[Radiosurgery as adjuvant treatment of a recurrent adult medulloblastoma. Ultra-early response]. / Radiocirugía como tratamiento complementario del meduloblastoma recidivadodel adulto: respuesta ultratemprana.

The role of radiosurgery after multimodality treatment of recurrent desmoplastic adult medulloblastoma is analyzed. The ultra-early clinical and pathological response of this tumor to adjunctive radiosurgery is stressed.

[Reversible primary empty sella. Case report]. / Silla turca vacía primaria reversible. A propósito de un caso.

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSF shunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sella may be an indicator of normal intracranial pressure in these cases.

Silla turca vacía primaria reversible. A propósito de un caso / Reversible primary empty sella. Case report

Se presenta el caso de un niña de 13 años con un aumento del tamaño de la hipófisis sugerente de adenoma que, tras un episodio de hidrocefalia aguda, desarrolló en la RM una silla turca vacía parcial.Tras la colocación de una derivación de líquido cefalorraquídeo, se normalizó la presión intracraneal y la hipófisis volvió a ocupar todo el espacio de la fosa sellar. Se discute la posibilidad de que en la silla turca vacía primaria con hipertensión intracraneal crónica idiopática, esté implicada una atrofia isquémica de la adenohipófisis que impide la recuperación del volumen glandular tras la restauración de la PIC a los niveles normales. La reversión de la silla turca vacía es un indicador de la normalización de la PIC (AU)

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSFshunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sell a may bean indicator of normal intracranial pressure in these cases (AU)

[Bupivacaine in continuous epidural infusion using a portable mechanical devise for postoperative analgesia after surgery for hernia of the lumbar disk]. / Bupivacaína en infusión epidural continua mediante dispositivo mecánico portátil para analgesia postoperatoria de cirugía de la hernia de disco lumbar.

OBJECTIVES: To determine the optimum concentration of bupivacaine administered by continuous epidural infusion, using a Baxter Single Day elastomeric infusor at a rate of 2 ml/h, to treat pain during the first 24 h after lumbar laminectomy. PATIENTS AND METHODS: Sixty patients undergoing elective repair of a herniated lumbar disk were randomly assigned to three homogeneous groups of 20 each. Group I received epidural infusion of 0.0625% bupivacaine, group II received 0.125% bupivacaine and group III received 0.25% bupivacaine. After surgery each patient was given a 4 mL solution of the local anesthetic being studied, followed by an infusion of the same through an elastomeric infusor at a rate of 2 ml/h throughout the first 24 h after surgery. Ketorolac was delivered through a device for patient controlled analgesia after surgery. Pain was assessed on a visual analog scale (VAS) at rest and during movement. Pain relief was assessed on a simple descriptive scale. RESULTS: Significantly less ketorolac was required during epidural infusion of 0.125% and 0.25% bupivacaine than when the 0.0625% concentration was being infused (29 +/- 16 and 28 +/- 13 mg, respectively, versus 110 +/- 35 mg; p < 0.001). VAS scores were significantly lower during infusion of 0.125% and 0.25% bupivacaine than with 0.0625% bupivacaine. No instances of motor blockade or infection related to catheter insertion were observed in any of the patients. CONCLUSIONS: Continuous epidural infusion of 0.125% and 0.25% bupivacaine through an elastomeric infusor gives excellent analgesia during the first 24 h after surgery. Administration of 0.25% bupivacaine is associated with a higher incidence of urinary retention. We therefore think that the most recommendable concentration of bupivacaine for infusion is 0.125%.

Bupivacaína en infusión epidural continua mediante dispositivo mecánico portátil para analgesia postoperatoria de cirugía de la hernia de disco lumbar / Continuous epidural infusion of bupivacaine through a portable mechanical device for postoperative analgesia after lumbar laminectomy

OBJETIVOS. Determinar la concentración óptima de bupivacaína administrada mediante infusión epidural continua, utilizando un infusor elastómero modelo Baxter Single Day infusor 2 ml/h®, para el tratamiento del dolor en las primeras 24 h del postoperatorio tras la cirugía de la hernia de disco lumbar. PACIENTES Y MÉTODOS. Se estudian 60 pacientes sometidos a cirugía electiva por hernia de disco lumbar bajo anestesia general. Los pacientes fueron distribuidos aleatoriamente en tres grupos homogéneos de 20 individuos cada uno de ellos: grupo I, perfusión epidural de bupivacaína al 0,0625 por ciento; grupo II, bupivacaína al 0,125 por ciento, y grupo III, bupivacaína al 0,25 por ciento. Al finalizar la cirugía, a cada paciente se le administraron 4 ml de la solución anestésica local que se iba a estudiar, seguida de una infusión de la misma por medio de un infusor elastómero con una tasa de infusión de 2 ml/h durante las primeras 24 h del postoperatorio. Se pautó analgesia postoperatoria por medio de un sistema de analgesia intravenosa controlada por el paciente (PCA) de ketorolaco. Se analizó el grado de dolor mediante la escala analógica visual (EAV) en reposo y durante la movilización, y el alivio del dolor utilizando una escala descriptiva simple. RESULTADOS. Los requerimientos de ketorolaco fueron significativamente menores durante la perfusión epidural de bupivacaína al 0,125 por ciento y al 0,25 por ciento que cuando se administró bupivacaína al 0,0625 por ciento (29 ñ 16 y 28 ñ 13 mg frente a 110 ñ 35 mg; p < 0,001). Las puntuaciones del dolor fueron significativamente inferiores durante la perfusión de bupivacaína al 0,125 por ciento y al 0,25 por ciento frente a la perfusión de bupivacaína al 0,0625 por ciento. No se observó bloqueo motor en ninguno de los pacientes estudiados ni infección en el emplazamiento del catéter. CONCLUSIONES. La perfusión epidural continua por medio de un infusor elastómero de bupivacaína al 0,125 por ciento y bupivacaína al 0,25 por ciento proporcionaron una excelente analgesia durante las primeras 24 h del postoperatorio, asociándose a la administración de bupivacaína al 0,25 por ciento una mayor incidencia de retención urinaria, por lo que consideramos que la pauta más recomendable es la infusión de bupivacaína al 0,125 por ciento (AU)

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Characterization of molecular forms of acetyl- and butyrylcholinesterase in human acoustic neurinomas.

Acoustic neurinomas were sequentially extracted with saline and saline-Triton X-100 buffers. Detergent was required to detach the bulk of acetylcholinesterase (AChE), but butyrylcholinesterase (BuChE) was mostly released with saline buffer. Sedimentation analysis and hydrophobic chromatography revealed that neurinomas contain principally amphiphilic AChE tetramers, dimers and monomers, and hydrophilic BuChE tetramers. The AChE dimers and monomers remained amphiphilic after incubation with phosphatidylinositol-specific phospholipase C (PIPLC), after or without prior treatment with alkaline hydroxylamine, which shows that, in contrast to the meningioma AChE dimers and monomers, the neurinoma isoforms are devoid of glycolipid. Neurinoma AChE reacted with the antibodies HR2 and AE1 raised against AChE from human brain or erythrocyte, whereas BuChE bound to a sheep antiserum.