Prevention of tumour cell dissemination in diagnostic needle procedures.

BACKGROUND: A side effect of diagnostic needle biopsies is the possibility to disseminate tumour cells into the needle track, which may cause concern in certain malignant tumour types. METHODS: In order to prevent tumour cell dissemination we developed a technology that uses radiofrequency (RF) pulses to sterilise the needle track and denaturate tumour cells. To determine feasibility, we applied this technology to fine needle aspiration biopsy (FNAB) and used breast cancer as a model tumour. Routine FNAB was performed in 88 patients with adenocarcinoma and blood droplets passing the skin orifice were cytomorphologically analysed for the presence of tumour cells. RESULTS: The analysis showed the presence of tumour cells in 65/88 cases (74%). When using an experimental anti-seeding device in a subset of patients viable tumour cells were found in 0/31 cases (P<0.001). In all 31 patients blood passing the skin orifice was sparse. No degrading effect on the cytological sample inside the needle was detected and pain caused by the RF pulses was comparable to that of the biopsy procedure itself. CONCLUSION: The herein presented method has the potential to prevent the dissemination of viable tumour cells in the needle track and minimize bleeding without additional pain or degradation of the aspirate.

[Relation of surgical results and proposed skull base meningioma grading system: analysis of clinical series with 42 patients].

UNLABELLED: Anatomical localisation of skull base meningioma link, their growth and relations with neurovascular structures reduce possibility for radical operation, and offten request additional preoperative or postoperative radiotherapy. We compared personal results of extent surgical resection and skull base meningioma treating outcome with predispose factors scale for surgical radicality and postoperative outcome. We present 42 patients, who were operated in Institute of neurosurgery CCS during the period from 2004 to 2006. RESULTS: Radical resection was possible in 29 cases, and in 13 cases reduction of tumor mass has been performed. Statistical significant predispose factor for radical resection were: absance of preoperative radiotherapy, intact functions of n.III, n.VI, tumor borders inside one skull base fossa and outside of magistral blood vessels. Karnofsky index at the end of following period statistical significant higher in patients with radical resection of skull base meningeioma. Preoperative radiological finding is singificant guide in planning of therapeutic protocol for skull base meningioma. Growth of tumor and relation with neurovascular structures restrict extent of resection and often request additional postoperative radiotherapy or reoperation.

Risk factors from brain tumors in children and adolescents: a case-control study in Belgrade, Serbia.

The objective of the present study was to test the different hypotheses about factors related to the occurrence of brain tumors in children and adolescents. The case-control study of brain tumors was conducted in Belgrade (Serbia) from 1998 through 2000. The study group consisted of 60 newly diagnosed brain tumor patients and the same number of hospital controls. In the analysis conditional univariate and multivariate logistic regression were applied. According to the final model of multivariate analysis the following factors were significantly related to brain tumors: schooling of father <14 years (OR = 11.05, 95% CI 2.41-50.63, P = 0.002), mothers - housewives or workers versus clerks (OR = 2.62, 95% CI 1.06-6.57, P = 0.036), number of brothers and sisters greater than one (OR = 3.02, 95% CI 1.50-7.22, P = 0.001), and more frequent presence of malignant diseases, including brain tumors, in family history (OR = 3.54, 95% CI 1.30-9.60, P = 0.001). This case-control study was made to investigate different factors of possible importance for brain tumors in children and adolescents. Lower family social status, and more frequent occurrence of malignant tumors amongst relatives seem to be the factors that contribute the most to the higher risk of brain tumors.

[Predictive factors for recurrent haemorrhagies in patients with brain cavernoma].

Haemorrhage is most important sequelae of brain cavernoma, so the surgical treatment is very important for treatment that complication. There are two types of bleeding chronic subclinical microhaemorrhage and acute real haemorrhage. Pathophysiological factors wich are responsible for bleeding are not still understanding. The reason for this study is understanding of clinical curse of cavernomas and identification of factors of influence. This is retrospective and prospective study. We analised 36 patients with simpthomatic brain cavernoma, surgicaly treated in Institute of neurosurgery KCS in 10 years period (1987-1997). Female were dominant but without statistical significance (p > 0.05). Male patients were older (32,1:29,8), but without statistical significance (p > 0.05). Almost 75% lesions were supratentorial, 25% infratentorial (p < 0.05). Focal neurological deficite (FND) was dominant clinical presentation in 52.8%. FND was dominant in 52.6% female, but without statistical singnificans (p > 0.05). Clinical presentation according the age was not statisticaly significant (p > 0.05). Clinical presentation was very diferent according the size of lesion (p < 0.001). FND as a sign of bleeding was in 57.9% supratentorial cavernomas and in 42.1% infratentorial (p < 0.005). More than 1/3 patients have recurent bleeding with 21 atack of haemorrhage or almost 2 atack per patient. We find that dominant predictive factors for recurent haemorrhages are localisation and size of lesion.

CNS tumours: oligoclonal immunoglobulin D in cerebrospinal fluid and serum.

Oligoclonal immunoglobulin D bands were detected by isoelectric focusing in 7 out of 25 unconcentrated cerebrospinal fluid (CSF) samples obtained from patients with tumours of the central nervous system (CNS). The tumours were confirmed by clinical and histological findings. Two patients with CNS malignancy had intrathecal synthesis of oligoclonal bands both IgD and IgG. Four patients with a variety of CNS tumours had a systemic IgD immune response but no oligoclonal IgG bands. One patient with the most malignant tumour histology had a systemic IgD response as well as local synthesis of IgG. The study reveals several new aspects regarding CNS tumours: they are immunologically active and are capable of invoking oligoclonal immunoglobulin production both within the CNS and systemically. Multiple immunoglobulin activation can be found in malignant CNS tumours, and systemic IgD production may occur independently from IgG synthesis and may represent an immune response to a neoantigen produced in the CNS compartment.

Computed tomography image analyzer: segmentation applying active contour models--"snakes".

Many diagnostic and therapeutic procedures depend on medical images. In order to overcome imperfections of obtained images which are due to acquisition process and to obtain new information from available images, many techniques have been developed. In this study relatively new method of image segmentation, active contour model--"snakes" was applied in analyzing computed tomography (CT) images in patients with acute head trauma. Using this method, lesion to brain (LBR) and ventricle to brain ratio (VBR) were obtained accurately. Quantitative variable LBR, is significantly higher in patients with other pathologic CT findings and who do not survive during hospitalization. Thus, by applying segmentation "snakes" model it is possible to extract maximum information from available CT scans. These variables could be basis for medical decision making in patients with acute head trauma.

Surgical treatment of craniopharyngiomas in children.

This paper sets out the surgical difficulties and the results of treatment in 50 cases of craniopharyngiomas in children up to the age of 13. During surgery, 10 patients were in a sub-comatose state, while 4 had respiratory arrest. Two-thirds of the children under 10 were given an A-V shunt implant. Radical excisions were attempted in 20 cases but were executed in only 13. Three of these died. Separation of the upper and posterior part of the capsule from the hypothalamus had to be interrupted in seven cases. The object of the operation was the radical removal of the capsule. We failed in one-third of our cases. Tumour excision is always attempted unilaterally. When this proves impossible, a second operation is undertaken on the opposite side when the hypothalamic disturbance subsides. If repeated surgery is indicated, it is always performed on the opposite side of the primary operation.

The electrocorticographic status and the extent of the cortical resection in epileptic patients.

In three patients operated on for focal epilepsy small pathological lesions in the functionally important cortical regions were microsurgically extirpated. The neighbouring areas of cortex were preseved, although they showed epileptic activity on electrocorticography. The patients are seizure-free three years, two years, and nineteen months later, respectively. On the bases of these facts and experience with another 35 patients operated on for focal epilepsy the authors speculate on the relations between the pathological lesion, epileptogenic cortical area, and the relative dependence of the extent of cortical resection on the electrocorticographic status.

[Elements in the objective evaluation of the carotid arteriogram]. / Elementi za objektivnu procenu karotidnog arteriograma.

The carotid angiography is widely used in our country, and has great importance even in those medical, neurosurgical, and neurotraumatic centers which employ the most advanced methods such as computerized tomography of the brain. To asure correct interpretation of a carotid arteriogram (thus making maximal use of such a tool) the interpreneur must have a more detailed knowledge of cephalic angiography. In the A--P picture the main elements are the infra and supraclinoid parts of the carotid, as well as the anterior and middle cerebral arteries and their branches. The authors describe these arteries and their anatomic peculiarities and changes to be expected in certain pathologic processes as illustrated by a new pictures. Of particular importance is the lateral carotid arteriogram whose changes allow diagnosis of expansive intracranial processes such as tumors and trauma.