Immunocytochemical analysis of glucose transporter protein‐1 (GLUT‐1) in typical,brain invasive,atypical and anaplastic meningioma

Glucose transporter‐1 (GLUT‐1) is one of the major isoforms of the family of glucose transporter proteins that facilitates the import of glucose in human cells to fuel anaerobic metabolism. The present study was meant to determine the extent of the anaerobic/hypoxic state of the intratumoral microenvironment by staining for GLUT‐1 in intracranial non‐embolized typical (WHO grade I; n = 40), brain invasive and atypical (each WHO grade II; n = 38) and anaplastic meningiomas (WHO grade III, n = 6). In addition, GLUT‐1 staining levels were compared with the various histological criteria used for diagnosing WHO grade II and III meningiomas, namely, brain invasion, increased mitotic activity and atypical cytoarchitectural change, defined by the presence of at least three out of hypercellularity, sheet‐like growth, prominent nucleoli, small cell change and “spontaneous” necrosis. The level of tumor hypoxia was assessed by converting the extent and intensity of the stainings by multiplication in an immunoreactive score (IRS) and statistically evaluated. The results were as follows. (1) While GLUT‐1 expression was found to be mainly weak in WHO grade I meningiomas (IRS = 1–4) and to be consistently strong in WHO grade III meningiomas (IRS = 6–12), in WHO grade II meningiomas GLUT‐1 expression was variable (IRS = 1–9). (2) Histologically typical, but brain invasive meningiomas (WHO grade II) showed no or similarly low levels of GLUT‐1 expression as observed in WHO grade I meningiomas (IRS = 0–4). (3) GLUT‐1 expression was observed in the form of a patchy, multifocal staining reaction in 76% of stained WHO grade I‐III meningiomas, while diffuse staining (in 11%) and combined multifocal and areas of diffuse staining (in 13%) were only detected in WHO grades II and III meningiomas, except for uniform staining in angiomatous WHO grade I meningioma. (4) “Spontaneous” necrosis and small cell change typically occurred away from the intratumoral capillary network embedded within the pattern of GLUT‐1 staining. Taken together, GLUT‐1 staining cannot be applied as a substitute for histologic grading in order to predict tumor behavior. However, assessment of tumor hypoxia in association with “spontaneous” necrosis and foci of small cell change may substantially contribute to the neuropathologic diagnosis of WHO grades II and III meningioma.     

Technique for soft tissue closure in surgeries for fixed implant-supported prostheses in the edentulous maxilla

A technique is presented that can be used as a straightforward, quick, and minimally invasive solution to improve soft tissue closure for surgeries involving bone reduction for fixed implant-supported prostheses in the edentulous maxilla.     

Precise Placement of Single‐Retainer Resin‐Bonded Fixed Dental Prostheses with an Innovative Splint Design

Single‐retainer resin‐bonded fixed dental prostheses (RBFDPs) are difficult to position due to the pressure of soft tissue at the pontic area and the single‐retainer design. This clinical report describes an innovative technique for the insertion of single‐retainer RBFDPs. An incisal inserting splint is used to position the RBFDPs reliably. With the help of grooves in the buccal and incisal area of the splint, the precise positioning of the splint on the adjacent teeth and the RBFDP can be controlled. Also, a hole in the retainer wing region of the splint gives access for pressure application on the wing during the bonding process. With the aid of this method, 25 single‐retainer FBFDPs were inserted in the correct position in a case series. The splint described here allows the precise insertion of single‐retainer RBFDPs and simplifies delivery.     

Vestibular paroxysmia in children: a treatable cause of short vertigo attacks

Vestibular paroxysmia due to neurovascular compression is a syndrome consisting of frequent short episodes of vertigo in adults that can be easily treated. Here we describe the initial presentation and follow‐up of three children (one female, 12y; two males, 8y and 9y) who experienced typical, brief, vertiginous attacks several times a day. Nystagmus was observed during the episodes. Cranial magnetic resonance imaging revealed arterial compression of the eighth cranial nerve. The attacks ceased after administration of low‐dose carbamazepine (2–4mg/kg daily). Vestibular paroxysmia must be considered in the differential diagnosis of children with brief vertiginous episodes.