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Compendium of chemical carcinogens by target organ: results of chronic bioassays in rats, mice, hamsters, dogs, and monkeys.

A compendium of carcinogenesis bioassay results organized by target organ is presented for 738 chemicals that are carcinogenic in chronic-exposure, long-term bioassays in at least 1 species. This compendium is based primarily on experiments in rats or mice; results in hamsters, monkeys, and dogs are also reported. The compendium can be used to identify chemicals that induce tumors at particular sites and to determine whether target sites are the same for chemicals positive in more than 1 species. The source of information is the Carcinogenic Potency Database (CPDB). which includes results of 6073 experiments on 1458 chemicals (positive or negative for carcinogenicity) that have been reported in Technical Reports of the National Cancer Institute/National Toxicology Program or in papers in the general published literature. The published CPDB includes detailed analyses of each test and citations. The CPDB is publicly available in several formats (http://potency.berkeley.edu). Chemical carcinogens are reported for 35 different target organs in rats or mice. Target organs in humans are also summarized for 82 agents that have been evaluated as human carcinogens at a particular target site by the International Agency for Research on Cancer (IARC). Comparisons are provided of target organs for mutagens versus nonmutagens and rats versus mice.

Animals↗

Monorail snare technique for the recovery of stretched platinum coils: technical case report.

OBJECTIVE AND IMPORTANCE: Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling microcatheter and stretched portion of the coil as a monorail guide. CLINICAL PRESENTATION: We have used this technique successfully in four patients to snare coils stretched during cerebral aneurysm embolization. Three of these patients were undergoing Neuroform (Boston Scientific/Target, Fremont, CA) stent-supported coil embolization of unruptured aneurysms. In all cases, the snare was advanced easily to the targeted site for coil engagement by use of the microcatheter as a monorail guide. Once the intact distal segment of the coil was ensnared, coil removal was uneventful, with no disturbance of the remainder of the indwelling coil pack or Neuroform stent. TECHNIQUE: A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Prowler-14 microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling SL-10 microcatheter (Boston Scientific, Natick, MA) was then cut away with a scalpel, leaving the coil pusher wire intact, and removed. The open 2-mm snare was then advanced over the outside of the coil pusher wire and microcatheter. The snare and Prowler-14 microcatheter were then advanced into the guiding catheter (6- or 7-French) as a unit over the indwelling SL-10 microcatheter. By use of the SL-10 microcatheter and coil as a "monorail" guide, the snare was advanced over and beyond the microcatheter and the stretched portion of the coil until the snare was in position to engage the distal unstretched coil. At this point, the snare was then closed around the intact portion of the coil, and the microcatheters, snare, and coil were removed as a unit. CONCLUSION: The monorail snare technique represents a fast, safe, and easy method by which a stretched coil can be removed.

Aged↗

Level of evidence and citation index in current neurosurgical publications.

Systematic clinical reviews or meta-analyses offer scientifically valid sources of clinical information. They provide information in a concise form and can contribute to clinical quality management. Such studies, however, are only able to reflect the quality of the articles reviewed. The aim of this study was to evaluate the quality of the neurosurgical literature according to evidence-based medicine (EBM) standards. We reviewed all articles published in 1999 in three major neurosurgical journals. These articles were subdivided according to the level of evidence (LOE) scale (from 0 to V), article type, and citation index. Nine hundred eighty-two articles were published in these journals in 1999. Of these, 346 (35%) were clinical studies, 287 (29%) case reports, 153 (16%) experimental studies, 122 (13%) technical reports, and 74 ( 8%) other types. Subdivision according to LOE was: Ia 0.3%, Ib 2.5%, IIa 0.2%, IIb 4.3%, IIc 9.5%, IIIa 0.1%, IIIb 3.9%, IV 22.4%, and V 1.6%. Fifty-five percent of all published studies were case reports, experimental studies, technical reports, or others and thus could not be subdivided according to the EBM standards. The number of articles published with high LOE seems to be rather low in 1999. If these data reflect overall publication practice, it seems unclear whether enough articles with high LOE are published to propose scientifically sound clinical treatment suggestions according to EBM standards.

Abstracting and Indexing↗

A method for the treatment of abductor spasmodic dysphonia with botulinum toxin injections: a preliminary report.

A preliminary technical report of the effective treatment of abductor spasmodic dysphonia with botulinum toxin is presented. Our technique attempts to place the toxin close to the posterior cricoarytenoid muscle to allow diffusion of the material to the PCA. Our pilot study demonstrates that botulinum toxin is an effective approach for reducing or eliminating the abductor glottal spasms during phonation and, thereby, providing functional speech communication.

Adult↗

Microsurgery in the removal of a large cerebral hydatid cyst: technical case report.

OBJECTIVE: Surgery is presently the mainstay in the treatment of cerebral hydatid cysts, but removal without perforation of the cyst wall is critical. The Dowling-Orlando technique has been the main surgical choice for the intact removal of intracranial hydatid cysts. Dowling described his technique in 1929, well before the introduction of the microscope in neurosurgery. Using the operating microscope has not been reported in the removal of a large hydatid cyst. CLINICAL PRESENTATION: The case of a 16-year-old male with a large, right parieto-occipital hydatid cyst is presented. INTERVENTION: In this case, surgery was greatly aided by the use of the microscope in the initial stage of the removal of the cyst. Cyst extraction during the delivery process was continued without the aid of the microscope. The cyst was successfully removed intact. CONCLUSION: The use of the magnification during the early part of the surgery of a hydatid cyst is extremely helpful because, at a crucial stage of the procedure, it prevents inadvertent damage of the very thin cyst wall and allows development of the critical surgical plane.

Adolescent↗

Cancer of the urinary bladder in highly exposed workers in the production of dinitrotoluenes: a case report.

Technical dinitrotoluene (consisting of 2,4- and 2,6-dinitrotoluene isomers) has been widely used as explosives. Both technical isomers are mutagenic in Salmonella typhimurium TA98 strains and carcinogenic in rodents. 2,4-dinitrotoluene shows a dose-dependency of malignant tumors of the kidneys, liver, and mammary glands in rats and mice. In this case report, we discuss a cluster of three cases of urothelial cancer amongst a group of about 60 workers exposed to dinitrotoluenes. The workers were employed in the manufacturing of nitrotoluene explosives in the former German Democratic Republic. The cases occurred within a period of 12 years (1990-2002) leading to a 15.9 fold higher incidence of cancer of the urinary bladder than of the federal state where the chemical factory was located. The observation of the cluster of urothelial cancer in persons highly exposed to nitrotoluenes underlines the putative human carcinogenicity of dinitrotoluenes with the human urothelium as a relevant target tissue.

Carcinogenicity Tests↗

[Unusual wound morphology after textile penetration by the automatic rifle (StG) 58. A case report].

Technical characteristics of the used fire-arm and ammunition, the firing range and the shot through garments of the victim are essential factors, that exercise an influence on the appearance of gunshot injuries. An exemplary case-report shall emphasize the importance of these factors. It deals with a suicidal double-shot fired from an automatic rifle by a young soldier. The wounds were localized in the left chest region and the adjacent skin was blackened by soot in a remarkable geometrical pattern, although an ammunition with a smokeless charge has been used. By means of comparative shots we have good reasons to suppose this phenomenon to be caused by rests of gun powder and pressure of the explosion gas leaved in the barrel after the first shot. The second projectile pushed out this explosion gas to the skin that had been uncovered in a star-shaped way by the first shot.

Adult↗

Parent vessel Guglielmi detachable coil herniation during wide-necked aneurysm embolization: treatment with intracranial stent placement: two technical case reports.

OBJECTIVE AND IMPORTANCE: Despite recent advances in technology, parent vessel coil herniation occasionally complicates successful Guglielmi detachable coil embolization, particularly in wide-necked aneurysms. We report endovascular stent deployment performed in two patients specifically to treat this complication. CLINICAL PRESENTATION: Two patients underwent Guglielmi detachable coil embolization of cavernous segment aneurysms. Both developed coil herniation into the internal carotid artery. In one patient, the herniation occurred during the initial procedure; in the other, it was discovered in a delayed fashion during a follow-up examination for ocular symptoms. INTERVENTION: In both patients, endovascular stent deployment was performed to isolate the herniated portion of the coil from the internal carotid lumen. Follow-up angiography at 6 months demonstrated no aneurysm recanalization and no stenosis of the parent internal carotid artery in the stented region in either patient. CONCLUSION: The use of intraluminal stents has been reported to be a helpful technical adjunct to the conventional endovascular treatment of aneurysms and balloon angioplasty. One additional indication for the use of this technology is sequestering herniated coils from the lumen of the parent artery to reduce potential embolic or occlusive sequelae.

Angiography, Digital Subtraction↗

Meta-modelling: the appropriate solution for a family of applications.

The aim of this paper is to present an appropriate framework able to generate models and to implement them, in the objective of computerizing a family of medico-technical reports. The accelerated rate of technical development makes it necessary to design computerized applications independently of data-processing technology. This apparent paradox is a quite real challenge which needs research and development software environments to support frameworks. In this article, we present a meta-model (i.e. a generic structure - supported by the Méta-Gen software tool) ) which is able to generate various models of medico-technical reports. These models in turn are able to generate various types of instances. This meta-model is a "Meta-medical record", it is constituted of basic concepts : " User Semantic Group " to which are attached a set of " sentence-type ", a set of several corpus of variables with a set of graphs ("navigators"). Five models (echocardiography for hospital "A", echocardiography for hospital "B", gastroscopy, fibercoloscopy A.E.P.). were already generated from this "Meta-Medical Record". A beginning of implementation in echocardiography report is presented here. The advantages are a very thorough personalization of the document for the user, and a greater independence of the design diagram from the technological platform.

Echocardiography↗

Malignant fibrous histiocytoma after total hip arthroplasty. A case report.

Technical advancements in total joint arthroplasty have led to components of varied design and substance and to increased longevity of the implanted components. Along with increased longevity of the implants comes concern about how these synthetic materials affect the tissues of the host. Experimentally, several materials currently used in implantable components have been shown to be potentially carcinogenic. Clinically, 12 cases of malignancy have been reported previously in association with orthopedic implants; of these, four were malignant fibrous histiocytomas (MFH). This report describes an additional case of MFH occurring in a patient who had multiple hip arthroplasties over a period of 15 years. While 13 malignancies associated with orthopedic implants could certainly be coincidental in view of the vast number of implanted orthopedic devices, each incidence of malignancy associated with an implant should be considered significant in determining any meaningful trends and relationships.

Adult↗

Chronic cortical stimulation for amyotropic lateral sclerosis: a report of four consecutive operated cases after a 2-year follow-up: technical case report.

OBJECTIVE AND IMPORTANCE: From April to July 2002, four consecutive patients affected by amyotrophic lateral sclerosis (ALS) were surgically treated with bilateral chronic cortical stimulation.. CLINICAL PRESENTATION: The preoperative diagnostic assessment was based on the results of a neurological examination, integrated by the ALS functional rating scale, electromyography, magnetic resonance imaging, and single-photon emission computed tomography (SPECT). In particular, SPECT provided a remarkable contribution in terms of its ability to demonstrate specific morphological and metabolic ALS lesions of the brain. INTERVENTION: The postoperative neurological follow-up was based mainly on the assessment of neurological status and the ALS functional rating scale, together with SPECT. Two years after surgery, at clinical examination, two patients demonstrated mild progression of their illness, and SPECT findings disclosed complete disappearance of ALS cerebral lesions, with apparent recovery of brain anatomic integrity. The third patient committed suicide. In the fourth patient, the disease seemed to have progressed inexorably at the time of clinical and SPECT monitoring, after transient improvement during the first 3 months after surgery.. CONCLUSION: These preliminary results are surprising, because they suggest that chronic cortical stimulation can play a role against ALS and deserve confirmation in larger numbers of patients and for a longer follow-up. We present the theoretical grounds for these findings, as well as the diagnostic and surgical procedures and results..

Amyotrophic Lateral Sclerosis↗

The use of microwave-induced hyperthermia in conjunction with afterloading irradiation of vaginal carcinoma. A preliminary report.

Technically improved microwave antennas for clinical hyperthermia induction have made it possible to combine this treatment modality with external and intracavitary irradiation of vaginal and cervical carcinomas. A microwave applicator with a frequency of 915 MHz was used in tissue phantom measurements and inserted into perspex vaginal obturators for measurement of the specific absorption rate in different planes. A Lund Science Hyperthermia System 4010 with a 200 W generator and a separate thermometry system (ATS 100) was used in the patient treatments. Nine patients with vaginal squamous cell carcinomas have been treated with this applicator and obturator setup as an adjunct to intracavitary irradiation with high dose-rate afterloading technique. The treatments of two patients are described in this preliminary report.

Aged↗

Toxicology and Carcinogenesis Studies of Ochratoxin A (CAS No. 303-47-9) in F344/N Rats (Gavage Studies).

Ochratoxin A is a naturally occurring fungal toxin that is a contaminant in corn, peanuts, storage grains, cottonseed, meats, dried fish, and nuts. Toxicology and carcinogenesis studies were conducted by administering ochratoxin A (98% pure) in corn oil by gavage to groups of F344/N rats of each sex for 16 days, 13 weeks, 9 months, 15 months, or 2 years. Only rats were studied because ochratoxin A has been shown to be carcinogenic in mice. Genetic toxicology tests were performed with bacterial and mammalian cells. Urinalysis, hematologic and serum chemical analyses, and bone marrow cellularity determinations were conducted at 9, 15, and 24 months in the 2-year studies. Sixteen-Day and Thirteen-Week Studies: Rats were administered 0, 1, 4, or 16 mg/kg ochratoxin A in corn oil by gavage 5 days per week for a total of 12 doses over 16 days. All rats that received 16 mg/kg ochratoxin A died within 6 days. Rats that received 4 mg/kg lost weight. Compound-related lesions in rats included bone marrow hyperplasia, thymic atrophy, necrosis and hyperplasia of the forestomach epithelium, renal tubular cell degenerative and regenerative changes (nephropathy), and adrenal gland hemorrhage. Renal tubular changes were most severe in animals that received 4 mg/kg. Rats that received 16 mg/kg had less severe renal lesions than those at 4 mg/kg, perhaps because the acute toxicity and early death did not allow sufficient time for full development of lesions. No compound-related deaths occurred in the 13-week studies (doses were 0 and 0.0625 to 1 mg/kg). The final mean body weight of rats that received 0.25, 0.5, or 1 mg/kg was 7%, 11%, or 19% lower than that of vehicle controls for males and 3%, 4%, or 9% lower for females. Compound-related lesions in the kidney were characterized as degeneration and regeneration of the epithelium of the proximal convoluted tubules with individual cell necrosis of moderate severity (see page 3 of the Technical Report). Karyomegaly of tubular epithelial cells was widespread but most pronounced in the straight portion of the tubules just above the corticomedullary junction. Karyomegaly was present in all dosed groups, and the severity increased as the dose increased. At lower doses, atrophy of the straight portions of the tubules at the corticomedullary junction and in the medulla was observed. Based on mortality and on the presence and severity of renal lesions, groups of 80 rats per sex and dose group were administered 0, 21, 70, or 210 ug/kg ochratoxin A in corn oil by gavage 5 days per week for up to 2 years. Groups of 15 rats per sex and dose were killed at 9 or at 15 months and the remaining animals at 2 years. Nine-Month and Fifteen-Month Studies: Administration of ochratoxin A by gavage for 9 months or 15 months to F344/N rats was associated with increased incidences of renal tubular cell neoplasms in males and hyperplasia, degeneration, and karyomegaly of renal tubular epithelial cells in both males and females (see page 4 of the Technical Report). Body Weight and Survival in the Two-Year Studies: Mean body weights of high dose rats were generally 4%-7% lower than those of vehicle controls. No significant differences in survival were observed between any groups of female rats (vehicle control, 32/50; low dose, 23/51; mid dose, 35/50; high dose, 34/50). Survival was decreased after 77 weeks in high dose male rats and after 96 weeks in low and mid dose male rats (39/50; 26/51; 26/51; 23/50). Clinical Pathology: Minor differences were observed for hematologic values between dosed and vehicle control animals, but these were not considered to be of biologic significance. Results of serum chemistry analysis were not clearly compound related. Ochratoxin A-dosed animals had slight increases compared with vehicle controls in urine volume and decreases in urine specific gravity in concentration tests, suggesting that exposure resulted in mild to moderate decreases in the ability to concentrate urine. Nonneoplastic and Neoplastic Effects in the Two-Year Studies: A spectrum of degenerative and proliferative cho-Year Studies: A spectrum of degenerative and proliferative changes occurred in the kidney of male and female rats given ochratoxin A for 2 years. Degeneration of the renal tubular epithelium with formation of tubular cysts, proliferation of the tubular epithelium, and karyomegaly of the nuclei of tubular epithelial cells occurred at increased incidences in dosed rats (see page 5 of the Technical Report). Hyperplasia of the renal tubular epithelium and renal tubular adenomas and carcinomas also occurred at increased incidences in the dosed rats; the tumors were frequently multiple within a single kidney or were bilateral, and many metastasized to other organs. The incidence of fibroadenomas of the mammary gland in high dose female rats was significantly greater than that in vehicle controls (vehicle control, 17/50; low dose, 23/51; mid dose, 22/50; high dose, 28/50). Multiple fibroadenomas of the mammary gland were observed at an increased incidence in high dose female rats (4/50; 4/51; 5/50; 14/50). One mammary gland adenoma was seen in a mid dose female, and two mammary gland adenocarcinomas were seen in each dosed group; one adenocarcinoma was seen in the vehicle control group. An adenoma of the pars intermedia of the pituitary gland was observed in one mid dose female rat, and a carcinoma was observed in a second mid dose female rat. Squamous cell papillomas of the tongue were seen in two low dose and two mid dose male rats. Neither the pituitary neoplasms nor the papillomas of the tongue were considered related to ochratoxin A exposure. Genetic Toxicology: Ochratoxin A was not mutagenic in four strains of Salmonella typhimurium (TA97, TA98, TA100, or TA1535) when tested both with and without exogenous metabolic activation. In cultured Chinese hamster ovary (CHO) cells, ochratoxin A induced sister chromatid exchanges (SCEs) in the presence, but not the absence, of metabolic activation; it did not significantly increase the number of chromosomal aberrations in these cells. Audit: The data, documents, and pathology materials from the 2-year studies of ochratoxin A have been audited. The audit findings show that the conduct of the studies is documented adequately and support the data and results given in this Technical Report. Conclusions: Under the conditions of these 2-year gavage studies, there was clear evidence of carcinogenic activity of ochratoxin A for male F344/N rats as shown by substantially increased incidences of uncommon tubular cell adenomas and of tubular cell carcinomas of the kidney. There was clear evidence of carcinogenic activity for female F344/N rats shown by increased incidences of uncommon tubular cell adenomas and of tubular cell carcinomas of the kidney and by increased incidences and multiplicity of fibroadenomas of the mammary gland. Ochratoxin A administration also caused nonneoplastic renal changes including tubular cell hyperplasia, tubular cell proliferation, cytoplasmic alteration, karyomegaly, and degeneration of the renal tubular epithelium. Synonym: (R)-N-[(5-chloro-3,4-dihydro-8-hydroxy-3-methyl-1-oxo-1H-2-enzopyran-7-yl)-carbonyl](-L-)phenylalanine

Journal Article↗

An oblique paraspinal approach for intracanalicular disc herniations of the upper lumbar spine: technical case report.

OBJECTIVE: To present our experience of treating the central or paramedian disc herniations of the upper lumbar levels through a paraspinal approach. CLINICAL PRESENTATION: We present four patients with intracanalicular disc herniations at the L1-L2 or L2-L3 level. All patients had unilateral or bilateral radicular leg pain and motor weakness. TECHNIQUE: Considering the unique characteristics of the upper lumbar spine, we performed the oblique paraspinal approach to expose the central portion of disc and removed the herniated disc effectively. Postoperatively, their symptoms were improved. There was no instability during the follow-up period. CONCLUSION: The oblique paraspinal approach for the treatment of central disc herniations at the upper lumbar levels is an effective nonfusion technique that preserves most of the facet joint and provides a wide surgical field.

Adult↗

Endoscopic fenestration of a symptomatic cavum septum pellucidum: technical case report.

OBJECTIVE: Cysts of the septum pellucidum (CSPs) may become symptomatic because of obstruction of cerebrospinal fluid flow, resulting in increased intracranial pressure and hydrocephalus requiring surgical intervention. Endoscopic fenestration may be the most effective and least invasive technique to treat this pathological condition. CLINICAL PRESENTATION: An 11-year-old boy sought treatment for frequent episodes of severe headache. On examination, he had papilledema. There was evidence on magnetic resonance imaging scans of a space-occupying CSP with obstructive hydrocephalus. INTERVENTION: The endoscopic technique of fenestration of both lateral walls of an enlarged CSP via a left frontal approach under ultrasound guidance using a rigid endoscope was successful. After surgery, the patient became asymptomatic, his papilledema resolved, and magnetic resonance imaging scans demonstrated collapse of the walls of the CSP toward the midline. CONCLUSION: Neuroendoscopic fenestration should be strongly considered as the treatment of choice for symptomatic CSPs. This procedure alone can lead to complete resolution of clinical symptoms and hydrocephalus, can reduce the size of the CSP, and can obviate the need for an implantable cerebrospinal fluid shunt.

Brain Diseases↗