Biomedical subjects
Publications and source records attributed to A Carteri.
A case of aqueductal stenosis following mumps infection is reported, to the authors' knowledge the 12th case in the literature. The pathogenetic events are discussed and the literature reviewed.
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c-AMP, c-GMP, HVA and 5 HIAA cerebrospinal fluid levels were investigated in 18 patients with subarachnoid haemorrhage (SAH). The main findings in the acute stage after SAH were represented by a marked increase of c-AMP and 5 HIAA values, whereas HVA levels were only slightly higher. In the chronic phase c-GMP levels turned out to be significantly increased, and were clearly related to intracranial hypertension. 5 HIAA and particularly HVA levels were decreased, probably due to the functional and anatomical lesion of the periventricular adrenergic structures, following the raised intracranial pressure.
A 5-year experience of the multidisciplinary treatment of pediatric medulloblastoma with the SIOP (International Society of Pediatric Oncology) trial is presented. 33 eligible patients finally reduced to a total of 30 evaluative cases were treated with major surgical resection, extensive irradiation, and combined chemotherapy (vincristine + CCNU). The overall survival rate without recurrence was encouraging, and the actuarial survival rate is satisfactory. At follow-up controls, most of the patients showed a good performance status and a promising neurological stage. However, the problem concerning quality of life remains unsolved: morbidity and sequelae following high-dose radiotherapy and concomitant antiblastic treatment were noticeable.
Cerebrospinal fluid levels of cyclic nucleotides in children with hypertensive communicating hydrocephalus secondary to leptomeningitis were investigated. 3':5'-cAMP and 3':5'-cGMP values were uniformly increased in pre-operative findings, suggesting a "passive" behaviour of the blood brain barrier after the inflammatory lesion. After ventriculo-peritoneal shunt, the mean ratio between the two nucleotides gradually became negative, with a marked increase of cGMP levels, probably related to selective barrier damage. In patients with shunt obstruction, the altered cAMP/cGMP ratio showed a gradual regression towards normal, due to a decrease in the cGMP level. The important role of endocranial pressure changes in the "second messenger" turnover is stressed.
The authors report their experience on the immunological monitoring of children with posterior fossa medulloblastomas. The most important findings concerning humoral and cell-mediated immunity in this kind of patient are discussed. Among the main immunobiological pictures, the authors stress the remarkable failure of the T-cell dependent immune response, generally correlated to the degree of malignancy of the tumor, and the characteristic appearance of cells with natural cytotoxic activity, whose precise outlining is, at present, in progress. The B-cell dependent pool, mostly investigated through immunofluorescence studies, turned out to be very close to normal.
The tumoral and cerebrospinal fluid (CSF) levels of cyclic nucleotides and of the main adrenergic metabolites (homovanillic acid and 5-hydroxyindoleacaetic acid) were investigated in a group of children with posterior fossa medulloblastomas. A longitudinal evaluation of CSF change of cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), and adrenergic metabolites before and after surgical removal of the tumor mass is presented. Some preliminary patterns concerning correlative levels in the neoplastic tissue are discussed. The relevant increase of cGMP in medulloblastoma specimens and in CSF samples operation and the rapid decrease in the CSF after surgical removal of the tumor seem to suggest a possible role of cyclic nucleotides in the neoplastic growth of these tumors. (Neurosurgery, 7: 359-362, 1980).
Recent advances indicate that cyclic nucleotides and perhaps certain adrenergic metabolites might be directly involved in contact-inhibition mechanisms and tumoral cell growth. CSF levels of 3'-5' cAMP, 3'-5' cGMP, HVA, and 5-HIAA were investigated in patients with supratentorial malignant gliomas, brain stem gliomas and posterior fossa medulloblastoma. cAMP levels were slightly decreased only in medulloblastomas, whereas no significant difference was detectable in patients with supratentorial gliomas. cGMP values turned out to be significantly higher, with a very peculiar increase in the most anaplastic neoplasms. Postoperative follow-up showed a gradual decrease of cGMP values, with progressive restoring of a normal cAMP/cGMP ratio. The possible correlation of these findings with CSF levels of HVA and 5-HIAA is discussed.
Preliminary findings in the evaluation of the immune response of children with primary neoplasms of the CNS, mainly medulloblastomas, are reported and discussed. A broad scheme for the monitoring of B- and T-cell-dependent immunity and of delayed hypersensitivity reactions in this type of patient is presented. The most important immunobiological findings are discussed. Special attention is given to the striking failure of the T-cell-dependent pool (currently identified by "active" RFC and blastigenesis tests) and to the remarkable decrease of hypersensitivity reactions (depressed skin-test response), both of which seem to be related to the degree of malignancy of the tumour. A very peculiar feature, i.e., the appearance of cells with natural cytotoxic activity, is dealt with in some detail. Our present knowledge concerning the immunobiology of primary CNS neoplasms is still very incomplete, but seems to suggest a possible role for immunotherapy in paediatric neurosurgery.
Recent evidence indicates that cyclic nucleotides are of importance for general and neurosurgical oncology, especially with respect to the contact-inhibition mechanisms and tumour cell growth. This preliminary report deals with the CSF levels of c-AMP and c-GMP in primary neoplasms in children and to problems related to the blood-brain barrier. Some cases of medulloblastoma were studied as well as a few cases of brain stem glioma and cystic astrocytoma. The importance of some rather unusual findings seems undebatable, i.e., the marked increase in c-GMP values usually observed in medulloblastoma and the decrease of c-AMP, that is fairly common in all malignant neoplasms. The main changes in the c-AMP/c-GMP ratio are also discussed.
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The experience with the use of RIHSA cisternography in cases of spontaneous or posttraumatic CSF rhinorrhea is reported. The utility of this method for identifying the fistulous tract so that the neurosurgeon can, as far as he is able, carry out a direct and not solely exploratory operation is pointed out.
The clinical and neurophysiological findings in two cases of spontaneous paralysis of the deep branch of the radial nerve are reported. The patients are sisters and the dominant hand was affected in both. One patient was submitted to surgical exploration, and 'entrapment neuropathy' was found to be the cause. After neurolysis the patient gained complete recovery. The usefulness of the EMG illustrated and stressed.
Adhesive arachnoiditis is an occasional finding during neurosurgical operations for pituitary adenoma, previously treated by radiation therapy. A case where an arachnoidal process was found in combination with an eosinophilic pituitary adenoma, which had never been treated by irradiation, is reported. A 44-year-old woman at the time of surgery with scarce endocrinologic symptoms had suffered visual loss from 2 episodes, 18 years apart. Analysis of her symptoms, neuro-ophthalmologic findings and neurodadiologic features suggest that her visual damage was due to an optochiasmatic arachnoiditis, rather than to the tumor itself.
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