Cerebrospinal fluid and serum IL-8, CCL2, and ICAM-1 concentrations in astrocytic brain tumor patients.

BACKGROUND: The aim of the study was the evaluation of serum and CSF concentrations of CCL2, IL-8, and sICAM-1 in patients with astrocytic tumors as compared to a group of non-tumoral patients. METHODS: Chemokine concentrations were measured using the ELISA method. RESULTS: Regardless of the parameter tested and the patient group (brain tumor or non-tumoral patients), statistical differences (P < 0.05) were found between concentrations obtained in CSF compared to values obtained in serum for all proteins tested. CSF IL-8 concentrations were significantly elevated in CNS tumor patients as compared to non-tumoral individuals (P = 0.000); serum CCL2 and sICAM-1 concentrations were significantly decreased in CNS tumors in comparison with the comparative group (P = 0.002 and P = 0.026, respectively). Among proteins tested in the serum, a higher area under the ROC curve (AUC) revealed CCL2 compared to sICAM-1 in differentiating subjects with CNS brain tumors from non-tumoral subjects. AUC for CSF IL-8 was higher than for its index (CSF IL-8/serum IL-8). CONCLUSIONS: For individual biomarkers (IL-8 and CCL2, sICAM-1), measured in CNS brain tumor patients, the appropriate material, respectively CSF or serum, should be chosen and quantitatively tested. Increased cerebrospinal fluid IL-8 with decreased serum CCL2 create a pattern of biomarkers, which may be helpful in the management of CNS astrocytic brain tumors.

N-cadherin, beta-catenin and connexin 43 expression in astrocytic tumours of various grades.

INTRODUCTION: Astrocytic tumors are the most common primary brain tumors, but little is known about their etiology and prognostic factors. N-cadherin and beta-catenin are adhesive proteins, and are often overexpressed in many types of cancers, including breast or colorectal cancer, resulting in better prognosis. Connexin 43 is a gap junction protein involved in cell-cell signaling pathway taking part in the process of carcinogenesis. The aim of the study was to evaluate N-cadherin, beta-catenin and connexin 43 expression in astrocytic tumors of various grades. MATERIALS AND METHODS: We examined 131 cases of astrocytic tumors, including 26 cases of diffuse astrocytoma (group I), 44 anaplasic astrocytomas (group II) and 61 glioblastoma cases (group III)--primary and secondary. To evaluate N-cadherin, beta-catenin and connexin 43 expression, we used immunohistochemical reaction with specific antibodies (Santa Cruz Biotechnology). The obtained results were correlated with clinical and morphological features. RESULTS: Beta-catenin expression was observed in 69.3% of diffuse astrocytomas, 75% of anaplastic astrocytomas, and 82% of glioblastoma cases. N-cadherin expression was observed in 92.3% of diffuse astrocytomas, 90.1% of anaplastic astyrocytomas, and in all glioblastoma cases. Connexin 43 was observed in 76.9% of diffuse astrocytomas, and in all cases of anaplastic astrocytomas and glioblastomas. Beta-catenin expression was significant within the nucleus of neoplastic cells in groups I and II. In group III, staining was observed only in the cellular membranes. N-cadherin and connexin 43 expression was observed only in the cells' membranes. In glioblastomas, both primary and secondary, all protein expression was significant within the cells surrounding the necroses and blood vessels and weak or absent in the tumor's margins. CONCLUSION: Our study shows that beta-catenin nuclear expression in group of diffuse astrocytomas and anaplastic astrocytomas is evidence for transcriptional function of beta-catenin in those groups. Strong N-cadherin and connexin 43 expression in those groups may be evidence for their role in tumor formation and progression. However, in glioblastomas a very important role of all examined proteins is generating intracellular connections to facilitate the escape of tumor cells from the effects of hypoxia or their accumulation around the blood vessels rather than tumor invasion into the brain parenchyma.

Endoscopic repair of CSF leaks in the postero-superior wall of the frontal sinus - report of 2 cases.

BACKGROUND: Bony defects extending laterally or superiorly within the posterior wall of the frontal sinus are generally deemed too difficult for endoscopic repair in spite of significant progress in surgical endoscopic techniques. PATIENTS AND METHODS: We describe a technique of endoscopic repair of posttraumatic cerebrospinal fluid (CSF) leak from the postero-superior aspect of the frontal sinus in a 40- and a 29-year-old male. In both cases after careful assessment of the surgical anatomy the sinus was widely opened transnasally (Draf IIB and Draf III approach, respectively). Angled (45 and 70°) optics and malleable, individually profiled instruments were used to fit specific anatomic variations encountered during the procedure. RESULTS: Endoscopic manipulation near the dome of the sinus proved to be very limited in spite of a wide surgical opening. In our cases the site of the leak could be identified and successfully sealed with gentle pressure on the dura mater. The bony defects were repaired with a 2-layer reconstruction technique. There were no signs of recurrence during 6 months follow-up. CONCLUSION: With contemporary endoscopic instrumentation, endoscopic closure of CSF leaks in the supero-posterior wall of the frontal sinus is feasible, especially in patients with favourable anatomy of the frontal sinus.

Endoscopic trans-nasal approach for biopsy of orbital tumours using image-guided neuro-navigation system.

BACKGROUND: Histopathological diagnosis of intraorbital tumours is of crucial value for planning further therapy. The aim of the study was to explore clinical utility of image-guided endoscopy for biopsy of orbital tumours. METHOD: Trans-nasal endoscopic biopsy of intraorbital mass lesions was performed in 6 patients using a neuro-navigation system (Medtronic Stealth Station Treon plus). The CT and MRI 1 mm slice images were fused by the system in order to visualise both bony and soft tissue structures. The anatomic fiducial registration protocol was used during the procedure. RESULTS: All lesions were precisely localised and the biopsies could be taken from the representative part of the pathological mass. None of the patients developed aggravation of ocular symptoms after the procedure. The operative corridor as well as the size of orbital wall fenestration could be limited to a minimum. The accuracy of neuro-navigation remained high and stable during the entire procedure. CONCLUSIONS: The image-guided neuro-navigation system facilitated endoscopic localisation and biopsy of intraorbital tumours and contributed to the reduction of surgical trauma during the procedure. The technique was particularly useful in small, medially located, retrobulbar tumours and in unclear situations when the structure of the lesion resembled surrounding intraorbital tissue.

Atraumatic suction tip for microneurosurgery--clinical experience.

Our two-year experience with a new atraumatic tip for the neurosurgical suction tube is described. During microneurosurgical procedures the tip reduces injury to fragile vital brain structures and protects them from being aspirated into the suction tube. The perforated membrane of the appended suction tip does not impede evacuation of blood in any situation and can be easily cleaned off without demounting. The device can be immediately attached to the tube and disconnected. The neurosurgeon need not concentrate on its use, in contrast to those systems with active suction pressure control. The atraumatic suction tip is available in several sizes to fit different callibers of suction tubes.

Activity of lysosomal exoglycosidases in human gliomas.

There is a lot of data suggesting that modifications of cell glycoconjugates may be important in progression of cancer. In the present work we studied activities of lysosomal exoglycosidases: beta-hexosaminidase and its isoenzymes A and B, beta-galactosidase and alpha-mannosidase, in human gliomas. Enzyme activity was determined spectrophotometrically based on the release of p-nitrophenol from p-nitrophenyl-derivative of appropriate sugars. The activities of the exoglycosidases tested were significantly higher in malignant glial tumors than in control tissue (normal brain tissue) and non-glial tumors. The highest activities of exoglycosidases were observed in high-grade gliomas, and a positive correlation of enzyme activities and degree of malignancy was noted. Our results suggest that lysosomal exoglycosidases may participate in the progression and dynamical development of glial tumors.

Detection and monitoring of cerebral hemodynamic disturbances with transcranial color-coded duplex sonography in patients after head injury.

Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic brain damage. Blood flow should therefore be monitored with a simple, reliable method. Transcranial color-coded Doppler sonography (TCCS) is an accepted tool for the diagnosis of cerebral vasospasm; however, its usefulness in evaluating patients with head injury has not been proven. Cerebral blood-flow velocity in the middle, anterior, and posterior cerebral arteries was measured with a 2.5 MHz probe (Aplio SSA 770A, Toshiba, Japan) in 36 subjects with moderate or severe head injury. Serial measurements of resistance index (RI), peak-systolic, end-diastolic, and mean velocity in the middle cerebral arteries were performed 2-24 h after head trauma and in the subsequent days during hospitalization. Immediately after head trauma, increased RI values, and unusually decreased blood-flow velocity (mainly in MCA) were observed. Microcirculation disturbances were suspected because the end-diastolic velocity had substantially diminished. Changes in blood-flow parameters correlated with the clinical state, and in most cases, a poor prognosis. In some patients, blood-flow velocity increased above the normal reference limit and this implied poor prognosis. Transcranial color-coded Doppler sonography is a reliable, repeatable, and accessible tool that provides information about cerebral blood-flow disturbances and may hold diagnostic and prognostic importance.

Orbital pseudotumor caused by a foreign body--a case report.

The case of a patient with a foreign body in the orbit is presented. The presence of this foreign body induced an aggressively expanding pseudotumor, infiltrating the eyelids, orbital muscles and the sclera. The process of diagnosis, management and the results of treatment are described. This case is noteworthy because of the atypical course of the disease in a patient with a foreign body following ocular injury.

Risk factors of massive suprachoroidal hemorrhage during extracapsular cataract extraction surgery.

PURPOSE: To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery. METHODS: The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test. RESULTS: The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction. CONCLUSIONS: Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.

Limitations of color Doppler sonography in the imaging of ocular vessels.

PURPOSE: To describe a case where detection of blood flow in the central retinal artery and the central retinal vein was limited by an artifact evoked by the optic disc drusen. METHODS Case report. RESULTS: During color Doppler sonography, examination of optic disc drusen may generate an artifact--the so-called twinkling artifact--which can simulate blood flow and make evaluation of the central retinal vessels impossible. CONCLUSIONS: Twinkling artifact does not allow evaluation of color Doppler sonography in the imaging of ocular vessels.

Bcl-xl and Bak protein expression in human optic nerve axons in eyeballs post-trauma and in the eyes with absolute glaucoma.

The aim of our study was an evaluation of Bcl-xl and Bak protein expressions in optic nerve axons in eyeballs after severe injury and absolute glaucoma. We examined a series of 41 eyeballs, which were enucleated, following extensive injury and a series of 19 eyeballs from patients with absolute glaucoma. The immunohistochemical reaction was performed, using antibodies against human Bcl-xl and Bak protein with LSAB and DAB. In the injured eyeballs in Group I, Bcl-xl protein expression was observed in 53.8%, Bak in 38.5%, in Group II, Bcl-xl in 40%, Bak 55%; in Group III, Bcl-xl in 62.5%, Bak in 62.5%. Nine (9), out of 19 (47.4%) cases showed Bcl-xl protein positivity, Bak 15, out of 19 (78.9%). The percentage of cases with Bak protein positivity was statistically higher than that for Bcl-xl (Bak/Bcl-xl p=0.0356). The results showed that there may be a dominance expression of proapoptotic proteins in optic nerve axons in glaucoma.

Bcl-2 and Bax protein expression in human optic nerve axons in the eyeballs after severe trauma and in the eyes with absolute glaucoma.

The aim of our study was to evaluate the immunohistochemical expression of Bcl-2 and Bax protein in optic nerve axons after severe eyeball injury and in the eyes with absolute glaucoma. A series of 19 eyeballs, enucleated because of absolute glaucoma and 41 eyeballs, enucleated, following extensive injury, at the Department of Ophthalmology of the Medical University of Bialystok, were taken into our study. The immunohistochemical reaction was performed with Bcl-2 and Bax protein antibodies and by the LSAB technique. DAB was used in order to visualise the reaction. The optic nerve axons in glaucomatous eyeballs showed statistically significant higher Bax protein expressions than those of Bcl-2 proteins. In the optic nerve axons after severe eyeball injury, a non-significantly higher Bcl-2 protein expression was observed.

Expression of PCNA and Ki-67 in posterior uveal melanomas in adults.

The aim of the study was to evaluate the expression of cell proliferation markers (PCNA and Ki-67) in posterior uveal melanomas in adults. Thirty-six enucleated eyes (without prior treatment) were included in histopatological study. A series of 15 cases of spindle cell type melanomas, 12 epithelioid and 9 of a mixed type were assessed, using the immunohistochemical method with monoclonal PCNA and Ki-67 antibodies. PCNA expression was observed in 75% and Ki-67 in 13.8% of all the examined tumours. The mean score of PCNA and Ki-67 index were the highest in tumours, which contained epithelioid cells and in large, more advanced (pT3, pT4) uveal melanomas. The results showed that the evaluation of expression of PCNA and Ki-67 may provide an additional infonnation about the progression of tumor process.

Oscillations of cerebrovascular resistance throughout the menstrual cycle in healthy women.

OBJECTIVES: Increased concentration of endogenous estrogen during a typical menstrual cycle has been shown to correlate with augmentation of blood flow through the internal carotid arteries (ICAs), which may be related to changes in vascular resistance within the brain. In this study we investigated the effects of endogenous estrogen and progesterone on cerebrovascular impedance in young healthy women. METHODS: The blood flow in the ICA and the common (CCA) and external (ECA) carotid arteries was studied with duplex Doppler sonography. The resistance index (RI) was determined and correlated with plasma 17beta-estradiol concentration in 14 young healthy women throughout their menstrual cycle. RESULTS: The concentration of 17beta-estradiol increased in the follicular phase of the cycle and reached a peak on day 14, whereas concentration of progesterone remained low. Along with an increase in estrogen concentration, the ICA RI had decreased from its initial level on average by 9.2% on day 13 and by 6.7% on day 14 (P < 0.05). In contrast, the trend of the ECA RI was to increase during the peak of estrogen concentration. There were no significant changes in the CCA RI or in the systolic blood pressure, heart rate, hematocrit and hemoglobin concentration through the menstrual cycle. CONCLUSIONS: Estrogen-related augmentation of blood flow through the ICA is caused mainly by decreased cerebrovascular impedance, as shown by a decrease in the ICA RI. These changes in RI suggest that estrogen influences cerebral impedance mainly by altering the resistance of cerebral microvasculature.

Tympanic temperature reflects intracranial temperature changes in humans.

The purpose of the study was to identify extracranial locations in which temperature changes in humans reflect those of intracranial temperature in a reliable and repeatable way. This was achieved by subjecting 14 non-anaesthetized patients after neurosurgery to face fanning while intracranial and extracranial temperatures were continuously measured. In all patients the cranium was closed and the group included both febrile and non-febrile as well as hyperthermic and normothermic patients. The patients' faces were fanned for 20-30 min, with a small fan at an air speed of 3.25 m s(-1). This gave intracranial temperature changes measured in the subdural space ( T(sd)) that were highly and significantly correlated ( r=0.91, P<0.05, n=14) with changes in tympanic temperatures ( T(ty)). A low, statistically insignificant correlation ( r=0.40, P>0.05, n=12) was found between T(sd) and oesophageal temperatures. In conclusion, intracranial temperature changes, induced by face fanning, were reliably reflected by the changes in T(ty).

Brain abscess as a rare complication in a hemodialysed patient.

BACKGROUND: Infections remain among the most common morbid events and are an important cause of death in end stage renal disease. They have reduced immune response and increased hazard of infections due to repeated puncture of an arterio-venous fistula, formation of haematoma at the site of cannulation and central vein catheterisation. CASE REPORT: We report a case of brain abscess in chronically haemodialysed patient admitted to our department due to haedache, vomiting, accelerated hypertension and fever. The clinical examination revealed narroving of the right palpebral slit, weeping and right oral angle hanging loose. He had mild microcytic anaemia and high level of g-globulin. Ophtalmologic examination showed normal oculi fundi. The computed tomography revealed heterogenous mass marginally enhanced with contrast agent in the right frontal cerebral lobe. The right fronto-temporal craniotomy was performed and the right frontal lobe abscess was found and totally excised. The postoperative course was uneventful besides of seizures which were effectively treated with carbamazepine. After bilateral nephrectomy the patient undervent succesfull kidney transplantation and is in good condition without any neurological defect. A probable cause of his brain abscess was peridontal abscess recognized 3 month earlier or bilateral vesicoureteral refluxes. CONCLUSIONS: 1. Uremic patients have a reduced immunocapacity and are a high risk group for infections of various etiology. 2. Prompt eradication of all sources of infection is essential in hemodialysed patients.

Importance of angle correction in the measurement of blood flow velocity with transcranial Doppler sonography.

BACKGROUND AND PURPOSE: The angle of insonation cannot be assessed with conventional transcranial Doppler sonography. Findings in healthy control subjects suggest that the angle is relatively small in routine clinical practice. Data regarding the angle in middle cerebral artery (MCA) stenosis are scarce. In this study, the angle and its effect on flow velocity measurements were assessed with transcranial color Doppler sonography in patients with MCA stenosis. METHODS: Eighteen patients (median age, 53 y; age range, 22-72 y) who satisfied qualifying criteria (eg, angiographically revealed unilateral MCA stenosis of > or =50%) were selected from 149 consecutive patients enrolled in a prospective study of transcranial color Doppler sonography and cerebral digital subtraction angiography. All had active neurologic symptoms. The angle of insonation and peak systolic and mean flow velocities in both MCAs were measured from videotapes generated at sonography. RESULTS: The mean angle of insonation was 47 +/- 11 degrees (range, 19-64 degrees ) on the stenotic side and 34 +/- 18 degrees on the contralateral side (P <.05). Angle-corrected velocities were higher than uncorrected ones. Differences between angle-corrected and uncorrected peak systolic and mean flow velocities on the stenotic side were 46.6% and 45.9%, respectively, of uncorrected values. Differences between corrected and uncorrected peak systolic and mean velocities were larger on the stenotic side compared with those on the contralateral side (P <.05). CONCLUSION: In patients with moderate or severe MCA stenosis, the angle of insonation can be substantial and cause large errors when flow velocities are measured without angle correction.

Transcranial color Doppler sonography in the emergency diagnosis of middle cerebral artery occlusion in a patient after head injury.

The purpose of this report is to highlight the utility of transcranial color Doppler sonography (TCCDS) in the emergency diagnosis of an ischemic stroke in a 64-year-old patient after head injury. An emergency CT identified a subdural hematoma, subarachnoid hemorrhage, a brain contusion and edema. The patient's status deteriorated after admission, and a second CT revealed an intracerebral hematoma and marked mass effect. Transcranial color sonography revealed no flow in the ipsilateral middle and anterior cerebral arteries, which was consistent with ischemic stroke. This case demonstrates that transcranial color Doppler sonography performed early after head injury may be useful in detecting associated occlusion of cerebral vessels.

Human brain temperature in vivo: lack of heating during color transcranial Doppler ultrasonography.

This study was undertaken to assess the effect of ultrasound on human brain temperature in vivo. The investigation consisted of direct recording of intracranial temperature during color transcranial Doppler (TCD) sonography in a neurosurgical patient. The temperature was recorded from 3 thermocouples. One was implanted together with an intracranial pressure sensor into a surgically reduced intraparenchymal hematoma, the second was placed within the subdural space close to the temporal acoustic window, and the third was located extracranially at the outer surface of the temporal bone. Tympanic temperatures were also measured to give an approximation of global brain temperature. A 2.5-MHz transducer was used, and the system settings were as follows: spatial peak temporal average intensity = 234 mW/cm2 in B-mode at a maximum power of 32.3 mW and 2132 mW/cm2 in Doppler mode at a maximum power of 149.3 mW. Neither increase in the intraparenchymal brain temperature nor increase in the temperature at the bone/soft tissue interface was observed during 30 minutes of insonation. The ipsilateral tympanic temperature increased by only 0.06 degree C, and this value may be regarded as a measure of the overall increase in brain temperature. Passive cooling effect produced by the transducer, which was at ambient temperature, was found to reach the brain surface and to surpass any possible heating caused by the ultrasound. The results indicate that no noticeable increases in human brain temperature occur in response to ultrasound emitted by a color TCD device at high transmitter power settings within the diagnostic range.