Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation.

PURPOSETo describe the spectrum of MR and CT findings in clinically symptomatic pineal cysts and to determine whether there are certain diagnostic imaging features that allow one to distinguish a benign pineal cyst from other neoplasms of the pineal region.METHODSMR and CT scans of 19 patients with clinically symptomatic pineal cysts were retrospectively reviewed. Age range was 15 to 46 years with a mean age of 28 years. There were five male and 14 female patients.RESULTSPresenting features included headache (15 patients), diplopia (four), nausea and vomiting (four), papilledema (four), seizure (three), Parinaud syndrome (two), ataxia (one), and hemiparesis (one). All cysts were resected or biopsied to provide histopathologic confirmation of the diagnosis. Preoperative diagnoses included pineal neoplasm (14 of 19), pineal cyst (3 of 19), and dermoid cyst (2 of 19). The lesions ranged from 0.8 to 3.0 cm, with a mean diameter of 1.6 cm. Three cysts showed fluid/fluid levels consistent with hemorrhage. Slightly less than half (9 of 19) had evidence of hydrocephalus. The MR signal changes were variable but typically demonstrated low signal on T1-weighted images and high signal on T2-weighted images. More than half (7 of 12) demonstrated enhancement with gadolinium. Calcification of the cyst wall was observed in only four of nine patients who had CT studies but identified histologically in all cases.CONCLUSIONThe MR appearance of benign pineal cysts is variable, ranging from that of an uncomplicated cystic mass to a mass associated with hemorrhage, enhancement, or hydrocephalus. This variability may make them indistinguishable from other pineal-region tumors.     

放线瑞香宁碱的解热镇痛作用

从青藤科植物黑吹风(Illigera sp)总生物碱中分离出一个单体,经化学鉴定命名为放线瑞香宁碱(actinodapbnine简称Ac)。分子式C_(18)H_(17)NO_4,为10-甲氧基-1,2-(次甲二氧基)-6-去甲阿朴菲-9-醇(图1)。动物实验表明,Ac具有解痉、镇痛、局麻及降低小鼠体温等作用,并证明其镇痛作用系非中枢性。本文进一步研究其镇痛作用和对不同动物正常     

师范院校贫困新生与非贫困新生心理健康状况的比较

目的:比较师范院校贫困新生与非贫困新生的心理健康状况。方法:于2005-10在衡阳师范学院完成调查。采用整群抽样横断面调查方法,以衡阳师范学院2005级3089名新生为调查对象,运用症状自评量表对其进行集体测查。在统一指导语下,学生根据最近1周内的自我感觉答题,独立完成,当场收卷。结果数据运用光电阅读机(OMR2000)输入计算机心理测评工具箱标准版V3.0系统进行总分和因子分的统计。量表中没有回答的项目记为"没有",5个以上项目未答者视为问卷无效以及总分低于95分的问卷因缺乏可靠性均不进行分析。所有数据输入电脑后用SPSS11.0软件进行统计分析;群体差异比较用t和Z检验。结果:共发放3089份问卷,收回有效答卷2994份,有效率为96.92%,其中贫困新生有效答卷510份,占17.03%。问卷结果显示,师范院校贫困新生在人际关系、偏执和精神病性3项因子上的得分分别为1.86±0.54,1.70±0.48和1.58±0.43,明显高于非贫困新生(1.78±0.51,1.65±0.46,1.53±0.39,t=3.34,2.02,2.92,P<0.05)。从阳性因子的人数比率来看,师范院校贫困新生在总分阳性的人数比率为0.28,明显低于非贫困新生(0.33,Z=-2.27,P<0.05);而在人际关系、偏执和精神病性3项因子阳性的人数比率分别为0.35,0.30,0.16,明显高于非贫困新生(0.31,0.24,0.13,Z=1.73,2.72,1.71,P<0.05)。结论:师范院校贫困新生的整体心理健康状况并不比非贫困新生差,但是在人际关系敏感、偏执和精神病性3个问题上明显比非贫困新生要严重。     

Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases

A review was done of 120 cases of malignant peripheral nerve sheath tumor (MPNST) seen during a 71-year period. Of the 120 patients, 52 were males and 68 were females with a mean age at diagnosis of 35.3 years; 12 patients were younger than 20 years. The series included 62 (52%) patients with neurofibromatosis, 13 (11%) with postradiation sarcomas, and 19 (16%) with metaplastic foci. The incidence of MPNST arising in neurofibromatosis was 4.6% in the current series and 0.001% in the general clinic population. Tumors greater than 5 cm and the presence of neurofibromatosis adversely affected the prognosis (P less than 0.05). When both features were present, survival was greatly decreased. Patients with tumor in the extremities did better than those with head or neck lesions. Metaplastic foci or previous radiation at the tumor site did not alter the prognosis. Each tumor was graded 1 to 4 on the basis of cellularity, pleomorphism, mitotic index, and necrosis. No significant correlation was noted between survival and either grade or mitotic rate. Survival was improved when total rather than subtotal resection was done. This was most marked in patients with a small lesion, which may reflect the difficulty in adequately excising large tumors. Adjuvant radiation or chemotherapy did not appear to affect survival. The MPNST is an aggressive uncommon neoplasm, and large tumor size, the presence of neurofibromatosis, and total resection are the most important prognostic indicators.     

The effects of dizocilpine maleate (MK-801), an antagonist of the N-methyl-D-aspartate receptor, on neurologic recovery and histopathology following complete cerebral ischemia in primates

The present study was designed to determine if the noncompetitive excitatory amino acid antagonist, dizocilpine maleate, when administered after a 17 min period of complete cerebral ischemia in primates, would improve postischemic neurologic function and hippocampal histopathologic outcome when compared to placebo-treated animals. Ten pigtail monkeys were anesthetized and subjected to complete cerebral ischemia using an established neck tourniquet model. Five minutes postischemia, five monkeys received dizocilpine 300 micrograms/kg i.v. over 5 min, followed by an infusion of 150 micrograms/kg/h for 10 h. This produced plasma levels of the drug in excess of 30 ng/ml for the duration of the infusion. An additional five monkeys were treated with an identical volume of saline placebo. All monkeys received intensive care for the initial 24 to 48 h postischemia. At 96 h postischemia, there was no significant difference in neurologic function between the two groups (p = 0.53, with the placebo group having the numerically better outcome). There also was no significant difference between hippocampal histopathology scores between dizocilpine and placebo-treated monkeys. The authors conclude that dizocilpine is not an efficacious therapy in the treatment of neurologic injury that occurs following complete cerebral ischemia in this primate model.     

Stereotactic resection of juvenile pilocytic astrocytomas of the thalamus and basal ganglia

Six patients with juvenile pilocytic astrocytomas of the thalamus or basal ganglia underwent seven computer-assisted stereotactic laser craniotomies with complete or nearly complete removal of the tumor in all cases. The tumor was located in the right basal ganglia in one patient, the left basal ganglia in one patient, and the left thalamus in four patients. Postoperative assessment of the completeness of tumor removal was confirmed by contrast-enhanced computed tomographic scanning within the first 2 weeks after operation. None of the patients was neurologically worse after the procedure, and five were improved. The duration of follow-up ranged from 6 months to 3.5 years. In this group of patients, the computer-assisted, stereotactically guided resection of these deeply located, benign tumors was accomplished with no morbidity or mortality.     

Granulomatous angiitis of the spinal cord associated with Hodgkin's disease

A 28-year-old man had a 5-month history of focal and generalized neurologic symptoms culminating in a thoracic myelopathy. Evaluation revealed granulomatous angiitis of the spinal cord in association with occult nodular sclerosing Hodgkin's disease. In previous reports, manifestations indicative of intracranial involvement have dominated the clinical presentation of granulomatous angiitis associated with Hodgkin's disease. Successful therapy for Hodgkin's disease may result in marked improvement of associated granulomatous angiitis, whereas the lack or failure of therapy results in a uniformly fatal outcome. Definitive antemortem diagnosis of granulomatous angiitis requires a biopsy of involved tissue. The cause of granulomatous angiitis, as well as the nature of its association with Hodgkin's disease, remains unexplained.     

Computer-assisted stereotaxic biopsy for the diagnosis of primary central nervous system lymphoma

Primary CNS lymphoma was diagnosed in 13 patients after stereotaxic biopsy of indeterminate intracerebral mass lesions. Two patients also had laser extirpation of CT-visible tumor. The group consisted of 10 men and 3 women, aged 17 to 81 (mean, 55 years; median, 60 years). The lesions on CT were characteristically hyperdense, homogeneously contrast-enhancing, and associated with mild to moderate mass effect. Five patients had more than one lesion visible on CT. Complete staging procedures for occult systemic lymphoma were negative in all 13 patients. The majority (eight) of the tumors were of the diffuse, large-cell type. Five biopsy specimens underwent special immunostaining as a supplemental diagnostic effort. Two patients with small lymphocytic tumors demonstrated features consistent with T cell phenotype. Two patients with diffuse, large-cell tumors were confirmed as B cell phenotype by monotypic immunoglobulin light chain content. Primary CNS lymphomas represent a treatable group of primary brain tumors. Because of their tendency to develop in deep cerebral regions, they are often inaccessible to conventional neurosurgical techniques. We propose that stereotaxic neurosurgery can provide safe and accurate diagnosis, which is a prelude to planning comprehensive management.     

Malignant bone tumors associated with neurofibromatosis

Neurofibromatosis (von Recklinghausen's disease), a phakomatosis inherited as an autosomal-dominant trait, predisposes to multiorgan neoplasia as well as to skeletal abnormalities. In an attempt to define more clearly the nature of osseous malignant lesions associated with von Recklinghausen's disease, we reviewed three cases of coexistent neurofibromatosis and malignant tumors of bone. None of the tumors was considered neurogenic. One patient had a fibrosarcoma, and two patients had malignant fibrous histiocytomas. No gross relationship to nerves was demonstrated, and special studies for axons were negative. Primary neurogenic sarcomas of bone are extremely rare; the diagnosis should be considered only when the tumor originates from an intraosseous nerve or contiguous neurofibroma. The occurrence of primary bone sarcomas in patients with neurofibromatosis seems to be a sporadic event.