Temporary alopecia after subarachnoid haemorrhage.

Primary endovascular intervention is increasingly the first choice of treatment for cerebral aneurysms, particularly for those with complex anatomy in the posterior circulation. However, their clinical management and follow-up continue to be predominantly in the hands of neurosurgeons. In this report, the development of alopecia following the coiling of posterior circulation aneurysms is described. The alopecia was transient and lasted for approximately 6 months, and occurred in the occipital and suboccipital regions of the scalp. This report aims to highlight this condition, which has not been previously reported in the neurosurgical literature. The potential hazards of irradiation should be borne in mind while carrying out complex endovascular procedures. The patient should be counselled and all necessary steps undertaken to limit radiation exposure.     

Mesenteric infarction secondary to tumor emboli from primary aortic sarcoma. Guidelines for diagnosis and management

Primary aortic tumors are rare, difficult to diagnose, and often fatal. This case and a review of the literature identified aortic tumors as a potential source of emboli leading to acute mesenteric insufficiency. The case showed the efficacy of magnetic resonance imaging in diagnosing and determining the extent and location of an aortic tumor.     

Microvascular reconstruction of complex craniofacial defects.

Many large vault or skull base tumours are best treated by wide surgical excision and primary reconstruction using a microvascular free tissue transfer (free flap). We report 23 patients who were reconstructed using free flaps, eight having been previously treated surgically elsewhere and seven of whom had recurrent disease after radiotherapy. There was one flap failure and a local recurrence rate of 16% (3/19). The outcome at a mean follow-up period of 29 months, was 19 patients alive and four deaths.     

Unexpected cytokinetic effects induced by puromycin include a G2-arrest, a metaphase-mitotic-arrest, and apoptosis.

The potent effects of low doses of PM on the cell cycle have to date been obscured by the conventional usage of this drug at high concentrations (5-50 micrograms/ml) to inhibit protein synthesis. In this in vitro study undertaken in a variety of malignant and non-malignant human and murine cell types, we found that low doses of PM (0.1-0.5 microgram/ml) disrupted significant phase-to-phase cell cycle transitions, causing a G2-arrest, a metaphase-mitotic-arrest, and apoptosis. In HL-60 cells these observations were elicited by PM concentrations starting at 0.1 microgram/ml, and were more pronounced at slightly higher PM concentrations, including that (0.5 microgram/ml) which inhibited [14C]leucine incorporation by approximately 20% after one hour, and by approximately 50% after 24 h. A concentration of CHX (0.25 microgram/ml) which was equivalent to 0.5 microgram/ml of PM, both in terms of molarity (0.9 microM) and degree of inhibition of [14C]leucine incorporation, failed to induce similar changes to those induced by PM. This suggests that at these particular concentrations the PM-induced changes were likely to have been related to the different mechanisms of protein synthesis inhibition exerted by these two 'classical' translation inhibitors. PM but not CHX generates nascent peptidyl-PM complexes (PMPs), and we therefore propose that the subsequent intracellular effects exerted by the PMPs may account, in part, for the differential cytokinetic effects elicited by these drugs. The role of PM is currently being evaluated in vivo as a low-dose component of a multidrug chemotherapeutic regimen in which its cell cycle-specific effects could potentially be synergistic with other agents.     

F-19 MR imaging of glucose metabolism in the rabbit

Noninvasive metabolic magnetic resonance (MR) imaging reflecting glucose metabolism in the aldose-reductase-sorbitol (ARS) pathway was performed in the rabbit head; after administration of the fluorinated glucose analogue 3-fluoro-3-deoxy-D-glucose (3FD-glucose), fluorine-19 images were generated. Images of 3FD-glucose showed significant 3FD-glucose uptake by adipose tissue, indicating its buffering effects in case of excess loads of glucose. Images of 3-fluoro-3-deoxy-D-sorbitol (3FD-sorbitol) demonstrated the spatial distribution of aldose reductase activities and significant sorbitol accumulation in the lens. Images of 3-fluoro-3-deoxy-D-fructose (3FD-fructose) showed preferential uptake of fructose by muscle tissue. The extremely low toxicity of 3FD-glucose indicates promise for its clinical application in metabolic imaging.     

Red blood cell distribution width in the anemia secondary to tuberculosis

A study was done to explore the claim that anisocytosis as measured by the red blood cell volume distribution width (RDW) is raised in iron-deficiency anemia, but is normal in the anemia of chronic disorders. Measurements were done on 283 normal patients, 22 iron-deficient patients, and 102 tuberculotic patients, using a model S plus Coulter Electronic Counter with standard calibration. Mean (+/- SD) values for RDW were as follows: normals, 7.36 (+/- 0.57); untreated iron deficiency, 10.39 (+/- 1.37); and 15 untreated anemic patients with tuberculosis, 10.44 (+/- 0.63). Mean values remained above 10.4 in 69 patients with tuberculosis during treatment, irrespective of whether or not the patients were anemic, but had fallen towards the normal mean (8.49 +/- 0.8) in the 18 subjects in whom it was measured at the end of therapy. By this time the mean corpuscular volume (MCV) and hemoglobin concentrations had risen to normal. It is concluded that RDW values in the chronic inflammatory disorder tuberculosis are not significantly different from those occurring in iron-deficiency anemia.     

Spontaneous intracerebral haemorrhage: a surgical dilemma

The optimal management, surgical or otherwise, of a patient following a spontaneous intracerebral haemorrhage (ICH) remains controversial. A survey of British neurosurgeons was carried out to assess current attitudes and practice. Patient management was most consistently influenced by the depth (71% agreement), dominance (74.3% agreement) and site (44.7%) of the haematoma. Almost half of neurosurgeons said they would evacuate an ICH in a deteriorating patient, but management choice was very varied in stable patients. However, 80% of the same respondents felt evacuation was helpful in reducing mortality, and 71.3% morbidity. Fifteen per cent of respondents were not influenced by the size of an ICH, but 31% would readily operate on haematomas with volumes of between 50 and 80 ml. Over 30% felt that there was no optimal time for surgical evacuation, but 66.9% felt delayed evacuation was helpful. Premorbid dependency was a stronger influence than age on management choice. Despite these variations, over half felt that they were consistent in their treatment of ICH. However, 81% expressed surgical uncertainty. Furthermore, respondents demonstrated a significant tendency to intervene surgically more readily in ICH related to aneurysm or AVM. Results from a prospective randomized controlled trial to assess the role of surgery are urgently needed.