Real-space and reciprocal-space Berry phases in the Hall effect of Mn(1-x)Fe(x)Si.

We report an experimental and computational study of the Hall effect in Mn(1-x)Fe(x)Si, as complemented by measurements in Mn(1-x)Co(x)Si, when helimagnetic order is suppressed under substitutional doping. For small x the anomalous Hall effect (AHE) and the topological Hall effect (THE) change sign. Under larger doping the AHE remains small and consistent with the magnetization, while the THE grows by over a factor of 10. Both the sign and the magnitude of the AHE and the THE are in excellent agreement with calculations based on density functional theory. Our study provides the long-sought material-specific microscopic justification that, while the AHE is due to the reciprocal-space Berry curvature, the THE originates in real-space Berry phases.

Formation of a topological non-Fermi liquid in MnSi.

Fermi liquid theory provides a remarkably powerful framework for the description of the conduction electrons in metals and their ordering phenomena, such as superconductivity, ferromagnetism, and spin- and charge-density-wave order. A different class of ordering phenomena of great interest concerns spin configurations that are topologically protected, that is, their topology can be destroyed only by forcing the average magnetization locally to zero. Examples of such configurations are hedgehogs (points at which all spins are either pointing inwards or outwards) and vortices. A central question concerns the nature of the metallic state in the presence of such topologically distinct spin textures. Here we report a high-pressure study of the metallic state at the border of the skyrmion lattice in MnSi, which represents a new form of magnetic order composed of topologically non-trivial vortices. When long-range magnetic order is suppressed under pressure, the key characteristic of the skyrmion lattice--that is, the topological Hall signal due to the emergent magnetic flux associated with the topological winding--is unaffected in sign or magnitude and becomes an important characteristic of the metallic state. The regime of the topological Hall signal in temperature, pressure and magnetic field coincides thereby with the exceptionally extended regime of a pronounced non-Fermi-liquid resistivity. The observation of this topological Hall signal in the regime of the NFL resistivity suggests empirically that spin correlations with non-trivial topological character may drive a breakdown of Fermi liquid theory in pure metals.

Hypericin for visualization of high grade gliomas: first clinical experience.

AIMS: We aimed to demonstrate that Hypericin, a component of St. Johns Wort, selectively visualizes malignant gliomas. Hypericin is known as one of the most powerful photosensitizers in nature with excellent fluorescent properties. METHODS: In five patients with a recurrence of a malignant glioma a newly developed water soluble formulation of hypericin was given intravenously (0.1 mg/kg body weight) 6 h before the surgical procedure. Tumor resection was performed under white light and fluorescence mode. The intensity grade of the tissue fluorescence was categorisized by the surgeon in three grades, highly fluorescent, weakly fluorescent and not fluorescent. In these areas tissue samples were taken and investigated by two blinded independent neuropathologists. Tissue samples were histologically classified differentiating between tumor tissue, tumor necrosis, tissue with scattered tumor cells and normal brain tissue. RESULTS: In all patients tumor tissue was clearly distinguishable by its typically red fluorescence color from normal brain tissue which was colored blue under a special fluorescent filter. Histological evaluation of the 110 tissue samples showed a specificity of 100% and sensitivity of 91% for one of the two neuropathologists, whereas specificity for second pathologist was 90% and sensitivity 94%. The i.v. application of Hypericin proofed to be safe in all cases and there were no side effects observed. CONCLUSION: Hypericin in its water soluble form is a well tolerated drug. In addition to its high photosensitizing properties hypericin will open up interesting new therapeutic possibilities especially when used in combination with fluorescence detection and simultaneously photodynamic therapy.

Spinal pilocytic astrocytoma: MR imaging findings at first presentation and following surgery.

OBJECTIVE: The objective of this article is to describe MR imaging findings of spinal cord pilocytic astrocytomas at first presentation and following neurosurgery and to discuss briefly some of the most common differential diagnoses. CONCLUSION: MR imaging findings in medullary pilocytic astrocytomas consist generally of focal or diffuse cord-enlarging masses that are irregularly shaped, accompanied by cystic elements and hydromyelia, present different degrees of contrast enhancement, high water diffusivity and a propensity for the thoracic and cervical cord.

Intracranial hemangiomas in a patient with POEMS syndrome.

POEMS syndrome is a rare multi-system disease with typical features of polyneuropathy, organomegaly, endocrinopathy, monoclonal plasmaproliferative disorder and skin changes. We describe a 44-year-old woman with polyneuropathy, hepatomegaly, IgA lambda-plasmacytoma, thrombocytosis, papilledema with elevated protein levels in cerebrospinal fluid and multiple cutaneous hemangiomas who was diagnosed with three intracranial lesions. Histology revealed capillary hemangiomas, one of them displaying partially glomeruloid features.

Skyrmion lattices in metallic and semiconducting B20 transition metal compounds.

High pressure studies in MnSi suggest the existence of a non-Fermi liquid state without quantum criticality. The observation of partial magnetic order in a small pocket of the pressure versus temperature phase diagram of MnSi has additionally inspired several proposals of complex spin textures in chiral magnets. We used neutron scattering to observe the formation of a two-dimensional lattice of skyrmion lines, a type of magnetic vortices, under applied magnetic fields in metallic and semiconducting B20 compounds. In strongly disordered systems the skyrmion lattice is hysteretic and extends over a large temperature range. Our study experimentally establishes magnetic materials lacking inversion symmetry as an arena for new forms of spin order composed of topologically stable spin textures.

Topological Hall effect in the A phase of MnSi.

Recent small angle neutron scattering suggests that the spin structure in the A phase of MnSi is a so-called triple-Q state, i.e., a superposition of three helices under 120 degrees. Model calculations indicate that this structure in fact is a lattice of so-called Skyrmions, i.e., a lattice of topologically stable knots in the spin structure. We report a distinct additional contribution to the Hall effect in the temperature and magnetic field range of the proposed Skyrmion lattice, where such a contribution is neither seen nor expected for a normal helical state. Our Hall effect measurements constitute a direct observation of a topologically quantized Berry phase that identifies the spin structure seen in neutron scattering as the proposed Skyrmion lattice.

Quantum order in the chiral magnet MnSi.

Systems lacking inversion symmetry, such as selected three-dimensional compounds, multilayers and surfaces support Dzyaloshinsky-Moriya (DM) spin-orbit interactions. In recent years DM interactions have attracted great interest, because they may stabilize magnetic structures with a unique chirality and non-trivial topology. The inherent coupling between the various properties provided by DM interactions is potentially relevant for a variety of applications including, for instance, multiferroic and spintronic devices. The, perhaps, most extensively studied material in which DM interactions are important is the cubic B20 compound MnSi. We review the magnetic field and pressure dependence of the magnetic properties of MnSi. At ambient pressure this material displays helical order. Under hydrostatic pressure a non-Fermi liquid state emerges, where a partial magnetic order, reminiscent of liquid crystals, is observed in a small pocket. Recent experiments strongly suggest that the non-Fermi liquid state is not due to quantum criticality. Instead it may be the signature of spin textures and spin excitations with a non-trivial topology.

Spinal cord compression through extraosseous extension of a vertebral low-grade hemangioendothelioma with histiocytoid differentiation.

Herein, we report the case of a 47-year-old man clinically presenting a slow progressive loss of lower extremity functions within 8 weeks followed by an acute neurogenic bladder dysfunction. The patient exhibited high-grade paralysis of both legs with reduced sensation from dermatome Th11 downwards as well as marked spasticity of the lower extremity. Neuroradiological examinations revealed a protruding spinal tumor with extraosseous-intraspinal extension. The resected tumor mass exhibited a highly vascularized tumor with architectural complexity and high cellularity finally leading to the diagnosis of a hemangioendothelioma. Interesting was the fact that the tumor vasculature exhibited many CD68-positive cells protruding into the lumen and, therefore, being part of a partially histiocytoid differentiation which is all the more uncommon in hemangioendothelioma. The time frame of 3 hours between embolization and tumor resection is too short to explain a monocytic intravascular reaction. Usually, hemangioendotheliomas arise from the soft tissue, lungs or liver, but intraspinal manifestations are only rarely observed. Furthermore, the clinical course with a progressive development of a paraparesis due to a hemangioendothelioma is very uncommon.

Primary anaplastic ganglioglioma with a small-cell glioblastoma component.

Gangliogliomas usually present as benign tumors corresponding to World Health Organization (WHO) Grade I. Very rarely, gangliogliomas show histological features of malignancy and are then classified as anaplastic gangliogliomas of WHO Grade III or IV. In most cases, anaplastic gangliogliomas developed after radiation therapy or progression from a pre-existing low-grade ganglioglioma. Here, we report the case of a 77-year-old male patient who was operated on a primary ganglioglioma with a highly anaplastic glial component corresponding to a small-cell glioblastoma. To our knowledge, this is the first reported case of a primary anaplastic ganglioglioma with a small-cell glioblastoma component.

Hypericin uptake: a prognostic marker for survival in high-grade glioma.

Currently adjuvant chemotherapy for glioblastoma patients can prolong survival time relative to patients who receive only surgery and radiotherapy. Despite these improvements and experimental and clinical efforts the prognosis for glioblastoma patients remains poor. At present, interest is focused on individual prognostic factors influencing patient responses to therapy. Photodynamic therapy may be a promising therapeutic option in the treatment of glioblastoma. In this investigation we examined whether uptake of hypericin (HY), a fluorescent photosensitization agent, by ex vivo glioblastoma cell lines correlates with prognosis of the individual from which the cell lines were derived. Twelve primary human glioma cell cultures were incubated with 20 micromol HY. Fluorescence intensity was measured using fluorescence microscopy. Three patients suffered from an anaplastic astrocytoma, WHO grade III, nine had a glioblastoma, WHO grade IV. In 6/12 patients complete tumour resection was possible. The mean survival time of the six patients in whom complete tumour resection was performed was 26 months, compared with 5 months for those who underwent incomplete resection. Eleven patients received radiation therapy. The five patients who received chemotherapy survived for a mean duration of 26 months, compared with the seven patients who survived for a mean duration of 5 months without chemotherapy. Statistical analysis using a parametric survival model based on the Weibull distribution showed that fluorescence intensity was the variable with the lowest p-value associated with survival (p=0.0225). An increase of 553 arbitrary units of fluorescence intensity is predicted to double survival time. Uptake of HY, a lipophilic molecule, is assumed to be related to low-density lipoprotein (LDL) uptake and metabolism. Cell proliferation is associated with a high turnover of cholesterol and membrane growth, which is related to cholesterol uptake by LDL. In summary, HY uptake by ex vivo glioblastoma cell cultures seems to be positively associated with survival of patients with malignant glioma.

Management of skull based meningiomas in the elderly patient.

BACKGROUND: The demographic evolution of Western society together with availability of modern imaging techniques leads to an increasing diagnosis of meningioma patients over 70 years of age. This raises the question of appropriate management of this histologically benign tumour in a geriatric population. DESIGN: Forty-three patients aged over 70 years were analyzed and matched in a retrospective study with a younger group of 89 patients according to tumour size, histology, symptoms, recurrence and presence of neurofibromatosis II. RESULTS: Changes in postoperative Karnofsky scores were not statistically different between the two age groups. Neurological outcome was worse among the younger group (12% vs. 7% deterioration). Regarding surgical complications we noted only a statistically significant higher infection rate in the geriatric age group. There was no peri-operative mortality. CONCLUSIONS: Age alone is not a criterion to deny a priori skull base surgery, since well selected geriatric patients may benefit from a meningioma operation that may enhance future quality of life.

[Coma. The prognostic value of evoked potentials in patients after traumatic brain injury]. / Koma. Prognostische Wertigkeit evozierter Potentiale bei Patienten nach schwerem Schädel-Hirn-Trauma.

BACKGROUND: The prognosis after traumatic coma is often unclear. We investigated the prognostic value of somatosensory (SSEP) and early acoustic (EAEP) evoked potentials on comatose patients in the intensive care unit regarding long-term outcome. Different evaluation systems were investigated. METHODS: This was a retrospective analysis of 100 patients. SSEP and EAEP were examined at different times and analysed according to the Riffel score. Combinations of the different types of potentials were evaluated regarding possible improvement of outcome prediction. RESULTS: The positive predictive value of at least one missing peak V of the EAEP regarding a fatal prognosis was 83%. The negative predictive value of the EAEP was 96%. A good outcome (GOS 4+5) could be predicted by bilateral normal SSEP and EAEP with a positive predictive value of 98%. CONCLUSIONS: Early evaluation of SSEP and EAEP allows reliable prognostic predictions regarding a later outcome in patients with severe traumatic brain injury and should therefore be used more often for intensive care patients.

Recurrence and increased proliferation rate of a solitary fibrous tumor in the central nervous system--case report and review of the literature.

Meningeal solitary fibrous tumors (SFTs) were at first estimated as rare benign tumors which can be cured by total resection. To date, only 37 patients with intracranial SFTs have been reported. Therefore, the natural history of this tumor entity needs more enlightenment. The authors report a case of a 77-year-old female in whom a SFT with infiltration of the transversal sinus was subtotally resected. After a short time, interval tumor recurrence was seen, 2 years and 6 months later second surgery was performed. Immunohistologically, in both specimens typical features for SFT with positivity for CD34, vimentin and BCL-2 and negative for epithelial membrane antigen was seen. No signs for malignancy occurred in the second resection. Notably the MIB-1 index increased from 1 to 5%. In conclusion, consequent long-time follow-up for SFTs are necessary, especially after incomplete tumor resection.

Extraventricular neurocytoma presenting with intratumoral hemorrhage.

A case of extraventricular neurocytoma with spontaneous intratumoral hemorrhage is reported. A 47-year-old man presented with sudden left-sided hemiparesis. Magnetic resonance imaging revealed a right parietal subcortical mass with intratumoral hemorrhagic transformation and without contact to the ventricular system. After complete microsurgical removal, the tumor was histologically diagnosed as neurocytoma. Usually, the term "central neurocytoma" is restricted to neurocytic neoplasms arising within the cerebral ventricles. In the majority of the cases, these slow-growing, generally circumscribed lesions become symptomatic by obstructive hydrocephalus. Hemorrhagic onset is sporadically reported in the literature. In contrast to central neurocytomas, neurocytic lesions located within the brain parenchyma, so-called "extraventricular neurocytomas" are very uncommon. To the knowledge of the authors, this is the first case of an extraventricular neurocytoma with histological classic features presenting with intratumoral hemorrhage in adults.

Combined therapy of cerebral arteriovenous malformations: histological differences between a non-adhesive liquid embolic agent and n-butyl 2-cyanoacrylate (NBCA).

OBJECTIVE: Based on 2 casuistics, the intraoperative qualities of a new, non-adhesive liquid embolic agent (Onyx, Micro Therapeutics. Inc., Irvine, CA, USA) are to be compared to those of n-butyl 2-cyanoacrylate (NBCA) with regard to the histopathological results after preoperative embolization of a cerebral arteriovenous malformation (AVM). PATIENTS AND METHODS: In a case example, the intraoperative quality of the nidus after embolization of a parieto-occipital AVM with Onyx--a new, non-adhesive liquid embolic agent--consisting of ethylene-vinyl alcohol copolymer (EVOH), dimethyl sulfoxide (DMSO) and tantalum, is described. In the second patient, embolization of a frontal high-flow AVM was performed with NBCA. Both patients underwent surgery with complete resection ofthe AVM. RESULTS: From a neurosurgical point of view, Onyx is suitable for preoperative embolization of AVMs, because the nidus intraoperatively remains elastic and formable and can be dissected from the surrounding brain tissue quite well by microsurgical technique. Inflammatory reactions can be found mainly in the lumina of the vessels. CONCLUSIONS: Onyx promises to be an embolic agent well suitable for subsequent neurosurgical resection. Further studies considering various intervals of time between embolization and resection as well as histopathological and electron microscopical examinations are necessary for evaluation of our first experience with this new embolization agent.

Cardiovascular indices of peripheral and central sympathetic activation.

OBJECTIVE: A number of sympathetic nervous system (SNS) parameters have been used in cardiovascular psychophysiology. This study aimed to describe the pattern and redundancy of a set of SNS parameters during peripherally induced changes of cardiac sympathetic activation and reflex modulation of central SNS control. Preejection period (PEP) was assessed as a marker of peripheral sympathetic activation. Low-frequency blood pressure variability (BPV) was assessed as an estimate of central SNS control. METHODS: Peripheral beta-sympathetic stimulation and blockade were achieved with epinephrine and esmolol hydrochloride (beta1-blockade), respectively. Changes in central SNS output were induced by loading and unloading arterial baroreceptors with norepinephrine and nitroprusside sodium, respectively. This single-blinded, crossover study in 24 healthy men also included two placebo control periods. PEP was derived from impedance cardiography and adjusted individually for heart rate. BPV was calculated by power spectral analyses of beat-to-beat heart rate and systolic blood pressure (Finapres system) data. RESULTS: PEP decreased during epinephrine infusion (-40.1 +/- 3.8 ms, p <.0001) and increased during esmolol infusion (+6.6 +/- 3.5 ms, p =.05). PEP was shortened after central SNS activation by nitroprusside (-16.8 +/- 2.9 ms, p < 0.0001). Systolic BPV in the low-frequency range (0.07-0.14 Hz, Mayer waves) increased during nitroprusside infusion (+0.44 +/- 0.19 ln mm Hg(2), p =.03) and decreased during norepinephrine infusion (-0.67 +/- 0.13 ln mm Hg(2), p < 0.0001). Low-frequency BPV did not change significantly during epinephrine or esmolol infusion. CONCLUSIONS: Our data provide empirical evidence of separable peripheral and central sympathetic response components. The combined report of low-frequency BPV and PEP gives distinct information on both central SNS control and the level of sympathetic cardiac activation achieved.

Chest pain early after percutaneous coronary intervention: incidence and relation to ECG changes, cardiac enzymes and follow-up events.

To investigate the incidence of chest pain early after percutaneous coronary interventions and its correlation with ECG changes, cardiac enzymes, clinical and procedural variables and follow-up events, we prospectively studied 199 patients (84% male; mean age, 60.1 +/- 9.4 years) after primary successful percutaneous coronary interventions (21% PTCA; 79% additional stent implantation). During the first 16 hours following the intervention, the occurrence of chest pain was noted, ECGs were recorded and serial measurements of cardiac enzymes were performed. Seventy-six patients (38%) with elevated enzyme levels at time 0 were excluded. A clinical follow-up was obtained at 6 months. Forty patients (32.5%) experienced chest pain; new ECG changes were detected in 3 (2.5%). The mean levels of all enzymes were significantly higher in patients with chest pain 16 hours after the intervention. In patients with chest pain versus those without, CK-MB mass and troponin I levels higher than twice the upper normal limit were seen in 43.6% versus 11.0% (p < 0.0001) and 45.0% versus 17.3% (p < 0.002), respectively. Elevated troponin I (< 0.004) and CK-MB mass (< 0.04) as well as presumed ischemic chest pain (< 0.03) could be identified as risk factors for recurrent chest pain during follow-up. In conclusion, chest pain was common early after percutaneous coronary interventions and correlated with elevated cardiac enzymes, suggesting peri-interventional myocardial necrosis. Elevated levels of CK-MB mass and troponin I, as well as presumed ischemic chest pain, were associated with recurrent chest pain during follow-up.