4-Hydroxynonenal as a second messenger of free radicals and growth modifying factor.

Immunohistochemical analysis of the distribution of the lipid peroxidation product 4-hydroxynonenal (HNE) in the brain of baboons exposed to experimental hemorrhagic traumatic shock or sepsis showed that systemic oxidative stress and the thereby generated HNE affect the blood:brain barrier and the regulation of cerebral blood flow determining secondary brain damage. Similarly, HNE was determined during ischemia in the brain blood vessels of rats exposed to ischemia/reperfusion injury of the brain. After reperfusion, HNE disappeared from the blood vessels but remained in neurones and in glial cells. Since HNE modulates cell proliferation and differentiation (including proto-oncogene expression), it is postulated that HNE might have prominent local and systemic effects that are not only harmful but beneficial, too, determining the outcome of various pathophysiological conditions based on oxidative stress.

[Modern diagnosis and treatment of pheochromocytoma in children]. / Suvremena dijagnoza i lijecenje feokromocitoma djece.

Pheochromocytoma is a rare tumor of chromaffin tissue of the adrenal gland that synthesizes, stores and releases cathecolamines. In 10% of the patients it arises outside the adrenal gland, and has been called paraganglioma. The following study describes our experience in the diagnostic process and treatment of pheochromocytoma in two children, a 8-year-old boy with the right ureteral paraganglioma, and a 8-year-old girl with pheo-chromocytoma of the leftsuprarenal gland. Characteristic clinical features with predominant signs of hypertension, as well as the diagnostic flow diagram, have been presented. We have analysed recent diagnostic possibilities, sensitivity of diagnostic methods (ultrasonography, CT, selective angiography and J131 MIBG scintigraphy), indications for their use, and the importance of appropriate preoperative management. The major role of the J131-metaiodobenzilguanidine scintigraphy in diagnostic assessment, especially in precise preoperative localization and postoperative verification of tumour removal, has been stressed.

p53 immunoreactivity in oligodendrogliomas.

Data are presented on p53 protein presence in human oligodendrogliomas whose progress from low grade to anaplastic oligodendroglioma can be followed. Expression was evaluated by formalin-fixed paraffin-embedded section immunohistochemistry, using monoclonal PAb 1801 antibody. The frequency of p53 protein accumulation is related to the stage of tumor malignancy. All the samples (100%) of malignant oligodendrogliomas were positive for p53 protein. Of 14 type II oligodendroglioma samples, 9 were positive (64%) while among type I oligodendroglioma the positivity was 28%. The mean proportion of reactive cells was also higher in malignant oligodendrogliomas. However, mean intensity staining did not differ among various grades of tumors. Our results point to the direct link between p53 protein accumulation and the malignant stage of human oligodendrogliomas. However, the value of p53 protein accumulation in predicting malignant behavior of oligodendrogliomas requires further confirmation.

Nm23-h1 protein in oligodendrogliomas.

We examined nm23-H1 protein levels in human oligodendrogliomas by immunohistochemistry. This class of brain tumor does not form spontaneous metastases, but its progression from benign (oligodendroglioma) toward malignant phenotype (oligodendroglioma transitionale and glioblastoma oligodendrogliale) can be followed. Two types of tumors, ODG-II and ODG-T, were highly positive for nm23 protein. However, there was no clear correlation between the extent of protein expression and tumor aggressiveness. No nm23 protein was detected in nonproliferative normal brain tissues and was found in only a few ODG-I specimens. As cell proliferation becomes more pronounced (OGD-II, ODG-T), nm23 protein becomes detectable in almost all samples. However, of the glioblastoma oligodendrogliale samples examined, 76% were negative for nm23-H1 protein. suggesting a change in nm23-H1 gene expression with increasing neoplastic progression. Our findings are in contrast to a proposed role of nm23-H1 protein as a tumor metastasis suppressor and support that it cannot serve as a reliable prognostic tumor indicator in all cases. However, our findings may contribute to a better understanding of glial tumor development and improve the accuracy of tumor diagnosis.

Mitochondrial cardiomyopathy and scapuloperoneal spinal muscular atrophy in a child.

A 14-year old boy was admitted for signs of heart failure and scapuloperoneal muscle weakness. He fulfilled the clinical, functional and diagnostic criteria for dilated cardiomyopathy. There was also a moderate increase in pulmonary vascular resistance. The immunohistochemical examination of the heart muscle revealed a slightly positive phytohemagglutinin reaction and minimal IgM deposits without complement. The electron microscopy examination disclosed increased numbers of abnormal mitochondria disrupting the usual cell structure; the mitochondria were of various sizes with irregular and abnormal structure of the cristae. The scapuloperoneal spinal muscular atrophy was mild and diagnosed according to clinical and electromyographic findings. Light microscope examination of the skeletal muscle revealed hypotrophic fibers. This patient is presumed to have postinflammatory mitochondriopathy and is currently being managed on low-dose digitalis, diuretics and captopril.

CT detection of minimal brain lesions in closed cerebral trauma.

From the group of patients with clinically manifested closed head injuries, patients with minimal traumatic lesions in the brain parenchyma, were separated and in addition radiographically analyzed. There were 22 patients in the group. On plain CT scans they had foci 5 to 10 mm large caused by trauma. CT is suitable investigation technique for detecting minimal traumatic brain lesions. Besides, CT is suitable for the follow up of the lesion evolution dynamics, which comprises not only changes in the lesions density but also the possibility of registering primarily reversible but macroscopically (invisible) lesions into (visible) reversible lesions on the control scans. The finding of only one or two minimal lesions in critical locations in the "inner cerebral trauma" always indicated the existence of possible lesions in other locations within the known pattern of the ICT. Minimal traumatic lesions of the brain frequently occur in ICT or in all cases where the acceleration of traumatizing forces has anteroposterior or postero-anterior course of direction. Their recognition by neuroimaging methods is of great importance due to the central localization of the foci, which otherwise cannot be detected by other methods.

Dumbbell meningioma of the cervico-clavicular region.

The authors are reporting on a case of a 55-year-old man with an epidural meningioma in the region from the C VII. to the Th I. segment. The tumor encircled this region, and to the front and right involved the channels through which pass the C VI, C VII. and C VIII. roots. Subdurally, no tumoral mass was found. Another part of this tumor, of the same histological architecture as the epidural cervicospinal part was found in the supraclavicular region to the right, closely connected to the arteries and nerves of this region. The authors discuss the possibility of the tumoral occurrence at this site, primarily taking into account the origin of this tumor from the cells of the outer surface of the arachnoidea, i.e. cap cells which can invade the dura, with later separation from the main arachnoidal layer. The other possibility of such dumbbell meningioma occurring at the outgoing openings of the neural paths from the spinal channel should be looked for in the remnants of the arachnoidal cells in the region of the outgoing openings. In the paper are also discussed and correlated clinico-pathological, CT and angiographic findings.

Medullomyoblastoma.

A case of medullomyoblastoma, arising in the cerebellar vermis of a five-year-old boy, is presented. The light and electron microscopic features of the tumor are described and compared to other published cases. Within typical medulloblastoma areas light microscopy revealed signs of neuroblastic differentiation thus indicating its neuroepithelial origin. No signs of glial differentiation were found. Myogenic tumor component formed irregular, distinctly separated islands although some intermingling of two cell types was observed at the borders between the two zones. Within the myogenic tumor component, electron microscopy revealed rhabdomyoblastic elements in different stages of differentiation, frequently forming small groups encompassed by the same basement membrane. No indication of a common host cell for two cell lines was observed. No mesenchymal elements other than muscle, and no indication of possible teratoid origin of this tumor were observed. Considering histogenesis of muscle elements within this neuroepithelial tumor, the origin from multipotential neural-crest-derived ectomesenchymal cells seems the most appropriate one.

[Neurocutaneous melanosis and melanoma of the brain]. / Neurokutana melanoza i melanomi mozga.

A case of neuro-cutaneous melanoma, in the course of which a bifocal melanoma of the cerebral hemisphere had developed, was used as a natural model for the study of the relation between tumorous and non-tumorous elements. The need is pointed out for the definition of such a cutaneous-meningeal syndrome before the development of a neoplasm. As tumours develop from the cells defining leptomeningeal melanosis, the possibility of a neuroradiological diagnosis of this process is accentuated, primarily by a minute examination of the sites characteristic of the disease. A premorbid detection of all such cases is imperative in order to introduce an early anti-tumour treatment.

[Subacute encephalitis caused by herpes simplex virus]. / Subakutni tok encefalitisa uzrokovanog virusom herpes simpleks.

The authors present a case of herpes-simplex encephalitis in a 58-year-old woman. The disease had a biphasic course and lasted 87 days. The clinical picture, laboratory data and the pathologic-anatomical changes of the disease are discussed. The authors also emphasize the importance of the encephalitic process in the brain stem, which can make the clinical picture even more complicated because of the appearance of respiratory disturbances.

[Primary brain sarcomas]. / Primarni sarkomi mozga.

The authors report on 79 cases of primary brain sarcomas, correlating clinical and pathoanatomical data. In the material analyzed the group of gliosarcomas prevailed, while the smallest group were rhabdomyosarcomas. In some groups the topic predilection did not show any specific characteristics, except that there were more gliosarcomas occurring in the parietal lobe. The symptoms lasted 1-3 months before operation.