Laparoscopically guided peritoneal insertion in ventriculoperitoneal shunts.

A technique of laparoscopically guided insertion of the peritoneal end of ventriculoperitoneal shunts is described. Eleven consecutive cases were done in this manner. There were no failures in inserting the peritoneal end of the ventriculoperitoneal shunt catheter. By way of comparison, 11 previous cases were reviewed. These were done through standard open methods. There were two failures in the open technique group. One of the failures was the result of insertion of the peritoneal end into the subcutaneous layer in an extremely obese patient. It is our belief that this technique deserves consideration when a ventriculoperitoneal shunt is contemplated in adults.

A suggested design for tips of aneurysmal clips: a new concept.

A suggested design with respect to the tips of aneurysm clips is described. Its advantages are mentioned.

Spontaneous resolution of subdural hematomas.

From a series of 35 cases of subdural hematomas in a 12 months span, 6 cases of subdural hematomas which spontaneously resolved were found. The sizes of these hematomas ranged from the relatively small to the huge. All of these cases displayed little if any neurological deficit when seen by us. It is thought that the mechanisms of resorption are: co-mingling with CSF and redistribution in the more acute variety and in instances of subdural hydromas; and thru the healing and reparative process in the chronic type.

Further observations on spinal meningeal nerves and their role in pain production.

Fifty-one cases of patients with back problems plus radiculopathy following the standard laminotomy or laminectomy for disc or spur excision were subjected to spinal meningeal denervation procedures. The results have been satisfactory. An autopsy finding on a patient with two previous disc surgeries was reported. There was considerable anatomical disruption of the meningeal nerves with myxoid intrafascicular changes similar to a Morton's neuroma (perineural fibromatosis), but with intact intradural spinal nerves, indicating that the damage to meningeal nerves may have been the cause of her pain.

An anatomical and clinical investigation of spinal meningeal nerves.

Anatomical studies on nerve roots obtained from autopsied subjects indicated that meningeal innervations of the dura surrounding spinal nerves are more numerous in the lumbar and cervical regions. They are most abundant near the surface of the dura, and on the ventral, lateral and ventro-lateral aspects of the spinal nerve root dura. A denervation procedure was conceived and carried out on 28 patients, 8 of which were failed discs. The results indicated that these nerves subserve the function of pain and their denervation may ameliorate such pain.

Anterior cervical discectomy without interbody fusion: an analysis of 81 cases.

An analysis of 81 patients subjected to anterior cervical discectomy without interbody fusion was made. In these, 62 operations were done with the aid of microscopic magnification. Nineteen were done without. The results appeared to be equally favourable. However, these comparable results should be interpreted in the light of patient selection. Only solitary soft discs were selected in the latter group. The concept of "tail" undoubtedly came into play in this group. In the other group, discs or spurs or both, including multiple level involvement with varying degrees of spinal stenosis, were candidates for such a procedure. The magnification provided the added dimensions of direct vision enabling the surgeon to see more and do more. The overall results are comparable to those done with interbody fusion. This fact, plus the relative simplicity and lack of complications, makes this procedure superior to that with fusion.

Characterization of tumor-specific DNA sequences: molecular grading of the astrocytomas.

Tumor-specific DNA sequences or unique sequences have been found in a number of human cancer cells including gliomas but not in equivalent normal cells. In a continuing effort to further elucidate the nature of these sequences, thermal analysis using the hydroxyapatite technique was carried out on the various grades of astrocytomas. A recycled DNA molecular probe from Grade IV astrocytomas was annealed to the various grades of astrocytoma DNAs and to normal brain DNA which served as control. There was an increasing percentage of hybridization in direct proportion to the degree of malignancy. The same results were obtained using a recycled DNA probe from medulloblastomas. Thermal melt analysis of these same tumors revealed a Tm (melting temperature or temperature of reassociation) of about 83 degrees C, irrespective of degree or grade of malignancy. These results would indicate that the type of genetic DNA sequences or tumor-specific DNA sequences involved in this type of tumor is the same, whether the tumor is benign or malignant. The demonstration of the increasing percentage of hybridization based on the increasing degree or grade of malignancy and the further demonstration that the involved tumor-specific DNA sequences are the same irrespective of the degree of malignancy, justify the conclusion that the number of copies of these sequences determines the degree or grade of malignancy. Pending further laboratory confirmation, this fact may be assumed to be true with respect to cancers from other organ sites.

Molecular evidence of viral-like biochemical activities in human genitourinary malignancies.

We have demonstrated previously that core structures of urine samples from patients with genitourinary malignancies contain ribonucleic acid-directed deoxyribonucleic acid polymerase and a high molecular weight ribonucleic acid. If these particles originated from the existing genitourinary malignancies then the malignancies should contain similar characteristics. We examined 13 prostatic carcinomas, 4 bladder carcinomas, 1 urethral carcinoma and 1 hypernephroma. Positive reactions were noted in 10 of the 13 prostatic carcinomas (77 per cent), all 4 bladder carcinomas, the 1 urethral carcinoma and the hypernephroma with the simultaneous detection assay. The control samples consisted of 7 tissues of benign prostatic hypertrophy, and tissue from 2 normal bladders and 1 normal kidney. None of these tissues showed a positive response. Tritium labeled deoxyribonucleic acid probes synthesized from the malignant tissues hybridized to the polysomal ribonucleic acids but not to the corresponding normal tissues. Particles derived from the probes have a density of 1,1620 in sucrose gradient. No sequence homology could be demonstrated with various known oncogenic ribonucleic acid viruses nor with malignancies arising from other organs.

Impacted "roof disc" as a cause of failure of lumbar disc surgery.

A clinical entity called roof disc is described. It is a centrally located disc extruction found posterior to the posterior borders of the vertebrae that is enclosed by the intact posterior longitudinal ligament; the roof disc exerts pressure against the dorsally lying thecal sac and its enclosed cauda equina roots, causing symptoms and signs incident to this pressure. The contention is made that, unless this roof disc is removed, the patient will continue to have symptoms. Three varieties are described and examples are presented. Its concealed location makes the conventional surgical approaches ineffective, including foraminotomy and laminotomy or laminectomy with standard discectomy.

Sequential CT scan as a parameter in the management of CNS lesions.

The value of sequential CT scans as a management determinant in various types of CNS lesions is described. Case reports are cited in support of such a contention. The prediction is that in the not too distant future, intraoperative CT scans will be as commonly done as the plain radiographs currently employed.

Tumor-specific DNA sequences in human gliomas.

Utilizing the technique of hydroxyapatite chromatography, normal cellular DNAs were used to recycle off the repeat or normal sequences found in [3H]DNA copied off 70S RNA from malignant astrocytomas. The recycled [3H]DNA were then used to hybridize against DNAs from normal human brain tissues and DNAs from malignant astrocytomas or Grade IV astrocytomas. The results indicated the presence of tumor-specific DNA sequences in malignant astrocytomas, absent in normal brain tissues. The percentages were 88% and 7%, respectively. When recycled medulloblastoma 70S[3H]DNA probes were utilized against DNA'S FROM Grade IV astrocytomas and from normal brain, similar results were obtained. The respective percentages of hybridization were 67% and 7%. Thus it would appear that malignant gliomas contain tumor-specific DNA sequences which are not found in normal brain tissues.

The phenomenon of ipsilateral innervation. One case report.

A patient with an anterior communicating artery aneurysm successfully treated surgically by occluding its major feeding vessel, the left anterior cerebral artery, displayed a homolateral hemiparesis. The possibility of ipsilateral innervation is strongly suggested based on clinical grounds and the post operative follow-up angiographic studies, EEG and PEG.

Detection of viral-like cores from the urine of patients with genito-urinary malignancies.

Simultaneous detection assays on the core structures derived from the cerebrospinal fluid samples of patients with various types of central nervous system tumors have demonstrated the feasibility of this technique in detecting some of the diagnostic features of RNA tumor viruses. Similar assays done on urine samples from patients iwth various types of tumors in their genitourinary tracts have shown that of the 18 such samples from tumor patients, 15 or 83% were found to be positive. The control samples consisted of three from patients with benign prostatic hypertrophy and four from normal persons. None of these gave a positive reaction. [3H]DNA probes synthesized from the core structures from them hybridized readily to their corresponding polysomal RNAs but no to control tissues. The densities of particles from these samples have been found to be 1.168 g/ml for bladder carcinoma and 1.165 for prostatic carcinoma, the same densities as those found RNA tumor viruses.

Embryogeneic cell type, organ site sequence specificity in human cancers.

An extensive series of cross-hybridization studies were carried out with the DNA-RNA molecular hybridization technique. Molecular 70 S [3H]DNA probes synthesized from human central nervous system, gastrointestinal, pulmonary, and prostatic carcinomas were hybridized to cytoplasmic RNA's isolated from cancers of virtually all organ sites of the human body. Results indicated sequence homology between cancers of the same organ or cell type but not with cancers of different cell types. Thus cell types based on embryological origins determine the organ site specificity of the involved sequences. The designation of 70 S [3H]DNA denotes those [3H]DNA's that were copied off the template 70 S RNA, as distinguished from total [3H]DNA product, which includes all DNA's synthesized. It does not necessarily follow nor is it to be inferred that the 70 S [3H] DNA thus designated contains the full complement of the sequences found in the 70 S RNA template.