Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions

OBJECT: The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls. METHODS: A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labbé is first identified and protected. Cerebrospinal fluid ([CSF] 50-100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Kawase triangle toward the clivus can be removed down to the inferior petrosal sinus if necessary. Anterior exposure can be extended to the carotid artery if required. It is only exceptionally necessary to follow the greater superior petrosal nerve toward the geniculate ganglion and to expose the length of the internal acoustic canal. The modified transdural anterior petrosectomy exposure has been used in nine patients-two with a mid-BA aneurysm, two with a dural arteriovenous fistula, one with a pontine glioma, three with a pontine cavernoma, and one with a pontine abscess. In one patient with a mid-BA aneurysm, subcutaneous CSF collection occurred during the postoperative period. No CSF fistula or approach-related cranial nerve deficit developed in any of these patients. There was no retraction injury or venous congestion of the temporal lobe nor any venous congestion due to the obliteration of the SPS or the petrosal vein. CONCLUSIONS: The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.     

On the application of light therapy in German-speaking countries

Many studies have investigated seasonal affective disorder (SAD; fall-winter-depression) and its treatment with light therapy (LT). However, to the best of our knowledge, no other study has investigated the usage of LT in Europe since 1994. Thus, we performed a survey in hospitals with adult psychiatric departments in German-speaking countries by questionnaire. First, a questionnaire was constructed, considering also recent developments in LT. This questionnaire was sent to all hospitals with adult psychiatric departments listed in the "Deutsches Krankenhaus Adressbuch," which contains hospitals from all German-speaking countries (Germany, Switzerland, and Austria). Non-responders were asked to answer the questionnaire by mail and by phone. We achieved a completion rate of 58%. Data show almost no relevant, non-artificial differences between countries as well as between type of hospital. LT is more frequently used in university and state hospitals than in other types of treatment facilities. Compared to 1994, the major findings are (1) a substantial increase in the use of LT from 13.0 to 69.8% with no differences between Germany, Austria, and Switzerland, (2) this increase is mostly due to treatment for various forms of depression and further possible applications are less often considered, (3) there is a shift in the usage of LT from monotherapy to combination of pharmacotherapy with LT as an adjunctive treatment, and (4) a north-south comparison showed no substantial differences. Considerably higher rates of usage of LT have been found compared to the last survey in German-speaking countries taking place in 1994. Usage almost tripled; however, possible indications for LT other than SAD and non-seasonal depression are not applied to full extent. Further efforts on the propagation of LT should therefore be undertaken, with the same rigorous studies as for pharmacotherapy.     

Human anti-mouse antibody response induced by anti-CD4 monoclonal antibody therapy in patients with rheumatoid arthritis

The development of human anti-mouse monoclonal antibodies (HAMAs) was investigated in 10 patients with rheumatoid arthritis (RA) who had undergone an experimental therapeutic trial with an anti-CD4 monoclonal antibody. In this patient group, the antibody 16H5 of the IgG1 isotype had been administered in a median total dosage of 140 mg per treatment cycle. Four patients took part in a second treatment regimen 6-8 weeks later. After the first treatment cycle, detectable HAMAs developed in 5 out of 10 patients. In 4 individuals undergoing a second course of therapy, increases of HAMAs were evident only in the 3 patients with previous HAMA responses. HAMAs were primarily of the IgG isotype, while the presence of rheumatoid factors usually interfered with the detectability of IgM HAMAs. However, using isolated F(ab)2 fragments of the monoclonal reagent used for therapy, HAMAs of the IgM isotype were also detectable. HAMAs of the IgG isotype did not exceed levels of 2.0 mg/liter after a single treatment cycle and 2.2 mg/liter after a repeated cycle. No IgE responses were detectable. Absorption experiments indicated that approximately 25% of the HAMA activity was directed against specific determinants of the 16H5 monoclonal antibody, presumably including anti-idiotypic reactivities. These data demonstrate that HAMAs developed only in a proportion of RA patients treated with the anti-CD4 monoclonal antibody 16H5. However, the amounts were rather low compared to other monoclonal reagents used in cancer patients and were therefore allowed for repeated applications without an apparent loss of efficacy.     

磁共振形态学半定量评分对新生儿细菌性脑膜炎出院结局的评估价值

目的 分析MRI形态学半定量评分对新生儿细菌性脑膜炎出院结局的评估价值。方法 收集复旦大学附属儿科医院2011年7月至2013年12月NICU收治的出院诊断为新生儿细菌性脑膜炎的病例,采用基于大脑损伤MRI形态学分析的半定量评分,对头颅MRI图像进行回顾性分析。MRI形态学评价包括脑室扩大、脑室旁白质容积丢失、脑白质囊性病灶、内囊后肢髓鞘化异常、皮质信号异常、颅内脑外间隙异常、基底节信号异常、脑白质非囊性信号异常、脑室内出血、脑室积脓、脑膜异常强化、室管膜异常强化和脑脓肿。将上述13项评分归纳为脑白质异常（WMA）、脑灰质异常（GMA）和非脑实质异常（NPA）。同时采集患儿出生孕周、发病时间、MRI检查时间、发病至MRI检查间隔时间和出院结局。按照出生孕周分为早产儿组和足月儿组,再按照出院结局分为预后良好和预后不良亚组,在各组内比较亚组之间时间因素、MRI单项评分和综合评分的差异。结果 63例新生儿细菌性脑膜炎病例进入分析（早产儿组18例,足月儿组45例）。MRI单项评分构成预后良好和预后不良亚组间差异有统计学意义的指标：早产儿组中有脑室扩大(P=0.012)和脑室旁白质容积丢失(P=0.004);足月儿组有脑室扩大(P=0.002)、脑室旁容积丢失(P=0.040)、颅内脑外间隙异常(P=0.005)和脑室内出血(P=0.038)。MRI综合评分中,早产儿组WMA评分(P=0.001)和NPA评分（P=0.039）、足月儿组NPA评分(P=0.018)在预后不良和预后良好亚组之间分布差异有统计学意义。足月儿组和早产儿组内不同预后亚组的各时间因素差异未发现统计学意义或临床意义。结论 新生儿细菌性脑膜炎MRI脑室扩大和脑室旁白质容积丢失预示早产儿出院不良结局;脑室扩大、脑室旁白质容积丢失、颅内脑外间隙异常和脑室内出血预示足月儿出院不良结局。WMA评分高预示早产儿出院不良结局,NPA评分高预示早产儿和足月儿出院不良结局。     

Genetic determinants of lung virus titers and resistance to lethal Sendai virus pneumonia

Summary C 57 BL/6J mice are resistant to lethal Sendai virus pneumonia and have lower lung virus titers than susceptible DBA/2J mice. Linkage between these phenotypes was tested indirectly in segregant hybrids.Sas-1,B2m, andb on chromosomes 1, 2, and 4 were linked to significant (P<.05) differences in virus-induced mortality;d on chromosome 9 was associated with a similar but smaller difference (.1>P>.05). Mean lung virus titers were higher in F₁ × DBA/2 J mice that were homozygous for DBA alleles atB2m, b, andd than in heterozygotes. The difference in lung virus titers was larger between mice that were dihomozygous/diheterozygous for paired combinations;B2m-d (P<.02),B2m-b (P<.06), andb–d (P<.05) and largest between mice that were trihomozygous/triheterozygous forB2m-b–d (P<.001). The distribution of virus titers among 22 recombinant inbred strains derived from C 57 BL/6 J and DBA/2 J progenitors indicated 1) that the loci linked toB2m, b, andd are among at least 4 loci that regulate lung virus titers, 2) thatSas-1 may be linked to a fourth locus, 3) that the C 57 BL/6 J genome contains at least one susceptibility locus, possibly within H-2, and 4) that some of these loci may be expressed through natural killer cell activity.     

Body dimensions and differential fertility in !Kung San males from Namibia

The relationship between paternal somatic morphology and number and sex of the offspring was investigated with 114 !Kung San males from Namibia. Significant correlations were observed between measures of facial and distal robustness and the total number of sons and daughters as well as for the sex ratio of children and the ratio of living to dead children. Anthropometric characteristics of !Kung San men correlated with the number of daughters more frequently than with the number of sons, and the majority of correlation coefficients were negative. This indicates that more slender men tend to have more daughters, while the positive correlations between body dimensions and the number of sons demonstrate that more robustly built and tall men tend to have more sons. Mortality of children also differs relative to the paternal body build. The mortality rate in children of more slender fathers is higher than in those of more robust fathers. Robust men have more male children and these children have a better chance to survive. The differential fertility of the !Kung may be explained by the association between a high social rank and robustness of physique which may lead to typical patterns of sexual selection. The results of the present study are consistent with the Trivers-Willard hypothesis, which describes differential sex-biased parental investment under different socioeconomic conditions. © 1994 Wiley-Liss, Inc.     

Effect of mouse lymphokines and cloned mouse interferon-gamma on the interaction of Rickettsia prowazekii with mouse macrophage-like RAW264.7 cells.

We studied the effects of crude mouse lymphokines and cloned mouse interferon-gamma on the interaction of Rickettsia prowazekii with mouse macrophage-like RAW264.7 cells. Treatment of RAW264.7 cells with lymphokines before infection, after infection, or both before and after infection with R. prowazekii led to killing of a substantial proportion of the RAW264.7 cells. Such cytotoxicity required both lymphokines and viable R. prowazekii and did not occur in mouse fibroblastic L929 cells. Untreated cultures of RAW264.7 cells supported good growth of the Breinl strain of R. prowazekii, but in lymphokine-treated cultures, little or no rickettsial growth occurred in the cells that survived the cytotoxic reaction. In addition, treatment of RAW264.7 cells with lymphokines before rickettsial infection was associated with suppression of the initial infection. The effects of cloned mouse interferon-gamma were similar to the effects of crude mouse lymphokines. Assessment of cytotoxicity, inhibition of the initial infection, and inhibition of rickettsial growth in RAW264.7 cells pretreated with various concentrations of interferon-gamma indicated that the effects of the lymphokines could be explained by the interferon-gamma that was present in these preparations. Treatment of RAW264.7 cells with interferon-gamma makes them unsuitable host cells for R. prowazekii.