A broad spectrum of disease entities affects the atlantoaxial-clival region. This area is readily accessible through a transoral approach, which offers capabilities for canal decompression and fusion. A case is reported that required transoral odontoidectomy with concurrent excision of an osteophyte from the base of an ununited odontoid fracture. Operative preparation, technique, and postoperative management are described in detail. The advantage and applications of the procedure are discussed.

Axis, Cervical Vertebra↗

PubMedDate not supplied

Malignant glial neoplasms: definition of a humoral host response to tumor-associated antigen(s).

There is increasing evidence that human tumors possess tumor-associated neo-antigens. The host mounts an immunological response to these antigens, as evidenced by the detection of circulating humoral antibodies in a variety of human neoplasia.An indirect immunofluorescent antibody technique was employed to detect antibodies to tumor-associated antigens in the sera of patients with malignant gliomas. Viable single cell suspensions were used to demonstrate antibodies to surface contents of tumor cells and cell preparations were snap-frozen at -160° C to demonstrate antibodies to cytoplasmic components of tumor cells. After incubation with serum, the preparations were treated with polyvalent sheep antihuman globulin conjugated to isomer-1-fluorescein isothiocyanate, washed, and examined with a Leitz incident fluorescent microscope.Of the 17 sera from histologically proven malignant glial neoplasm patients, 2 (11%) were positive for an autologous surface antibody reaction. Five (23%) of 21 were positive for an autologus cytoplasmic antibody, however, 10 (47%) of 21 of the sera gave a positive reaction for cross-reacting cytoplasmic antibodies when tested with a battery of tumor cells obtained from different patients with malignant glial tumors.No reaction was observed with normal brain tissue. Absorption studies indicated the presence of a tumor-associated antigen.This study demonstrated that certain patients with malignant gliomas possess circulating antibodies to cytoplasmic components of their own tumor cells. The fact that a number of sera cross-reacted with tumor cells obtained from different patients suggests that antigenic cross-reactivity exists between malignant glioma cells from different patients. It is suggested that with further refinement, immunofluorescent detection of antibodies could evolve as a useful diagnostic adjunct in malignant glioma.

Antibodies, Neoplasm↗

PubMedDate not supplied

Myo-fascial pain dysfunction syndrome.

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Temporomandibular Joint Dysfunction Syndrome↗

PubMedDate not supplied

Pituitary adenomas. Correlation of the cytologic appearance with biologic behavior.

OBJECTIVE: To determine the extent of nuclear pleomorphism in pituitary adenomas and the relationship of these cytologic changes to clinical features, endocrine evaluations and proliferative potential. STUDY DESIGN: The study group consisted of 93 sequential patients with pituitary adenomas in which smear and touch preparations were performed. Nuclear pleomorphism was assessed semiquantitatively and compared to immunohistochemical analyses of pituitary hormones on formalin-fixed paraffin sections, endocrine evaluations, clinical observations and proliferative potential as determined by immunoreactivity to Ki-67 on frozen sections. RESULTS: Varying degrees of nuclear pleomorphism were observed in 66/93 tumors. However, these changes were more pronounced in clinically functioning (growth hormone, prolactin or ACTH), as compared to nonfunctioning, tumors (P < .01). Pleomorphism did not correlate with macroscopic invasiveness. The pituitary adenomas that showed pleomorphism had significantly higher Ki-67 indices than did those without nuclear changes (P < .02). Significantly higher Ki-67 expression was also found in clinically functioning tumors when compared to nonfunctioning tumors (P < .03). CONCLUSION: Significant nuclear pleomorphism is common in functional pituitary adenomas of several types but does not correlate with more aggressive behavior.

Adenoma↗