Microcystic meningiomas—an unusual morphological variant of meningiomas

Evidence for tumour suppressor genes (anti-oncogenes, hemerogenes, flatogenes) has been obtained from the behaviour of familial childhood tumours in man, tumours in Drosophila caused by recessive mutations, experiments on fusing tumour cells to normal cells in tissue culture and revertants of oncogene-transformed cells. They may comprise more than one class of genes, one of which is likely to consist of genes responsible for normal differentiation. In large long-lived animals like man, which have a large potential somatic mutational load, mutant genes are associated with autosomal dominant behaviour in families. The susceptible individuals inherit heterozygosity of the tumour gene but the emergence of a tumour appears to follow a second somatic mutational event which results in homozygosity or hemizygosity. Hence, in tumour cells the mutations behave in a recessive manner. Success in isolating the normal genes may provide new tools for antenatal diagnosis of carriers and open up the possibility of developing new gene therapy.     

Emergency Cardiac Pacing for Severe Bradycardia

ALTAMURA, G., ET AL.: Emergency Cardiac Pacing for Severe Bradycardia. Our study included the treatment of transcutaneous cardiac pacing (TCP) in 32 patients: (A) 19 patients were treated in the emergency area for complete symptomatic AV block before endocavitary pacing; (B) five patients were in asystole following DC shock or out-of-hospital cardiac arrest; and (C) eight patients were affected by bifascicular block undergoing emergency surgery and were treated in order to prevent complete AV block. Two transcutaneous stimulators were used. PaceAid-CRC model 50/52 with 20-msec pulse width; the electrodes were positioned on the V, ECG position and on the back. Results: in all but two patients, it was possible to obtain stable cardiac capture; in one patient arrived in hospital in asystole after prolonged cardiac arrest and in the other one was affected by complete AV block, TCP was ineffective. In groups A and B, TCP was maintained for a mean time of 15 minutes; in group C, TCP was tested in all patients, but performed in only one patient during surgery. Mean threshold was 81 mA. Stimulation was well tolerated in all but five patients. TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by medical staff. In our opinion, it should be considered as the first choice emergency treatment of severe symptomatic bradycardia. In asystole, beneficial effects can be obtained only if TCP is performed early enough after the onset of arrhythmia.     

Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients

Schärer LO, Hartweg V, Valerius G, Graf M, Hoern M, Biedermann C,Walser S, Boensch A, Dittmann S, Forsthoff A, Hummel B, Grunze H, Walden J. Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients. Bipolar Disord 2002: 4(Suppl. 1): 107–108. © Blackwell Munksgaard, 2002     

Prolonged Atrium Electromechanical Interval Is Associated with Stroke in Patients with Atrial Fibrillation After Catheter Ablation

Electromechanical Interval and Strokes After Ablations of AF . Introduction: Atrial fibrillation (AF) is associated with increased risk of embolic stroke. Catheter ablation of AF provides an effective therapy for patients with symptomatic and drug‐refractory AF. The aim of this study was to evaluate whether the atrial electromechanical interval is useful in identifying patients at risk of stroke after successful catheter ablation. Methods and Results: A total of 279 AF patients who received catheter ablation and showed no evidence of recurrences were enrolled. Electromechanical interval (PA–PDI) was determined as the time interval from the initiation of P wave deflection to the peak of mitral inflow A wave on pulse wave Doppler imaging. The PA–PDI interval was measured for each patient after the 3‐month blanking period of catheter ablation. The clinical endpoint was the occurrence of ischemic stroke. During the follow‐up of 46.5 ± 17.2 months, 6 patients suffered from ischemic strokes. Patients with strokes had higher CHA₂DS₂–VASc scores and longer PA–PDI intervals (138.7 ± 12.4 ms vs 161.2 ± 7.7 ms, P value < 0.001) compared to those without strokes. At a cutoff point of 150 ms identified by ROC curve, the positive and negative predictive values of the PA–PDI interval to predict stroke were 86.7% and 100%, respectively. The PA–PDI interval improved the predictive performance of the CHA₂DS₂–VASc score, and the area under the ROC curve increased from 0.75 to 0.85. Conclusions: Our results suggest that the PA–PDI interval is a useful tool to identify patients with high risk of stroke after successful catheter ablation of AF. (J Cardiovasc Electrophysiol, Vol. 24, pp. 375‐380, April 2013)     

Time Course of Inhibition Induced by a Putative Saccadic Suppression Circuit in the Dorsal Lateral Geniculate Nucleus of the Rabbit

Psychological studies have revealed that a visual suppression occurs during the saccadic eye movements to maintain the stable visual image. This visual suppression is named saccadic suppression. A typical saccadic suppression precedes the saccadic eye movements by 30–60 ms, lasts 120–180 ms, and is followed by a 100–150-ms facilitation. Recently, we have revealed an inhibitory circuit connecting the deep layers of the superior colliculus (SC) to the dorsal lateral geniculate nucleus (LGN), via the central lateral nucleus in the thalamus (CL) and thalamic reticular nucleus (TRN). We speculated that this inhibitory circuit might mediate saccadic suppression in the rabbit. In the present study, we used intracellular recording technique to further examine the synaptic and intrinsic responses of CL cells, TRN cells, and LGN cells to the activation of this inhibitory circuit. We found that the stimulation of the deeper layers of the SC induced a fast excitation postsynaptic potential (EPSP) in CL cells, followed by a robust EPSP in TRN cells and a prolonged inhibitory postsynaptic potential (IPSP) in LGN cells. The EPSP in TRN cells was always followed by a small inhibitory postsynaptic potential (IPSP). The IPSP in LGN cells lasted about 133 ± 27 ms. Sometimes, a rebound bursting occurred after the IPSP in LGN cells. We also examined whether activation of this inhibitory circuit could suppress the retino-geniculo-cortical pathway. We found that the SC stimulation always suppressed the evoked potential in the visual cortex induced by the stimulation of the optic chiasm. Our results of the inhibitory circuit can induce an inhibition in the LGN and a suppression on the retino-geniculo-cortical pathway. The time courses of the inhibition and suppression were compatible with that of saccadic suppression revealed by psychological and physiological studies. These results support the idea that the inhibitory circuit of SC (deeper layers)-CL-TRN-LGN may mediate the saccadic suppression in the rabbit LGN. Copyright © 1996 Elsevier Science Inc.     

ANAESTHETIC MANAGEMENT OF A 2-MONTH-OLD INFANT FOR LASER RESECTION OF VOCAL CORD GRANULOMA

A 2-month-old infant underwent excision of granulomata of vocalcords with a carbon dioxide laser. High frequency jet ventilationwas given through a surgical metal suction tube during the operation.The anaesthetic technique for the infant and the problems ofthe use of carbon dioxide laser in laryngeal surgery are discussed.     

Ursodeoxycholic acid in the treatment of primary biliary cirrhosis: A short-term, randomized, double-blind controlled, cross-over study with long-term follow up

Abstract In order to evaluate the efficacy of ursodeoxycholic acid (UDCA) in the treatment of Chinese patients with primary biliary cirrhosis, a short-term, randomized, double-blind controlled, cross-over study was done with long-term follow up. In the first part of the study, 12 patients were randomly chosen to receive either UDCA 600 mg/day for 3 months followed by a placebo for 3 months or a placebo for 3 months followed by UDCA for 3 months. The clinical symptoms of pruritus improved when the patients were receiving UDCA but became worse when receiving a placebo. Mean serum levels of alkaline phosphatase (ALPase), γ-glutamyl transferase (γ-GT), total bilirubin, cholesterol, alanine aminotransferase (ALT) and aspartate aminotransferase all decreased below the baseline values when receiving UDCA treatment and all increased above the baseline values when receiving the placebo. The difference was statistically significant. In the second part of the study, 19 patients received long-term UDCA treatment (mean 20 months). The clinical symptoms of pruritus improved in 90% of the pruritic patients. Serum levels of ALPase, γ-GT and ALT fell significantly from the pretreatment values 6, 12 and from the mean 20 months after UDCA treatment. Serum levels of total bilirubin fell significantly 6 and 12 months after UDCA treatment but did not reach statistical significance at the last follow up. No patient lost antimitochondrial antibody and elevated immunoglobulin levels did not improve significantly, but the Mayo clinical risk score improved significantly after long-term UDCA treatment. Treatment failure was noted in three patients: two patients in the histologic stage IV with clinical overt jaundice died of complications 4 and 5 months after UDCA treatment, respectively; another patient underwent a liver transplantation 1 year after the UDCA treatment due to progressive jaundice. No severe adverse reaction was noted during UDCA treatment, only one patient suffered from a mild allergic reaction. In conclusion, UDCA is safe and effective in the treatment of Chinese PBC patients in stages I—III.     

Regressed Subungual Melanoma Simulating Cellular Blue Nevus: Managed with Sentinel Lymph Node Biopsy

BACKGROUND: Subungual melanoma, a not uncommon presentation of cutaneous melanoma in Asian populations, is easily overlooked as benign and thus is improperly treated. OBJECTIVE: To present two cases with clinical suspicion of subungual melanoma. Skin biopsies failed to demonstrate the diagnostic features of malignancy. METHODS: Lymphoscintigraphy and sentinel lymph node (SLN) biopsies were performed to determine regional lymph node status. RESULTS: Both hematoxylin-eosin and HMB45 staining revealed melanoma cells in the SLN of the patient. The second patient's SLN was negative for malignant cells, but her excised primary lesion showed extensive regressed melanoma. CONCLUSION: Regression phenomena are not uncommon for subungual melanoma. An extention biopsy techniques are useful for determining nodal basin status in regressed subungual melanoma.     

伽玛刀治疗原发性三叉神经痛22例疗效分析

目的 探讨伽民治疗原发性三叉神经痛的疗效，疗效与剂量关系。方法 采用OUR－XGD／B型旋转式伽玛刀Leksell-G型立体定位仪，1.0TMRI扫描定位，Gamma-TPS规划系统，在痛侧三叉神经根部，用4mm准直器，布1－2靶点中心，中心剂量为80－100Gy。结果 22例获得随访3.5-32.5个月（平均19.6个月）。整剂量组平均缓解时间115天，90－100Gy剂量组疼痛缓解时间明显缩短（平均26天），中心剂量90－100Gy组与其他剂量组不良反应没有明显差异（P＜0.05)。59.1%患者疼痛完全缓解，22.7%患者疼痛缓解＞90％，9.1%患者疼痛缓解＞50％，总有效率（90.9%)。结论 伽玛刀治疗原发性三叉神经痛是一种安全有效的方法，治疗中心剂量一般考虑为90－100Gy。