Laparoscopically guided peritoneal insertion in ventriculoperitoneal shunts.

A technique of laparoscopically guided insertion of the peritoneal end of ventriculoperitoneal shunts is described. Eleven consecutive cases were done in this manner. There were no failures in inserting the peritoneal end of the ventriculoperitoneal shunt catheter. By way of comparison, 11 previous cases were reviewed. These were done through standard open methods. There were two failures in the open technique group. One of the failures was the result of insertion of the peritoneal end into the subcutaneous layer in an extremely obese patient. It is our belief that this technique deserves consideration when a ventriculoperitoneal shunt is contemplated in adults.

Further observations on spinal meningeal nerves and their role in pain production.

Fifty-one cases of patients with back problems plus radiculopathy following the standard laminotomy or laminectomy for disc or spur excision were subjected to spinal meningeal denervation procedures. The results have been satisfactory. An autopsy finding on a patient with two previous disc surgeries was reported. There was considerable anatomical disruption of the meningeal nerves with myxoid intrafascicular changes similar to a Morton's neuroma (perineural fibromatosis), but with intact intradural spinal nerves, indicating that the damage to meningeal nerves may have been the cause of her pain.

Characterization of tumor-specific DNA sequences: molecular grading of the astrocytomas.

Tumor-specific DNA sequences or unique sequences have been found in a number of human cancer cells including gliomas but not in equivalent normal cells. In a continuing effort to further elucidate the nature of these sequences, thermal analysis using the hydroxyapatite technique was carried out on the various grades of astrocytomas. A recycled DNA molecular probe from Grade IV astrocytomas was annealed to the various grades of astrocytoma DNAs and to normal brain DNA which served as control. There was an increasing percentage of hybridization in direct proportion to the degree of malignancy. The same results were obtained using a recycled DNA probe from medulloblastomas. Thermal melt analysis of these same tumors revealed a Tm (melting temperature or temperature of reassociation) of about 83 degrees C, irrespective of degree or grade of malignancy. These results would indicate that the type of genetic DNA sequences or tumor-specific DNA sequences involved in this type of tumor is the same, whether the tumor is benign or malignant. The demonstration of the increasing percentage of hybridization based on the increasing degree or grade of malignancy and the further demonstration that the involved tumor-specific DNA sequences are the same irrespective of the degree of malignancy, justify the conclusion that the number of copies of these sequences determines the degree or grade of malignancy. Pending further laboratory confirmation, this fact may be assumed to be true with respect to cancers from other organ sites.

Molecular evidence of viral-like biochemical activities in human genitourinary malignancies.

We have demonstrated previously that core structures of urine samples from patients with genitourinary malignancies contain ribonucleic acid-directed deoxyribonucleic acid polymerase and a high molecular weight ribonucleic acid. If these particles originated from the existing genitourinary malignancies then the malignancies should contain similar characteristics. We examined 13 prostatic carcinomas, 4 bladder carcinomas, 1 urethral carcinoma and 1 hypernephroma. Positive reactions were noted in 10 of the 13 prostatic carcinomas (77 per cent), all 4 bladder carcinomas, the 1 urethral carcinoma and the hypernephroma with the simultaneous detection assay. The control samples consisted of 7 tissues of benign prostatic hypertrophy, and tissue from 2 normal bladders and 1 normal kidney. None of these tissues showed a positive response. Tritium labeled deoxyribonucleic acid probes synthesized from the malignant tissues hybridized to the polysomal ribonucleic acids but not to the corresponding normal tissues. Particles derived from the probes have a density of 1,1620 in sucrose gradient. No sequence homology could be demonstrated with various known oncogenic ribonucleic acid viruses nor with malignancies arising from other organs.

Impacted "roof disc" as a cause of failure of lumbar disc surgery.

A clinical entity called roof disc is described. It is a centrally located disc extruction found posterior to the posterior borders of the vertebrae that is enclosed by the intact posterior longitudinal ligament; the roof disc exerts pressure against the dorsally lying thecal sac and its enclosed cauda equina roots, causing symptoms and signs incident to this pressure. The contention is made that, unless this roof disc is removed, the patient will continue to have symptoms. Three varieties are described and examples are presented. Its concealed location makes the conventional surgical approaches ineffective, including foraminotomy and laminotomy or laminectomy with standard discectomy.

Sequential CT scan as a parameter in the management of CNS lesions.

The value of sequential CT scans as a management determinant in various types of CNS lesions is described. Case reports are cited in support of such a contention. The prediction is that in the not too distant future, intraoperative CT scans will be as commonly done as the plain radiographs currently employed.

Tumor-specific DNA sequences in human gliomas.

Utilizing the technique of hydroxyapatite chromatography, normal cellular DNAs were used to recycle off the repeat or normal sequences found in [3H]DNA copied off 70S RNA from malignant astrocytomas. The recycled [3H]DNA were then used to hybridize against DNAs from normal human brain tissues and DNAs from malignant astrocytomas or Grade IV astrocytomas. The results indicated the presence of tumor-specific DNA sequences in malignant astrocytomas, absent in normal brain tissues. The percentages were 88% and 7%, respectively. When recycled medulloblastoma 70S[3H]DNA probes were utilized against DNA'S FROM Grade IV astrocytomas and from normal brain, similar results were obtained. The respective percentages of hybridization were 67% and 7%. Thus it would appear that malignant gliomas contain tumor-specific DNA sequences which are not found in normal brain tissues.

Detection of viral-like cores from the urine of patients with genito-urinary malignancies.

Simultaneous detection assays on the core structures derived from the cerebrospinal fluid samples of patients with various types of central nervous system tumors have demonstrated the feasibility of this technique in detecting some of the diagnostic features of RNA tumor viruses. Similar assays done on urine samples from patients iwth various types of tumors in their genitourinary tracts have shown that of the 18 such samples from tumor patients, 15 or 83% were found to be positive. The control samples consisted of three from patients with benign prostatic hypertrophy and four from normal persons. None of these gave a positive reaction. [3H]DNA probes synthesized from the core structures from them hybridized readily to their corresponding polysomal RNAs but no to control tissues. The densities of particles from these samples have been found to be 1.168 g/ml for bladder carcinoma and 1.165 for prostatic carcinoma, the same densities as those found RNA tumor viruses.

Embryogeneic cell type, organ site sequence specificity in human cancers.

An extensive series of cross-hybridization studies were carried out with the DNA-RNA molecular hybridization technique. Molecular 70 S [3H]DNA probes synthesized from human central nervous system, gastrointestinal, pulmonary, and prostatic carcinomas were hybridized to cytoplasmic RNA's isolated from cancers of virtually all organ sites of the human body. Results indicated sequence homology between cancers of the same organ or cell type but not with cancers of different cell types. Thus cell types based on embryological origins determine the organ site specificity of the involved sequences. The designation of 70 S [3H]DNA denotes those [3H]DNA's that were copied off the template 70 S RNA, as distinguished from total [3H]DNA product, which includes all DNA's synthesized. It does not necessarily follow nor is it to be inferred that the 70 S [3H] DNA thus designated contains the full complement of the sequences found in the 70 S RNA template.

Biochemical evidence for viral-like characteristics in cerebrospinal fluids of brain tumor patients.

Previous work done in this laboratory has shown that human Central Nervous System tumors possess attributes in common with those found in RNA tumor viruses. Because of the intimate physical relationship between the circulating cerebro-spinal fluid and the Central Nervous System, particles derived from tumors in this system may very well be shedded into the surrounding fluid system thus displaying similar biochemical attributes. Twenty samples of cerebro-spinal fluids were examined. Fifteen were from patients with various types of tumors in various location of the Central Nervous System. Five were from patients with unrelated diseases. Eleven or 74% of those from tumor patients were found to be positive when simultaneous detection assays were done on their core structures. None of the control was positive. The [3H]DNA synthesized from core structures hybridized readily to polysomal RNAs from a solid tumor. Particles from them were found to have a density of 1.867 g/ml sucrose gradient.

Biochemical evidences for ribonucleic acid viral-like characteristics in malignant diseases of gastrointestinal tract and lung in humans.

It has been demonstrated that malignant diseases of the gastrointestinal tract and lung in humans possess three characteristics invariably found in ribonucleic acid tumor viruses: the presence of a ribonucleic acid directed deoxyribonucleic acid polymerase, reverse transcriptase; a high molecular weight ribonucleic acid with a sedimentation coefficient of 70 Svedberg units, and particulate elements with densities of 1.16 to 1.18 grams per milliliter sucrose gradient. Twelve of 17 carcinomas of the colon, three of five carcinomas of the stomach, all three carcinomas of the rectum and seven of ten carcinomas of the lung displayed detectable evidence of these viral-like entities. None of the corresponding normal tissues had positive reactions.

Molecular evidence for a viral etiology of human CNS tumors.

The newer methods of molecular virology, including molecular hybridization and the "simultaneous detection test," were used to examine human brain tumors for evidence of RNA tumor viruses. It was found that they contained 70S RNA and RNA-directed DNA polymerase, both encapsulated in a particle possessing a density of 1.17 g/ml. These particles therefore satisfy the three diagnostic features that characterize the animal RNA tumor viruses. Of 26 of the most malignant (glioblastoma and medullo blastoma) brain tumors examined, 24 (92%) contained these virus-like entities. The possible usefulness of these particles as aids in diagnosis and monitoring therapy is briefly discussed.

Evidence of particle-associated RNA-directed DNA polymerase and high molecular weight RNA in human gastrointestinal and lung malignancies.

Previous communications have demonstrated that neoplastic cells of human breast cancers, leukemias, lymphomas, sarcomas, and brain tumors contain particles with similar diagnostic attributes as those found in RNA oncornaviruses. The present paper concerns malignancies of the gastrointestinal and pulmonary systems for which, like brain tumors, no suitable animal model or corresponding virus exists. By means of the simultaneous detection assay, these tumors have been found to contain 70S RNA and RNA-directed DNA polymerase encapsulated in particulate components possessing densities of 1.16-1.17 g/ml. Twelve out of 17 (70%) colon carcinomas, three out of five (60%) gastric carcinomas, all of three rectal carcinomas, and seven out of ten (70%) lung carcinomas contained detectable levels of these virus-like entities. None of the corresponding normal tissues was positive.

Particles with RNA of high molecular weight and RNA-directed DNA polymerase in human brain tumors.

We have previously shown that neoplastic cells of human breast cancers, leukemias, lymphomas, and sarcomas contain particles similar to the viruses that have been established as etiologic agents of these diseases in mice. The present paper concerns tumors of the central nervous system for which no suitable animal model or corresponding virus exists. Nevertheless, using the simultaneous detection test, we showed that human brain tumors contain 70S RNA and RNA-directed DNA polymerase encapsulated in a particulate component possessing a density of 1.17 g/ml. These particles satisfy the three diagnostic criteria that characterize RNA tumor viruses of animals. 24 Out of 26 (92%) of the most malignant (glioblastoma and medulloblastoma) brain tumors examined contained these virus-like entities.