The role of different imaging modalities: is MRI a conditio sine qua non for ETV?

Objective To describe the different imaging modalities used for the diagnosis and classification of hydrocephalus, their role in defining the optimal treatment of hydrocephalus and to define the optimal preoperative diagnostics for endoscopic third ventriculocisternostomy (ETV). Methods An overview on available imaging modalities for hydrocephalus will be given and their pros and cons discussed. In addition, different aspects of the treatment of hydrocephalus by shunts and by ETV will be highlighted. Discussion The role of the technical aspects of performing an ETV, the role of the surgeon’s philosophy, the role of the urgency of the procedure, and the role of informed consent on the requirements for the imaging of the hydrocephalus will be discussed. Conclusion The authors conclude that MRI is a conditio sine qua non for ETV in elective surgical cases.     

Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006.

Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though solutions have been identified, governments and donor countries have been slow to implement programs to contain the problem. While poverty and low educational level remain the underlying cause of PPH, the current literature suggests that active management of the third stage of labor can prevent it. The International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH crisis by educating their members on best practices and on troubleshooting where resources are inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active management is the norm. However, secondary clinical effects may prove more troublesome with oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally effective in low-resource settings. Two new interventions are also proposed, the anti-shock garment and the balloon tamponade.     

Stereotactic endoscopic treatment of colloid cysts of the third ventricle

Summary In order to avoid invasive procedures (transfrontal, transcallosal) in the surgical treatment of colloid cysts the stereotactic aspiration technique was introduced by Bosch, RÄhn and Backlund in 1978. The viscosity of the intracystic colloid and the displacement of the cyst away from the aspiration needle are possible reasons for unsuccessful aspiration. GT-guided stereotactic endoscopic technique gives the opportunity to fenestrate the cyst wall under direct visual control.After CT-guided stereotactic puncture of the right lateral ventricle with the foramen of Monro as target a steerable endoscope is introduced and the foramen of Monro is passed. The wall of the cyst is fenestrated and coagulated by means of monopolar (or laser) coagulation.Using this technique we have treated four patients with colloid cysts. Immediately postoperatively all of them were relieved of their complaints and have been symptomfree for a mean follow up period of twelve months. Studies of cerebrospinal fluid flow patterns, performed prior to and every six months after the endoscopic intervention, confirmed a remarkable reduction of foraminal obstruction.     

Primary cerebral neuroblastoma (neurocytoma) in adults

Summary We report a case of a third ventricular neuroblastoma (neurocytoma) in a 66 year old man. A stereotactic needly biopsy was performed to obtain a tissue diagnosis and was followed by total resection. We elected not to give radiation or chemotherapy and to follow the patient closely with serial CT scans. Presently, 48 months postoperatively, the patient is free of tumor by head CT scan and able to live independently. We reviewed the literature of primary cerebral neuroblastomas/neurocytomas occurring in adults (15 years of age) and found 32 cases. Our patient is the oldest of this group with a mean age of 32 ± 14 years (S.D.). The location of the 33 neoplasms was intraventricular in 17 cases (52%) and intraparenchymal in 16 cases. The male to female ratio was 2: 1. Of the 17 patients having a minimal follow-up period of 5 months (mean 51 months), five developed recurrences after 5 to 144 months (mean 50 months) compared to 12 patients without recurrence after a 6- to 72-month follow-up period (mean 52 months). Recurrences occurred statistically significantly more often in parenchymal neuroblastomas/neurocytomas than in intraventricular tumor locations.     

Synthesis and Optical Properties of a New Series of Side‐Chain Poly(amic acid)s With p‐π Conjugation

Summary: After the condensation polymerization of benzoguanamine (BGA) and pyromellitic dianhydride (PMDA) under microwave irradiation, the resulting p‐π conjugate poly(amic acid) was grafted via the azo coupling reaction. The obtained side‐chain polymers were further grafted with TDI‐aliphatic alcohol derivatives and TDI‐aniline derivatives. The third‐order NLO coefficient and response time of PAA and graft polymers were measured by degenerated four wave mixing (DFWM) technique and their fluorescent properties were also investigated. All of the graft polymers have larger NLO coefficients and film‐formability than PAA. Their fluorescent properties were also changed by the different electronic effect of the side‐chains. The influences of the introduction of side‐chains, the side‐chain length and the electronic effect of the substituting groups on the azobenzol side‐chain to both optical properties of the polymers by varying the conjugation degree were investigated.

     

内窥镜下第三脑室手术的应用解剖

目的 :为神经内窥镜下进行第三脑室手术提供解剖学资料。方法 :对 2 1例成人尸头固定标本进行第三脑室的解剖观察和测量 ,对 9具新鲜尸头进行经室间孔入路神经内窥镜下第三脑室的解剖学观察。结果 :室间孔长径、宽径为 (5 .4± 1.2 )mm、(2 .7± 0 .9)mm ,中间块长径、宽径为 (6.8± 2 .3 )mm、(3 .8± 1.0 )mm ,前后联合间距 (2 1.8± 2 .1)mm ,前、后联合到中间块为 (6.3± 0 .8)mm、(8.8± 1.3 )mm ,前后联合中点处第三脑室高度 (13 .8± 1.4)mm ,室间孔下、后联合前及中间块上、下第三脑室宽度分别为 (6.3±2 .2 )mm、(4 .9± 1.8)mm、(3 .4± 1.6)mm和 (4 .3± 1.8)mm ,中间块上、下最小高度为 (4 .4± 1.3 )mm和(4 .3± 1.3 )mm。内窥镜可较清晰显示第三脑室内结构 ,但中间块可影响显露。结论 :内窥镜下经室间孔入路进行第三脑室手术有一个理想的操作空间。     

A multicentre randomized controlled trial of oral misoprostol and i.m. syntometrine in the management of the third stage of labour

Postpartum haemorrhage accounts for nearly 28% of maternal mortality in developing countries. Syntometrine is an effective and commonly used oxytocic in preventing postpartum haemorrhage, but it requires a controlled storage environment and i.m. administration. Misoprostol is an orally active uterotonic agent. A total of 2058 patients having a singleton pregnancy, low risk for postpartum haemorrhage and vaginal delivery were randomized to receive either 1 ml syntometrine or 600 microgram misoprostol for the management of the third stage of labour. There were no significant differences between the two groups in the mean blood loss, the incidence of postpartum haemorrhage and the fall in haemoglobin concentration. The need for additional oxytocic injection was significantly higher in the misoprostol group [relative risk (RR) 1.62, 95% confidence interval (CI) 1.34-1.96], but that of manual removal of placenta was reduced (RR 0.29, 95% CI 0.09-0.87). Shivering and transient pyrexia were more common in the misoprostol group. Oral misoprostol might be used in the management of the third stage, especially in situations where the use of syntometrine is contraindicated and facilities for storage and parenteral administration of oxytocics are limited.     

Purification of bovine conglutinin using pepsin digestion

This paper describes a new method for the purification of bovine conglutinin based on the relative resistance of this protein to pepsin digestion. First, conglutinin is purified by absorption on yeast, then the preparation is treated with 2% pepsin (w/w) at 4°C for 18 hr, and finally gel filtrated on agarose A5m. The yield is 60–75% and conglutinin thus prepared appears physically, immunochemically and functionally intact. This procedure allows for a rapid production of sufficient amounts of conglutinin for immune complex detection or purification methods.     

Isolated pupil-sparing third nerve palsy

The challenge in managing patients with pupil-sparing third nerve palsies is met most efficiently by dividing such patients into three groups according to the relative deficits in pupillomotor and extraocular muscle function: (1) patients with a normal pupillary sphincter and completely palsied extraocular muscles. Such patients should not have cerebral angiography if they are aged 50 or more; (2) patients with a normal pupillary sphincter and incompletely palsied extraocular muscles. Such patients should have angiography, particularly if the inferior oculomotor division is spared; (3) patients with a subnormal pupillary sphincter and completely palsied extraocular muscles ("relative pupil-sparing"). Such patients should have angiography unless they have clear-cut vasculopathic findings.     

Applications of CT-adapted stereotaxis for the diagnosis and treatment of intracranial lesions

Summary Two hundred twenty five patients with intracranial lesions underwent diagnostic and therapeutic stereotactic surgery during the period 1978–1985. In the first 98 cases target coordinates were determined by transferring the information from the CT images to the standard stereotactic films. In the remainder, a simple, CT adapted stereotactic system has been used. Operations were as a rule performed under local anaesthesia. Positive histological diagnosis using paraffin embedding was achieved in 96% of the patients (biopsy success rate). Therapeutic procedures included abscess and cyst aspiration, cyst shunting, interstitial (Ir 192) or intracavitary (Y 90) irradiation and ventriculocisternostomy. Stereotactic surgery implied a refinement of the eventual therapeutic management in 90% of the cases. Transient neurological deficit occurred in 5.7% of the patients and there were three deaths (mortality rate 1.3%). Infection or other complications were not seen. The rationale and indications for non-functional stereotaxis are discussed.