Cardiac biomarkers of disordered eating as a function of diagnostic subtypes.

OBJECTIVE: The purpose of this study was to identify cardiac biomarkers of disordered eating as a function of diagnostic subtype as assessed via self-report inventory. METHOD: Mean heart rate (HR), systolic and diastolic blood pressure, mean R wave amplitude (mV), mean T wave amplitude (mV), QTc interval (sec), Tpeak-Tend interval prolongation (sec), QTc interval prolongation (sec), QRS prolongation (sec), and spectral indicators of cardiac dysfunction (LF/HF spectral ratio, HF spectral power) were assessed via electrocardiography among women with no eating disorder symptoms (n = 32), subclinical eating disorder symptoms (n = 92), anorexia nervosa (n = 7), bulimia nervosa (n = 89), binge eating disorder (BED: n = 20), and other specified feeding and eating disorders (OSFED: n = 19). RESULTS: MANOVA results showed statistically significant group differences. Follow-up tests revealed significantly decreased mean R wave amplitude among participants with self-indicated clinical (bulimia nervosa, binge eating disorder) and subclinical forms of disordered eating compared to asymptomatic controls. DISCUSSION: Results suggest decreased mean R wave amplitude is a promising cardiac biomarker of disordered eating.

Intraoperative preservation of corticospinal function in the brainstem.

BACKGROUND: The corticospinal tract features a largely exposed course through the brainstem, and is therefore at risk in many brainstem-related procedures. No large case series on motor-evoked potential (MEP) monitoring during brainstem surgery have been reported as yet. OBJECTIVE: To understand intraoperative MEP changes during brainstem-related surgery, and to explore the value of MEP monitoring for preventing permanent new paresis. METHODS: Myogenic MEPs after transcranial electrical train stimulation were monitored in 70 cases of intraparenchymal (n = 39) and extraparenchymal (n = 31) brainstem-related tumours and vascular lesions. MEP recordings failed in another five cases. Motor outcome and intraoperative MEP results were documented prospectively and correlated for this study. RESULTS: Significant MEP changes occurred in 46% of cases. Stable and only reversibly deteriorated MEPs warranted unimpaired motor outcome (n = 50, 71% of all cases). Irreversible deterioration and reversible loss (n = 19, 27%) indicated a 37% risk for transient deficit. Irreversible loss (one case, 1.5%) predicted permanent paresis. MEPs and motor outcome correlated equally well in intra- and extraparenchymal lesions. Somatosensory-evoked potentials (SEPs) did not reliably reflect motor outcome. Permanent motor deficit occurred in one out five cases (20%) with failed MEP recordings. CONCLUSIONS: MEP monitoring-as opposed to SEPs-is a valid indicator of corticospinal function in brainstem-related surgery, independent from the type of lesion operated on. New deficit occurs only after more pronounced MEP changes than in supratentorial surgery, but complete loss as in spinal surgery is not required. MEPs may help to prevent permanent new paresis.

Pure distant, leptomeningeal metastasis of esthesioneuro-epithelioma.

BACKGROUND: Esthesioneuro-epithelioma is a very rare variant of olfactory neuroblastoma that originates in the region of the cribriform plate. Its intracranial manifestation is due to infiltration of the anterior skull base and frontal lobes. METHODS: The authors describe a 52-year-old man with a history of a subtotally resected right maxillary sinus ethesioneuro-epithelioma 2 years earlier who presented with a left hemiparesis and signs of increased intracranial pressure. CT examination revealed a tumour of the right temporoparietal region. The tumour and its dural attachment were totally removed. The patient made a full recovery postoperatively. FINDINGS: The features of esthesioneuro-epithelioma were found on histopathological examination. INTERPRETATION: The intracranial tumour resected was a distant, leptomeningeal metastasis of esthesioneuro-epithelioma. To our knowledge such a documented case has not been published before.

A case of cystic form of angiomatous meningioma with prominent microvascular pattern mimicking haemangioblastoma.

A surgical case was reported of an unusual angiomatous variant of meningioma with predominant microvascular component and extensive cystic changes. The tumour was incidentally detected in a 79-year-old woman who was admitted to the hospital because of a head injury. The CT scan revealed in addition to bilateral subdural haematomas a large-sized (5 x 5 x 4 cm) multicystic tumour with a solid contrast-enhancing nodule in the right frontal region. Microscopically, the tumour tissue was composed predominantly of a dense meshwork of small, capillary-like and thin-walled dilated blood vessels and a relatively small component of intervening meningotheliomatous tumour cells. The resemblance of the presented case to some rare cases of cystic meningioma which were formerly classified as a haemangioblastic variant of meningioma or transitional forms between meningioma and haemangioblastoma is briefly discussed.

The influence of ruptured cerebral aneurysm localization on the blood flow velocity evaluated by transcranial Doppler ultrasonography.

The relationship between changes of blood flow velocities in cerebral arteries measured by transcranial Doppler ultrasonography and aneurysm localization was investigated in a group of 165 patients after aneurysmal subarachnoid hemorrhage (SAH). Mean blood flow velocities (MFV) in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) were registered. In patients with aneurysm of internal carotid artery and MCA (group A) statistically significant higher values of MFV from the 1st to the 5th day and on the 12th, 13th, 14th, 15th, and 19th day after SAH were found compared to patients with aneurysm of the anterior communicating artery, ACA, and pericallosal artery (group B). Pathological values of MFV exceeding 120 cm sec-1 in MCA were registered during 14 days in group A and during eight days in group B. Blood flow velocities in ACA were statistically significantly higher in group B on the 2nd, 7th, 9th and 11th day compared to group A. Pathological values of MFV exceeding 90 cm sec-1 in ACA were registered during nine days in both groups. MFV differences between group A and group B in 38 patients subjected to delayed surgery were not observed. The influence of aneurysm localization was observed between the 7th and 14th day after SAH. Critical MFV values for vasospasm in the MCA should be 120 cm sec-1 and in the ACA 90 cm sec-1.

[Revascularisation after encephalo-duro-arterio-synangiosis. Case report]. / Rewaskularyzacja mózgowia u chorych po wykonaniu encephalo-duro-arterio-synangiosis. Opis przypadku.

In surgical treatment was performed of patients after cerebral ischaemic stroke and cerebral ischaemia. The authors applied the surgical technique of indirect anastomosis (EDAS-encephalo-duro-arterio synangiosis). The Japanese authors described this method first as a treatment for moya-moya disease. The acetazolamid (Diamox) test and clinical symptoms were the main criteria to perform this surgical procedure. All patient with abnormal Diamox test were treated surgically. After 6 months control angiography was performed to visualize a new network of vessels near the main vessel (superficial temporal artery).

Xanthomatous changes in atypical and anaplastic meningiomas. Light and electron microscopic investigations.

Xanthomatous changes may occur in meningiomas of different histological type, however their incidence in combination with histological features of atypical or anaplastic meningioma has not been previously documented. In this report we present clinicopathologic, immunohistochemical and ultrastructural studies in the surgical cases of two atypical and three anaplastic meningiomas exhibiting prominent xanthomatous changes. In all tumors the xanthomatous cells were seen in association with typical meningioma structures such as meningothelial whorls or psammoma bodies as well as within the tumor parts displaying pleomorphism, patternless growth, increased cellularity, presence of necroses and mitoses or brain invasion. Ultrastructural study revealed a wide-range of lipid-containing cells, reflecting a continuum of gradual transition between polymorphic meningioma cells and xanthomatous cells. Commonly, the lipidized cells exhibited different degrees of plasmalemmal interdigitations and desmosomal junctions. Our study allowed us to confirm the meningothelial origin of xanthomatous cells in atypical and anaplastic meningiomas. Moreover, the ultrastructural observations of lysosomes in the majority of xanthomatous cells and the immunoreactivity for the CD68 antigen indicated their macrophage characteristics. It seems that a mixed meningeal/macrophage nature of xanthomatous cells can be related to the functional and structural multipotentiality of the primary leptomeningeal cells.

Cytoarchitectonic basis for safe entry into the brainstem.

This work is a continuation of the anatomical study in which safe approach zones through the floor of the fourth ventricle--infrafacial and suprafacial--were morphologically and morphometrically defined (Acta Neurochir (1997) 139: 1014-1019). The purpose of cytoarchitectonic study was to analyze correlation between morphometry of the facial colliculus and hypoglossal triangle and localization of the corresponding cranial nerves nuclei in the brainstem tegmentum in order to verify morphometrical borders of the previously defined zones. Morphometrical evaluation of the fourth ventricle floor of 10 examined brainstems was initially performed. Distances from obex to the rostral portion of hypoglossal triangle and facial colliculus were determined. Then a series of axial sections of each specimen, stained for Nissl substance, were analyzed to define the distance from obex to the rostral portion of the hypoglossal and abducens nuclei. Distances of motor trigeminal and facial nuclei from the midline sagittal plane were also measured. The obtained results allowed morphometrical determination of the infra-abducental and supra-abducental region of safe entry into the brainstem tegmentum. Infra-abducental region corresponds to infrafacial safe approach zone and supra-abducental to suprafacial zone. The distance of the rostral portion of facial colliculus from obex was longer than the distance of the rostral pole of abducens nucleus from obex in every examined specimen (by 0.7 mm on average). A very similar correlation between the distance of the rostral margin of hypoglossal triangle and localization of the rostral pole of hypoglossal nucleus was found. The rostral portion of hypoglossal triangle was longer by 1.5 mm on average. The obtained results show that previously defined infrafacial and suprafacial safe approach zones via the fourth ventricle floor correspond morphometrically to tegmental regions of safe entry--infra-abducental and supra-abducental respectively. It suggests that morphometrical evaluation of the fourth ventricle floor proposed by the authors could be useful in the intra-operative determination of safe entry via the rhomboid fossa into the brainstem tegmentum.

[The usefulness of intraoperative high-frequency doppler flowmetry in surgeries for intracranial aneurysms]. / Przydatnosc sródoperacyjnego aparatu dopplerowskiego wysokiej czestotliwosci w operacjach tetniaków tetnic mózgowych.

The flowmeter enables estimation of blood flow velocity changes in small calibre arteries. The authors examined blood flow velocity patterns in the vessels during aneurysm operations and blood flow velocity and its disturbances inside aneurysm. Evaluation technique, technical data of the flowmeter use are described and the characteristics of the blood flow velocity picture in cerebral arteries obtained by this method is presented. The presented method enables a very precise estimation of blood flow velocity and detection of changes in flow patterns. The method may become very helpful in identification of the vessels in other types of cerebral surgery.

Experience with intraoperative high frequency Doppler sonography in neurosurgical practice.

The method of blood flow velocity (BFV) evaluation by intraoperative application of the high frequency Doppler is presented. The device is used to estimate BFV changes in small caliber arteries by direct placement of the probe upon the examined vessel. BFV examinations were performed on the site during aneurysm operations, during transsphenoidal approaches to identify the intracavernous portion of ICA embedded in the tumor mass and in patients after encephalodurosynangiosis evaluated on the outpatient basis. Technical characteristics of the flowmeter used are described and examples of the BFV pictures in cerebral arteries are presented. The device allows a precise BFV evaluation in the selected vessel and detection of changes in BFV patterns particularly useful during aneurysms surgery. This method of identifying cerebral vessels may become applicable in other types of neurosurgical operations.

[The examination of the blood flow velocity in arterial vessel during and after encephalo-dura-arterio-synangiosis. Preliminary results]. / Badania przeplywu krwi w naczyniu tetniczym uzytym do rewaskularyzacji. Encephalo-duro-arterio-synangiosis. (non bypass anastomosis). Doniesienie wstepne.

The Japanese authors first described encephalo-duro-arterio-synangiosis, a new treatment for moya-moya disease, 17 years ago. The other authors used this method (EDAS, indirect anastomosis) in surgical treatment of patients suffered cerebral transient ischaemic attack and cerebral ischaemia. In our department this method was applied in 5 patients with cerebral ischaemia. All patients had internal carotid artery occlusion. After angiography, to localize carotid artery occlusion, acetazolamid (Diamox) test was performed. The patients with negative Diamox test were treated surgically (EDAS). The authors used the intraoperative microdoppler device to monitor blood flow velocity of the prepared vessel (temporal superficial artery) at every stage of surgery. The device was also useful in controlling the patency of encephalo-duro-arterio-synangiosis percutaneously after the surgery. The proximal and the distal part of the non-bypass anastomosis was examined in the follow up during 5-8 months before angiography.

[Multi-stage method for the diagnosis of low-pressure hydrocephalus]. / Wieloetapowa metoda rozpoznawania wodoglowia niskocisnieniowego.

Multistage method of low-pressure hydrocephalus diagnosis, elaborated in our department, is discussed. The method consists of four stages: I Clinical and neuropsychological examinations, standard computerized tomography. II Somatosensory evoked potentials. III Determination of water concentration and distribution in fluid compartments of the brain by utilising new mathematical formula. IV Three-phase complementary test. The application of this method allows to eliminate many false diagnoses and may contribute to lower costs of treatment.

The anatomical aspects of a surgical approach through the floor of the fourth ventricle.

In 1993 Kyoshima et al. introduced safe entry zones in the region of the 4th ventricle floor: infrafacial triangle and suprafacial triangle. Is it possible to demarcate these zones precisely in every case intra-operatively? A postmortem study of 40 brainstems of patients who had died of non-brain disease was performed to evaluate the degree of individual morphological and morphometrical variability of the 4th ventricle floor. The purpose of this study was to find constant landmarks and distances within the rhomboid fossa region which would help a neurosurgeon to determine safe approach zones through the 4th ventricle floor to brainstem lesions. Several anatomical landmarks-median sulcus, obex, vestibular area, vagal triangle, hypoglossal triangle-were found to be sufficiently visible in all examined brainstems. However, the facial colliculus which is a border structure between the infrafacial and suprafacial safe approach zone was poorly visible in about 37% of the analyzed material. The striae medullares were not found to be good orientation structures as they were not visible in 30% of the material and exhibited individual variability of a high degree in relation to their number and arrangement. In the morphometrical study analyzed measurements were taken by utilizing the digital image analyzer MULTISCAN. Based on the results obtained the authors suggest new borders of the infrafacial safe approach zone and morphometrical directions to determine the suprafacial safe approach zone in cases when the facial colliculus is not clearly visible or invisible intra-operatively.

Digital-image analysis of the rhomboid fossa surface.

Forty brainstems were investigated in order to evaluate morphological and morphometrical variability of the 4th ventricle floor. Visibility evaluation of the following rhomboid fossa structures: striae medullares, facial colliculus, superior fovea, vestibular area, sulcus limitans, incisure, medial eminence, median sulcus, vagal triangle, hypoglossal triangle and obex was performed. Obex, median sulcus, vestibular area, vagal and hypoglossal triangles were found to be sufficiently visible in all specimens. Facial colliculus was poorly visible in 37% of the examined brainstems. Striae medullares were invisible in 30% of the analysed material and exhibited individual variability of a high degree in relation to their number and arrangement. Morphometrical study showed measured distances to be individually variable with a relatively low coefficient of variation of approximately 10%.

High prevalence of antibodies to hepatitis C virus in three haemodialysis centres in south-western Poland.

We assessed the prevalence of anti-hepatitis C virus (anti-HCV) antibodies and markers of hepatitis B virus (HBV) infection in patients of three haemodialysis centres before initiating anti-HBV vaccinations. Of the 94 patients, 39 (41.5%) were anti-HCV positive (+) and 81 (86.2%) were anti-hepatitis B core antigen (HBc) positive. There was a high rate of anti-HBc positivity among anti-HCV (+) patients (92.3%), although the presence of anti-HCV and anti-HBc antibodies were not significantly related to each other. Multiple blood transfusions (> 5 units) was a risk factor for development of HCV infection (P < 0.02), while none of our patients admitted intravenous drug abuse. Although 53.8% of anti-HCV (+) patients have had moderate serum alanine aminotransferase (ALT) elevations during the study period, none has had considerable liver disease, nor did the increased ALT correlate with the presence of anti-HCV. Only two of 17 staff members participating in the survey were anti-HCV (+), though almost every one gave a history of accidental needlestick exposure. All the study subjects were human immunodeficiency virus (HIV) negative. Our results, obtained with the second-generation, highly specific enzyme immunoassay and verified by the immunoblot assay for anti-HCV antibodies, support a recent suggestion that earlier reports might have underestimated the true prevalence of anti-HCV antibodies in haemodialysis patients.

The variety of clinical and histopathologic presentations of glomerulonephritis associated with latent syphilis.

Glomerulonephritis is a well established but rather uncommon complication of latent secondary syphilis. We present three cases of glomerulopathies associated with luetic infection, observed and managed in our institutions in the past three years. They illustrate a variety of clinicopathologic presentations of this nephropathy, from acute nephrotic syndrome through membranous glomerulopathy up to rapidly progressive glomerulonephritis. Regardless of the clinical course and histologic type, they were all characterized by strongly positive results of serologic tests for syphilis. Our observations suggest the necessity of eliminating luetic infection in aetiologic considerations of each newly diagnosed case of nephrotic syndrome.

[Human recombinant erythropoietin in the treatment of anemia in patients on long-term hemodialysis]. / Ludzka rekombinowana erytropoetyna w leczeniu niedokrwistosci u chorych dlugotrwale hemodializowanych.

Recombinant human erythropoietin (EPO) was administered i.v. to anaemic patients (pts) on hemodialysis in doses from 40 to 120/IU/kg 3 times a week. 20 out of 21 pts showed an increase in hemoglobin (Hb) level above 11 g/dl after 8-12 weeks. Maintenance doses to keep Hb value about 10 g/dl varied from 2 X 40 IU/kg to 3 X 40 IU/kg per week (subcutaneous). EPO improved the well-being and physical condition in all of pts. Six pts developed rise in blood pressure and most an increase in predialysis serum potassium and urea levels during first 16 weeks of treatment.