摘要:

&NA;We have measured insulin and insulin‐like growth factor I (IGF‐I) binding in human gliomas, meningiomas, and normal brain and studied the effect of insulin on the morphology, proliferation, and differentiation of central nervous system tumor and normal fetal cells in culture. Specific125I‐insulin and125I‐IGF‐I binding was demonstrated by competition‐inhibition binding assays. Insulin binding was measured in plasma membrane preparations from 9 freshly isolated human meningiomas, 4 glioblastomas multiforme (GBMs), a low‐grade glioma, a normal adult brain, and a fetal brain. IGF‐I binding was measured in similar preparations from 5 meningiomas, 4 GBMs, a low‐grade glioma, and a normal adult brain. Incubations were carried out at 4°C for 18 to 20 hours. Meningiomas showed higher specific insulin binding per 0.25 mg of protein than GBMs (19% versus 3%,P< 0.005), and this difference was not related to small differences observed in insulin degradation. By contrast, IGF‐I binding was significantly higher in gliomas than in meningiomas (27% versus 12%,P< 0.005). Also, IGF‐I binding was significantly higher than insulin binding in GBMs (27% versus 3%,P< 0.03); binding of both IGF and insulin was high in meningiomas. In normal adult brain IGF‐I and insulin binding was 7 to 10%. The ability of insulin to support and enhance the growth of central nervous system tumor cells in culture was investigated. Cell cultures were derived from a freshly isolated glioblastoma, a low‐grade glioma, and 3 meningiomas. Cells initially grown in serum were exposed to either serum‐containing media, serum‐free media (SFM), or SFM supplemented with 30 &mgr;g of insulin/ml. In contrast to SFM, insulin added to SFM maintained cell survival and significantly increased proliferation, similar to serum in low‐grade glioma and meningioma cells (P< 0.05) and induced morphological changes suggestive of differentiation in the tumors studied. Moreover, insulin sustained the ability of GBM cells to stain for glial filament acidic protein, which was lost in SFM. Similar studies were performed with normal fetal brain cells and comparable effects of insulin were observed. (Neurosurgery24:791‐797, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To assess the value of whole brain radiotherapy (WBRT) after complete resection of a single brain metastasis we reviewed the records of 98 patients who had elective craniotomy between 1978 and 1985. Seventy‐nine patients received postoperative WBRT (Group A) and 19 patients no radiotherapy (RT) (Group B). Neurological relapse was designated as local (i.e., at the site of the original metastasis) or distant (i.e., elsewhere in the brain). Postoperative WBRT significantly prolonged the time to any neurological relapse (P= 0.034) with a 1‐year recurrence rate of 22% in Group A and 46% in Group B patients; however, it did not specifically control either local or distant cerebral recurrence. Recurrence of metastatic brain disease was not affected by location of the original lesion; however, meningeal relapse occurred in 38% of cerebellar lesions, but only in 4.7% of supratentorial metastases (P= 0.003). The total radiation dose or fractionation scheme of RT did not affect survival nor time to neurological relapse. The median survival was 20.6 and 14.4 months for Groups A and B, respectively (not statistically different). Forty‐eight percent of Group A and 47% of Group B patients survived for 1 year or longer; however, 11% of patients who had received RT and survived 1 year developed severe radiation‐induced dementia. All patients with radiation‐related cerebral damage received hypo‐fractionated RT with high daily fractions as commonly designed for rapid palliation of macroscopic brain metastases. Thus, postoperative WBRT may be an important adjunct to complete resection of a single brain metastasis, particularly in patients with limited or no systemic disease who have the potential for long‐term survival or even cure, but it carries a substantial risk of late neurological toxicity when hypofractionated RT schedules are used. For these good‐risk patients, postoperative WBRT should be administered by standard fractionation schemes of 180 to 200 cGy/day to a total of 4000 to 4500 cGy, or hyperfractionation, which provides even lower doses/fraction to minimize potential neurotoxicity while delivering a maximally efficacious total dose, should be considered. (Neurosurgery24:798‐805, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Thirty‐eight patients with primary recurrent anaplastic gliomas and glioblastomas, were treated with 1,3‐bis(2‐chloroethyl)‐1‐nitrosourea (BCNU) and the polyamine inhibitor &agr;‐difluoromethylornithine (DFMO). There were 5 brain stem, 1 cerebellar, and 32 supratentorial glioma tumors. All had been treated with surgery (except in the case of 4 brain stem tumors for which biopsies were not obtained) and radiotherapy. Eight patients had received prior chemotherapy. Of the 21 patients with evaluable supratentorial anaplastic gliomas, 2 (9.5%) had a partial response and 10 (47.6%) had stable disease. The median time to tumor progression for the anaplastic gliomas has not been attained yet. However, median survival for these 12 patients was 119 weeks measured from the initiation of chemotherapy. Median survival for the entire anaplastic glioma group of 21 was 56 weeks. Minimal activity was seen against glioblastoma multiforme. The median time to tumor progression was 8 weeks with median survival of 21 weeks. Of the 5 patients with brain stem tumors, 3 are alive with stable disease at 77, 93, and 220 weeks. The combination was well tolerated with doselimiting toxicity being myelosuppression and hearing loss. Further trials are warranted to compare the combination of BCNU and DFMO against BCNU alone in a prospective randomized trial. (Neurosurgery24:806‐809, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To examine the feasibility of shipment of brain tumor specimens to a central laboratory for drug sensitivity testing, an experimental gliosarcoma (9L) was grown subcutaneousley in rats, harvested, stored, and disaggregated. Growth of the disaggregated tumor cells in monolayer culture was evaluated after storage for various times at 2 to 6°C and 37°C in saline and minimum essential medium. Growth potential was maintained for 24 hours when tumor specimens were stored under refrigerated conditions and was best maintained when specimens were stored in saline. Specimens stored at 37°C grew best when stored in minimum essential medium, but growth potential was lost after 12 hours unless the specimens were refrigerated. Shipment of tumor specimens to a central laboratory for drug sensitivity testing appears to be feasible, since under most circumstances, specimens should reach the laboratory for processing within 24 hours of their removal. Storage and transport of specimens in saline on wet ice appears to be optimal. (Neurosurgery24:810‐813, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic‐guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown. These results seem to indicate that stereotactic aspiration can play a definite role in the treatment of spontaneous intracerebral hematoma. (Neurosurgery24:814‐819, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Increasing numbers of reports demonstrate the importance of iron and oxygen free radicals in brain injury and brain edema. We investigated the protective effects of three different ferric and ferrous iron‐chelating agents on cold‐induced brain edema. Vasogenic brain edema was produced by a cortical freezing lesion. Thirty‐eight cats were separated into five groups: Group 1 (N = 8): normal control group without lesion; Group 2 (N = 8): untreated group; Group 3 (N = 8): deferoxamine (extracellular and intracellular ferric iron chelator)‐treated group; Group 4 (N = 8): 2,3‐dihydroxybenzoic acid (extracellular ferric iron chelator)‐treated group; and Group 5 (N = 6): 2,2‐bipyridine (intracellular ferrous iron chelator)‐treated group. In Groups 3, 4, and 5, each agent was administered intravenously 15 minutes before lesion production and 60 minutes later. Animals in Groups 2, 3, 4, and 5 were killed 6 hours after lesion production. Brain water content in 8 sampling areas was measured by the specific gravity method. Blood‐brain barrier disruption was assessed by the spread of Evans blue dye measured by planimetry. Brain water contents and Evans blue dye extravasated areas were significantly reduced in Groups 3 and 5 in comparison to Groups 2 and 4. These data suggest that both ferrous and ferric iron‐chelating agents, which can penetrate the cell membrane and, presumably, act intracellularly, are effective in reducing cold‐induced brain edema. (Neurosurgery24:820‐824, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. Hemostasis in 269 patients with head injuries alone was screened using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT), fibrinogen assay (FIB), level of fibrin‐fibrinogen degradation products (FDP), and disseminated intravascular coagulation (DIC) score in the first 24 hours after injury. Test results were compared with the outcome (discharged or dead) in the entire group and in subgroups divided on the basis of the severity of injury as determined by the Glasgow coma score (GCS). Increased consumptive coagulopathy at admission, as reflected in the DIC score, predicts the outcome of head‐injured patients with a high degree of accuracy. The degree of increase of the initial FDP level and prolongation of TCT also correlated positively with the outcome. Prolongation of the APTT correlated strongly with unfavorable outcome in a large group of patients, and in a small group, markedly accelerated APTT also predicted death. Stepwise logistic regression analysis demonstrated that GCS, FDP level, and DIC score predicted outcome. Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients. (Neurosurgery24:825‐832, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A technique for linear accelerator radiosurgery has been used in clinical practice since 1982. The technique is based on multiple intersecting arc irradiations focused on a stereotactic target. From November 1984 to October 1988, 97 patients with cerebral arteriovenous malformations have been treated. Seventy‐nine patients suffered one or more than one hemorrhage. Four patients had progressive neurological symptoms. In 14 patients, epilepsy was the principal complaint. Stereotactic localization was performed by stereotactic angiography. Lesion dimensions varied from 4 to 40 mm in diameter. Doses from 18.7 to 40 Gy were delivered in one or two sessions. Mean follow‐up is 17.1 months (from 1 to 49). Four instances of minor rebleeding were observed after treatment: 3 patients complained of transient neurological deterioration. Of 56 patients who were followed longer than 1 year, 50 underwent 12‐month follow‐up angiography. In 26 patients complete obliteration of the malformation was demonstrated (52%), in 12 patients subtotal obliteration was obtained (24%), in 11 patients the obliteration was evident but not significant (22%), and in 1 patient the AVM was unchanged. Other angiographic features in incompletely obliterated cases were a significant reduction of flow velocity through the malformation together with a reduction in diameter of both feeding arteries and draining veins. (Neurosurgery24:833‐840, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Forty patients aged 6 to 18 years have now been treated for inoperable intracranial arteriovenous malformations (AVMs) using stereotactic heavy‐charged‐particle Bragg peak radiosurgery at the Lawrence Berkeley Laboratory 184‐inch Synchrocyclotron at the University of California, Berkeley. This paper describes the procedures for selection of patients, the treatment protocol, and the neurological and neuroradiological responses to stereotactic radiosurgery in this age group. The volumes of the treated AVMs ranged from 265 mm3to 60,000 mm3. The results are favorable: thus far, 20 of 25 patients have experienced ≥50% obliteration of their AVMs within 1 year after treatment, and 14 of 18 patients have experienced total obliteration of the AVM by 2 years after treatment. Two patients hemorrhaged from radiosurgically treated AVMs within 12 months after treatment, but none thereafter. Complications include vasogenic edema and arterial occlusion; three patients have had neurological worsening as definite or possible sequelae of treatment. The strengths and limitations of the method are discussed. (Neurosurgery24:841‐852, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;One hundred and twenty patients with soft lateral disc herniation underwent surgery by anterior microsurgical discectomy and routine ablation of the posterior longitudinal ligament between 1976 and 1986. The study excluded patients with hard discs and soft disc extrusion with medullary symptoms. In our series 76.6% of patients were men. In 64% of the patients no causative factor was found. All of the patients presented with cervicobrachialgia; 53% also had a motor deficit. In 91.7% a single disc was involved. The last 40 cases were evaluated by computed tomography alone. In 51.5% an extruded disc was found. No permanent postoperative complication was encountered. All patients returned to their previous activities. Fifty patients underwent follow‐up radiological evaluation at 1 and 5 years after the intervention and vertebral fusion was observed in 70% of these. (Neurosurgery24:853‐859, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID