The Diagnosis and Treatment of Spina Bifida

The clinician need not and indeed should not apply every new anesthetic technic that is described or try every new anesthetic agent. It is wiser to rely on those that have served well in the past until large-scale research projects prove the merit and safety of a new method. Improved management of particular anesthetic problems may depend more on acquisition of greater skill than on development of new drugs. Reliable, inexpensive, simple monitoring equipment would be especially helpful.     

Presence of serum carbonic anhydrase autoantibodies in patients relapsed after autologous stem cell transplantation indicates an improved prognosis

Here we report patients with Hodgkin's disease and multiple myeloma, who relapsed/progressed after high dose therapy and autologous stem cell transplantation. In patients who developed aplastic anemia type syndrome, spontaneous tumor regression was observed and concomitantly high titers of serum autoantibodies were found. In order to identify the antibody specificity, two-dimensional electrophoresis, blotting and immunoreactions were used to analyze the peripheral blood stem cell extract with autoantibodies containing serum. The unique protein spot visualized exclusively by serum of patients with aplastic anemia type syndrome was identified as carbonic anhydrase I (CA I, accession No. P00915 and Q7M316) by means of mass spectrometry. The specificity of autoantibodies was confirmed by reaction with commercial CAs I, II, IX and XII. Immunoreaction in Western blots with these CA isoforms differed in sera obtained from patients with various types of the disease. Sera of Hodgkin's disease patients reacted with CA I, II and XII; sera of multiple myeloma patients reacted with the CA I, II, XII and IX. Patients developing and/or possessing CA autoantibodies had a significant survival benefit over those who did not develop CA anhydrase autoantibodies. Possible relevance of the presence of CA autoantibodies and clinical outcome is discussed.     

Spinal cord compression secondary to Gaucher's disease

A case of compression of the spinal cord and cauda equina secondary to collapse of the T-12 and L-3 vertebral bodies in a patient with type 1 Gaucher's disease is presented. Decompressive laminectomies were done at both the T-12 and L-3 levels with moderate improvement of the patient's neurologic findings. Histologic examinations confirmed the presence of Gaucher's cells in the bone. Review of the literature revealed only one previous report.     

Contrast-enhancing computed tomography ring in glioblastoma multiforme after intraoperative endocurietherapy

The significance of the contrast-enhancing ring seen on serial follow-up postirradiation computed tomograms (CT) of the brain was evaluated in a group of 41 patients with glioblastoma multiforme (GM) who were treated in a phase I/II study by means of intraoperative remote afterloading endocurietherapy (ECT) with a high activity cobalt 60 probe (20.00 Gy) in one high-dose rate fraction), and conventional fractionated external-beam (EXRT) radiotherapy (60.00 Gy in 30 fractions in 7.5 weeks). All received minimum total tumor doses of 80.00 Gy. After completion of treatment, all patients were followed with serial CT scans of the brain. Two to 6 months after treatment, 27 of 41 patients developed the similar thin-walled, regular, contrast-enhancing CT rings with low-density attenuation inside and outside the ring. Postmortem study in two of these patients revealed that the thin-walled, regular, contrast-enhancing ring represented a continuous capsule of dilated cerebral vessels with inner low-density attenuation corresponding to necrosis, and outer low-density attenuation corresponding to edema. The CT appearance of the thin-walled, regular, contrast-enhancing ring produced after high-dose rate intraoperative ECT and EXRT is distinctly different from the CT ring characteristic of untreated or recurrent GM. After high-dose rate intracranial ECT and EXRT, the appearance of a post-ECT contrast-enhancing CT ring should not be automatically interpreted as recurrent disease as previously reported after conventional fractionated EXRT.     

A new method for treatment of unresectable, recurrent brain tumors with single permanent high-activity 125iodine brachytherapy

We describe a new method for treating unresectable recurrent brain tumors in previously-irradiated patients with localized high-dose intracranial brachytherapy of 10,000-30,000 rads using permanent implantation of a single high-activity 125Iodine seed. For unresectable recurrent previously-irradiated pituitary tumors, a single high-activity 125Iodine seed is permanently implanted into the center of the tumor with an interstitial needle inserted under fluoroscopic guidance via a transsphenoidal approach. For unresectable recurrent meningiomas, a single high-activity seed is permanently implanted into the tumor at craniotomy. The clinical course of five patients treated by this method is described. Excellent long-term local control was obtained in all implanted cases. There were no intraoperative, postoperative, or chronic complications.     

Intraoperative remote afterloading endocurietherapy with high-activity 60cobalt for treatment of glioblastoma multiforme

An intraoperative remote afterloading endocurietherapy technique with high-activity 60Co for the treatment of glioblastoma multiforme is described. The technique can be used for initial management of the unresectable tumor or for retreatment of patients with recurrent tumor who have been treated previously with surgery and postoperative radiotherapy. Neither intraoperative nor postoperative complications were encountered in our treatment of 11 patients in this Phase I toxicity study.     

Transoral application of EEA stapler after subtotal oesophagectomy.

OBJECTIVE: To describe a new transoral technique of cervical oesophagogastric and oesophagojejunal anastomoses using the EEA stapler. DESIGN: Prospective clinical study. SETTING: University Hospital, Bratislava, Slovakia. SUBJECTS: Two patients with squamous cell carcinoma of the middle and distal third of the oesophagus. INTERVENTIONS: Transhiatal subtotal oesophagectomy without thoracotomy, and cervical oesophageal anastomosis by transoral EEA stapling. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Transoral stapling was successful in both patients with no anastomotic leaks. The patients were discharged on the 14th and 21st postoperative days, respectively. CONCLUSIONS: Transoral stapling of the cervical anastomosis gave good results in two patients. More development and evaluation are needed.     

Pain-patient Minnesota Multiphasic Personality Inventory (MMPI) subgroups: Evaluation of long-term treatment outcome

Six hundred thirty-five chronic pain patients completed the Minnesota Multiphasic Personality Inventory (MMPI) prior to participation in a multidisciplinary inpatient pain treatment program. Three male and four female MMPI subgroups were identified by means of cluster analyses for each of two samples. Pretreatment and long-term follow-up differences were then examined among the MMPI subgroups. Results indicated that the subgroups identified in the present study closely resembled each other and those previously reported in the literature. However, at long-term follow-up only a few outcome differences were identified among male subgroups, while no differences were found among female subgroups. Possible explanations for no differential treatment outcomes among the MMPI subgroups are discussed.