discipline, prevalence ranged from 3% (soccer) to 14% (canoeing). Prevalences in weight lifting, judo, wrestling, rowing, and shooting were ≥10%; in boxing, soccer, handball, cycling, and horse riding, ≤6%. 95% CI ranged between 0.08-0.11. BP exists in adolescent athletes, but is uncommon and shows no gender differences. A prevalence increase after age 14 is obvious. Differentiated prevention programs in daily training routines might address sport discipline-specific BP prevalence.

The application of Gadopentate-Dimeneglumin has no impact on progression free and overall survival as well as renal function in patients with monoclonal plasma cell disorders if general precautions are taken.

OBJECTIVES: The current analysis investigated the prognostic significance of gadopentetate dimeglumine on survival and renal function in patients with monoclonal plasma cell disorders. METHODS: In this study 263 patients who had received gadopentetate dimeglumine within a prospective trial investigating dynamic contrast-enhanced magnetic resonance imaging (MRI) were compared with 335 patients who had undergone routine, unenhanced MRI. RESULTS: We found no significant prognostic impact of the application of contrast agent on progression-free survival in patients with either monoclonal gammopathy of undetermined significance, smouldering or symptomatic myeloma and no significant prognostic impact on overall survival in patients with symptomatic myeloma. Since renal impairment is a frequent complication of myeloma, and decreased renal function is associated with a higher risk of complications in patients receiving contrast agents, we evaluated the impact of contrast agent on renal function after 1 year. In the present analysis the only significant adverse impact on kidney function occurred in symptomatic myeloma patients who already had impaired renal parameters at baseline. Here, the renal function did not recover during therapy, whereas it did so in patients with normal or only slightly impaired renal function. CONCLUSION: If general recommendations are adhered to, gadopentetate dimeglumine can be safely applied in patients with monoclonal plasma cell disease.

The challenge of a 2-year follow-up after intervention for weight loss in primary care.

BACKGROUND: Many weight loss programmes show short-term success, but long-term data in larger studies are scarce, especially in community settings. Attrition is common and complicates the interpretation of long-term outcomes. OBJECTIVE: To investigate 2-year outcomes and explore issues of attrition and missing data. SUBJECTS: A total of 772 overweight and obese adults recruited by primary care practices in Australia, Germany and the UK and randomised to a 12-month weight loss intervention delivered in a commercial programme (CP) or in standard care (SC). MEASUREMENT: Weight change from 0-24 and 12-24 months including measured weights only and measured and self-reported weights, using last observation carried forward (LOCF), baseline observation carried forward (BOCF), completers-only and missing-at-random (MAR) analyses. RESULTS: A total of 203 participants completed the 24-month visit. Using measured weights only, there was a trend for greater 24-month weight loss in CP than in SC, but the difference was only statistically significant in the LOCF and BOCF analyses: LOCF: -4.14 vs -1.99 kg, difference adjusted for centre -2.08 kg, P<0.001; BOCF: -1.33 vs -0.74 kg, adjusted difference -0.60 kg, P=0.032; completers: -4.76 vs -2.99 kg, adjusted difference -1.53 kg, P=0.113; missing at random: -3.00 vs -1.94 kg, adjusted difference -1.04 kg, P=0.150. Both groups gained weight from 12-24 months and weight regain was significantly (P<0.001) greater for CP than for SC in all analysis approaches. Inclusion of self-reported weights from a further 138 participants did not change the interpretation of the findings. CONCLUSION: Initial weight loss was poorly maintained during the no-intervention follow-up, but both groups did have lower weight over the 24 months. Attrition was high in both groups, and assumptions about missing data had considerable impact on the magnitude and statistical significance of treatment effects. It is vital that trials on weight loss interventions consider the plausibility of these differences in an analytical approach when interpreting research findings and comparing data between studies.

Development and validation of a national clinical pharmacy competency framework for hospital pharmacists in Austria: a multi-method study.

BACKGROUND: Despite the publication of a European wide competency framework for hospital pharmacy by the European Association of Hospital Pharmacist (EAHP) in 2017, not all countries have adopted and implemented such a framework. AIM: This study aimed to develop and validate a bespoke national hospital pharmacy competency framework for Austria that supports the hospital pharmacy workforce development. METHOD: A multi-method study was carried out in three phases. (I) A systematic literature review across 48 websites of healthcare-related associations and six scientific databases was conducted, identifying competency frameworks, guidelines and related documents. (II) Extracted behaviour competencies were reviewed for contextual national appropriateness by three researchers prior to mapping against the "Patient Care and Clinical Pharmacy Skills" domain of European Common Training Framework (CTF). (III) Validation of the resultant draft clinical skills competency framework took place by an expert panel (n = 4; Austrian Association of Hospital Pharmacists (AAHP) board members) discussion. Reporting of findings is aligned with the recommendations for reporting Competency Framework Development in health professions (CONFERD-HP guidelines) and the PRISMA 2020 checklist. RESULTS: The systematic review (SR) resulted in 28 frameworks, guidelines and related documents and the identification of 379 behaviour competencies, with nineteen mapped to the "Patient Care and Clinical Pharmacy Skills" domain of the CTF (after removal of duplicates). Expert panel discussion resulted in suggested changes to ensure contextual national appropriateness. CONCLUSION: This study resulted in the development and validation of the first clinical national pharmacy competency framework for Austria. Future studies should focus on political and practical structures necessary for its successful implementation.

Environmental sensitivity for milk yield in Luxembourg and Tunisian Holsteins by herd management level.

Milk production data of Luxembourg and Tunisian Holstein cows were analyzed using herd management (HM) level. Herds in each country were clustered into high, medium, and low HM levels based on solutions of herd-test-date and herd-year of calving effects from national evaluations. Data from both populations included 730,810 test-day (TD) milk yield records from 87,734 first-lactation cows. A multi-trait, random regression TD model was used to estimate (co)variance components for milk yield within and across country HM levels. Additive genetic and permanent environmental variances of TD milk yields varied with management level in Tunisia and Luxembourg. Additive variances were smaller across HM levels in Tunisia than in Luxembourg, whereas permanent environmental variances were larger in Tunisian HM levels. Highest heritability estimates of 305-d milk yield (0.41 and 0.21) were found in high HM levels, whereas lowest estimates (0.31 and 0.12, respectively) were associated with low HM levels in both countries. Genetic correlations among Luxembourg HM levels were >0.96, whereas those among Tunisian HM levels were below 0.80. Respective rank orders of sires ranged from 0.73 to 0.83 across Luxembourg environments and from 0.33 to 0.42 across Tunisian HM levels indicating high re-ranking of sires in Tunisia and only a scaling effect in Luxembourg. Across-country environment analysis showed that estimates of genetic variance in the high, medium, and low classes of Tunisian environments were 45, 69, and 81% lower, respectively, than the estimate found in the high Luxembourg HM level. Genetic correlations among 305-d milk yields in Tunisian and Luxembourg HM environments ranged from 0.39 to 0.79. The largest estimated genetic correlation was found between the medium Luxembourg and high Tunisian HM levels. Rank correlations for common sires' estimated breeding values among HM environments were low and ranged from 0.19 to 0.39, implying the existence of genotype by environment interaction. These results indicate that daughters of superior sires in Luxembourg have their genetic expression for milk production limited under Tunisian environments. Milk production of cows in the medium and low Luxembourg environments were good predictors of that of their paternal half-sisters in the high Tunisian HM level. Breeding decisions in low-input Tunisian environment should utilize semen from sires with daughters in similar production environments rather than semen of bulls proven in higher management levels.

Accessing genotype by environment interaction using within- and across-country test-day random regression sire models.

First-lactation test-day (TD) milk records of Luxembourg and Tunisian Holsteins were analysed for evidence of genotype by environment interaction (G x E). The joint data included 730 810 TD records of 87 734 cows and 231 common sires. Random regression TD sire models with fourth-order Legendre polynomials were used to estimate genetic parameters via within- and across-country analyses. Daily heritability estimates of milk yield from within-country analysis were between 0.11 and 0.32, and 0.03 and 0.13 in Luxembourg and Tunisia, respectively. Heritability estimates for 305-day milk yield and persistency (defined as the breeding value for milk yield on DIM 280 minus the breeding value on DIM 80) were lower for Tunisian Holsteins compared with the Luxembourg population. Specifically, heritability for 305-day milk yield was 0.16 for within- and 0.11 for across-country analyses for Tunisian Holsteins and 0.38 for within- and 0.40 for across-country analyses for Luxembourg Holsteins. Heritability for apparent persistency was 0.02 for both within- and across-country analyses for Tunisian Holsteins and 0.08 for within- and 0.09 for across-country analyses for Luxembourg Holsteins. Genetic correlations between the two countries were 0.50 for 305-day milk yield and 0.43 for apparent persistency. Moreover, rank correlations between the estimated breeding values of common sires for 305-day milk yield and persistency, estimated separately in each country, were low. Low genetic correlations are evidence for G x E for milk yield production while low rank correlations suggest different rankings of sires in both environments. Results from this study indicate that milk production of daughters of the same sires depends greatly on the production environment and that importing high merit semen for limited input systems might not be an effective strategy to improve milk production.

Genotype x environment interaction for milk yield in Holsteins using Luxembourg and Tunisian populations.

Test-day (TD) milk yield records of first-lactation Holstein cows in Luxembourg and Tunisia were analyzed using within-and between-country random regression TD models. Edited data used for within-country analysis included 661,453 and 281,913 TD records in Luxembourg and Tunisia, respectively. The joint data included 730,810 TD records of 87,734 cows and 231 common sires. Both data sets covered calving years 1995 to 2006. Fourth-order Legendre polynomials for random effects and a Gibbs sampling method were used to estimate variance components of lactation curve parameters in separate and joint analyses. Genetic variances of the first 3 coefficients from Luxembourg data were 46 to 69% larger than corresponding estimates from the Tunisian data. Inversely, the Tunisian permanent environment variances for the same coefficients were 52 to 65% larger than the Luxembourg ones. Posterior mean heritabilities of 305-d milk yield and persistency, defined as estimated breeding values (EBV) at 280 days in milk-EBV at 80 days in milk, from between-country analysis were 0.42 and 0.12 and 0.19 and 0.08 in Luxembourg and Tunisia, respectively. Heritability estimates for the same traits from within-country analyses, mainly from the Tunisian data, were lower than those from the joint analysis. Genetic correlations for 305-d milk yield and persistency between countries were 0.60 and 0.36. Product moment and rank correlations between EBV of common sires for 305-d milk yield and persistency from within-country analyses were 0.38 and 0.41 and 0.27 and 0.26, respectively. Differences between genetic variances found in both countries reflect different milk production levels. Moreover, low genetic and rank correlations suggest different ranking of sires in the 2 environments, which implies the existence of a genotype x environment interaction for milk yield in Holsteins.

Genetic diversity and joint-pedigree analysis of two importing Holstein populations.

Genetic diversity and relatedness between 2 geographically distant Holstein populations (in Luxembourg and Tunisia) were studied by pedigree analysis. These 2 populations have similar sizes and structures and are essentially importing populations. Edited pedigrees included 140,392 and 151,381 animals for Tunisia and Luxembourg, respectively. To partially account for pedigree completeness levels, a modified algorithm was used to compute inbreeding. The effective numbers of ancestors were derived from probabilities of gene origin for the 2 populations of cows born between 1990 and 2000. The 10 ancestors with the highest contributions to genetic diversity in the cow populations accounted for more than 32% of the genes. Eight of these 10 ancestors were the same in both populations. The rates of inbreeding were different in the 2 populations but were generally comparable to those found in the literature for the Holstein breed. Average inbreeding coefficients per year, estimated from the data, ranged from 0.91 and 0.50 in 1990 to 3.10 and 2.12 in 2000 for the Tunisian and Luxembourg populations, respectively. Genetic links have also strengthened with time. Average additive relationships between the 2 populations were as high as 2.2% in 2000. Results suggest that it would be possible to investigate genotype by environment interactions for milk traits using the Tunisian and Luxembourg dairy populations.

The Ly-49 family: regulation of cytokine production in murine NK cells.

Most proteins encoded by members of the Ly-49 gene family are class I-recognizing receptors on murine natural killer (NK) cells. Class I recognition by Ly-49 receptors usually results in inhibition of NK cell lysis of target cells. However, NK cells function not only in a lytic capacity, but also can mediate cytokine production. In this report we have demonstrated the ability of Ly-49A and Ly-49G2 to inhibit production of cytokines by NK cells by showing that specific antibodies against these gene products stimulate cytokine production. Murine NK cells were cultured in the presence of P815 (H2-Dd), and supernatants were analyzed for the production of interferon-gamma (IFN-gamma), tumor necrosis factor alpha (TNF-alpha), and granulocytemacrophage colony-stimulating factor (GM-CSF). NK cell populations were sorted for Ly-49A+ or Ly-49G+ subsets, and these subsets were analyzed for their ability to alter cytokine induction by target cell interaction. In the presence of target cells expressing the appropriate class I molecules, Ly-49A and G2 were found to inhibit cytokine induction by NK cells. Examination of mRNA for IFN-gamma and GM-CSF indicated that Ly-49 receptors increased mRNA levels of NK cells. These results demonstrate that class I binding of these NK receptors can inhibit production of important physiological cytokines, in addition to the regulation of cytotoxic activity.

[Tendinopathies of the Lower Extremities in Sport--Diagnostics and Therapy]. / Tendinopathien der unteren Extremität im Sport--Diagnostik und Therapie.

Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.

16-Epiestriol, a novel anti-inflammatory nonglycogenic steroid, does not inhibit IFN-gamma production by murine splenocytes.

All the steroidal anti-inflammatory drugs currently available are glucocorticoids. The desired anti-inflammatory activities of glucocorticoids frequently are accompanied by adverse side effects, notably glycogenic activities and profound immunosuppression, that can limit clinical use. We recently identified 16-epiestriol, a naturally occurring steroid, as exhibiting significant anti-inflammatory activity without glycogenic activity. In the present study, we compared the effects of 16-epiestriol and hydrocortisone on the capacity of murine splenocytes to produce interferon-y (IFN-y). We injected young adult male BDF1 mice once with 20 mg/kg hydrocortisone or 20, 5, or 1 mg/kg 16-epiestriol and 4 h later harvested the splenocytes. Flow cytometric analysis confirmed that 16-epiestriol did not alter the number of CD3+ T cells in the spleen. In contrast to the suppressive effects of hydrocortisone, none of the 16-epiestriol concentrations inhibited concanavalin A-stimulated IFN-gamma production by spleen cells, as determined by ELISA. Incubating spleen cells from untreated mice in concentrations of 16-epiestriol ranging from 1 mg/ml to 100 pg/ml did not alter profiles of IFN-gamma production, in contrast to the suppressive dose-response effects of hydrocortisone. Collectively, these results support the contention that 16-epiestriol may be a clinically useful safe anti-inflammatory steroid without profound immunosuppressive activities.

Altered long-term potentiation in the young and old Ts65Dn mouse, a model for Down Syndrome.

We investigated the phenomenon of long-term potentiation (LTP) in a genetic model of Down Syndrome, the segmental trisomy mouse (Ts65Dn). Ts65Dn mice survive to adulthood and have an extra chromosome that contains a segment of chromosome 16 homologous to human chromosome 21. In this study, field excitatory postsynaptic potentials (fEPSP) were recorded from the CA1 area of in vitro hippocampal slices from diploid and Ts65Dn mice, and LTP was induced by a single tetanizing pulse train (1 sec in duration) at 100 Hz. The hippocampus from both young (2 months) and older (9 months) Ts65Dn mice had a reduced LTP over a period of 60 min compared with LTP in age-matched controls. This finding may explain the reported behavioral and learning impairments in Ts65Dn mice; it suggests that this mouse model can be used to study the role of altered synaptic plasticity in mental retardation of Down Syndrome.

Increased expression of voltage-activated calcium channels in cultured hippocampal neurons from mouse trisomy 16, a model for Down syndrome.

Calcium is an important second messenger that affects metabolic and physiological activities of developing and mature neurons. It has been reported that electrical activity is abnormal in cultured hippocampal and DRG neurons from the trisomy 16 (Ts16) mouse, a model for Down syndrome (trisomy 21-Ts21 in human). Whole-cell voltage-clamp, radiolabeled ligand binding techniques and mRNA measurements were used to study the effect of Ts16 on voltage-dependent calcium currents in cultured fetal hippocampal neurons from the Ts16 mouse. In neither Ts16 nor control diploid neurons were low-voltage-activated calcium currents detected. However, a high-voltage-activated (HVA) calcium current was identified and shown to be dihydropyridine sensitive. The density of this HVA calcium current was 80% greater in Ts16 neurons than in control. This difference correlated with a 70% increase in binding of radiolabeled dihydropyridine, PN200-110, a marker of L-type calcium channels. However, mRNA levels encoding the alpha1C and alpha1D subunits were unchanged in the Ts16 neurons. In contrast, mRNA level of the myo-inositol transporter, the gene for which is located on mouse chromosome 16, was elevated in Ts16 neurons due to a gene-dosage effect. Therefore, it is likely that posttranscriptional regulation of dihydropyridine-sensitive voltage-dependent calcium channels is abnormal in Ts16. As dihydropyridine sensitive HVA Ca channels are implicated in heterosynaptic long-term depression and long-term potentiation, the differences reported here, if also present in the Down syndrome brain, may contribute to mental retardation in that disorder.

Impairment in mitochondrial cytochrome oxidase gene expression in Alzheimer disease.

Brains from 5 patients with Alzheimer's disease (AD) showed a 50%-65% decrease in mRNA levels of the mitochondrial-encoded cytochrome oxidase (COX, a marker of oxidative metabolism) subunits I and III in the middle temporal association neocortex, but not in the primary motor cortex, as compared to 5 control brains. The amount of mitochondrial-encoded 12S rRNA was not altered, nor was the amount of nuclear-encoded lactate dehydrogenase B mRNA (a marker of glycolytic metabolism). These data suggest that the decrease in COX I and III subunits mRNA in affected brain regions may contribute to reduced brain oxidative metabolism in AD.

Localization of cytochrome oxidase (COX) activity and COX mRNA in the perirhinal and superior temporal sulci of the monkey brain.

Cytochrome oxidase (COX) activity and COX II mRNA expression were localized in the perirhinal and superior temporal sulci of the rhesus monkey brain. In both regions, a laminar distribution of COX activity and COX II mRNA was observed. COX activity was intense in layers I and IV and were localized to the neuropil. In contrast, COX II mRNA was localized to neuronal cell bodies. In the prorhinal region, highest levels of COX II mRNA was detected in cell bodies of layers II and IV, and in the perirhinal region, in cell bodies of layers III and V-VI. In the superior temporal sulcus, COX II mRNA was detected in cell bodies of layers III and V-VI. Thus, COX II mRNA and COX activity are uniquely localized in the cortical layers and to those neurons that support cortico-cortical connections.

Long-term transplants of mouse trisomy 16 hippocampal neurons, a model for Down's syndrome, do not develop Alzheimer's disease neuropathology.

Hippocampal tissue from embryonic day 15-17 fetal mice, euploid or trisomic for chromosome 16, was transplanted into the striatum or the lateral ventricle of 6-8 week old female C57B1/6 mice. After 6-14 months of survival, host brains were sectioned and the grafts were examined by histochemical techniques and by immunocytochemistry for antigens present in pathological brain structures of Alzheimer's disease (AD) patients. Nissl-stained grafts contained aggregations of neurons similar to the pyramidal or the granule cell layers of the normal adult mouse hippocampus. No obvious morphological difference was detected between trisomic and control transplants. The monoclonal antibody Alz-50, which recognizes the paired helical filaments characteristic of AD, or an antibody raised to beta-amyloid peptide, did not reveal neurodegeneration in these grafts. Antibodies against ubiquitin, 200 kDa subunit of neurofilament, alpha 1-antichymotrypsin and tau also did not demonstrate AD-type immunoreactivity in the trisomic or control grafts. Thioflavin S- or silver stained-sections were also negative. We conclude that transplanted hippocampal tissue from the trisomy 16 mouse does not represent an animal model for AD-type neurodegeneration. These results differ from those of Richards et al., EMBO J. (10) (1991) 297-303, who reported AD-type degeneration in trisomy 16 hippocampal transplants.

Localization of cytochrome oxidase (COX) activity and COX mRNA in the hippocampus and entorhinal cortex of the monkey brain: correlation with specific neuronal pathways.

Cytochrome oxidase (COX) activity and COX II mRNA expression were localized in the hippocampal formation and entorhinal cortex of the rhesus monkey brain by means of enzyme histochemistry and in situ hybridization, respectively. Within the hippocampal formation, the terminal field of the perforant pathway showed the highest levels of COX activity, whereas COX II mRNA was localized mainly in neuronal cell bodies. In the entorhinal cortex. COX II mRNA was detected in neuronal cell bodies of layers II and IV. These results indicate that the pattern of localization of COX and its mRNA in entorhinal cortex correlates with the input and output pathways of the hippocampus.

Downregulation of oxidative phosphorylation in Alzheimer disease: loss of cytochrome oxidase subunit mRNA in the hippocampus and entorhinal cortex.

Messenger RNA (mRNA) for cytochrome oxidase subunit II (COX II) was localized by in situ hybridization in the entorhinal cortex and hippocampal formation of postmortem brain tissue from normal human subjects and from patients with Alzheimer disease (AD). In the control entorhinal cortex, COX II mRNA was detected mainly in neuronal cell bodies of layers II and IV. In control hippocampal formation, highest levels were localized in neuronal cell bodies of the dentate gyrus and the CA3 and CA1 regions, neurons that are involved in the major input and output pathways of the hippocampal formation. In AD brain, COX II mRNA was markedly reduced in the entorhinal cortex and the hippocampal formation compared with control brain. In the AD hippocampal formation, reductions were in regions severely affected by AD pathology as well as in regions that were relatively spared. These results are consistent with the hypothesis that reduced mitochondrial energy metabolism reflects loss of neuronal connections in AD.

Reduced expression of voltage-gated sodium channels in neurons cultured from trisomy 16 mouse hippocampus.

Voltage-gated sodium channels are responsible for the initial depolarizing phase of the action potential. In hippocampal neurons cultured from trisomy 16 (Ts16) mice (a model for Down's syndrome), the maximum inward conductance mediated by these channels was reduced 47% relative to control diploid neurons. This reduced conductance was reflected in a 35% decrease in binding of radiolabeled saxitoxin, a sodium channel-specific ligand, indicating expression of fewer channels in these neurons. The mRNAs encoding the alpha and beta 1 subunits were, however, present at the same levels in Ts16 neurons and control diploid neurons. Thus, the altered regulation of voltage-gated sodium channels in Ts16 neurons is apparently a post-transcriptional event and possible mechanisms are discussed.

Malignant astrocytoma six years after the resection of a cerebral metastatic cardiac myxoma: case report.

We describe a woman who had a total resection of a cardiac myxoma followed 8 months later by a hemorrhage in the right frontal lobe secondary to extravascular metastasis of the myxoma. Six years later, after an asymptomatic follow-up, she developed a recurrence of left-sided seizures and an enhancing mass in the same location as the previous tumor. At operation, a malignant astrocytoma was demonstrated. Cardiac myxoma is a true neoplasm with benign histology, which may be associated with heart failure, systemic illness, or peripheral embolization. The neurological manifestations of embolization may include no symptoms, acute or delayed infarction, and intravascular proliferation with aneurysmal dilatation and potential for hemorrhage. The development of extravascular metastatic tumor deposits has been reported previously in only three histologically verified cases. Once the integrity of the blood vessel wall is destroyed by the tumor, a portal of entry is established for tumor cell proliferation in the brain parenchyma. There is no known association between a metastatic cardiac myxoma and a malignant glioma in the literature. Several possibilities for the occurrence of these two neoplasms are discussed.