The CD44s Isoform is a Potential Biomarker for Predicting Craniopharyngioma Recurrence in Children.

Adamantinomatous craniopharyngioma (ACP) is an intracranial tumor considered partly malignant due to its ability to infiltrate surrounding structures and tendency to relapse despite radical resection. CD44 is a known stem cell marker in ACP and is upregulated in cell clusters of invasive ACP protrusions; however, the functions of its alternative splicing isoform variants, CD44s and CD44v1-10, have not yet been studied in terms of ACP recurrence, despite their confirmed roles in cancer development and progression. In this study, we first confirmed the difference in total CD44 expression between samples from patients who experienced relapse and those from patients who did not. Moreover, our findings showed that, in recurrent samples, the predominant isoform expressed was CD44s, which might indicate its significance in predicting ACP recurrence. The association between increased CD44 expression and recurrence may lead to the development of prognostic markers of ACP aggressiveness and relapse potential; however, further studies are needed to clarify the exact mechanism of CD44 expression.

The evaluation of function and the ultrasonographic picture of thyroid in children treated for medulloblastoma.

PURPOSE: Medulloblastoma (MB) is one of the most frequent and sensitive to radiation aggressive brain tumor in children. Abnormalities of the thyroid function are common complications of head and neck irradiation for childhood cancer. The aim of this study was to assess thyroid function in children treated for medulloblastoma according to the treatment protocol phase. PATIENTS AND METHODS: Twenty-three children with MB were enrolled to this study. All patients underwent chemotherapy and radiotherapy to the whole craniospinal axis and boost with the conformal therapy restricted to the tumor bed to a total dose of 54 Gy. Thyroid function was evaluated based on thyroid-stimulating hormone (TSH), free thyroxine (fT4) levels controlled before MB treatment, directly after irradiation and at the end of the treatment protocol. Ultrasonography has been used to detect parenchymal abnormalities. RESULTS: All patients presented normal thyroid hormone range before chemotherapy. Hypothyroidism was found in 12 patients in the course of treatment, in 2 patients hormone deficits diagnosed directly after irradiation, in 10 patients such condition was observed at the end of the whole therapy. All of these patients needed thyroid hormone substitution. None of them presented clinical symptoms of hypothyroidism. Ultrasound-detected abnormalities have been found in 20 patients. CONCLUSIONS: It is crucial to monitor the functions of the thyroid gland in children treated for medulloblastoma because of the high risk of hypothyroidism resulting from the treatment. The change in the echogenicity of the thyroid gland may be an early marker for a dysfunction of this organ in children treated for medulloblastoma.

Apoptotic proteins and markers of differentiation in childhood pineal parenchymal tumors: relationships and prognostic value.

Pineal parenchymal tumors (PPTs) in children and adolescents are uncommon and more data on their biological activity and behavior are still needed. The aim of our study was to estimate the expression and prognostic value of some proteins regulating apoptosis and cell cycle as well as being markers of cellular differentiation in PPTs. Tumor specimens obtained from 27 patients who underwent surgical treatment for PPTs were evaluated in immuno-histochemical analysis. The expression of Bcl-2, Bax, p53, NSE (neuron specific enolase), GFAP (glial fibrillary acidic protein), beta-III tubulin and nestin were studied. Co-localization of two chosen antibodies (e.g. Bcl-2/Bax, BCl-2/NSE, p53/NSE, etc.) was also made with a scanning confocal microscope. Histopathological examination revealed: 15 pineocytomas, 1 intermediately differentiated PPT and 11 pineoblastomas. For further analysis two groups were created: Group I: patients with pineocytoma or intermediately differentiated PPTs (16 cases) Group II: patients with pineoblastoma (11 cases). A statistically significant positive correlation between patients' survival time and tubulin and NSE expression was found. Bcl-2, p53 and nestin correlated negatively with survival time.

Endoscopic third ventriculostomy for hydrocephalus: early and late efficacy in relation to aetiology.

OBJECTIVES: The aim of the study was to analyse the effectiveness and usefulness of treatment of hydrocephalus by Endoscopic Third Ventriculostomy (ETV). We sought to relate rates of failure to the cause of hydrocephalus, distinguishing between early and late outcome. PATIENTS AND METHODS: Between September 1999 and April 2001, 30 patients underwent ETV. In 23 patients hydrocephalus was caused by an expansive mass (tumour). Three groups of patients were distinguished, according to the different aims of ETV. Thus in group T--ETV was carried out to eliminate hydrocephalus prior to the main surgery (53%), in C--ETV was the definite treatment of choice (30%), and in group P--ETV was a palliative treatment (17%). The results were assessed in the early postoperative period and in long term follow-up using clinical relief of symptoms, and radiological criteria (pre- and postoperative computed tomography and/or magnetic resonance scans). RESULTS: In the early postoperative period ETV was rated to be effective by clinical criteria in 29 patients, and by radiological criteria in 27. According to late assessment the method was successful in 25 patients using clinical criteria, and in 21 using radiological criteria. There was no peri-operative mortality. A transient complication (wound CSF leak) occurred in two patients. CONCLUSIONS: ETV is effective in well chosen patients in relieving symptoms of hydrocephalus. It is valuable before a definitive major operation to remove the cause of hydrocephalus, as a palliative treatment, and in itself as a method of definitive management when indications are correct.

Cerebral aneurysms in childhood.

OBJECTS: The aim of this work was to ascertain any clinical and anatomical factors allowing differentiation between aneurysms of childhood and those occurring in adults by comparing both groups. METHODS: Results obtained in a total of 17 children and adolescents aged up to 18 who had been operated on for cerebral aneurysm in our department from 1989 to 1997 (3% of all patients treated for subarachnoid haemorrhage resulting from ruptured cerebral aneurysm in this period) were compared with those in the adult group operated on in our department. In contrast to the situation in adults, there was a male predominance in our population. In children we found only 1 case of middle cerebral aneurysm and 1 case of multiple aneurysms. We also found a high rate of rebleeding in the paediatric group. CONCLUSIONS: We suggest that the very good outcome (100% very good results in patients operated on early) obtained and the high risk of rebleeding in children with cerebral aneurysm allow the recommendation of early surgery in children with ruptured cerebral aneurysms.

How should we manage children after mild head injury?

There are many controversies concerning the management of children after mild head injury. Most of these patients achieve a full recovery without medical or surgical intervention. A small percentage of them deteriorate owing to intracranial complications. The goal of this study was to identify significant factors that might allow the identification of patients at risk of subsequent deterioration. Its secondary goal was to establish a clinical protocol for the management of mild head injuries in children. We retrospectively reviewed the records of 166 children and adolescents with head trauma who had Glasgow Coma Scale (GCS) or Children Coma Scale (CCS) scores of 13-15 at the time of admission. The patients were divided into five age categories: babies younger than 1 year, children 1-3, 4-6, and 7-14 years old, and adolescents 15-17 years of age. The largest age group consisted of children 7-14 years old (83 cases). There was a male predominance (2:1). The main causes of injury were traffic accidents (55 cases) and falls (53 patients). Neurosurgical procedures were required in 93 of the 166 patients (56%). The most common intracranial lesion was subdural and epidural hematoma (60 cases). In 26 children (15.6%) diffuse brain swelling was the only lesion. A skull fracture was found in 103 cases and was accompanied by epidural hematoma (HED) in 19 cases (18%) and by subdural hematoma (HSD) in 12 cases (12%). However, the 63 children without a fracture also included 18 (29%) who had HSD and 11 (17%) who had HED. In our population 165 (99%) of the patients obtained a very good or good result. None was left severely disabled or in a vegetative state. One patient with GCS 13 died of an infection. We concluded that skull X-ray examination is not sufficient to rule out intracranial hematoma. We recommend CT scanning and admission to hospital for 24-h observation for all children with minor head injury, because of the risk of delayed hematoma.

Surgery or conservative treatment in children with traumatic intracerebral haematoma.

In contrast to the case of extracerebral haematomas, the criteria for operative treatment of traumatic intracerebral haematoma (TIH) are not clear. The purpose of this study was to find factors that would be helpful in reaching a decision for surgical or conservative treatment of TIH. We performed a retrospective analysis of 31 consecutive cases of TIH treated in our department. The following factors were estimated: age, mechanism of injury, initial GCS or CCS score, neurological deficits, coexistence of arterial hypotension and respiratory disturbances, and localisation and size of the haematoma. The outcome was evaluated according to a modified GOS. Treatment was surgical for 20 patients and conservative for 11. Patients with GCS or CCS scores of 3-8 were treated surgically significantly more often than those with higher scores. The other factors did not correlate with type of treatment. It seems, then, that the clinical status of the patient, especially the level of consciousness according to the GCS or CCS score, is the most important predictor of the need for surgery in children with TIH.

[Pineal cyst in MRI: clinical symptoms and analysis]. / Analiza i symptomatologia torbieli szyszynki w badaniach rezonansu magnetycznego.

Application of magnetic resonance imaging (MRI) in radiology allows to estimate and analyse pineal gland and pineal region pathology more precisely. We report 47 MRI brain studies of patients in whom pineal cyst was recognized as the only pathologic finding. MRI of the brain was performed because of clinical symptoms as headaches (32%), vertigo (26%) and altered behaviour (13%). Because of the common occurrence of pineal cyst in MRI brain imaging it seems to be important to decide whether these patients need neurosurgical intervention, especially if together with morphologic abnormality definite clinical symptoms exist.

[Head injuries in pediatric age]. / Urazy czaszkowo-mózgowe wieku dzieciecego.

Head trauma is the leading cause of morbidity and death in paediatric population. The authors present an outline of contemporary knowledge on the paediatric head injury on the ground of literature and own experience. The value of Glasgow Coma Scale, its modifications and other prognostic factors in children's population after head trauma is discussed. The management of mild head injury is also disputed. In conclusion it is stressed that since many differences in epidemiology, mechanism, pathophysiology and outcome of head injury in childhood and adults exist the separation of "paediatric neurotraumatology" is reasonable.

[Epidermoid cysts in the area of the pontocerebellar angle]. / Torbiele naskórkowe okolicy kata mostowo-mózdzkowego.

Five cases of epidermoid tumours in the vicinity of the pontocerebellar angle were treated surgically. The mean age of the patients was 31 years. Four were women, one man. Good and very good result was achieved in 80%. The surgical technique and difficulties in cases of epidermoids in this situation are described. The own experience of the authors is compared with the reports of other authors and the need for radical removal of the lesion is stressed since malignant transformation is possible, even long after operation.

[Growth of intracranial meningiomas after trauma. A case report]. / Wzrost oponiaków sródczaszkowych po urazach. Opis przypadku.

A case is described of intracranial meningioma development in a woman aged 69 who had craniotomy 28 years earlier. The meningioma grew at the site of previous craniotomy. Documented cases from the literature are quoted in which craniocerebral trauma was unequivocally related to meningioma development, although the coincidence of trauma with meningioma is still controversial.

[Two cases of intracranial lipomas]. / Tluszczaki wewnatrzczaszkowe. Opis dwóch przypadków.

The authors report two rare cases of intracranial lipomas recognized in CT of the head. The tumours were situated in the corpus callosum in one case, and in the posterior fossa in the other case. Both cases were thought unsuitable for surgical intervention, and one of the patients was given only anticonvulsant treatment.

[Certain problems of surgical treatment of third ventricle tumours]. / Wybrane zagadnienia chirurgicznego leczenia guzów komory trzeciej mózgu.

The authors present an outline of the modern knowledge on the surgery of third ventricle tumours. Both anatomy and most common pathology of the third ventricle is discussed. The operative procedures are divided on the basis of tumour localisation into anterior or posterior third ventricle ones. In conclusion it is stressed that in spite of existing controversies these operative procedures are now performed with good results in many neurosurgical centers.

[A case of large myelomeningocele complicated with liquorrhoea in a 32-year old man]. / Przypadek powiklanej plynotokiem duzej przepukliny oponowo-rdzeniowej u 32-letniego mezczyzny.

A case is presented of a 32-year-old man with giant myelomeningocele situated in the lumbosacral segment of the spine. The patient was admitted to the department with manifestations of active liquorrhoea from the dorsal surface of the hernial sac. An X-ray examination was performed which demonstrated an extensive spina bifida from L3 to S2. The patient was operated on preparing the myelomeningocele gate. In the described case the attention is paid to the lack of other developmental anomalies of the nervous, urinary, and osteoarticular system.

[Primary sclerosing cholangitis and primary biliary liver cirrhosis as the causes of intrahepatic cholestasis]. / Pierwotne stwardniajace zapalenie dróg zólciowych i pierwotna marskosc zólciowa, jako przyczyny cholestazy wewnatrzwatrobowej.

Primary sclerosing cholangitis and primary biliary cirrhosis are rarely diagnosed diseases which should, however, be considered in the diagnosis of cholestasis. The authors present an outline of the modern knowledge on these diseases with particular reference to differential diagnosis.