Biomedical subjects
Publications and source records attributed to Andrew H Kaye.
Pelvic schwannoma is a rare cause of sciatic pain. We report a case of retroperitoneal pelvic schwannoma presenting with chronic sciatica which was diagnosed and monitored radiologically for several years before successful surgical resection.
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OBJECTIVE: Cerebrospinal fluid rhinorrhea, pneumocephalus and meningitis are serious complications following transsphenoidal excision of sellar, suprasellar and parasellar lesions. This study evaluates the use of a new bioadhesive, Bioglue as an adjunct in reconstructing the sellar floor and preventing CSF fistula and investigates the possible complications associated with its use. METHODS: In thirty-two patients (31 pituitary adenomas and 1 meningioma) Bioglue was used to help reconstruct the sellar floor after endonasal transsphenoidal procedures between January 2001 and April 2002 at the Royal Melbourne Hospital. RESULTS: There were no post-operative CSF rhinorrhea, allergic rhinitis, meningitis, pneumocranium, granulomas or other complications associated with the use of Bioglue. CONCLUSION: This technique of reconstruction of sellar floor using Bioglue is simple and time efficient in preventing CSF fistula formation following transsphenoidal procedures for sellar region lesions.
Tumour cell invasion is a dynamic process that depends on a co-ordinated series of biochemical events. This review discusses the role of the proteolytic enzyme system, the plasminogen activation cascade, in glioma cell invasion.
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Current treatment strategies for high-grade gliomas are inadequate with high rates of disease recurrence and poor overall survival. Photodynamic therapy has been extensively investigated for a variety of tumours including high-grade gliomas. We have previously described a novel boronated porphyrin (BOPP) which has highly selective uptake by tumour cells. A Phase I study documented that BOPP at a dose of 4mg/kg was well tolerated. We report here the survival data arising from this Phase I study. Overall 28 patients (pts) with high-grade gliomas were treated with BOPP photodynamic therapy with a median overall survival (OS) of 14 months (2-48+ months). Sixteen pts had glioblastoma multiforme (GBM) with a median OS of 8 months (2-38+). Of 9 pts with recurrent GBM, the median OS was 11 months (3-38+), with 56% surviving at least 12 months. In conclusion, BOPP photodynamic therapy was associated with encouraging survival particularly in the recurrent GBM setting.
Lymphocytic hypophysitis is a rare but important cause of pituitary hypofunction which predominantly affects young women in the peripartum period. It is believed to be an autoimmune disorder with an association with other autoimmune disorders and expression of anti-pituitary cytosolic and anti-nuclear antibodies. Clinically, it presents most frequently with symptoms and signs attributable to pituitary hypofunction, headache, visual disturbance and amenorrhoea. It is difficult to distinguish lymphocytic hypophysitis from a pituitary adenoma on pre-operative imaging and definitive diagnosis rests on histology which classically demonstrates destruction of anterior pituitary acini by an inflammatory infiltrate rich in plasma cells and T lymphocytes. Surgical management therefore plays a crucial role to obtain a histological diagnosis and to relieve pressure effects on the optic apparatus in patients with visual disturbances.
The primary objective of this study was to evaluate the incidence of warfarin use in 156 consecutive patients presenting to a single tertiary referral centre with spontaneous intracerebral haemorrhage. Our study found that 11% of patients (16/159) presenting with spontaneous intracerebral haemorrhage were on warfarin for prophylactic anticoagulation at time of presentation. Comparison was made to other published Australian data with regard to the incidence of warfarin use in patients presenting with spontaneous intracerebral haemorrhage. Patient outcomes were also examined.
Lymphocytic hypophysitis is an uncommon disease with a variable presentation and unclear pathophysiology. We present the case of a 30 year old woman who presented with features typical of a pituitary macroadenoma. She underwent a transphenoidal resection of the mass and histopathological examination revealed lymphocytic hypophysitis. This case illustrates the difficulty in differentiating pituitary macroadenoma and lymphocytic hypophysitis and the variable presentations of lymphocytic hypophysitis.
OBJECTIVE: The interactions of CD44 with hyaluronan are thought to be crucial for tumor cell attachment to the extracellular matrix, migration, and invasion. For migration to occur, however, the interactions between hyaluronan and cell surface receptors need to be transient. Hyaluronidases may facilitate the degradation of hyaluronan bound to the cell surface and thus reduce the interactions of the cells with the matrix, whereas the overproduction of hyaluronan in the absence of hyaluronidase activity may prevent cells from proliferating or invading normal surrounding tissue. METHODS: We analyzed the effects in vitro and in vivo of hyaluronan synthase-2 (HAS2) overexpression on a murine glioma cell line that is deficient in hyaluronidase activity. In addition, we evaluated the expression levels of HAS and hyaluronidase genes in human glioma cell lines and in glioma specimens. RESULTS: Increased hyaluronan synthesis had no effect on the in vitro proliferation of the cells but diminished their in vivo growth rate. Several human glioma cell lines were found to overexpress hyaluronan synthases, but they did so in conjunction with hyaluronidase Hyal2 and MGEA5 expression. Similarly, all glioblastomas multiforme expressed hyaluronidases MGEA5 and Hyal2. CONCLUSION: The data suggest that an increased synthesis of hyaluronan by astrocytoma cells is only promoting tumor cell growth in vivo if the cells express hyaluronidases as well.