Association of Mild Leg Length Discrepancy and Degenerative Changes in the Hip Joint and Lumbar Spine.

OBJECTIVE: The purpose of this study was to evaluate the correlation between mild leg length discrepancy (LLD) and degenerative joint disease (DJD) or osteoarthritis. METHODS: We evaluated standard postural lumbopelvic radiographs from 255 adults (121 women and 134 men) who had presented with spinal pain for chiropractic care. Symmetry of femoral head diameters was used to exclude magnification errors. Pearson's partial correlation was used to control for age and derive effect sizes for LLD on DJD in the hip and lower lumbar motion segments. Krippendorff's α was used for intraobserver and interobserver reliability. RESULTS: A strong correlation was found between LLD and hip DJD in men (r = 0.532) and women (r = 0.246). We also found a strong correlation between LLD and DJD at the L5-S1 motion segment in men (r = 0.395) and women (r = 0.246). At the L4-5 spinal level this correlation was much attenuated in men (r = 0.229) and women (r = 0.166). CONCLUSIONS: These findings suggest an association between LLD and hip and lumbar DJD. Cause-effect relationships between mild LLD and DJD deserve to be properly evaluated in future longitudinal cohort studies.

Anatomic features of glioblastoma and their potential impact on survival.

BACKGROUND: Many reports on glioblastoma multiforme discuss the prognostic impact of anatomical features such as cysts, necrotic changes, extent of edema or subependymal spread of tumor cells. In the present study, we examined different growth patterns and their possible relations to patient survival. METHODS: To analyze whether anatomical characteristics are related to prognosis, we reviewed the prospectively collected pre- and postoperative MRIs of 83 patients in the 5-ALA study, provided by the 5-ALA Glioma Study Group. Following a standardized analytic work flow, the tumor volume and site, presence of necrosis or cysts, and perifocal edema were assessed preoperatively. In the same way, postoperative MRI and the MRI at first recurrence were analyzed. In addition, survival time of the patients was documented. RESULTS: Median survival time of all 83 patients was 15.1 months (range 1.5 to 70.1, mean 18). The site or volume of glioblastoma, as well as the presence of intratumoral necrosis or cysts, did not exert a significant effect on survival time; 96.4 % of recurrences occurred within the former resection margin. Tumors with initial contact with the subependymal zone had multifocal or ventricular recurrences significantly more often. In patients with residual tumor on early postoperative MRI, the follow-up images displayed enlargement of the remnants in 91.9 % of these cases. CONCLUSIONS: A merely anatomical analysis of the glioblastoma growth pattern cannot reliably provide prognostic information. The occurrence of most recurrences next to the resection margin and the high percentage of growing residual tumors underline the importance of complete resections.

[Impact of implementation strategies on adherence rates to colorectal cancer (CRC) guidelines after polypectomy in a university hospital]. / Einfluss von Weiterbildungsmaßnahmen auf die leitliniengerechten Nachsorgeempfehlungen nach Polypektomie aus dem Dickdarm in einem Universitätsklinikum.

BACKGROUND: Colorectal cancer (CRC) is the second most common malignancy in Germany. Screening colonoscopies with polypectomy have been demonstrated to reduce the incidence of CRC. Detailed recommendations on scheduling screening and follow-up colonoscopies have therefore been included into national guidelines. Knowledge about CRC guidelines and adherence to guideline recommendations varies greatly among physicians. METHODS: We combined different implementation strategies (training courses, case discussion, handouts, wall charts) to improve adherence of recommendations for scheduling follow-up colonoscopy. To assess adherence, written recommendations given at discharge after inpatient treatment for polypectomy were analysed before (n = 111) and after (n = 83) the implementation of the above-mentioned implementation measures. Additional factors possibly influencing the recommendations of physicians were collected (histology, polyp size). RESULTS: The adherence to the CRC guideline before implementation of the above-mentioned measures was moderate. After intervention, there was a non-significant increase from 47 % to 53 %. Senior physician review and editing of the discharge summaries improved guideline adherence of recommendations to 69 %. Neither the education level of residents nor their affiliation to a certain department had an impact on the quality of the recommendations. Histology and in particular information on the resection status of the polyps in the pathology report (complete versus incomplete resection) had an influence of the recommended schedule. Furthermore, size of the polyps, but not the number, had a statistically significant influence on the quality of the recommendations. CONCLUSIONS: The inadequate improvement of guideline adherence can possibly be explained by the insufficient interactive and repetitive character of interventions. As the histology reports seem to have an influence on the recommendations in regards to the interval to the next colonoscopy, interdisciplinary teaching is necessary to improve guideline concurrent care.

Herpes simplex virus infects skin gamma delta T cells before Langerhans cells and impedes migration of infected Langerhans cells by inducing apoptosis and blocking E-cadherin downregulation.

The role individual skin dendritic cell (DC) subsets play in the immune response to HSV remains unclear. We investigated the effect of HSV on DC virus uptake, viability, and migration after cutaneous infection in vitro and in vivo. HSV increased the emigration of skin DCs from whole skin explants over 3 d postinfection (p.i.) compared with mock controls, but the kinetics of emigration was influenced by the skin DC subset. Uninfected (bystander) Langerhans cells (LCs) were the major emigrant DC subset at 24 h p.i., but thereafter, large increases in infected CD103(+)langerin(+) dermal DC (dDC) and uninfected langerin(-) dDC emigration were also observed. LC infection was confirmed by the presence of HSV glycoprotein D (gD) and was associated with impaired migration from cultured skin. Langerin(+) dDC also expressed HSV gD, but infection did not impede migration. We then followed the virus in live MacGreen mice in which LCs express GFP using a fluorescent HSV-1 strain by time-lapse confocal microscopy. We observed a sequential infection of epidermal cells, first in keratinocytes and epidermal gammadelta T cells at 6 h p.i., followed by the occurrence of HSVgD(+) LCs at 24 h p.i. HSV induced CCR7 upregulation on all langerin(+) DC, including infected LCs, and increased production of skin TNF-alpha and IL-1beta. However, a large proportion of infected LCs that remained within the skin was apoptotic and failed to downregulate E-cadherin compared with bystander LCs or mock controls. Thus, HSV infection of LCs is preceded by infection of gammadelta T cells and delays migration.

Traditional medicinal knowledge and practices among the tribal communities of Thakht-e-Sulaiman Hills, Pakistan.

BACKGROUND: Little is known about the medical material and practices of tribes in the western border areas of Pakistan. The local population has inhabited this remote and isolated area for centuries, and gained medicinal knowledge with personal experiences and knowledge learned from forefathers. Due to the geographical isolation of the communities in the Sulaiman hills of Pakistan and their unique culture, the area is of importance for exploration and assessment. METHODS: A total of 116 informants were interviewed in five foothill villages and the associated migratory mountain villages during 2010-2012 and 2015. Information was gathered mainly through semi-structured interviews and freelisting. Local diseases were categorized based on symptoms and affected organs. Descriptive statistics were used for data analysis. RESULTS: Depending on the type of illness, typically a pulse diagnoser or a religious specialist is consulted. Medicinal plant knowledge and use is mostly known and advised by elders within the family. A total of 44 plant species from 32 families (588 use reports), 7 animal species and 6 minerals and other sources (384 use reports) were documented as materia medica. Among the plants, the Lamiaceae is the most dominantly used plant family, followed by Pinaceae. The most frequently reported single species was Teucrium stocksianum. The most often mentioned diseases and treatments fall into the categories of gastrointestinal, ritual, and musculoskeletal diseases. The use of goat and sheep skin as medicine was pivotal in the local medicinal system. Remedies from animal parts and other biological and non-biological sources were mainly used for musculoskeletal ailments and ritual treatments. Overall, people rely on both traditional and biomedical medication and treatments and combination of these systems. CONCLUSION: This paper provides insight into the pluralistic medication system of rural communities of northwest Pakistan. It highlights the materia medica most commonly in use. A considerable part of the documented materia medica and local practices is part of an oral tradition and cannot be found in written sources or scientific articles. The gaining of new medicinal knowledge in the area was the good sign of continuation of traditional medicinal practices.

Ovulatory Shifts in Sexual Desire But Not Mate Preferences: An LH-Test-Confirmed, Longitudinal Study.

The presented data are part of a longitudinal within-subject study designed to examine ovulatory shifts in human sexuality in a diverse German sample using validated questionnaires. The final sample consists of 78 individuals (76 female, 2 agender) who declared to be mainly or exclusively attracted to males. Questionnaires were completed anonymously online at three cycle phases. Following the gold standard, the fertile window was calculated through the reverse cycle day method and confirmed via urinary tests detecting luteinizing hormone. The questionnaire included the Sexual Desire Inventory, Dresdner Body Image Inventory, the Revised Sociosexual Orientation Inventory, and an adjective list to measure mate preferences. One hundred eighty-four questionnaires were included in the data analysis using linear mixed models. Findings support previous research reporting heightened sexual desire and an improved body image during the fertile window. No shifts were found for mate preference or sociosexual orientation, thus adding to a growing body of literature contesting parts of the ovulatory shift hypothesis.

[Case allocation of extensive operations on head and neck within the German DRG system 2004-2007: what is the net result of the continued developments in case allocation?]. / Analyse der Abbildungsqualität grosser operativer Eingriffe an Kopf und Hals in den G-DRG-Systemen 2004-2007: Was hat die Weiterentwicklung der Fallpauschalen gebracht?

BACKGROUND: When the German DRG system was implemented there was some doubt about whether patients with extensive head and neck surgery would be properly accounted for. Significant efforts have therefore been invested in analysis and case allocation of those in this group. The object of this study was to investigate whether the changes within the German DRG system have led to improved case allocation. METHODS: Cost data received from 25 ENT departments on 518 prospective documented cases of extensive head and neck surgery were compared with data from the German institute dealing with remuneration in hospitals (InEK). Statistical measures used by InEK were used to analyse the quality of the overall system and the homogeneity of the individual case groups. RESULTS: The reduction of variance of inlier costs improved by about 107.3% from the 2004 version to the 2007 version of the German DRG system. The average coefficient of cost homogeneity rose by about 9.7% in the same period. Case mix index and DRG revenues were redistributed from less extensive to the more complex operations. Hospitals with large numbers of extensive operations and university hospitals will gain most benefit from this development. CONCLUSION: Appropriate case allocation of extensive operations on the head and neck has been improved by the continued development of the German DRG system culminating in the 2007 version. Further adjustments will be needed in the future.

[Synchronous bilateral renal cell cancer with a single ovarian metastasis and a fibromuscular dysplasia of the renal artery]. / Synchroner bilateraler Nierentumor mit singulärer Ovarialmetastase und fibromuskulärer Dysplasie der Nierenarterie.

INTRODUCTION: Ovarian metastases of renal cell cancer (RCC) are extremely rare with less than 20 cases reported to date. These metastases occur in the majority of cases metachronous (i. e. prior to or after identification of the primary tumour) or--such as in our case--synchronous. CASE REPORT: A 42-year-old women was diagnosed for synchronous bilateral renal and a left-sided ovarian mass. In a first surgical step, the ovarian metastasis was removed laparoscopically and the 20 cm tumour on the right kidney via a transperitoneal tumour nephrectomy (histology: clear cell RCC, pT3bN0V1R0M1). Prior to nephron-sparing surgery of the left kidney an angiography was performed revealing a massive fibromuscular dysplasia. Under cold ischaemic perfusion, the two RCCs (pT1aV0R0) on the left side were excised and the renal artery replaced by a Goretex graft. Twelve hours postoperatively the patient became anuric and two stents were placed endoradiologically because of a stenosis of the proximal anastomosis. Two years after surgery the patient is recurrence-free and her renal function is normal. CONCLUSION: Although extremely rare, the possibility of an ovarian metastasis should be considered in women with RCC. The presented case was unique because of synchronous bilateral RCC, an ovarian metastasis and a fibromuscular dysplasia of the renal artery requiring a sophisticated surgical approach.

Angelica sinensis (Oliv.) Diels: Influence of Value Chain on Quality Criteria and Marker Compounds Ferulic Acid and Z-Ligustilide.

Background:Dang gui (Apiaceae; Angelica sinensis radix) is among the most often used Chinese medicinal plants. However, hardly anything is known about its value chain and its influence on the main marker compounds of the drug. The aim of this study is to investigate the value chain of dang gui in Gansu and Yunnan, and the analysis of the marker compounds ferulic acid and Z-ligustilide concentration in relation to quality criteria such as the production area and size of the roots. Methods: During six months of field research in China, semi-structured interviews with various stakeholders of the value chain were undertaken and plant material was collected. High-performance thin layer chromatography (HPTLC) was used for semi-quantitative analysis of ferulic acid and Z-ligustilide. Results: Small-scale household cultivation prevails and in Gansu-in contrast to Yunnan-the cultivation of dang gui is often the main income source of farmers. Farmers and dealers use size and odor of the root as main quality criteria. For Chinese medicine doctors, Gansu as the production area is the main criterion. Higher amounts of ferulic acid in plant material from Yunnan compared to Gansu were found. Additionally, a negative relation of root length with both ferulic acid and Z-ligustilide as well as head diameter with ferulic acid were found. Conclusions: HPTLC is a valid method for semi-quantitative analysis of the marker compounds of dang gui. However, the two main marker compounds cannot explain why size and smell of the root or production area are seen as quality criteria. This hints at the inherent difficulty to correlate quality notions of medicinal plants with specific chemical compounds. With respect to this, more attention should be paid to quality in terms of cultivation and processing techniques.

Clinical Outcomes of Outpatient Cervical Total Disc Replacement Compared With Outpatient Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: A single-center, retrospective study. OBJECTIVE: The aim of this study was to determine the safety and outcomes of total disc replacement (TDR) as an outpatient procedure in the ambulatory surgery center (ASC). SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion (ACDF) has been demonstrated to be safe in the outpatient setting, as the awareness of same-day surgery procedures is on the rise due to better outcome and shorter recovery time. There is a need for motion preservation in a subset of patients TDR provides a solution. Transitioning spine surgery to the outpatient setting including cervical TDR is the next logical step. METHODS: The medical records of 55 consecutive patients undergoing single level TDR (Group 1) were compared with our control group of 55 patients who had single-level ACDF (Group 2). Outcomes assessed included Visual Analogue Scale (VAS) neck, arm, neck disability index (NDI) scores, and complication rate. RESULTS: Fifty-five patients in Group 1 (TDR, 60%) were male with the group's mean age being 42.6 ±â€Š1.4 years and body mass index (BMI) 24.8 ±â€Š1.2 kg/m. Fifty-five patients in Group 2 (ACDF), 57%, were male with the group's mean age being 53 ±â€Š1.0 years and mean BMI 27.9 ±â€Š0.8 kg/m. There was no statistically significant intergroup difference in 2-year VAS neck, arm and NDI scores. Dysphagia was the most common postoperative compliant in both groups (six patients), with no intergroup significance, P = 0.4. CONCLUSION: In the ambulatory setting, TDR has shown statistical significant intragroup improvement in VAS neck, arm pain scores, and NDI scores (P < 0.001). In this study, no patients reported serious complications, no incidence of hematoma formation, or worsening postop pain. We conclude that single-level TDR can be safely done in an ASC with satisfactory clinical and patient-reported outcomes. This is comparable to single-level ACDF in the outpatient setting and previous 2-year TDR studies. LEVEL OF EVIDENCE: 3.

In vivo measurements of subacromial impingement: substantial compression develops in abduction with large internal rotation.

BACKGROUND: Subacromial impingement is a widely recognized mechanism of chronic shoulder pain. The magnitudes of the compressive forces that impinge the subacromial structures were often measured from cadaveric specimens, but it is questionable to use this data as a sole basis to determine the shoulder motions and/or shoulder configurations that induce impingement in live subjects performing active motion. The purpose of the present study was to determine in vivo the magnitude of the compressive force at selected shoulder configurations. METHODS: The subacromial structures may be impinged by the downward-directed forces exerted by the coraco-acromial ligament. The reactions of these forces push the ligament upwards and deform it into a curved shape. A single resultant of these reaction forces was determined with an inverse approach to quantify the magnitude of the impingement force. An ultrasound unit was used to visualize the deformed shape of the coraco-acromial ligament for thirteen subjects with no symptomatic shoulder problem actively holding their shoulders in five configurations. FINDINGS: The impingement force in 90 degrees abduction+maximum internal rotation (mean=21.3N) and that in the Hawkins test position (mean=18.3N) were significantly greater than those in 90 degrees abduction+neutral and external rotation (means < or = 3N). INTERPRETATION: For young asymptomatic shoulders, the motions that induce impingement are not any arm abduction, but the arm abduction with a large internal rotation. Further study is indicated to examine the impingement force among various age groups.

Dietary magnesium deficiency decreases plasma melatonin in rats.

It has been postulated that Mg depletion is associated with decreased melatonin. Exogenous magnesium (Mg) has been found to increase the activity of serotonin N-acetyltransferase, an enzyme in the pathway for melatonin synthesis; but no data have been found on the effect of Mg deficiency on plasma melatonin. This pilot study examined the effect of a dietary Mg deficiency on plasma melatonin in male, Sprague-Dawley rats. Weanling rats were placed on a Mg-deficient (150 ppm) or a Mg-adequate (1000 ppm) diets for four weeks, after which they were sacrificed 4, 5 or 7 hours into the dark cycle. Plasma was assayed for melatonin concentrations. A significant decrease (p = 0.0101) occurred in mean (+/- SEM) plasma melatonin levels of the Mg-deficient animals (50 +/- 6.4 pg/mL) when compared to the Mg-adequate animals (75 +/- 6.6 pg/mL). There was no obvious phase shift in the melatonin profile of the Mg-deficient animals when compared to the Mg-adequate animals.

Influence of graded magnesium deficiencies on white blood cell counts and lymphocyte subpopulations in rats.

Increased white blood cell counts or leukocytosis have been observed primarily in young rats fed diets extremely low in Mg (< 60 ppm) and high in phosphorus (0.5 % P). We investigated the influence that acute and moderate Mg deficiencies have on blood leukocytes at high and low dietary phosphorus levels. For four weeks, male Sprague-Dawley rats (initially 7 weeks old) were fed diets containing 30, 60, 120, 208, or 850 ppm Mg and either 0.3 % or 0.5 % dietary phosphorus. Total leukocytes were increased in rats fed 30 ppm Mg (p < 0.0001), and the leukocyte subpopulation counts of lymphocytes, neutrophils, monocytes and eosinophils increased significantly only in the rats fed 30 ppm Mg (p < 0.0001). B-cells decreased significantly as a percentage of lymphocytes (p < 0.0093) as dietary Mg decreased. As total counts in blood, B-cells, CD4 and CD8 cells were significantly increased in the rats consuming the 30 ppm Mg diet. Dietary phosphorus only had an effect in combination with the lowest dietary Mg. These results demonstrate a threshold effect for increased leukocytes during a Mg deficiency of four weeks. A Mg deficiency of a longer duration may show different results.

Critical illness myopathy in a cervical spine-injured patient.

Neuromuscular weakness acquired in the intensive care unit (ICU) causes significant impairment in critically ill patients. The spectrum of critical illness neuromuscular disease includes critical illness myopathy, critical illness polyneuropathy or both, and occurs in approximately one-third of patients admitted to the ICU and those who are ventilated for at least 7 days. Recognized risk factors include sepsis, systemic inflammatory response syndrome, multi-organ failure, neuromuscular blocking agents and corticosteroids, however the absence of predisposing factors should not preclude critical illness neuromuscular disease. A 23-year-old male suffered a cervical spine injury and was admitted to the ICU. Two weeks post admission, he lost all power in his upper limbs, neck and face. Nerve conduction studies and needle electromyography were performed 4 weeks and 3 months after the injury, suggesting that myopathy was the likely cause of weakness. The definitive diagnosis of critical illness myopathy was based on muscle biopsy demonstrating myosin filament loss. Evaluation of new-onset weakness in ICU patients is essential to distinguish neurological causes from complications of critical illness. Signs and symptoms of critical illness neuromuscular disease must be identified early to encourage recovery, promote rehabilitation, and reduce morbidity and mortality.

Novel aminoalkyl tris-cyclometalated iridium complexes as cellular stains.

Herein we report the synthesis and investigation of the properties of two tris-cyclometalated luminescent iridium complexes. These complexes are the simple derivatives of fac-[Ir(ppy)3] bearing amino alkyl groups on one of the phenylpyridine rings. The complexes are highly emissive and exhibit structured emission peaks in aqueous solution while having only broad unstructured emission in organic solvents. The complexes have been shown to be taken up by NIH-3T3 and PC3 cells, where they localize in the lysosomes and remain emissive with lifetimes in the microsecond domain.

Hypertension as related to renal function in diabetes mellitus.

The relationships between blood pressure and renal function were investigated in 78 hypertensive patients with diabetes mellitus type I or II. Renal function was assessed by determining the glomerular filtration rate and the para-aminohippurate clearance in 32 and serum creatinine in 46 subjects. In the latter, the reciprocal serum creatinine, corrected for age and changing creatinine/insulin clearance ratio, was used as an estimate of glomerular filtration rate. In the 54 patients with serial determinations, the duration of follow-up averaged 10.5 years. In older patients with type II diabetes without clinical proteinuria, hypertension developed either before or after the onset of diabetes. When it appeared, renal function was only slightly reduced. During follow-up, the decline in reciprocal serum creatinine averaged 2.7% per year, a figure very similar to that found in nondiabetic patients with benign essential hypertension. It did not correlate with the blood pressure. In patients with a proteinuria greater than 2.5 g per day and histologic and/or clinical evidence of diabetic glomerulosclerosis, the severity of hypertension correlated inversely with the level of renal function. The rate of decline in function averaged 11% per year but varied widely. It was not significantly related to the blood pressure. These data suggest that different types of hypertension (essential, diabetic, and nephrogenic) may be associated with diabetes mellitus. The rate of decline in renal function is closely related to the presence or absence of clinical proteinuria but not to the level of blood pressure.

Topical tacrolimus treatment of atopic eyelid disease.

PURPOSE: To describe the effects of topical tacrolimus treatment of severe atopic eyelid disease. DESIGN: Interventional consecutive case series. METHODS: A description of clinical findings and therapeutic response for five consecutive adult patients (mean age, 56.2 years; range 44-62) treated with topical tacrolimus for severe atopic eyelid disease at one institution. RESULTS: Five patients with bilateral atopic eyelid disease that was refractory to treatment with topical corticosteroids were treated with tacrolimus 0.03% ointment, applied to the affected eyelid skin of both eyes twice daily. Eyelid induration, erythema, and eczematous changes were substantially improved within 1 to 3 weeks after initiation of topical tacrolimus treatment in all patients. There was an associated decrease in ocular surface irritation and inflammatory signs in each of four patients who also had atopic keratoconjunctivitis. No adverse effect associated with tacrolimus treatment was noted during continued treatment for 5 to 14 months. All patients were able to discontinue longstanding use of topical corticosteroid drugs. CONCLUSIONS: Application of topical tacrolimus on eyelid skin may be effective for treatment of severe atopic dermatitis of the eyelids, and may have secondary benefits for atopic keratoconjunctivitis. Topical tacrolimus may be used for at least 1 year without apparent adverse reaction in some patients, although the rate of adverse reaction cannot be determined from this small series.

Transthyretin and transferrin in hemangioblastoma stromal cells.

Hemangioblastoma, a rare benign tumor of the CNS, consists of two main components: capillaries and stromal cells. Despite many efforts, the histogenesis of stromal cells is still unknown. We took a new approach to clarify the origin of stromal cells using immunohistochemical methods. Paraffin-embedded tissue of 24 surgically removed hemangioblastomas of the CNS was examined with antibodies against transthyretin, transferrin, vimentin, NSE, protein S-100, CK 8, KL-1, EMA, CD34, factor VIII rAg, and collagen IV. Stromal cells showed a positive reaction with anti-transthyretin in 12 of 24 hemangioblastomas, a positive reaction with anti-transferrrin, to a different extent, in 13 of 24 cases, and many stromal cells expressed basal membrane collagen IV on the cell surface in 19 of 24 cases. The expression of transthyretin and transferrin in stromal cells of hemangioblastomas is reported for the first time, thus providing an antigenic profile of hemangioblastoma stromal cells that is very similar to that of immature choroid plexus epithelium. These findings support the notion that hemangioblastoma stromal cells may originate from the embryonal plexus epithelium. We discuss our results with special regard to stromal cell histogenesis, including a review of the literature.

Quantitative investigation of nuclear morphology in glioblastomas and its relation to survival time.

OBJECTIVE: To investigate the influence of nuclear morphology of tumor cells on survival time of patients with primary glioblastomas. STUDY DESIGN: Tumor cell nuclei have been measured in paraffin sections from 51 glioblastomas (Ki-67 immunostaining). In each tumor, the region with the highest proliferative activity has been selected for performing the morphometric analysis. Nuclear area, shape variables (roundness factor, Fourier amplitudes) and the proliferation index Ki-67 have been determined. Statistical relationships between these variables have been tested by principal component analysis and Spearman's correlation analysis. The survival time has been tested using Kaplan-Meier analysis. The influence of morphometric variables on survival time and on the time until recurrence has been tested by Cox analysis. RESULTS: There is a significant correlation of mean value and standard deviation of nuclear area with shape variables. Cox analysis showed a significant influence of the quantitative morphologic variables on survival time for patients with and without complete surgical resection. For patients with complete surgical resection, there was a distinct influence of mean nuclear area on survival time. Patients with incomplete surgical resection of the tumors had a significantly shorter survival. No significant influence of the variables on the time from surgery to recurrence could be shown. CONCLUSION: Quantitative morphology of tumor cell nuclei in our set of glioblastoma cases showed a statistically significant relation with the survival time of the patients, indicating the biological significance of nuclear morphology in glioblastomas.

Giant cell arteritis in a 19-year-old woman associated with vertebral artery aneurysm and subarachnoid hemorrhage.

Giant cell arteritis (GCA) is a disease chiefly found in elderly patients. Intracranial vessels are rarely involved in GCA. Here we report the case of a 19-year-old woman with GCA in the basilar and vertebral arteries. Two weeks after the first symptoms, she developed an aneurysmatical dilatation of the right vertebral artery which ruptured leading to subarachnoid hemorrhage. Although the ruptured right vertebral artery was clipped neurosurgically, she died two days later. Autopsy revealed GCA with focal medial necrosis and intimal thickening of the vertebral arteries and the basilar artery. No other arteries were affected. In the involved vessels, the media exhibited C1q immunoreactivity. At the intimal site of the internal elastic lamina there were increased levels of elastase. Other arterial diseases showing the pattern of GCA were excluded. This case demonstrates that GCA is not necessarily restricted to elderly people. Moreover, this case shows that a GCA-induced aneurysm is a very rare reason for subarachnoid hemorrhage even in young adults.