Anatomically conformable, three-dimensional, detachable platinum microcoil system for the treatment of intracranial aneurysms

BACKGROUND AND PURPOSE: The configurations of detachable platinum coils have evolved over the last decade. Our objective was to assess the efficacy of the anatomically conformable three-dimensional (ACT) detachable platinum microcoil in the treatment of intracranial aneurysms. METHODS: A series of 141 patients presented between May 2000 and August 2002 to a single neurointerventionalist for endovascular treatment of intracranial aneurysms. Eight patients were treated at another institute or are now overseas. The remaining 133 patients had 141 aneurysms, which were treated; 110 were ruptured and 31 were unruptured. The clinical conditions and aneurysm locations were recorded. The procedural technique was the same as that used with the Guglielmi detachable coil (GDC) device, though the coil detachment mechanism was unique. The ACT microcoil was used in almost all cases as the initial coil. RESULTS: Complete (100%) occlusion was achieved in 104 (74%) aneurysms. Thirty four (24%) had subtotal occlusion > or = 95%), and three (2%) had incomplete occlusion (<95%). The ACT coil conformed to both spherical and irregularly shaped aneurysms. No procedure-related deaths occurred, and there was no aneurysm rupture related to coil deployment. No postprocedural rebleeding was observed. CONCLUSION: The ACT microcoil device is feasible as an alternative platinum coil device, offering some advantages over other currently available devices.     

Bilateral endoscopic adrenalectomy for Cushing's syndrome in a patient with polycystic liver and kidney disease

Microadenomectomy via a transsphenoidal approach is today's treatment of choice to achieve normal cortisol blood levels in patients with ACTH-secreting pituitary tumors. Should neurosurgery fail, bilateral adrenalectomy is recommended. Today the endoscopic, transabdominal or retroperitoneal adrenalectomy is regarded as the gold standard for the operation of endocrine-active adrenal tumors. Therefore, in principle, the question of the indication for the endoscopic operation no longer arises but only the question of the technical feasibility in individual cases. We report on a patient with a pituitary-dependent Cushing's syndrome after a twice-repeated unsuccessful transsphenoidal adenomectomy and with additional polycystic kidney and liver disease, who underwent bilateral retroperitoneoscopic adrenalectomy. Despite the massive enlargement of both kidneys, it was possible to safely perform a bilateral retroperitoneoscopic adrenalectomy. In the case of marked bilateral cystic kidneys, a bilateral retroperitoneoscopic adrenalectomy in Cushing's syndrome is technical possible and a safe and effective method of treatment.     

Chromosomal translocation t(18;21)(q23;q22.1) indicates novel susceptibility loci for frontotemporal dementia with ALS

A chromosomal translocation t(18;21)(q23;q22) is reported in a patient with frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). We exclude the physical involvement and silencing of the ALS-linked gene for copper/zinc superoxide dismutase (SOD1) on chromosome 21q22.1. The breakpoints are assigned to sequences flanked by the markers ATA1H06, D18S462, D21S1915, and D21S1898. These critical regions may contain susceptibility loci for FTD associated with ALS.     

Neural correlates of metaphor processing

Metaphoric language is used to express meaning that is otherwise difficult to conceptualize elegantly. Beyond semantic analysis, understanding the figurative meaning of a metaphor requires mental linkage of different category domains normally not related to each other. We investigated processing of metaphoric sentences using event-related functional magnetic resonance imaging (fMRI). Stimuli consisted of 60 novel short German sentence pairs with either metaphoric or literal meaning. The pairs differed only in their last one to three words and were matched for syntax structure, word frequency, connotation and tense. Fifteen healthy subjects (six female, nine male, 19-51 years) read these sentences silently and judged by pressing one of two buttons whether they had a positive or negative connotation. Reading metaphors in contrast to literal sentences revealed signal changes in the left lateral inferior frontal (BA 45/47), inferior temporal (BA 20) and posterior middle/inferior temporal (BA 37) gyri. The activation in the left inferior frontal gyrus may reflect semantic inferencing processes during the understanding of a metaphor. This is in line with the results from other functional imaging studies showing an involvement of the left inferior frontal gyrus in integrating word and sentence meanings. Previous results of a right hemispheric involvement in metaphor processing might reflect understanding of complex sentences.     

Familial ALS in Germany: origin of the R115G SOD1 mutation by a founder effect

Mutations in the gene encoding Cu/Zn superoxide dismutase (SOD1) account for approximately 20% of patients with familial amyotrophic lateral sclerosis (FALS). In this study, sequence analysis of exons 1-5 of SOD1 in a large German cohort with FALS was performed. Among 75 affected patients, who were not obviously related probands with a positive family history, nine had missense mutations in SOD1. Four of the nine probands carry the same R115G mutation in exon 4 of the SOD1 gene. Genotyping with markers from the SOD1 locus revealed a common haplotype and shared allelic characteristics in these patients. These findings suggest that the R115G mutation in the German population originates from a common founder.     

Pulmonary tuberculosis due to Mycobacterium bovis subsp. caprae in captive Siberian tiger

We report the first case of pulmonary tuberculosis caused by Mycobacterium bovis subsp. caprae in a captive Siberian tiger, an endangered feline. The pathogen was isolated from a tracheal aspirate obtained by bronchoscopy. This procedure provided a reliable in vivo diagnostic method in conjunction with conventional and molecular tests for the detection of mycobacteria.     

Successful episodic memory retrieval of newly learned faces activates a left fronto-parietal network

It is easier to recognize a familiar face than a newly learned face. The neural basis of familiar face recognition has been elucidated in functional imaging and lesion studies. Behavioural and neuropsychological data indicate, however, that brain systems involved in episodic retrieval of familiar and newly learned faces are distinct. In our study, 12 subjects viewed 30 novel faces in an encoding session. In the study condition, event-related functional magnetic resonance imaging (fMRI) was used to compare brain activation during correct recognition of the recently learned faces to that observed during correct rejection of unknown control faces. Differences were present in the left inferior parietal (BA 40) and left medial frontal/anterior cingulate (BA 32/9) cortex. These two regions may be part of a pathway in the dorsal visual stream, responsible for a "feeling of familiarity" in contrast to the ventral pathway in the temporal lobes, which is mainly involved in the recognition of personal identity.