Cervical meningioma masquerading as schwannoma: two cases and a review of the literature.

Two patients presenting with intradural, extramedullary, transforaminal ''dumbbell-shaped'' tumors are discussed. While imaging studies were strongly suggestive of schwannoma, both patients were diagnosed with meningioma. Presentation, imaging studies, operative intervention and pathology are described. Due to the difficulty in achieving complete resection, and the propensity for recurrence, long-term follow-up is recommended.

A new approach to improve sludge dewatering using a semi-continuous hydraulic press system.

In future, it will be necessary to incinerate an increasing proportion of the sludge produced by public wastewater treatment. In this context, equipment for more effective dewatering of sewage sludge is required. A hydraulic press system (Bucher HP) which has been used to date in the food industry could represent an alternative to the sludge dewatering systems currently used. The basic suitability of this press system was demonstrated in comprehensive industrial-scale trials at the Glarnerland STP (Switzerland). Dry solids contents of up to 43% were measured in the pressed sludge. Currently, the optimization of individual process parameters is being investigated in a pilot plant at the Schwelm STP operated by Wupperverband (Germany).

Textile damage caused by vapour cloud explosions.

The aim of the project was to investigate the damage to garments caused by particular vapour cloud explosions. The authors would like to be able to provide investigators with specific information on how to link clothes to a specific type of crime: a particular case study was the inspiration for the examinations. Experiments were carried out in the fire reconstruction chamber of the laboratory using a selection of 26 clothes and 15 household garments differing in colour, fibre composition and textile construction.

Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy.

OBJECTIVE: To assess presentation, imaging, treatment, and outcome of patients with myelopathy due to a dural arteriovenous fistula (DAVF). PATIENTS AND METHODS: This retrospective review identified 94 patients with DAVF surgically treated at our institution between June 1985 and December 1999. The mean ages of the 75 men and 19 women were 62.6 years and 63.0 years, respectively (range, 31-83 years). Magnetic resonance imaging was performed in 87 patients, computed tomography-myelography was performed in 37 patients, and spinal angiography was performed in all patients. Initial examination findings were retrospectively adjusted to a modified Aminoff-Logue myelopathy scale. RESULTS: Of the 94 patients, 47 presented with symptoms that worsened with erect posture or Valsalva maneuver. As myelopathy progressed, patients' symptoms increased, and 6 patients had paraplegia at presentation. The mean time from symptom onset to diagnosis was 23 months (range, 2-120 months). Magnetic resonance imaging confirmed the diagnosis in 86 patients; computed tomography-myelography was needed to confirm the fistula in 1 patient. Spinal angiography detected the fistula in all patients. Surgical obliteration of the DAVF was successful in 93 patients; in 1 patient surgery failed because the DAVF was not localized, but acrylic endovascular embolization was successful. No patient experienced permanent morbidity or mortality. Of the 94 patients, 93 improved postoperatively 1 or 2 levels based on a modified Aminoff-Logue scale. Older patients with severe long-term deficits had poor outcomes. CONCLUSIONS: The diagnosis of a DAVF seems to be delayed considerably because DAVF is not included in the differential diagnosis of myelopathy and because of clinicians' unfamiliarity with suggestive or revealing findings on diagnostic imaging. Neurodiagnostic imaging confirms the diagnosis, and spinal angiography localizes the fistula. Surgical intradural disconnection of the DAVF clinically reverses the pathophysiology. Additionally, surgical treatment is associated with low short-term morbidity, no permanent morbidity, and no mortality. If the diagnosis is made early and treatment initiated in such patients, they generally do well.

Receptor mediated antiproliferative effects of the cytotoxic LHRH agonist AN-152 in human ovarian and endometrial cancer cell lines.

Eighty percent of human ovarian and endometrial cancers express receptors for luteinizing hormone-releasing hormone (LHRH). These receptors might be used for targeted chemotherapy with cytotoxic LHRH analogs such as AN-152, in which doxorubicin is linked to agonist carrier [D-Lys6]LHRH. The antiproliferative effects of doxorubicin and AN-152 were assessed in LHRH receptor-positive ovarian (EFO-21, EFO-27) and endometrial (HEC-1A, Ishikawa) cancer cell lines as well as in LHRH receptor negative ovarian SKOV-3 and endometrial MFE-296 lines. The mechanism of action of AN-152 was investigated by a blockage of receptors using an excess of the LHRH agonist [D-Trp6]LHRH. In some cases, confocal laser-scanning microscopy was used to visualize the accumulation of AN-152 or doxorubicin within the cells. In 3 of 4 LHRH receptor-positive cell lines (EFO-21, HEC-1A, Ishikawa) AN-152 was more effective than doxorubicin in inhibiting cell proliferation. The effect of AN-152 was shown to be receptor-mediated because it could be reduced by competitive blockade of the LHRH receptors with [D-Trp6]LHRH. In contrast, AN-152 was less active than doxorubicin in LHRH receptor-negative lines. Confocal laser-scanning microscopy showed an intranuclear accumulation of AN-152 and competitive inhibition thereof by [D-Trp6]LHRH in LHRH receptor-positive cell lines, but no intracellular accumulation of AN-152 could be detected in the receptor-negative SKOV-3 line. These results suggest a selective receptor-mediated action of AN-152 in receptor-positive cell lines.

Recurrent lumbar ependymoma presenting as headache and communicating hydrocephalus.

We describe a patient with a recurrent spinal cord ependymoma who initially presented with symptoms of increased intracranial pressure rather than symptoms directly relating to involvement of the conus medullaris. Brain magnetic resonance imaging with gadolinium showed communicating hydrocephalus. Magnetic resonance imaging of the entire spinal cord with gadolinium revealed recurrent tumor. Postoperatively, a permanent ventriculoperitoneal shunt was placed. Recognition of the association between spinal cord ependymoma and hydrocephalus is important in the evaluation of patients with headache.

Capillary hemangioma of the spinal cord. Report of four cases.

The authors describe the clinicopathological features of four cases of capillary hemangioma of the spinal cord. All occurred in adult patients. The presenting symptoms were similar to those of more common intramedullary tumors. Radiologically, they resemble other vascular spinal cord tumors. All patients underwent surgery, and the outcomes varied. Histologically, the lesions resembled capillary hemangioma of skin or of soft tissue that is composed of lobules of small capillaries with associated feeding vessels, all enveloped by a delicate fibrous capsule. Capillary hemangiomas of the central and peripheral nervous system are extremely rare. Although examples of these lesions have been described as occurring in the dura mater and in peripheral nerve, including spinal nerve roots, none has occurred within the spinal cord. Knowledge of their existence may help practitioners to avoid misdiagnosis of tumor and resultant overtreatment of these benign lesions.

Emerging antibody-based HER2 (ErbB-2/neu) therapeutics.

Targeting HER2(ErbB-2/neu) overexpressing tumor cells to selectively deliver anticancer agents and thereby reduce host toxicity represents a rational and emerging strategy for the treatment of breast and other epithelial cancers. The extracellular domain of the HER2 receptor tyrosine kinase is readily accessible to systemically administered antibody-based therapeutics, including growth-inhibiting monclonals such as rhuMAbHER2 (trastuzmab/Herceptin) as well as anti-HER2 immunotoxins, antibody-dependent enzyme prodrug therapy (ADEPT), and immune cell recruiting bispecific antibodies. In addition to summarizing recent advances in these antibody-based strategies, this review focuses on preclinical advances in the development of anti-HER2 immunoliposomes (ILs) as a platform technology for targeted drug delivery. Extensive in vitro and in vivo testing including efficacy and tumor uptake studies in multiple human tumor xenograft models now provide conclusive evidence for the superior therapeutic efficacy of anti-HER2 ILs-doxorubicin (dox) over free dox or liposomal (Ls)-dox, and even over combinations of dox and Ls-dox with rhuMAbHER2. As anti-HER2 ILs-dox approaches clinical testing in patients with advanced HER2 overexpressing breast cancer, future applications of this novel targeting strategy will also broaden to include intracellular delivery of other anticancer agents as well as therapeutic nucleic acids (oligonucleotides, genes).

Hemangioma of spinal nerve root.

OBJECT: Hemangiomas of the spinal nerve roots are rare. Only 12 cases have been reported in the literature, all since 1965. These lesions occurred in adults, primarily in males, and were located in the cauda equina. Of the 12 lesions, eight were cavernous hemangiomas. The authors report here the clinicopathological features of 10 cases of hemangioma of the spinal nerve root, nine of which were of the capillary type. METHODS: The group included six men and four women who ranged in age from 40 to 62 years. The majority of patients presented with pain and weakness. One patient also experienced worsening of pain during menses. In all cases, gadolinium-enhanced magnetic resonance imaging or computerized tomography myelography demonstrated a discrete intraspinal extramedullary mass. Administration of contrast agent resulted in uniform, intense enhancement. A gross-total resection was achieved in all but one case; in most cases, it was necessary to sacrifice the parent nerve root. Preoperative symptoms and signs improved in nine cases. On histological examination, all but one tumor, a spindle-cell hemangioendothelioma, were shown to be ordinary capillary hemangiomas. Two lesions exhibited a cavernous component, and five showed a partly solid growth pattern resembling juvenile capillary hemangioma. In all cases, the relationship with the nerve root was histologically confirmed. The tumor-nerve relation varied. The intact nerve was displaced by the epineurial mass in three cases. The fascicles appeared separated in six cases, and individual nerve fibers were seen throughout one lesion with endoneurial involvement. CONCLUSION: . Hemangiomas of spinal nerve roots pose a challenging diagnostic problem. Knowledge of their existence is relevant in that they may mimic tumors and are amenable to surgical treatment.

Development of postoperative fibromatosis after resection of an intraspinal meningioma. Case report.

The authors report the case of an adult female patient who developed a paraspinous thoracic fibromatosis (desmoid tumor) after undergoing resection of an intraspinal thoracic meningioma that was complicated by postoperative wound infection. To the best of the authors' knowledge, this is the first report of such a tumor occurring after resection of a spinal meningioma. Awareness of the development of postoperative fibromatosis and recognition of its association with wound sepsis is important. Although rare, this distinctive lesion should be considered in the differential diagnosis of the apparent rapid regrowth of otherwise indolent lesions including meningioma.

Vascular anatomy of the spinal cord.

Knowledge of spinal cord vascular anatomy is essential to the neurosurgeon planning and undertaking procedures on vascular lesions of the spinal cord. This article relates general concepts and nomenclature regarding this unique circulation and describes the regional and segmental arterial and venous anatomy of the spinal cord. The article concludes with surgical considerations and recommendations based on this anatomy.

Juxtafacet cysts of the cervical spine.

OBJECTIVE: We report a retrospective series of 13 patients who presented with symptoms and signs caused by cervical juxtafacet cysts. Clinical findings, radiographic features, surgical management strategies, and possible causes are reported and discussed. METHODS: We reviewed clinical histories, radiographic studies, surgical notes, and pathological records of all 13 patients who underwent surgery for subaxial cervical juxtafacet cysts from 1984 to 1997 at the Mayo Clinic in Rochester, MN. During the summer of 1997, surgical outcomes were assessed by direct or telephone interview. RESULTS: Nine patients were men and four were women. The average age at the time of presentation was 66 years. One patient had undergone a previous anterior cervical fusion below the level of the cyst. Ten patients presented with radiculopathies. Two patients presented with myeloradiculopathies. One patient presented with a cervical myelopathy. Computed tomographic myelography and magnetic resonance imaging were essential in establishing a preoperative diagnosis. The cysts were located at C7-T1 in nine patients, at C4-C5 in two patients, at C6-C7 in one patient, and at C3-C4 in one patient. All patients underwent posterior laminectomy or hemilaminectomy, excision of the cyst, and decompression of the thecal sac and/or nerve root. Two patients underwent concurrent posterior fusion procedures for instability. All patients experienced good to excellent relief of their radicular pain. All three myelopathies stabilized after surgery. There were no major complications or recurrences. CONCLUSION: Juxtafacet cysts seem to be a degenerative change of the cervical spine rather than a traumatic event. Similar to their counterparts in the lumbar spine, they tend to arise in segments with increased mobility. Surgical treatment is effective.

Cervicomedullary compression: an unrecognized cause of vocal cord paralysis in rheumatoid arthritis.

Cervicomedullary compression (CMC) from traumatic, infectious, or congenital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from destructive arthritic changes and inflammatory pannus formation at the occipito-atlanto-axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unrecognized cause of vocal cord immobility. Previously, vocal cord immobility in patients with RA has been assumed to be cricoarytenoid arthritis with joint fixation. We report 3 patients with RA and radiographically demonstrated CMC with vocal cord immobility. One patient had bilateral vocal cord immobility and airway obstruction; 2 patients had unilateral cord paralysis and contralateral paresis without airway compromise. All patients had myelopathy and neck pain in addition to brain stem symptoms. All patients underwent transoral-transpharyngeal decompression of the anterior craniocervical junction with subsequent posterior fusion. These patients demonstrated full return of vocal cord function within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized without appropriate imaging studies of the skull base and physician awareness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.

Single photon emission computed tomography scanning in diagnosis of a rare pelvic avulsion fracture.

Avulsion fractures of the anterior inferior iliac spine are a relatively uncommon injury. Their diagnosis is usually made based on history, findings of the clinical examination, and standard roentgenograms. In the patient described, the diagnosis of avulsion of the anterior inferior iliac spine was made with the assistance of a single photon emission computed tomography scan, a relatively new diagnostic tool.

[Not Available]. / Die physikalische Medizin und die jüdischen Arzte.

Many pioneers of the developing medical specialties in the 19th century were Jewish physicians. This phenomenon is explained by the difficulties Jews had in obtaining academic careers and therefore the necessity to cultivate the periphery of science. The development of "physical medicine" seems to be a good example to investigate this thesis. A quantitative analysis of the rise of institutes and departments for physical medicine in Vienna shows that this special field was first established in the private sector between 1890 and 1914. At the same time 75 per cent of the "Dozenten" of the University of Vienna, who worked in the field of physical medicine, were Jewish doctors. This affinity can be explained by the scientific appeal of physical medicine on the one hand and the chance to work independently of public institutions on the other. The result indicates that the development of physical medicine as a specialised part of modern medicine was predominantly due to the work of Jewish physicians.

Infections of the dural spaces.

Suppuration involving the epidural and subdural spaces is a rare occurrence in modern neurosurgical practice. Early diagnosis and appropriate treatment of infections of the dural spaces may avert the high incidence of neurologic disability and death traditionally associated with them, however. Prompt neurosurgical intervention in the treatment of these lesions has been the standard with which all other therapies have been compared.

A simple and reliable technique to monitor intracranial pressure in the rat: technical note.

A technique for intracranial pressure (ICP) monitoring in the rat that uses a permanent cisterna magna cannula is described. The cannula is placed into the subarachnoid space through the atlanto-occipital membrane with the operating microscope and is secured with cement. The distal end is connected to a pressure transducer and a polygraph recorder. To study the consistency of this technique, 12 anesthetized adult rats were subjected to baseline ICP measurements 2 days after placement of the cannula. Baseline pressures ranged between 1.0 and 10.0 cm H2O, with a mean of 5.6 cm H2O. Respiratory variations were detected in all tracings, and manual abdominal compressions (Valsalva maneuver) correlated with immediate transient rises in ICP in all rats. While CSF pressure was being continuously monitored, rats were subjected to subarachnoid hemorrhage induced by transclival basilar artery puncture. Of the 12 rats, 10 showed a moderate transient rise in cerebrospinal fluid pressure, which peaked approximately 2 minutes after subarachnoid hemorrhage (mean peak change, 10.5 cm H2O; range, 0-32.5 cm H2O). Reliable pressure tracings were obtained in three of five animals examined 3 days after subarachnoid hemorrhage (ICP range, 4.0-4.5 cm H2O; mean, 4.2 cm H2O). We conclude that this cannula is easy and inexpensive to construct and that it provides reliable ICP tracings during experimental procedures in the rat.

Chronic cerebral blood flow changes following experimental subarachnoid hemorrhage in rats.

Experimental subarachnoid hemorrhage was induced in 52 adult male Wistar rats by microsurgical transclival basilar artery puncture. Telencephalic blood flow measured in 24 rats with subarachnoid hemorrhage was compared with that in 23 sham-operated rats and 10 unoperated control rats using the [14C]butanol indicator fractionation technique. Telencephalic blood flow was significantly less in the rats with subarachnoid hemorrhage than in the sham-operated rats 3 (78.7 +/- 6.9 [n = 7] and 112.0 +/- 8.5 [n = 8] ml/100 g/min, respectively; p less than 0.01), 7 (74.9 +/- 5.1 [n = 9] and 112.6 +/- 4.6 [n = 8] ml/100 g/min, p less than 0.001), and 14 (81.9 +/- 6.0 [n = 8] and 104.1 +/- 5.4 [n = 7] ml/100 g/min, p less than 0.01) days after surgery. Telencephalic blood flow in unoperated controls (114.7 +/- 4.9 ml/100 g/min) did not differ significantly from sham-operated rats. Clinically, the 52 rats with subarachnoid hemorrhage were indistinguishable from 32 sham-operated rats. Postmortem examinations in 10 rats used in a preliminary investigation demonstrated significant blood clot in the basal cisterns 2 hours after basilar artery puncture. Intracranial pressure was slightly elevated (2.3 mm Hg over baseline) 30 minutes after the hemorrhage (n = 7), but when measured 3 (n = 3) or 7 (n = 3) days after surgery it had returned to baseline. Histologic examination of the brains from 10 rats subjected to subarachnoid hemorrhage 7 (n = 5) or 14 (n = 5) days before sacrifice revealed no evidence of cerebral ischemia or vasculopathic changes in the cerebral arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Disintegration of kidney calculi with a piezoelectric instrument system. Initial clinical experiences]. / Die Zertrümmerung von Nierensteinen mit einem piezoelektrischen Gerätesystem. Erste klinische Erfahrungen.

Since December 1985 extracorporeal piezoelectric renal lithotripsy has been tested in humans. Up to now 50 patients with renal calculi have been treated. The lithotriptor consists of a special mobile table with an opening in the surface to apply shock waves. Urinary calculi are located by integrated ultrasound location systems. As the piezoelectrically generated high-energy sound pulse does not cause pain, treatment is possible without anesthesia. Permanent ultrasonic control of the stones in the focus during lithotripsy allows effective application of shock waves. With this piezoelectric system the electrocardiogram does not have to be triggered. So far the results have been encouraging and following these tests clinical application is expected to be successful.