Brain Tumor-Related Epilepsy

In patients with brain tumor (BT), seizures are the onset symptom in 20-40% of patients, while a further 20-45% of patients will present them during the course of the disease. These patients present a complex therapeutic profile and require a unique and multidisciplinary approach. The choice of antiepileptic drugs is challenging for this particular patient population because brain tumor-related epilepsy (BTRE) is often drug-resistant, has a strong impact on the quality of life and weighs heavily on public health expenditures.In BT patients, the presence of epilepsy is considered the most important risk factor for long-term disability. For this reason, the problem of the proper administration of medications and their potential side effects is of great importance, because good seizure control can significantly improve the patient’s psychological and relational sphere. In these patients, new generation drugs such as gabapentin, lacosamide, levetiracetam, oxcarbazepine, pregabalin, topiramate, zonisamide are preferred because they have fewer drug interactions and cause fewer side effects. Among the recently marketed drugs, lacosamide has demonstrated promising results and should be considered a possible treatment option. Therefore, it is necessary to develop a customized treatment plan for each individual patient with BTRE. This requires a vision of patient management concerned not only with medical therapies (pharmacological, surgical, radiological, etc.) but also with emotional and psychological support for the individual as well as his or her family throughout all stages of the illness.     

Dexmedetomidine Postconditioning Reduces Brain Injury after Brain Hypoxia-Ischemia in Neonatal Rats

Perinatal asphyxia can lead to death and severe disability. Brain hypoxia-ischemia (HI) injury is the major pathophysiology contributing to death and severe disability after perinatal asphyxia. Here, seven-day old Sprague-Dawley rats were subjected to left brain HI. Dexmedetomidine was given intraperitoneally after the brain HI. Yohimbine or atipamezole, two α2 adrenergic receptor antagonists, were given 10 min before the dexmedetomidine injection. Neurological outcome was evaluated 7 or 28 days after the brain HI. Frontal cerebral cortex was harvested 6 h after the brain HI. Left brain HI reduced the left cerebral hemisphere weight assessed 7 days after the brain HI. This brain tissue loss was dose-dependently attenuated by dexmedetomidine. Dexmedetomidine applied within 1 h after the brain HI produced this effect. Dexmedetomidine attenuated the brain HI-induced brain tissue and cell loss as well as neurological and cognitive dysfunction assessed from 28 days after the brain HI. Dexmedetomidine postconditioning-induced neuroprotection was abolished by yohimbine or atipamezole. Brain HI increased tumor necrosis factor α and interleukin 1β in the brain tissues. This increase was attenuated by dexmedetomidine. Atipamezole inhibited this dexmedetomidine effect. Our results suggest that dexmedetomidine postconditioning reduces HI-induced brain injury in the neonatal rats. This effect may be mediated by α2 adrenergic receptor activation that inhibits inflammation in the ischemic brain tissues.     

脑出血和重型颅脑伤术后的高血糖控制

目的观察高血压性脑出血和重型颅脑损伤术后患者血糖变化,并对胰岛素辅助治疗的疗效进行观测。方法对所有高血压性脑出血和重型颅脑损伤术后的患者,常规给予胰岛素皮下注射(6U/Q6h),应用one touchⅡ型血糖仪连续2周动态检测患者血糖水平。结果高血压性脑出血和重型颅脑损伤术后患者应激性高血糖得到有效控制,且控制不良者预后极差。结论在高血压性脑出血和重型颅脑损伤术后,采用正规胰岛素皮下注射法和血糖仪的连续监测,确实简单易行,安全有效,有助于对术后病情的评估和预后的判断。     

原发性脑干肿瘤

本文分析34例原发性脑干肿瘤的临床特征和CT表现。原发性脑干肿瘤以桥脑肿瘤最多见,占91.7％。其临床特征为出现多数颅神经麻痹,小脑性共济失调和运动感觉障碍。斜视、核间性眼肌麻痹,水平联合注视障碍和垂直注视麻痹等多种眼球运动障碍较为突出。不自主发笑和肌阵挛发作可见于部分脑干肿瘤,应引起重视。CT对脑干肿瘤的确诊率为95.5％。平均约66.7％显示等密度或低密度,邻近脑室、脑池变形移位占76.2％。强化扫描约半数肿瘤显示均一块状,不规则或环状增强。     

脑多形性黄色星形细胞瘤

报告３例罕见的脑多形性黄色星形细胞瘤，观察了其临床、光镜、电镜及免疫组化特征。结果显示，本瘤好发于脑表浅部位，界限清楚，有囊腔形成。光镜下瘤细胞奇形怪状，提示恶性的组织学形态，酷似巨细胞胶质母细胞瘤，以往均 被误诊。然而多形性黄色星形细胞瘤预后良好，存活期长，且光镜下缺乏坏死，核分裂相当少。随访２例，术后生存时间为１３年７个月和７年９个月。     

单唾液酸四己糖神经节苷脂钠对脑损伤所致脑水肿的影响研究

目的:观察单唾液酸四己糖神经节苷脂钠(GM1)治疗对脑损伤所致脑水肿的临床疗效。方法:78例脑损伤致脑水肿患者随机分为治疗组与对照组,各39例。对照组予常规治疗。治疗组加用GM1,急性期(2周)100 mg加入100ml生理盐水中,ivgtt,qd;维持期(2周)20 mg肌注,每日1²次。4周为1个疗程。测算脑水肿面积,行格拉斯哥昏迷(GCS)评分,测定血清中一氧化氮(NO)和一氧化氮合酶(NOS),记录不良反应。结果:治疗前,治疗组与对照组的GCS评分分别为(9.6±1.0)分和(9.8±1.3)分,治疗后分别为(12.9±1.6)分和(11.2±1.5)分,均较治疗前提高(P<0.05或P<0.01),且治疗组更高(P<0.05)。两组治疗7d水肿面积均明显增大(P<0.01),治疗14、28 d均明显缩小(P<0.01);组间比较,治疗组治疗7、14、28 d脑水肿面积均明显较小(P<0.05或P<0.01)。治疗组NO、NOS均显著降低(P<0.01),组间比较差异均有统计学意义(P<0.01)。两组均无严重不良反应出现。结论:GM1治疗脑损伤所致脑水肿,可明显降低水肿面积、NO及NOS,改善GCS评分。     

Brain effects of melanocortins

The melanocortins (α, β and γ-melanocyte-stimulating hormones: MSHs; adrenocorticotrophic hormone: ACTH), a family of pro-opiomelanocortin (POMC)-derived peptides having in common the tetrapeptide sequence His-Phe-Arg-Trp, have progressively revealed an incredibly wide range of extra-hormonal effects, so to become one of the most promising source of innovative drugs for many, important and widespread pathological conditions.The discovery of their effects on some brain functions, independently made by William Ferrari and David De Wied about half a century ago, led to the formulation of the term “neuropeptide” at a time when no demonstration of the actual production of peptide molecules by neurons, in the brain, was still available, and there were no receptors characterized for these molecules.In the course of the subsequent decades it came out that melanocortins, besides inducing one of the most complex and bizarre behavioural syndromes (excessive grooming, crises of stretchings and yawnings, repeated episodes of spontaneous penile erection and ejaculation, increased sexual receptivity), play a key role in functions of fundamental physiological importance as well as impressive therapeutic effects in different pathological conditions.If serendipity had been an important determinant in the discovery of the above-mentioned first-noticed extra-hormonal effects of melanocortins, many of the subsequent discoveries in the pharmacology of these peptides (feeding inhibition, shock reversal, role in opiate tolerance/withdrawal, etc.) have been the result of a planned research, aimed at testing the “pro-nociceptive/anti-nociceptive homeostatic system” hypothesis.The discovery of melanocortin receptors, and the ensuing synthesis of selective ligands with agonist or antagonist activity, is generating completely innovative drugs for the treatment of a potentially very long list of important and widespread pathological conditions: sexual impotence, frigidity, overweight/obesity, anorexia, cachexia, haemorrhagic shock, other forms of shock, myocardial infarction, ischemia/reperfusion-induced brain damage, neuropathic pain, rheumathoid arthritis, inflammatory bowel disease, nerve injury, toxic neuropathies, diabetic neuropathy, etc.This review recalls the history of these researches and outlines the pharmacology of the extra-hormonal effects of melanocortins which are produced by an action at the brain level (or mainly at the brain level). In our opinion the picture is still incomplete, in spite of being already so incredibly vast and complex. So, for example, several of their effects and preliminary animal data suggest that melanocortins might be of concrete effectiveness in one of the areas of most increasing concern, i.e., that of neurodegenerative diseases.     

Cocaine in the Brain

Abstract

Three types of individual drug abuse counseling were investigated in a private methadone clinic in order to replicate and extend previous work on node-link mapping techniques (two dimensional graphic approaches for visualizing problems and solutions). Standard counseling, enhanced counseling with free-form maps (f-maps), and enhanced counseling with both f-maps and guide-maps (g-maps) were compared at six and 12 months of treatment. Also assessed were differential effects of these counseling conditions on clients with low and high levels of behaviors related to attention deficit hyperactivity disorder (ADHD; low-problem versus high-problem clients). Dependent variables included the number of scheduled sessions attended per month, counselor ratings of session characteristics (e.g., powerful, valuable), client psychological status ratings (i.e., self-esteem, depression, and anxiety) and treatment retention (i.e., the number of months clients remained in treatment). Findings replicate and extend prior work indicating the positive impact of using nodelink maps in individual drug abuse counseling. Particular benefits were found for clients with high levels of ADHD-related problems.     

Brain tumours in man

Brain tumours occur at all ages but they differ in type depending upon the age of the patient. In adults, probably more than 50% of tumours in the brain are metastatic carcinomas or melanomas. The pathological classification of primary brain tumours depends largely upon the cell type involved. Recently, immunocytochemical identification of cell-specific proteins by the use of polyclonal or monoclonal antibodies has greatly enhanced the accuracy of cell identification within tumours. Primary brain tumours in children arise mainly in the brain stem and cerebellum and are astrocytomas, primitive neuroectodermal tumours (medulloblastomas) and ependymomas. Gliomas form the largest group of primary brain tumours in adults, with an annual incidence of 3.94/100,000 in Southern England. In young adults, well differentiated astrocytomas and oligodendrogliomas arise in the cerebral hemispheres. Poorly differentiated, malignant glial tumours include anaplastic astrocytomas and glioblastoma multiforme; these tumours are most common in older adults with a peak annual incidence of 7.3/100,000 in the sixth decade. The major complication of brain tumours is due to their mass effect from tumour growth and from peritumoral oedema. Surgical excision of gliomas is difficult and usually incomplete due to the infiltrative nature of the tumour. As yet these tumours respond poorly to irradiation and chemotherapy.     

Brain levels of tryptamine

A modification of the method of Hess and Udenfriend (1959) for the extraction and identification of tryptamine, as well as a gas chromatographic method for identifying tryptamine, has been described. Tryptamine, using these methods, as well as thin layer chromatography, has been identified in steer, dog and human brain. Tryptamine was not found in the rat brain. In the dog, isocarboxazid increased brain and spinal cord tryptamine levels two or three times. In view of the fact that tryptamine resembles LSD-like hallucinogens in many of its actions, it is suggested that tryptamine may be a naturally occurring hallucinogen that may play a role both in normal and pathologic functioning of the brain.A preliminary report of this work was presented at the meeting of the Federation of American Societies for Experimental Biology, April 1971 [Fed. Proc. 30, 271 (1971)].     

外伤性弥漫性脑肿胀

目的;分析外伤性弥漫性脑肿胀临床分类、CT征象、发病机制及治疗方法。结果;55例外伤性脑肿胀．16例CT扫描示两侧大脑半球肿胀,39例示一侧大脑半球肿胀,病死率分别为25％、64％。21例手术治疗,16例死亡（76％）;34例保守治疗,13例死亡（38％）。结论：双侧大脑半球脑肿胀预后较好,单侧半球脑肿胀愈后较差。手术治疗效果不佳,采用大剂量地塞米松、甘露醇和速尿对治疗急性弥漫性脑肿胀有一定效果。