Biomedical subjects
Publications and source records attributed to J Ransohoff.
We describe a patient with a foot drop attributable to both herniated disk and peripheral neuropathy susceptible to external compression. Early electrodiagnostic studies and sural nerve biopsy indicated a role for myelin dysfunction in this disorder.
Chordoma at the T-9 level, originally manifested by lumbosacral radiculopathy, developed in a 50-year-old man. The patient underwent three operations and radiation therapy for this condition, but ten years later, thoracic myelopathy developed, followed by left facial weakness. On autopsy, extensive dissemination of chordoma was found along the base of the brain and in the leptomeninges of the spinal cord.
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Sera from 30 patients with astrocytoma were tested for antibody reacting with cell surface antigens of cultured autologous astrocytoma cells. Ten percent of the patients had antibody detectable by mixed hemadsorption assays, approximately 50% by immune adherence and protein A assays, and 100% by anti-C3-mixed hemadsorption assays. Absorption analysis of reactive sera with autologous, allogeneic, and xenogeneic cells permitted the definition of three classes of astrocytoma cell surface antigens. Class I antigens showed an absolute restriction to autologous astrocytoma cells. Class II antigens were shared by all astrocytomas tested and could be detected also on neuroblastoma, sarcoma, and some (but not all) melanoma cell lines; these antigens were not found on cell lines derived from carcinomas or normal tissues. Class III antigens were widely distributed on cultured normal and malignant cells of human and animal origin. In this series, sera from 2 patients recognized class I antigens, 4 patients' serum recognized class II antigens, and 13 patients' sera recognized class III antigens. Absorption tests have shown that the AJ (class II) antigen of astrocytoma is serologically related to the previously described AH (class II) antigen of melanoma; in tests of nine melanoma cell lines, there was a correspondence between the AJ and AH phenotypes. This method of autologous typing provides a way to classify the cell surface antigens of astrocytomas and to assess the clinical significance of humoral immunity to these antigens.
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Because of the ability of sodium nitroprusside (SNP) to dilate cerebral blood vessels, intracranial pressure (ICP) should increase with its use. In patients with vascular intracranial tumors following SNP (0.01%) infusion, ICP increased from 14.58 +/- 1.85 to 27.61 +/- 3.33 torr (p greater than 0.0005) and cerebral perfusion pressure decreased from 89.32 +/- 3.5 to 43.23 +/- 4.60 torr (p less than 0.0005) when the mean arterial pressure had reduced by 33%. These results suggest that SNP not be used in patients with raised ICP unless previous measures have been taken to improve intracranial compliance.
A controlled, prospective, randomized study evaluated the use of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and/or radiotherapy in the treatment of patients who were operated on and had histological confirmation of anaplastic glioma. A total of 303 patients were randomized into this study, of whom 222 (73%) were within the Valid Study Group (VSG), having met the protocol criteria of neuropathology, corticosteroid control, and therapeutic approach. Patients were divided into four random groups, and received BCNU (80 mg/sq m/day on 3 successive days every 6 to 8 weeks), and/or radiotherapy (5000 to 6000 rads to the whole brain through bilateral opposing ports), or best conventional care but no chemotherapy or radiotherapy. Analysis was performed on all patients who received any amount of therapy (VSG) and on the Adequately Treated Group (ATG), who had received 5000 or more rads radiotherapy, two or more courses of chemotherapy, and had a minimum survival of 8 or more weeks (the interval that would have been required to have received either the radiotherapy or chemotherapy). Median survival of patients in the VSG was, best conventional care: 14 weeks (ATG: 17.0 weeks); BCNU: 18.5 weeks (ATG: 25.0 weeks); radiotherapy: 35 weeks (ATG: 37.5 weeks); and BCNU plus radiotherapy: 34.5 weeks (ATG: 40.5 weeks). All therapeutic modalities showed some statistical superiority compared to best conventional care. There was no significant difference between the four groups in relation to age distribution, sex, location of tumor, diagnosis, tumor characteristics, signs or symptoms, or the amount of corticosteroid used. An analysis of prognostic factors indicates that the initial performance status (Karnofsky rating), age, the use of only a surgical biopsy, parietal location, the presence of seizures, or the involvement of cranial nerves II, III, IV, and VI are all of significance. Toxicity included acceptable, reversible thrombocytopenia and leukopenia.
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A rare instance of leiomyosarcoma metastatic to the brain in a 60-year-old male is presented. The primary site was in the gastrointestinal tract. Previously reported cases of similar nature are reviewed.
Nine patients with herpes simplex encephalitis examined by CT scan were reviewed. A total of 15 satisfactory scans was analyzed. The majority of our cases had CT scan abnormalities: lucency 63% (5 of 8, one case with suboptimal scan), mass effect 50% (4 of 8), abnormal contrast enhancement 57% (4 of 7). The earliest CT scan finding was lucency, presented in two out of three cases studied within 48 hours following onset of symptoms. The primary role of CT scan is to support the suspected diagnosis of herpes simplex encephalitis as well as to indicate the best site for brain biopsy and to permit early effective treatment with adenine arabinoside.
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Levamisole, a drug that stimulates the immunologic defenses of the host, was tested on the experimental malignant neurinoma grown subcutaneously in young female inbred CDF rats in 3-month trial. The drug resulted in prevention of tumor growth in 80% of the treated animals, whereas tumors grew in 100% of the controls. After discontinuation of the drug, none of the animals in the treated group showed evidence of tumor growth upon clinical and pathologic examination 1 month after drug treatment was terminated. Treated animals failed to show any side effects related to levamisole upon clinical and pathologic examination.
Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (methylprednisolone 200-2000 mg/day) for up to 151 days (mean 55 days). Neurological improvement occurred in eight patients on high doses after deterioration on concentional doses (methylprednisolone 80-120 mg/day). In two patients steroids could be completely discontinued for several months. Serious adverse effects included sepsis in three patients and myopathy in tow. All three patients with sepsis also received chemotherapy. There were no deaths that could be attributed to steroids. The most likely effect of high dosage steroids is reduction of cerebral oedema. It is conceivable that in some instances high dose steroids may also result in tumour inhibition or oncolysis or both.
The authors have summarized their experience in the application of computerized axial tomography to the overall management of hydrocephalus.
The authors review 100 consecutive cases of ruptured intracranial aneurysms to assess the overall morbidity and mortality. Patients were placed on a regimen of bed rest, sedation, control of blood pressure, anticonvulsants, and antifibrinolytic therapy. Surgery was performed on 86 patients with hypotensive anesthesia and microsurgical techniques. The incidence of early rebleeding while on epsilon aminocaproic acid and control of blood pressure was 11.8%. The overall surgical mortality was 8.1%, and the surgical mortality of patients in Grades 1, 2, and 3 was 6.3%. Of the 100 patients, 60 were able to return to their prior activities, and 25 had moderate neurological deficits that required limitation of their activities. The total case mortality was 15%. The evidence presented indicates that the regimen of active medical treatment before microsurgical intervention has improved the overall case morbidity and mortality, as well as the chance for long-term survival.