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  • 1
  • 2
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Arteriovenöse Gefäßmißbildung ; spinale ; Arteriovenöse Malformation ; spinale ; Fistel ; arteriovenöse ; Fistel ; spinale durale ; Rückenmark ; Kernspintomographie ; Magnetische Resonanztomographie ; spinale ; Myelographie ; Angiographie ; Therapie ; Embolisation ; Key words Spine ; vascular abnormalities ; Arteriovenous malformations ; spinal ; Fistula ; arteriovenous ; Fistula ; spinal dural ; Spinal cord ; magnetic resonance imaging ; Myelography ; Angiography ; Therapy ; embolization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Congestive myelopathy, formerly referred to as varicosis spinalis or Foix-Alajouanine syndrome, is caused by a spinal dural arteriovenous fistula (SDAVF). So far, the blood supply from the meningeal arteries draining through the fistula into the medullary venous system can only be verified by spinal angiography. Patients predominantly male and over the age of 60 are afflicted. Initially reversible functional disorders caused by the congestion of the spinal cord veins eventually become irreversible, the most common symptom being an increasingly paretic gait disorder, the signs of which generally begin symmetrically and progress from distal to proximal signs. Simultaneously, predominantly transverse sensory dysfunctions develop, as well as bladder and bowel dysfunctions, most oftenly leading to incontinence. MRI typically shows a central medullary signal enhancement with slight swelling of the afflicted region, initially indicative of a reversible congestive edema and later of an irreversible infarction, and extended perimedullar vessels. Thus, if the clinical course and the characteristic MRI findings suggest the possibility of disease related to congestive myelopathy, spinal angiography becomes indispensable. Since ensuing the success of therapy and prognosis depends on rapid determination of the extent of the illness, a speedy diagnostic reaction is mandatory to institute the treatment necessary to prevent paraplegia.
    Notes: Zusammenfassung Die kongestive Myelopathie durch die spinale Durafistelerkrankung (SDAVF) – früher oft als Varikosis spinalis oder Foix-Alajouanine-Syndrom bezeichnet – wird durch eine bislang nur angiographisch nachweisbare arteriovenöse Kurzschlußverbindung verursacht, wobei der arterielle Zuflußüber die meningealen Arterien und der venöse Abfluß des arterialisierten Blutes in die spinalen perimedullären Venen erfolgt. Die Erkrankung tritt bevorzugt bei Männern und jenseits der 6. Lebensdekade auf. Der chronische Rückstau in die Rückenmarksvenen führt zunächst zu funktionellen und reversiblen, schließlich bleibenden Schäden, wobei als häufigstes Symptom eine zunehmend paretische Gangstörung beobachtet wird. Die von distal nach proximal aufsteigenden, häufig symmetrischen Paresen sind im Verlauf der Erkrankung meist langsam progredient. Analog hierzu entwickeln sich Sensibilitätsstörungen, die bei Diagnosestellung überwiegend querschnittsförmig verteilt sind, und Störungen der Blasen-Mastdarm-Funktion, die meist zu einer Inkontinenz führen. Der kernspintomographische Befund ist durch eine typischerweise zentral im Rückenmark gelegene, leicht raumfordernde Signalanhebung, die initial einem rückbildungsfähigen Stauungsödem und später Stauungsinfarkten entsprechen, sowie erweiterte perimedulläre Gefäße gekennzeichnet. Tritt die beschriebene klinische Befundkonstellation in Kombination mit diesem relativ charakteristischen kernspintomographischen Befundmuster auf, ist die Verdachtsdiagnose der kongestiven Myelopathie so wahrscheinlich, daß eine angiographische Abklärung indiziert werden muß. Da unsere Ergebnisse belegen, daß der therapeutische Erfolg der Behandlung und damit die Prognose der Erkrankung entscheidend vom Ausmaß der klinischen Symptome zum Zeitpunkt der Diagnosestellung abhängt, muß angesichts der guten Behandlungsmöglichkeiten die Diagnose, die bei Beachtung der klinischen Leitsymptome mit Hilfe der kernspintomographischen Schnittbilddiagnostik leichter denn je vorverlegt werden kann, so früh wie möglich erfolgen, um den Patienten vor einem bleibenden spinalen Querschnitt zu bewahren.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 4 (1998), S. 632-638 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Maligne Hirntumoren stellen ein großes therapeutisches Problem dar. Die chirurgische Resektion ist heute noch die effektivste Behandlungsmethode obwohl der Tumor in seiner Ausbreitung eigentlich keine chirurgisch heilbare Erkrankung ist. Zusätzlich zur Resektion, die je nach Lage des Tumors mehr oder weniger ausgedehnt sein kann, hat sich nur die Bestrahlung als generelles zusätzliches Behandlungsprinzip etabliert. Abgesehen von vielen systemischen Therapieansätzen, die sich in der Erprobung befinden, gewinnen lokale Therapieformen, die sich intraoperativ bei Resektion oder über stereotaktische Verfahren anbieten, zunehmend an Bedeutung, zumindest was die aktuelle Forschungsrichtung angeht. Dabei macht man sich zunutze, daß therapeutisch wirksame Substanzen jenseits der Blut-Hirn-Schranke appliziert werden und dadurch ein wesentliches pharmakologisches Hindernis umgangen wird. Diese lokalen Therapieansätze umfassen Chemotherapie, Gentherapie und auch Immuntherapie.
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  • 4
    ISSN: 1432-0533
    Keywords: β-Endorphin ; Corticotropin-releasing factor ; Cushing's disease ; Nelson's syndrome ; Pituitary adenoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Tissues from 12 human corticotropin-secreting adenomas, obtained during transsphenoidal surgery for Cushing's disease (CD, ten cases) or Nelson's syndrome (NS, two cases), were mechanically dispersed. The resulting single cells and cell aggregates were plated on extracellular matrix derived from bovine corneal endothelia. CD and NS cells showed distinct morphological differences initially, CD cells being much more spherical than the flattened NS cells. By 10 days at the latest after plating, however, CD and NS cells were indistinguishable morphologically. Cultured cells from both entities responded with rounding to cortisol (hydrocortisone, 10−6M) within 4–6 h. Synthetic ovine corticotropin-releasing factor (10−8M) produced flattening and extension of cytoplasmic processes after as early as 2 h.
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  • 5
    ISSN: 0942-0940
    Keywords: Ethiblock ; AV fistulas ; coils
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We present the results of a series of 105 patients with cerebral arteriovenous malformations (AVMs) who were treated by a combined protocol including endovascular occlusive measures and open surgical resection. 25 patients were treated only by surgical intervention, 72 patients underwent preoperative endovascular embolization and 8 patients were treated only by embolization, seven of which were only treated for palliation. After superselective angiography the vascular territories suitable for endovascular or microsurgical approach were defined, and in most cases these territories were complementary to each other. In 56 cases, only one embolization was necessary and due to an advantageous co-localization of the departments the whole combined endovascular/neurosurgical procedure was done in one anesthesia. If several endovascular sessions were necessary (16 patients), the resection was mostly carried out immediately after the last neuroradiological session in the same anesthesia with total time of such combined procedure now averaging about 7 hours. According to the proposed grading system by Spetzler we treated 25 grade 1, 24 grade 2, 40 grade 3, 11 grade 4, and 5 grade 5 lesions. The overall success rate defined as complete resection without additional permanent neurological deficit was 89.6% (87 out of 97 surgical cases). The benefits of such combined approach to cerebral AVMs become apparent in shortened and safer surgical procedures as well as in a low complication rate.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 142 (2000), S. 113-138 
    ISSN: 0942-0940
    Keywords: Keywords: Glioma; growth factors; oncogenes; platelet-derived growth factor (PDGF); epidermal growth factor (EGF); erbB, vascular endothelial growth factor (VEGF); fibroblast growth factor (FGF); hepatocyte growth factor (HGF); insulin-like growth factor (IGF); therapy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Overexpression or untimely expression of wild-type or mutated protein growth factors and their receptors is associated with the biology of malignant gliomas and other types of cancer. It may result in unchecked tumour cell proliferation, migration/invasion into normal tissue, tumour angiogenesis, escape from immune surveillance, and decreased apoptotic cell death, i.e. after treatment with cytotoxic agents. This often involves activation of growth factor receptors either by simultaneous production of growth factors and corresponding receptors on the same or adjacent tumour cells or by constitutive receptor activation due to mutations. In several instances, the cellular genes encoding these growth factors and receptors are homologous to transforming genes/oncogenes from tumourigenic retroviruses and have thus been regarded as cellular proto-oncogenes. In recent years much progress has been made towards a better understanding of the function of these molecules and how they lead to the aggressive phenotype of malignant gliomas and its inherent resistance to adjuvant therapies. This, still insufficient, knowledge is a prerequisite for the development of novel therapies for this non-curable disease. The aim of this review is to address relevant growth factor receptor systems with emphasis on their particular role in glioma biology.
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  • 7
    ISSN: 1432-0533
    Keywords: β-Endorphin ; Corticotropin-releasing factor ; Cushing's disease ; Nelson's syndrome ; Pituitary adenoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Tissues from 12 human corticotropin-secreting adenomas, obtained during surgery for Cushing's disease (CD, ten cases) or Nelson's Syndrome (NS, two cases), were exclusively mechanically dispersed. Single cells and cell aggregates were plated on extracellular matrix derived from bovine corneal endothelia. Functional responses to physiological stimuli were analyzed by measuring human β-endorphin (βh-EP) immunoreactivity (IR) by radioimmunoassay in the culture medium. All adenomas responded with stimulated secretory activity to arginine vasopressin (AVP), corticotropin-releasing factor (CRF), or both. Cortisol higher than 10−8 M suppressed basal secretion and CRF- or AVP-stimulated βh-EP-IR secretion. There was no consistent difference in response of the cells when cultured in medium containing 10% fetal calf serum (FCS) or in serum-free conditions. A change of cells from serum to serum-free conditions usually resulted in 10%–50% reduction in the basal secretion level that remained stable for at least 2 weeks and, in one case (NS), 10 weeks. In cells maintained in medium supplemented with 5% serum obtained from the respective patients 40 min after adenoma removal, basal secretion was suppressed to 60% of the baseline level in a 10% FCS control. Long-term incubation with CRF (10−9 M) showed sustained stimulation of hormone secretion. No remarkable cell proliferation was observed under basal conditions or during long-term, low-dose incubation with cholera toxin (10−12 M) in two cases (CD), or CRF (10−9 M) in two cases (NS, CD). Parallel β-EP-IR and adrenocorticotropin secretion was verified in selected cases.
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  • 8
    ISSN: 1432-0533
    Keywords: Key words TrkA ; TrkB ; TrkC ; Astrocytoma ; Oligodendroglioma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neurotrophins regulate the proliferation and differentiation of neurons in the central nervous system via a family of specialized receptors, including TrkA, TrkB, and TrkC. As little is known about their expression or potential role in human glial tissues and glial tumors, we undertook an immunohistochemical analysis of human glia, glioma tissues and cell cultures of glial tumors to characterize the expression of Trk family members (full-length TrkA, TrkB, the truncated form of TrkB, and TrkC). In normal human brain Trk A, B, and C immunoreactivity was found in neurons and some weak staining was also seen astrocytes. No Trk expression was seen on oligodendrocytes. Strong reactivity was seen in reactive astrocytes in a glial scar. In a total of 34 glioma tissue specimens, which included 16 astrocytic tumors (4 low-grade astrocytomas and 12 glioblastomas multiforme) and 15 oligodendrogliomas (8 low-grade and 7 anaplastic) as well as 3 oligoastrocytomas (WHO grade II), TrkA, B, and C immunoreactivity was observed exclusively in specimens from astrocytic gliomas (16/16), but not in any of the oligodendrocytic gliomas (0/15). In the oligoastrocytomas, staining was restricted to the astrocytic component. In the astrocytoma and oligodendroglioma specimens, Trk A, B, and C immunoreactivity was also seen in the surrounding reactive astrocytes. Trk expression was independent of age, sex or histological grade of the investigated tumors. In six primary cell cultures, one derived from human astrocytes and five established from malignant astrocytomas, only TrkA immunoreactivity could be detected, while TrkB (both full-length and truncated isoforms) and TrkC were absent. The TrkA expression in primary cell cultures decreased with continuous cell passaging, and no Trk could be detected in established cell lines derived from glioblastoma. In conclusion, our data suggest that in human glial tissues Trk A, B, and C may be expressed in a lineage-restricted manner, thereby distinguishing between astrocytes and oligodendrocytes in a marker-like fashion. Trk expression, like GFAP expression appears to be increased in activated (reactive)/ neoplastic astrocytes.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Pure and applied geophysics 119 (1980), S. 80-86 
    ISSN: 1420-9136
    Keywords: Statistics of directions ; Paleomagnetism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Geosciences , Physics
    Description / Table of Contents: Abstract Statistical analysis of non-orientated directions. A computing mode of principal directions of a set of non-orientated directions or lineations and statistical tests are presented. An application to the analysis of a set of poles and for finding the intersection of remagnetisation circles is shown.
    Notes: Résumé On propose un mode de calcul des directions principales d'un ensemble de directions non orientées et des tests de précision. On propose des applications à l'analyse de nuages de pôles et à la recherche d'intersection de cercles de réaimantation.
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  • 10
    ISSN: 0942-0940
    Keywords: Posterior third ventricle tumours ; pineal tumours ; management ; operative indication ; technique ; chemotherapy ; results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The evaluation of tumours located in the posterior part of the third ventricle or pineal region is achieved best by magnet resonance imaging (MRI). It shows the exact localization and extent, the involvement of neighbouring structures like thalamus or quadrigeminal plate and the displacement of the large veins, the internal cerebral veins, the vein of Galen and the veins of Rosenthal. If only CT is available, angiography shoud be performed prior to operation to identify the course of the veins. In children with a pineal region tumour the “tumour markers” AFP and β-HCG should be determined before operation. We approach the rare tumours entirely located within the posterior part of the third ventricle by the posterior interhemispheric transcallosal route with the patient in prone position with the head elevated. The same approach is used for pineal region tumours extending above the internal cerebral veins. Tumours arising from the posterior thalamus extending into the thalamus and ventricle as well, are better approached by the posterior transcortical transventricular route since the lateral view is rather limited by the midline approach. The most frequent tumours in the pineal region are approached if they are located below the internal veins by the infratentorial, supracerebellar route in the sitting position. A total of 60 cases are evaluted. If AFP and/or β-HCG are positive a highly malignant nongerminomatous germ-cell tumour must be suspected. We recommend initial chemotherapy with a combination of Vinblastine, Ifosfamide and Cis-platin without biopsy to avoid tumour seeding. After the “markers” are normalized operative removal of the residual tumour and radiotherapy should be carried out. In a series of 13 children operated on for pineal region tumours a rigid neuropsychological and endocrine evaluation was perfomed with encouraging results. During the last 10 years we have performed 49 open operations and 11 stereotactic biopsies. 40% of the patients were children under the age of 18. 40% of the tumours in childhood and 60% in adults were benign. In childhood 24% were germinomas and 20% non-germinomatous germ cell tumours. The indications for stereotactic biopsy and for open operation after biobsy are discussed.
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