An endoscopic approach to cysticercosis cysts of the posterior third ventricle.

An attempted removal of a third ventricular cysticercosis cyst by an endoscopic approach was aborted before surgery when a preoperative scan demonstrated migration of the cyst into the fourth ventricle. In a second case, successful endoscopic removal of a cysticercosis cyst of the posterior third ventricle by a precoronal, transforaminal approach is described. Transforaminal endoscopic removal of third ventricular cysticercosis lesions is feasible, and immediate preoperative imaging should be performed to rule out migration of the lesion before surgery.

Transcerebellar biopsy of posterior fossa lesions using the Leksell gamma model stereotactic frame.

We describe a technical modification of the Leksell gamma stereotactic system that enables a direct transcerebellar biopsy of posterior fossa lesions. By using an additional pair of long (14 cm) posts placed in the posterior positions of the frame, the frame can be positioned low enough to allow for direct approaches to the posterior fossa. With the patient in the semisitting position, a biopsy can be performed under local anesthesia. We have found this technique provides a simple, comfortable, and effective biopsy of posterior fossa lesions.

Human brain tumor cyst fluid is mitogenic for primary astrocytes in culture.

Tumor cyst fluid from five patients with malignant glial neoplasms was assayed for mitogenic activity by measuring [3H]thymidine uptake by rat astrocyte cultures in serum-free defined media. Cyst fluid from all patients stimulated [3H]thymidine uptake three- to fourfold in astrocyte cultures in comparison with untreated controls. Mitogenic activity was found to be soluble and resistant to freezing, but inactivated by heat and trypsin. The activity was retained by ultrafiltration through a 100-kd molecular weight filter. It appears from these results that mitogenic factor(s) for nonneoplastic astrocytes are present in human brain tumor cyst fluid and that such factors appear to be protein in nature and associated with a complex of molecular weight greater than 100,000.

Long-term follow-up of adrenal medullary transplantation for Parkinson's disease.

Long-term follow-up of eight patients who underwent stereotactic grafting of adrenal medullary tissue into unilateral or bilateral caudate nuclei is presented. We demonstrate that this procedure can be performed with minimal risk. Our results show little benefit when the group as a whole is analyzed. A subgroup of four patients was identified who responded to the procedure, as evidenced by a reduction in motor scores, reduction in medication requirements, and greater "on" time. Three of these patients continue to accrue benefit after 2 years. No characterization of a responder profile was evident. We conclude that a modest benefit is derived from this procedure that may persist for as long as 2 years. Future clinical studies to evaluate grafting procedures are encouraged.

Utilization of unilateral and bilateral stereotactically placed adrenomedullary-striatal autografts in parkinsonian humans: rationale, techniques, and observations.

A limited clinical pilot study involving an amalgam of specialized disciplines including neurology, neuropharmacology, neuropsychology, neurosurgery, neuroanesthesia, neuroradiology, surgical pathology, neuropathology, and urological surgery was organized to clarify issues related to patient selection, optimization of grafting materials, design of a safe, effective, standardized, and reproducible surgical technique, and possible modification of clinical patterns. After initial assessment of 82 Parkinsonian patients for periods of 6 to 20 months, 10 (age, 39-68 years) were selected for unilateral or bilateral adrenomedullary autografts to the caudate nucleus with ependymal and cerebrospinal fluid contact, employing image-directed stereotactic methods. Selection was made only after clear definition of clinical pattern and optimization of medication responses. Adrenal glands were harvested by a retroperitoneal approach (mean estimated blood loss less than 75 ml). Care was taken to maximize the graft content of medullary tissue. Stereotactic methods afforded standardized, reproducible, precise targeting and transit trajectory with unilateral or bilateral placement of materials within the striatum (tissue volume, 80 mm3) with access to the ventricular fluid of the frontal horn. Considerable variability in satisfactory donor medullary tissue was encountered. One patient did not undergo grafting because of unsatisfactory medullary tissue. No significant surgical complications were noted and all patients were ready for discharge 7 days after surgery. One patient who manifested no apparent clinical change died 6 weeks after bilateral grafting of unrelated causes during a lithotripsy procedure. Postmortem examination disclosed precise graft placement with a paucity of structurally preserved medullary cells. Postoperative observations, including parameters of clinical observation, medication schedules and records, patient and family commentaries, and imaging studies (computed tomograms and single photon emission computed tomograms), have been made for periods from 16 to 20 months. Sustained improvement in preexisting clinical patterns and reduction in drug requirements were observed in 4 of 8 patients. No increased benefit could be ascribed to bilateral graft placement. These observations would indicate a safe, and reproducible surgical method. In addition, the clinical observations indicate favorable alterations in the established pattern of the disorder, which would justify further cautious exploration of alternate donor sources or refinements of biological graft site manipulations.

Development of N-methyl-D-aspartate excitotoxicity in cultured hippocampal neurons.

Immature hippocampal neurons (E-18) were maintained in defined medium for up to 3 weeks and their susceptibility to N-methyl-D-aspartic acid (NMDA)-induced cell death was studied at various days in vitro. Upon acute exposure to NMDA (5 min), hippocampal neurons in vitro (8-12 days after plating) showed cell body swelling and dendritic degeneration that preceded cell death 24 h later. NMDA-induced neurodegeneration could be prevented by MK-801 treatment but not by tetrodotoxin. In contrast, immature (5-7 days old) neurons were unaltered by exposure to 500 microM NMDA for either 5 min or 24 h. One explanation for the resistance of immature neurons to glutamate neurotoxicity may be related to maturation of the NMDA receptor complex. Glutamate binding to the NMDA receptor in vivo increased from 14.6 +/- 1.6% (0 day) to 55.2 +/- 4.5% (day 7), 79 +/- 4.9% (day 14), 93.8 +/- 2.8% (day 21) until it reached the adult Sprague-Dawley value of 100 +/- 0.8% (day 90).

Integrative shifts for the theory and practice of family systems therapy.

This paper describes several disagreements among approaches to family therapy and proposes two conceptual shifts providing a more integrative perspective. The first shift focuses on the implications of different ways therapists orient themselves to the developing structures of the therapy system and to the disabled structures of the client system. The second shift reconsiders theoretical approaches in terms of the types of distance they require of the therapist and the types of information these distances provide and ignore. Finally, the paper also discusses a means for classifying the different types of goals therapists establish for their clients, emphasizing that these goals must be consistent with the clients' views of themselves and the world.

Family dynamics and treatment of anorexia nervosa and bulimia.

This paper describes the nature of the family involvement typically observed in anorexia nervosa and bulimia and the role of family therapy in a comprehensive treatment approach. Both the patterns of family interaction observed by clinicians and researchers and the varieties of family treatment used to address these disorders are described. The different types of relationships observed between the eating-disordered patient and the family are also described.