Nonfulminant herpes simplex encephalitis as a cause for mesial temporal sclerosis.

Although mesial temporal sclerosis has been recognized for more than 100 years, its etiology remains unknown. It is proposed that a common infectious agent, herpes simplex virus type-1, may cause this disorder by means of a nonfulminant infection of mesial temporal lobe structures, which is resolved by the immune system and becomes gliotic in the course of healing by the central nervous system. Brain sections from a long-term experiment in a model of herpes simplex encephalitis reveal such a scar, which shows a high concentration of glial fibrillary acidic protein, without any evidence of residual herpes antigen, by immunocytochemistry.

Small central cervical disc syndrome: evaluation and treatment of chronic disabling neck pain.

In this retrospective study of 22 patients with severe disabling neck, interscapular, and shoulder pain we evaluated the effectiveness of magnetic resonance imaging (MRI) for the diagnosis of small central cervical disc ruptures, and anterior cervical discectomy for the treatment of this condition. Conservative therapy had failed for all patients. All had been disabled for their normal activities for at least 6 months. MRI demonstrated two patterns of mid- or parasagittal disc disease. Anterior cervical discectomy produced nine excellent, six good, five fair, and two poor results. All but one patient returned to his/her former occupation. MRI is essential in the evaluation of patients with chronic neck pain who have failed conservative therapy and present with axial rather than appendicular complaints. Anterior cervical discectomy can be useful in well-selected patients with this syndrome.

Osteoplastic pterional craniotomy.

We describe a new method for small frontotemporal craniotomies. Adequate exposure is obtained. Sparing of the trunk of the frontotemporal branch of the facial nerve as it passes near the eyebrow preserves forehead mimetic function, and maintenance of the blood supply to the bone flap helps to prevent resorption.

Black and white photography of horseradish peroxidase-stained histological slides.

Utilizing a new film and paper system, produced by the Eastman Kodak Company, and a simple enlarger, histologic slides stained by horseradish peroxidase techniques can be reproduced in black and white photographs, without loss of detail and with good contrast.

Correlation of tumor plasminogen activator with peritumoral cerebral edema. A CT and biochemical study.

Extracts from 15 human cerebral tumors were tested by a fibrin-plate plasminogen-dependent assay for levels of tumor plasminogen activator (TPA) activity. The TPA activity was correlated with the amount of perineoplastic edema as quantified on computerized tomography (CT) brain scanning. Analysis of the results showed a correlation coefficient of 0.72 when all tumors were included. Analysis of the nine tumors with the highest TPA levels showed a correlation coefficient of 0.96. One metastatic tumor had the highest level of TPA activity, equivalent to a pure 100-micrograms/ml solution of urokinase, and the greatest amount of cerebral edema on CT. Meningiomas generally had the next highest levels of TPA activity and edema, followed by astrocytomas of varying grades, which generally had the lowest level of TPA activity. However, three astrocytomas that had low TPA activity also had significant edema surrounding the tumor, indicating that more than one mechanism may be producing peritumoral edema. There was no correlation between tumor size and the amount of perineoplastic edema. These preliminary results suggest that TPA's may be involved in the production of perineoplastic cerebral edema and that treatment of patients with currently available plasminogen activator inhibitors may be successful in reducing peritumoral edema.

Accumulation of vancomycin after intraventricular infusions.

A 50-year-old man with an infected intracerebral hematoma was treated with daily intraventricular infusions containing 10 mg of vancomycin (half the dose suggested by others). A vancomycin level in the ventricular CSF of 606 micrograms/ml after nine days of therapy indicates a potential for accumulation of this drug in patients with extensive brain damage.

Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula.

As demonstrated by selective spinal cord arteriography, over 80% of spinal cord arteriovenous malformations (AVM's) occupy a predominantly extramedullary position. Current therapy frequently requires surgical stripping of the long dorsal intradural vessel(s) from the underlying spinal cord over many cord segments. The authors report six patients with a dural arteriovenous fistula fed by a cluster of abnormal epidural arteries. These vessels, which surrounded and were embedded into the dural covering of a thoracic nerve root, drained into a long sinuous intrathecal paramedullary vein(s). The angiographic and surgical appearance of the intradural component of these lesions was identical to that of lesions previously classified as Type I AVM's of the spinal cord. All patients had symptoms and signs of myelopathy. In five patients, surgery was limited to coagulation and excision of the extradural vessels and division of the intradural arterialized vein. Progressive improvement began within days following surgery. No residual abnormality was demonstrated by postoperative selective spinal cord arteriography, which was performed in all five patients. The findings support those of Kendall and Logue, that surgery restricted to elimination of the arteriovenous fistula at the intervertebral foramen is curative, and that more extensive surgery is unnecessary for this subgroup of AVM's of the spinal cord. These lesions comprise a sizable percent of all spinal AVM's. Resolution of myelopathy in these patients supports the hypothesis that venous hypertension causes chronic progressive myelopathy.

Calcified chronic spinal subdural hematoma demonstrated by computed tomography.

Spinal subdural hematoma is a rare clinical condition that may result in spinal cord compression. The authors present a patient with chronic calcified spinal subdural hematoma demonstrated by computerized tomography. Surgical removal resulted in clinical improvement.

Immunological, biochemical, ultrastructural, and electrophysiological characteristics of a human glioblastoma-derived cell culture line.

This report presents the results of a study using multiple techniques of the established human cell line, LM, which has been developed in culture medium from a patient with a right temporoparietal glioblastoma. This cell line has human subtetraploid karyotype and has several features of a transformed line in culture. These include continuous propagation for 10 years, ability to form tumor nodules when transplanted into immunologically suppressed hamsters, and pleomorphic appearance. Ultrastructurally, it is characterized by multiple nuclei, few actin cables, and numerous surface-membrane microvilli, as well as abundant 9- to 10-nm cytoplasmic filaments. By its immunological reactivity, the line can be shown to contain glial fibrillary acidic protein at low levels, consistent with its glial origin and continued nature. Dibutyryl cyclic adenosine monophosphate (db-cAMP) induces formation of long astrocytic-like processes as well. Its membrane electrical characteristics include a low resting membrane potential and short time constant. Used in a microtiter antiglioma antibody cytotoxicity assay, LM yields a positive reaction to antibodies in the sera of 80% of patients with astrocytomas and only 9% of normal blood-bank donors, suggesting that it shares common antigens with other astrocytic tumor lines. The varied characteristics of this glioblastoma-derived line emphasize the "multiforme" nature on the neoplasm and suggest that for characterization of any such line, multiple parameters are necessary to allow comparison with other long-term glioblastoma lines in the literature. The usefulness of the LM line in in vitro cell biological, immunological, chemotherapeutic, and radiobiological studies of gliomas makes such efforts very worthwhile.

Pott's disease following BCG therapy of melanoma.

The first reported case of a patient with BCG-induced Pott's disease following immunotherapy for melanoma is presented. No signs or symptoms of the disease were detected for 2 1/2 years after therapy. The diagnosis and treatment of this complication of melanoma therapy are discussed.

Complement fixation by IgM and IgG autoantibodies on cultured human glial cells.

The humoral immune response to autologous gliomas has been investigated in 16 patients using immune adherence and anti-C3 immunofluorescence assays of serum samples. Significant antiglioma antibody activity was detected in 56% of these sera. Fractionation experiments demonstrated that IgM class antibodies were more effective that IgG in their ability to fix complement on cultured glioma cell membranes. In addition, autologous IgG was shown to inhibit IgM complement-fixing activity in some experiments. "Capping" of immune complexes on the glioma cell surface is also described.

Cysticercus of 60-milliliter volume in human brain.

A cerebral cyst 5 cm in diameter and 60 ml in volume was found to be as large as a racemose cysticercus. Because this cyst bore necrotic remnants of a scolex and its hooks, it was presumed to be a cysticercus of Taenia solium. This case demonstrates that in contrast with the unusual presentation of cerebral cysticercosis, cysts of the Taenia solium type can be very large, and when such cyst is encountered, a special search should be made for evidence of a scolex.

Autologous humoral response to human gliomas and analysis of certain cell surface antigens: in vitro study with the use of microcytotoxicity and immune adherence assays.

In 25 patients with intracranial gliomas, the autologous humoral response was studied in vitro with the use of microcytotoxicity (MC) and immune adherence (IA) assays. Antibodies were detected to autologous cultures in 44% of the cases by MC and in 50% by IA. These positive responses occurred in statistically different groups of patients, which suggested that different functional types of antibody were involved. Direct testing and absorption experiments showed that antibody was not significantly directed against autologous fibroblasts. Autologous cytotoxic antibodies were detected by 67% of astrocytoma cases and in only 10% of patients harboring a glioblastoma, the most anaplastic tumor of the glioma series. By means of the IA assay, absorption experiments were performed with the use of adult and fetal brains and cultures of autologous and allogeneic gliomas and fibroblasts. In this serologic system, the types of antigenic expression of a human glioma could be categorized as follows: 1) highly restricted glioma antigen(s), 2) common glioma antigen(s), 3) neurectoderm-derived antigen(s), and 4) brain and fibroblast-associated oncofetal antigen(s). The common glioma antigen and oncofetal antigen appeared to be qualitatively different, and the glioma antigen was expressed in uncultured tumor tissue.

Growth-inhibitory effect of diphenylhydantoin on murine astrocytomas.

In previous work reported from this laboratory we found that diphenylhydantoin (DPH) inhibited the growth of 7 of 10 tissue-cultured human astrocytoma cell lines in a microtiter system. In this report we describe significant growth inhibition by DPH of two murine astrocytoma tissue cultures and correlate these in vitro findings with the in vivo activity of DPH in rat subcutaneous and intracranial tumor models. In the in vivo studies, rats were inoculated either subcutaneously or intracranially with RT9 or C6 rat gliomas. DPH or placebo was injected intraperitoneally in doses ranging from 50 to 150 mg/kg daily for 15 days. The DPH-treated rats showed significantly slower rates of tumor growth than untreated rats (p less than 0.01) in both the subcutaneous and intracranial models. At sacrifice, the tumor volume of the rats with subcutaneous tumors treated with DPH (100 mg/kg daily) was 62% less than the tumor volume of the control rats. Also, the number of "clonogenic" cells and thus, indirectly, the number of actively dividing tumor cells was 54% less in the intracranial tumors of the DPH-treated rats. These findings indicate that DPH may be a potentially useful adjunctive agent in the clinical chemotherapy of astrocytic tumors. Furthermore, the data presented indicate that in vitro test results are predictive for in vivo effects, supporting the idea that tissue culture can be used to screen for the effectiveness of clinically used chemotherapeutic agents.

Cytotoxic antibody responses in astrocytoma patients. An improved allogeneic assay.

Early diagnosis of brain tumors may be facilitated by a microcytotoxicity assay which the authors have used to detect a humoral immune response against an allogeneic glioblastoma cell line. Sixty-seven of 82 serum samples (82%) from astrocytoma patients elicited significant cytotoxicity, while only six of 65 samples (9%) from normal blood-bank donors demonstrated a similar response. Positive results were more frequently obtained in lower-grade astrocytomas. Meningiomas, acoustic schwannomas, pituitary adenomas, and metastatic tumors were positive in variable numbers of cases. A small series of serum samples were platelet-absorbed to insure that cytotoxicity was not merely due to histocompatibility antigens, and seven of eight samples, when retested on the target cell line, remained significantly positive. The assays were performed under strictly monitored conditions that afforded optimum reliability and minimal experimental variability. As the specificity of this test increases, it may lead to early detection of astrocytomas.

Detection of humoral immune response to human brain tumors: specificity and reliability of microcytotoxicity assay.

A humoral microcytotoxicity assay has been used to study the immune response to human malignant astrocytic tumors. Two series are described. When the assay was performed under uniform, ideal conditions, the sera from 36 of 45 patients with these tumors (80%) produced significant cytotoxicity against allogeneic astrocytoma cells. Only 4 of 55 (7%) normal sera tested demonstrated cytotoxicity. The second series describes a five year study of over 400 sera with several sera assayed each week. The assay was found to vary in specificity and reliability over this five year period. The reasons for this variability are discussed and methods of standardizing the technique are proposed. Recent information concerning the mechanisms of the humoral microcytotoxicity assay offer promise of improved reliability and clinical utility.