Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology.

PURPOSE: The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities. METHODS: The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies. RESULTS: The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies. CONCLUSION: The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

Production of hyperpolarized H_{2} molecules from H[over →] atoms in gas-storage cells.

The preservation of the nuclear polarization of hydrogen atoms during the recombination to molecules was observed on different surface materials in the temperature range from 45 to 100 K and for magnetic fields up to 1 T. On a gold and a fused quartz surface, the expected molecular polarization of about 50% or lower of the atomic polarization was measured, while a surface layer of perfluoropolyether (Fomblin) shows a nearly complete preservation (at least 97%) of the atomic polarization during the recombination process. Further experiments have the possibility of storing polarized deuterium molecules and to use them in nuclear-fusion installations. Another application might be the production of polarized substances for enhanced NMR techniques.

Determination of erythromycin and related substances in enteric-coated tablet formulations by reversed-phase liquid chromatography.

An isocratic method for the identification and quantitation of erythromycin and related substances in enteric-coated tablet formulations using high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection at 205 nm is described. A novel method for sample preparation using a molecular weight centrifuge filter to reduce the interferences observed from polymeric tablet coating material is also presented. Erythromycin HPLC assays are best run at high pH; therefore, various polymer columns were evaluated. The resulting HPLC method that was developed has several advantages over current pharmacopeial assay methods for enteric-coated erythromycin tablets. Comparative data from both methods for the same batch of EryTab tablets are presented. The method can also be applied to various other erythromycin formulations, including particle-coated tablets, erythromycin stearate tablets, and erythromycin ethylsuccinate suspensions and fermentation broths. A C18 Polymeric column is used with a mobile phase composition of 0.02 M potassium phosphate dibasic buffer (pH 9): acetonitrile (60:40) and flow rate of 1 mL/min. This method is more sensitive, specific, and rugged than the pharmacopeial method.

Castration increases and androgens decrease nitric oxide synthase activity in the brain: physiologic implications.

Sex differences in nitric oxide synthase (NOS) activity in different regions of the rat brain and effects of testosterone and dihydrotestosterone (DHT) treatment in orchidectomized animals were investigated. Regional but no sex differences in NOS activity were detected in gonadectomized animals. Orchidectomy significantly increased NOS activity in the hypothalamus, "amygdala," and cerebellum but not in the cortex. In the hypothalamus, the increase in NOS activity after castration and its reversal by androgen treatment was mimicked by changes in neuronal NOS mRNA level. In contrast, androgen receptor (AR) mRNA level in the hypothalamus was slightly reduced by castration and increased by treatment with DHT. Again in the hypothalamus, the increase in NOS activity in castrated rats was accompanied by an increase in the number of neuronal NOS+ cells determined immunohistochemically, whereas androgen treatment prevented this increase. The changes in NOS+ neurons correlated with the changes in the number of AR+ cells to a degree. Overlap of AR in NOS+ cells was not present in the regions of the hypothalamus analyzed. These results indicate that testosterone or, most likely, its metabolite DHT down-regulates NOS activity, mRNA expression or stabilization, and the number of neuronal NOS+ neurons.

Influence of intraoperative using of recombinant tissue plasminogen activator on the development of cerebral angiospasm after subarachnoid haemorrhage in patients with ruptured intracranial aneurysms.

For a few years conducted experimental studies and clinical trials set one's hopes on the role of the fibrynolytic treatment using recombinant tissue plasminogen activator (rt-PA) in preventing cerebral vasospasm. In our study the target population was 45 patients with ruptured saccular aneurysms causing severe SAH. In the group of 24 patients treatment consisted of a single intraoperative injection of 10 mg of rt-PA into the opened basal subarachnoid cisterns following aneurysm clipping. The patients underwent surgery with aneurysm clipping within 72 hours from subarachnoid haemorrhage in all patients. Control group of 21 patients underwent early operation after SAH and rt-PA was not given. All patients had significant basal cistern blood accumulation seen on CT scans preoperatively according to Fisher's grade III. Patients in our study were classified in clinical grade I and II according to classification of Hunt/Hess. Transcranial Doppler Daily examinations in postoperative course were performed in all patients. The postoperative results were evaluated according to Glasgow Outcome Scale. Postoperatively patients were evaluated by daily transcranial Doppler and serial CT scans. TCD demonstrated reduction in the development of vasospasm to a greater degree in the rt-PA treated group. Serial CT examinations demonstrated radical blood clot removal in all rt-PA treated patients. The postoperative results according to the Glasgow Outcome Scale in the rt-PA treated group were as follow: 22 patients were grades I and II, 2 patients were grade III. In the control group 13 patients were grades I and II, 6 patients were grade III, and 2 patients died. In the rt-PA treated group only one patient presented delayed ischemic deficit.

The role of apoptosis in sexual differentiation of the rat sexually dimorphic nucleus of the preoptic area.

The sexually dimorphic nucleus of the preoptic area (SDN-POA) in the rat hypothalamus is larger in volume in males than in females due to a larger number of cells in the nucleus. Although the SDN-POA, and its development, have been extensively studied, the actual mechanism of its sexual differentiation has not been established. The results of previous studies have not supported a role for gonadal steroids in the regulation of neurogenesis or the determination of the migratory pathway perinatally. In this study, the role of cell death in the development of the sexual dimorphism in the SDN-POA was investigated using in situ end-labeling to visualize fragmented DNA in apoptotic cells. In the experiments described here, the incidence of apoptosis was determined in part of the SDN-POA, the central division of the medial preoptic nucleus (MPNc), over the first 13 days postnatally in male and female rats. There was a sex difference in the incidence of apoptosis in the MPNc between postnatal days 7 and 10; the incidence was higher in females. The role of testosterone (T) in regulating the incidence of apoptosis in the developing MPNc was examined in neonatally castrated males following T or vehicle injection. Testosterone had a profound inhibitory effect on the incidence of apoptosis between days 6 and 10. In a control region within the lateral preoptic area, there was no sex difference in the incidence of apoptosis, nor was there an effect of T. Thus, the data indicate that the regulation of apoptosis by T is one mechanism involved in the sexual differentiation of the SDN-POA.

[Contribution to the microanatomy of the proximal part of the arteria centralis longa (Heubner's artery)]. / Przyczynek do mikroanatomii poczatkowego odcinka tetnicy srodkowej dlugiej ("Heubner'a").

The anterior communicating artery complex is one of the most frequent intracranial aneurysm sites. Pterional craniotomy is the usual way to expose this region. While exposing of the aneurysmal dome, the posterior part of the gyrus rectus is frequently resected. In this stage of the procedure and later during clipping of the aneurysm, the surgeon's manipulation is closely related to the proximal part of the Heubner's artery. This vessel feeds important structures in the region of the basal ganglia. The anatomy of the Heubner's artery was described by many authors. However the intraoperative identification of this artery is still not clear. Therefore we performed detailed microanatomical investigation of the proximal part of the Heubner's artery in 40 brain hemispheres. It was found that during resection of the posterior part of the gyrus rectus two arteries are exposed. The recurrent Heubner's artery runs posteriorly to the gyrus rectus. The second artery runs on the medial and inferior surface of gyrus rectus supplying cerebral cortex. This artery frequently originates from the A1/A2 junction or the proximal part of the A2 segment of the anterior cerebral artery. Because of it, this cortical artery is difficult to distinguish from the recurrent Heubner's artery. This artery can branch out from the recurrent Heubner's artery or the frontopolar artery. In conclusion, the greatest probability of the injury to the recurrent Heubner's artery may occur during resection of the posterior part of the gyrus rectus.

Structural sexual dimorphisms in the anteroventral periventricular nucleus of the rat hypothalamus are sensitive to gonadal steroids perinatally, but develop peripubertally.

The volume of the anteroventral periventricular nucleus (AVPv) of the rat hypothalamus is larger in females than in males. A preliminary study from this laboratory found that this sexual dimorphism develops between days 30 and 91. The present study was designed to confirm and extend these findings and to determine the role of endogenous gonadal steroids in the development of the AVPv postnatally. The results indicate that the sexual dimorphism in AVPv volume arises between days 30 and 40 and that the length of the nucleus becomes sexually dimorphic between days 60 and 80. Additionally, both AVPv volume and length increased between days 30 and 80 in females. Castration of male rats on the day of birth sex-reversed AVPv volume in adulthood and AVPv length was sex-reversed by castration of males 5 days after birth; ovariectomy of females at these ages had no effect on either parameter. Moreover, in both males and females, AVPv volume and length were unaffected by gonadectomy at later ages. That the AVPv appears to be influenced by testicular hormones neonatally, but changes structurally around the time of puberty in females, clearly challenges current concepts of sexual differentiation that limit the process to the early postnatal period.

A revised critical period for the sexual differentiation of the sexually dimorphic nucleus of the preoptic area in the rat.

The volume of the sexually dimorphic nucleus of the preoptic area (SDN-POA) of the rat is several times larger in males than in females. Several studies have established the importance of gonadal steroids perinatally in the sexual differentiation of the SDN-POA as well as a critical period for the permanent influences of exogenous androgen on the volume of the nucleus. Recent preliminary evidence from this laboratory had suggested, however, that the critical period for the effects of the removal of endogenous gonadal steroids on SDN-POA volume may not match that for the administration of exogenous gonadal steroids. A series of experiments was designed to examine further the effects of the removal of endogenous gonadal steroids on adult SDN-POA volume by castrating male rats at various ages. In spite of a rather clear definition of a postnatal critical period for the effects of exogenous steroid administration, the results of this study indicate that the volume of the SDN-POA is sensitive to the removal of endogenous gonadal steroids for a prolonged period of time, extending through at least day 29 postnatally. The data suggest that there may be multiple critical periods for the sexual differentiation of the SDN-POA and reinforce the concept that these critical periods are distinct from those for other sexually differentiated parameters.

Differential cDNA cloning by enzymatic degrading subtraction (EDS).

We describe a new method, called enzymatic degrading subtraction (EDS), for the construction of subtractive libraries from PCR amplified cDNA. The novel features of this method are that i) the tester DNA is blocked by thionucleotide incorporation; ii) the rate of hybridization is accelerated by phenol-emulsion reassociation; and iii) the driver cDNA and hybrid molecules are enzymatically removed by digestion with exonucleases III and VII rather than by physical partitioning. We demonstrate the utility of EDS by constructing a subtractive library enriched for cDNAs expressed in adult but not in embryonic rat brains.

Homogeneity of intracellular electrophysiological properties in different neuronal subtypes in medial preoptic slices containing the sexually dimorphic nucleus of the rat.

The sexually dimorphic nucleus of the preoptic area (SDN-POA) is larger in male than in female rats, the male phenotype requiring the presence of circulating androgens perinatally. These experiments investigated the intracellular electrophysiology and morphology of SDN-POA neurons and compared these properties with those of other medial preoptic area (MPOA) neurons. Biocytin-injected cells in the SDN-POA either had one or two primary dendrites, or they had multipolar dendritic arrays; dendrites were aspiny or sparsely spiny and displayed limited branching. Neurons in other parts of the MPOA were similar morphologically. Regardless of morphology, neurons situated in either the SDN-POA or surrounding MPOA had low-threshold potentials and linear or nearly linear current-voltage relations. In most (73%) cells, stimulation of the dorsal preoptic region evoked a fast excitatory postsynaptic potential followed by a fast inhibitory postsynaptic potential (IPSP). Bicuculline blocked the fast IPSPs, which reversed near the Cl2 equilibrium potential (-71 +/- 5 mV), indicating their mediation by gamma-aminobutyric acid (GABA)A receptors. Neurons in the SDN-POA have electrophysiological properties similar to those of other medial preoptic cells. When compared with the hypothalamic paraventricular nucleus, the MPOA appears relatively homogeneous electrophysiologically. This is despite the morphological variability within this population of neurons and heterogeneities that are also apparent at other levels of analysis. Finally, GABA-mediated, inhibitory synaptic contacts are widespread among medial preoptic neurons, consistent with indications from earlier reports that GABA provides a link in the feedback actions of gonadal steroids on the release of gonadotropic hormones.

Testosterone propionate administration prevents the loss of neurons within the central part of the medial preoptic nucleus.

In the rat, the central part of the medial preoptic nucleus (MPNc) of the male is larger in volume and has a greater number of neurons than that of the female. The nucleus of the female, however, can be "sex reversed" by exposing the rat to gonadal steroids perinatally. The purpose of the present study was to examine the development of the MPNc to determine when the sex difference first appears and whether this difference occurs due to the relative accumulation of neurons into the compact part of the MPNc of the male and sex-reversed female rat or to the loss of MPNc neurons in the control female. Pregnant, female Sprague-Dawley rats were given an injection of [3H]methyl thymidine on embryonic day 18 (E18). Rats were exposed to testosterone propionate (TP) or vehicle from E20 to postnatal day 10 (PN10) or until the time of sacrifice. Pups from three groups [males (oil), females (oil), and sex-reversed females (TP)] were sacrificed on PN2, PN4, PN7, PN10, or PN30. The volume of the compact part of the MPNc increased in males and sex-reversed females after PN4 but the volume in the nucleus of females remained relatively constant. The number of neurons and [3H]thymidine-labeled cells remained elevated from PN2-PN30 in males or sex-reversed females but decreased dramatically in oil-treated females between PN4 and PN7, reaching a minimal number by PN10. Cell cross-sectional area increased with age while cell density decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of thymectomy on reproductive function and behavior.

The effects of thymectomy in perinatal Long-Evans rat pups on their reproductive function in early adulthood were examined. Thymectomized females had decreased lordotic responsivity to estrogen, while thymectomized males exhibited differences in mount latency or postejaculatory interval; these results suggest a possible influence of the thymus on the normal development of the neural substrates of sexual behavior. Gonadal histology appeared unperturbed in rats of either sex. No statistical abnormalities in luteinizing hormone or testosterone levels were seen in male animals. Likewise, no disturbances were observed in the ability of females to exhibit normal positive feedback after estrogen and progesterone administration; negative feedback after unilateral ovariectomy (as judged by ovarian compensatory hypertrophy) was also normal. The timing of puberty was not statistically delayed in females, even though slowed growth rates were observed. A heightened surgical stress response, as judged by progesterone levels in experimental females, suggests that perinatal thymectomy may possibly alter the sensitivity of adults to stress.

Sexual orientation and the size of the anterior commissure in the human brain.

The anterior commissure, a fiber tract that is larger in its midsagittal area in women than in men, was examined in 90 postmortem brains from homosexual men, heterosexual men, and heterosexual women. The midsagittal plane of the anterior commissure in homosexual men was 18% larger than in heterosexual women and 34% larger than in heterosexual men. This anatomical difference, which correlates with gender and sexual orientation, may, in part, underlie differences in cognitive function and cerebral lateralization among homosexual men, heterosexual men, and heterosexual women. Moreover, this finding of a difference in a structure not known to be related to reproductive functions supports the hypothesis that factors operating early in development differentiate sexually dimorphic structures and functions of the brain, including the anterior commissure and sexual orientation, in a global fashion.

Effect of androgens on the brain and other organs during development and aging.

Androgens have important biological effects on accessory sexual organs and have a broad range of effects on metabolic processes. Male hormones have been shown to have important organizational and activational effects on morphological, behavioral, and cognitive activity in experimental animals. Sexual dimorphic effects on cognitive and behavioral activities in animals have been linked to androgens during the fetal period. The effects of testosterone on sexual drive are well established in humans, although the threshold for such activity appears to be lower than that required for many of the other and organic effects of testosterone. There are suggestive data to link fetal androgen levels to cognitive and behavioral activities in children and adults, but the behavioral activities may be modified by social and other learning processes. Androgen levels fall in older men at a time when impaired sexual function, osteopenia, and decreased muscle mass can be identified. The relative importance of androgen deficiency in these disorders requires further study, since they are likely to be multifactorial in pathogenesis. Replacement therapy of elderly men who have lowered testosterone levels has been proposed to decrease bone and muscle loss as well as to improve sexual function and general well-being. Careful studies will be required to assess the risk-to-reward ratio of such treatment, since theoretical adverse effects on prostate and cardiovascular diseases may occur. While conservation in management has its virtues, we should be reminded that several decades ago estrogen replacement of postmenopausal women was highly criticized until data supporting its favorable therapeutic ratio were demonstrated.

Sex differences in subregions of the medial nucleus of the amygdala and the bed nucleus of the stria terminalis of the rat.

Sex differences are described in subregions of two nuclei of the rat brain: the medical nucleus of the amygdala (MA) and the bed nucleus of the stria terminalis (BNST). The volume of the posterodorsal region of the medial nucleus of the amygdala (MApd) is approximately 85% greater and the volume of the encapsulated region of the bed nucleus of the stria terminalis (BNSTenc) is approximately 97% greater in males than in females. The MApd and BNSTenc are distinct subregions of the MA and BNST. They exhibit intense uptake of gonadal hormones and are anatomically connected to each other and to other sexually dimorphic nuclei. The MA and BNST in general are involved in regulation of several sexually dimorphic functions, including aggression, sexual behavior, gonadotropin secretion and integration of olfactory information. Precise localization of sex differences in subregions of the MA and BNST, such as the MApd and BNSTenc, may facilitate understanding of the neural basis of such functions.