Medications used to treat Parkinson's disease and the risk of gambling.

Recent case-series studies indicated that a medication used to treat Parkinson's disease (PD), in particular Pramipexole, is associated with gambling. A case-series study cannot test this hypothesis; therefore, we need to design a case-control or cohort study to test the aforementioned hypothesis. Typical of a case-control design, we sampled on the dependent variable, which we defined as incident gambling in PD. A research neurologist, who was kept uninformed of the case-control status, retrospectively measured the exposure of interest (i.e. medications used to treat PD) by using the medical database system of Mayo Clinic Jacksonville. Eleven patients with PD without history of gambling, but had newly developed gambling, were matched by age and sex to the control group of 37 PD patients without gambling at a ratio of one case to at least three controls. Disease duration, age, and sex did not differ between cases and controls. Combined therapy with Pramipexole and levodopa did not increase the risk of gambling as compared to monotherapy with Pramipexole (OR, 0.15; 95% CI, 0.01-1.26). Treatment with Pramipexole was associated with increased risk of gambling and this association approached significance (OR, 3.6; 95% CI, 0.9-14.9). Patients with PD who newly developed gambling behavior were more likely to have been taking Pramipexole than other anti-PD medication. However, the association between Pramipexole and gambling behavior is not necessarily etiologic.

Mitochondrial DNA phylogeography of the polytypic North American rat snake (Elaphe obsoleta): a critique of the subspecies concept.

Subspecies have been considered artificial subdivisions of species, pattern classes, or incipient species. However, with more data and modern phylogenetic techniques, some subspecies may be found to represent true species. Mitochondrial DNA analysis of the polytypic snake, Elaphe obsoleta, yields well-supported clades that do not conform to any of the currently accepted subspecies. Complete nucleotide sequences of the cytochrome b gene and the mitochondrial control region produced robust maximum-parsimony and maximum-likelihood trees that do not differ statistically. Both trees were significantly shorter than a most parsimonious tree in which each subspecies was constrained to be monophyletic. Thus, the subspecies of E. obsoleta do not represent distinct genetic lineages. Instead, the evidence points to three well-supported mitochondrial DNA clades confined to particular geographic areas in the eastern United States. This research underscores the potential problems of recognizing subspecies based on one or a few characters.

Smear technique in the intra-operative brain tumor diagnosis: its advantages and limitations.

The role of intra-operative pathological diagnosis increases along with a development of minimally invasive neurosurgery, especially stereotactic and endoscopic techniques. The authors present their own experience with the cytological method and evaluate its usefulness in intra-operative diagnosis of brain tumors. Brain tumor biopsy specimens obtained during craniotomy from 217 patients were examined. The cytological preparations (smears) were stained with 1% toluidin blue and/or with May-Grünwald-Giemsa stain. In 199 cases (92%) the cytological diagnosis was consistent with the histopathological one. A 99% sensitivity and 69% specificity were obtained. The histogenesis of gliomas was correctly established in 90% and their grade in 73% of cases. The most frequent diagnostic errors were: undergrading of gliomas (20), incorrect assessment of their histogenesis (10), diagnosis of low grade astrocytoma in a case of gliosis (3) and diagnosis of glioblastoma multiforme instead of metastatic carcinoma (2 cases). The most important advantages of cytological examination are rapidity, simplicity and relatively high diagnostic efficacy. Even very tiny specimens, especially of soft consistency are suitable for this technique, which is extremely important in operations of brain tumors localized in functionally important brain areas. In the authors' opinion this method still merits wider popularization in neurosurgical centers.

Effect of endothelin-1 receptor antagonist BQ-123 on basilar artery diameter after subarachnoid hemorrhage (SAH) in rats.

Aim of the study was to quantify cerebral vasospasm in rats after subarachnoid hemorrhage (SAH) by morphometric examination of basilar artery and to evaluate the influence of endothelin receptor blocker BQ-123 on basilar artery constriction. The rat cisterna magna (CM) was cannulated and after 7 days SAH was developed by administration of 100 microl autologic, non-heparinized blood to the CM. The sham subarachnoid hemorrhage was developed by intracisternal administration of 100 microl of artificial cerebrospinal fluid. Endothelin receptor blocker BQ-123 was injected into the CM in a dose of 40 nmol diluted in 50 microl of cerebrospinal fluid 20 min. before SAH, and 24h and 48 h after SAH. After perfusion fixation the brains were removed from the skull and histological preparations of basilar artery were done. The internal diameter and wall thickness of basilar arteries was measured by interactive morphometric method. The most severe vasospasm was found in rats after SAH. The presence of numerous infiltrations composed of neutrophils and macrophages correlated with advanced vasospasm (index of constriction 5 times lower than in normal), suggesting the role of other factors participating in the late phase of vasospasms after SAH. Administration of BQ-123 in the late phase after SAH caused the dilatation of basilar artery. Following the administration of BQ-123 in the late phase (48 h after SAH) the basilar artery dilated, its wall became thinner, and the number of leukocyte infiltrations in the subarachnoid space decreased compared to the values after SAH alone.

Cerebral angiogenesis after subarachnoid hemorrhage (SAH) and endothelin receptor blockage with BQ-123 antagonist in rats.

The aim of the study was to determine the effect of chronic vasospasm after SAH on angiogenesis and the effect of endothelin-1, the main causative factor in vasospasm, on this process. Male Wistar rats, 220-250 g, were examined. Seven days after cannulation of the cisterna magna (CM), a 100 microl dose of non-heparinized blood was administered to induce SAH. Sham SAH (aSAH) was induced by intracisternal injection of 100 microl of artificial cerebrospinal fluid. Endothelin receptor antagonist BQ-123 in a dose of 40 nmol in 50 microl of cerebrospinal fluid was given three times: 20 min. before SAH and aSAH, 60 min and 24 hours after SAH and aSAH. The same pattern of BQ-123 administration was used in the nonSAH group. The brains were removed 48 hours later for histological evaluation. Vascular surface density was measured in cerebral hemisphere sections (at the level of the dorsal part of the hippocampus) and brain stem sections (1/2 of the pons). An increase in angiogenesis was observed after SAH, compared to control values. The administration of BQ-123, a specific endothelin receptor blocker inhibits angiogenesis in cerebral hemispheres after SAH.

Paraneoplastic syndrome simulating encephalitis in the course of testicular seminoma.

A case of paraneoplastic syndrome diagnosed post mortem in a 68-year-old man with a single submandibular lymphatic metastasis of testicular seminoma is presented. The syndrome developed 3 years after orchidectomy and clinically combined the features of limbic and bulbar encephalitis together with signs of cerebellar degeneration. Histological examination revealed marked loss of cerebellar Purkinje and granular cells and to a lesser extent of cerebral cortical neurons. Additionally axonal injury (spheroids) and multifocal demyelination with sparse lymphocytic infiltrations was observed. Immunohistochemically, strong reaction with monoclonal anti-human IgG in some neurons of cerebellum was detected whereas the reaction with anti-complement (C3b) receptor in corresponding sections was negative. It is suggested that the presented case may represent a "burn out" stage of paraneoplastic syndrome associated with anti-neuronal antibodies, however the isolation of specific antibodies was not performed.

Expression of adhesion molecule CD44 in metastatic brain tumors.

Expression of CD44 (m.w. 80-95 kD) in 48 metastatic brain tumors was examined using monoclonal antibody on paraffin sections. The CD44 expression was found in 48% of studied tumors. The most constant expression of CD44 was observed in metastases from thyroid, skin and breast cancer. The brain metastases were characterized by quite heterogenous distribution of CD44 glycoprotein--the most pronounced expression was seen in individual neoplastic cells embedded in abundant stroma and in the vicinity of preserved neural tissue. Such a topographical distribution of CD44 supports its role in interactions of cancer cells with extracellular matrix components of the tumor stroma as well as of neural tissue.

Sarcomatosis of leptomeninges, brain and spinal cord coexisting with von Recklinghausen's neurofibromatosis. A case report and review of the literature.

A case of 56-year-old male with sarcomatosis of leptomeninges as well as of the brain and spinal cord coexisting with Recklinghausen's neurofibromatosis is presented. Neurological and neurophysiological symptoms of the disease resembled those of amyotrophic lateral sclerosis (ALS). Patient died 7 months after onset of the initial symptoms. The post-mortem examination revealed neoplastic infiltration of the leptomeninges of brain and spinal cord. Histologically sarcomatosis of the leptomeninges was diagnosed and immunohistochemical analysis of the neoplastic infiltrates can indicate fibrohistiocytic origin of the neoplasm, suggesting also a probable contribution of perineurial cells in the pathogenesis of the tumor. On the grounds of the performed immunohistochemical study together with a review of the literature, the differential diagnosis of malignant mesenchymal tumors of the CNS is discussed with a special regard to their histogenesis.

BCL2 and BAX mRNA concentration profile in fibrillary astrocytoma.

A high level of the BCL2 protein and the lack of apoptosis promoting protein BAX are beginning to be treated as markers of cellular resistance to anti-neoplastic drugs. The object of the study were specimens from stereotactic biopsy of Astrocytoma fibrillare in the central brain area, inaccessible to conventional surgery. The cytological preparations have been evaluated with histopathological and immunohistochemical methods in order to determine the origin of the tumour and assess cell proliferation activity. The molecular analysis conducted in order to determine the sensitivity of the tumour to radio- or chemotherapy included the determination of the number of mRNA BCL2 alpha and beta molecules and of BAX in 1 microg total RNA obtained from microscope slides. A higher expression of BAX than of BCL2-alpha is a prognosis for a positive result of chemo- or radiotherapy. A trace number of mRNA BCL2-beta molecules and a smaller number of mRNA BCL2-alpha molecules than mRNA BAX is a good prognosis for therapy.

Secretory meningioma of the brain. Report of two cases.

Two cases of cerebral secretory meningioma, occurring in 57 and 33-year-old females are reported. The tumors were located in the tentorial and frontotemporal region, respectively. The general histologic appearance of the tumors was of meningothelial meningioma (case 1) and meningioma with microcystic and angiomatous features (case 2). The most striking histological finding in both tumors were numerous pseudopsammoma bodies, localized chiefly around blood vessels. The inclusions were slightly eosinophilic, stained strongly with PAS method and were differing in size from 3 to 30 microns. Tumor cells containing or surrounding pseudopsammomas were immunopositive for cytokeratin and epithelial membrane antigen. In the first case, individual pseudopsammomas were strongly positive for carcinoembryonic antigen. Some diagnostic aspects of this antigen and problems regarding differential diagnosis in secretory meningioma are briefly discussed.

Expression of vascular endothelial growth factor (VEGF) in rat brain after subarachnoid haemorrhage and endothelin receptor blockage with BQ-123.

Cerebral vasospasm is one of the most severe complications of subarachnoid haemorrhage (SAH), leading to pathological changes in the vessel wall itself and in the nervous tissue, due to ischaemia of endothelial cells and neurones. Amongst the known substances inducing vasospasm, the most potent spasmogenic effect is exerted by endothelin-1 (ET1). The constriction of cerebral arteries and obliteration of capillaries highly stimulates the secretion of growth factors by endothelial cells and induces compensatory formation of collateral circulation in response to brain ischaemia. Expression of vascular endothelial growth factor (VEGF), the main factor responsible for angiogenesis and vascular permeability, was found to be increased in hypoxic cells (irrespective of the cause of hypoxia) as well as in neoplastic cells in the brain. The aim of the study was to determine whether chronic vasospasm and hypoxia of endothelial cells stimulate expression of VEGF, and whether blockage of the endothelin receptor ET(A) reduces this expression. The SAH was induced experimentally in male Wistar rats and the ET(A) receptor antagonist--BQ-123 was administered into the cisterna magna. After 48 hours the brain was removed and expression of VEGF studied immunohistochemically on paraffin sections. We found that hypoxia of endothelial cells, induced by chronic vasospasm after SAH, caused increased expression of VEGF in brain vessels and neurones of the cerebral hemispheres, brain stem and cerebellum. After administration of the endothelin receptor antagonist BQ-123, no changes in VEGF expression in the brain were found.

[A case of aneurysmal bone cyst of orbit roof in a boy aged 14]. / Przypadek torbieli tetniakowatej kosci stropu oczodolu u 14-letniego chlopca.

A case of a very rare localisation of aneurysmal bone cyst within orbital roof is presented. The peculiar site of the pathological process caused two-way expansion, i.e. towards the orbit and the cranial cavity. The patient was operated on using the transcranial approach and total cure was obtained.

[A case of hemorrhagic cerebral abscess with sudden clinical onset]. / Przypadek ukrwotocznionego ropnia mózgu o udarowym przebiegu klinicznym.

A rare case with unfavourable clinical course of haemorrhagic cerebral abscess in the parietal region is presented. Attention is drawn to diagnostic difficulties in cerebral abscesses with non-typical radiological and clinical picture as well as putative mechanisms responsible for haemorrhage within abscess are discussed.

[Multiple spinal meningeal cysts in the thoracic region associated with lymphedema of the legs (Milroy's disease)]. / Mnogie torbiele nadoponowe w odcinku piersiowym kregoslupa wspólistniejace z zespolem obrzeku limfatycznego konczyn dolnych (choroba Milroya).

Intraspinal extradural meningeal cysts are uncommon cause of spinal compression. Either the classification or the etiopathology of these changes are indistinct in the literature. A rare case of multiple extradural meningeal cysts associated with lymphedema of the legs is presented. The total surgical removal was followed by the quick neurological improvement. Some etiological, diagnostic and therapeutic aspects of these pathologies have been discussed.

[Cerebral ischemia in young patients]. / Zespól niedokrwienny mózgu u ludzi mlodych.

The clinical, angiographic and computed tomography (CT) examinations of 19 patients aged from 12 to 30 years with signs of ischaemic brain syndrome are presented. On the basis of these examinations and data obtained from literature it is supposed that in a majority of patients the disease is caused by basal arteriopathies + i.e. pathological changes in the wall of cerebral arteries, mainly of the circulus Willis. The features distinguishing this syndrome from ischaemic disease in adults are presented and discussed. These are first of all: sudden onset connected with physical effort, deep neurological deficit, narrowing or occlusion of basal cerebral arteries seen in angiography and signs of ischaemia within deep cerebral structures visible in CT. The methods of treatment are discussed, mainly STA-MCA anastomosis used in most cases. The results of treatment are discussed. Finally the problem of the cerebral ischaemic syndrome in young people is presented from the point of view of haemodynamics, principally in the aspect of haemodynamic reserve of cerebral blood flow.

[The study of the role of intervertebral disc neovascularization and immune response in the pathogenesis of lumbar discopathy]. / Badanie roli neowaskularyzacji krazka miedzykregowego oraz odf1wiedzi immunologicznej w patogenezie dyskopatii ledzwiowej.

In adult humans moral intervertebral disc (id) is an avascular tissue and becomes so called sequestrated autoantigen. Any acquired defect of anulus fibrosus may potentially lead to contact of immunocompetent cells circulating in the blood with id antigens thus inducing autoimmune reaction. 34 patients operated on because of lumbar discopathy were studied. The id injury was divided into: a) protrusion, B) simple prolapse, c) subligamentous prolapse, d) sequester. The samples of surgically removed id were subjected to histopathological and immunohistochemical study. Presence of granulation tissue, neovascularization and humoral response (confirmed by immunopositive reaction to factor VIII and IgG) was found in decreasing pattern in the following groups: I) sequesters, 2) simple prolapses, and 3) subligamentous prolapses. Among protrusions there were only two cases positive for IgG. A negative reaction to C3bR was seen in all the groups of id. The obtained results suggest that immune reaction against lumbar id is rather an effect than a cause of its herniation.

Phylogeny of the Colubroidea (Serpentes): new evidence from mitochondrial and nuclear genes.

The Colubroidea contains over 85% of all the extant species of snakes and is recognized as monophyletic based on morphological and molecular data. Using DNA sequences (cyt b, c-mos) from 100 species we inferred the phylogeny of colubroids with special reference to the largest family, the Colubridae. Tree inference was obtained using Bayesian, likelihood, and parsimony methods. All analyses produced five major groups, the Pareatidae, Viperidae, Homalopsidae, the Elapidae, and the Colubridae. The specific content of the latter two groups has been altered to accommodate evolutionary history and to yield a more stable taxonomy. We propose an updated classification based on the reallocation of species as indicated by our inferred phylogeny.

Multimodal sex therapy for the treatment of vulvodynia: a clinician's view.

Sex therapists are often challenged when treating women with the primary diagnosis of vulvodynia or subtypes of vulvar-vestibular pain. This article presents an overview of how a sex therapist can assess problem areas related to this diagnosis and approach treatment in a practical and comprehensive fashion. What follows is based on anecdotal clinical experience of the author. It outlines a multimodal approach that includes cognitive-behavioral techniques, both individual and conjoint therapy, as well as close cooperation with physicians who provide concurrent medical management.