Biomedical subjects
Publications and source records attributed to F Mundinger.
To further reduce the incidence of haemorrhagic complications during stereotactic biopsy, the use of a microvascular Doppler system is proposed. The microprobes are fitted into the biopsy cannula to detect vessels in the neighbourhood of the target point. The first clinical results are promising.
The molecular size distribution of somatostatin-like immunoreactivity (SLI) in the cerebroventricular fluid of patients with Parkinson's disease, dystonic syndromes, multiple sclerosis, basal and midline tumors, epilepsy and pain syndromes was investigated by separation with a Sephadex G-50f column and subsequent radioimmunoassay of the eluate. Marked heterogeneity of SLI was observed in most of the pools investigated. The most conspicuous feature of the elution profiles was the preponderance of the peak coeluting with synthetic somatostatin-14, whereas the peaks comigrating with synthetic somatostatin-28 and attributable to precursor-like SLI represented only minor or trace amounts of total immunoreactivity. These findings are consistent with the greater biological activity of somatostatin-14 in the human central nervous system, whereas somatostatin-28 appears to represent the more active form in the pituitary and in the intestinal mucosa. Solely in the case of brain tumor patients, some differences could be seen, resulting in an approximately equal distribution of somatostatin-14 and somatostatin-28 in two pools of ventricular fluid and by the detection of a degradation product of somatostatin-14 in another one. These observations could be explained by a lowered barrier function as a consequence of increased intracranial pressure in case of brain tumors, which is well in accordance with a markedly elevated total protein content being a sign of a lowered barrier function.
The concentration of somatostatin-like immunoreactivity (SLI) was determined by specific radioimmunoassay in the cerebroventricular fluid of patients with tumours of the basal midline and compared to findings in patients with multiple sclerosis. Mean SLI levels of the two groups were not significantly different. In patients with basal tumours (astrocytoma, craniopharyngioma, etc.) SLI levels varied widely and tended to increase with increased intracranial pressure. Lateral ventricular SLI levels decreased in patients with blockade of foramen Monro and in patients with communicating hydrocephalus or post-radiation encephalopathy. There was no apparent correlation with dysfunction of the hypothalamohypophyseal axis.
Two neurosurgical centers, Bologna (Italy) and Freiburg (FRG), have compared results obtained with stereotactic mesencephalotomy (SM; Bologna) and multiple thalamotomies (MT; Freiburg) in the surgical treatment of chronic cancer pain syndromes. In total, 161 patients were operated, 109 in Bologna and 52 in Freiburg. In SM the lesions were single and centered on the spinothalamic tract at the mesencephalic level, while in MT the lesions were multiple in the thalamic nuclei (ventrocaudal parvocellular nucleus, nucleus limitans, lamella medialis, centromedian nuclei). The following results emerged after 2-7 months' follow-up: (1) in an antalgic sense, SM was much more beneficial, with 91 patients (83.5%) pain-free after the operation versus 27 patients (51.9%) who had only an attenuation of the pain syndrome after MT; (2) SM, compared to MT, is burdened by mortality and a higher morbidity [2 deaths (1.8%) vs. 0; 3 anesthesia dolorosa and 8 severe gaze palsies (10.1%) vs. only 1 case of permanent aphasia (1.9%)].
Colloid cysts in the foramen of Monro and third ventricle account for 0.5% to 1% of all intracranial space-occupying lesions. The introduction of computerized tomography (CT) and magnetic resonance imaging has represented a major advance in the early detection of these cysts. The risks associated with the management of benign space-occupying lesions by open surgical procedures have made it necessary to search for safer techniques. The CT-stereotaxic method provides a simple, precise, and safe method of puncturing deep-seated space-occupying cysts. Between January, 1979, and December, 1984, 12 patients with colloid cysts in the foramen of Monro and third ventricle were operated on by this method. The operations were successful, and there were no intraoperative or postoperative complications. The advantages of the CT-stereotaxic method are discussed and the results are presented.
The CT stereotactic technique of dentatotomy is described and illustrated with two examples. With this combined technique, ventriculography or pneumencephalography is no longer needed to determine the target point. In addition, due to the direct representation of anatomic structures in the CT, abnormal positions of the dentate nucleus may be taken into consideration in the determination of the target point and approach for the coagulation probe.
The diagnosis of intracerebral haematomas, especially of those which are relatively small, occupy little space and are deeply situated, presents considerable problems. The problem is even greater when the expected acute case history and the acute beginning of the symptoms do not occur and unusual localisations are found. The consequences of this are false diagnoses and the treatment of these patients within the framework of blanket diagnosis "intracerebral tumours" or "space occupying processes" without any confirmation of the histological diagnosis. - Using a sample of 26 patients where the histological diagnosis of non-recent intracerebral hemorrhages had been confirmed (out of a series of 818 CT-stereotactically biopsied patients punctured by us from the beginning of 1983 until the end of 1984), the problem of establishing a diagnosis is exposed. - A histological diagnoses should in any case be confirmed before any thorough and deep-reaching therapy is begun, since false diagnoses and misinterpretations can cause serious consequences for the patient.
The CT stereotactic method (Mundinger/Birg) and the bioptic results of intracranial processes in 815 cases are reported. In 17% of the cases, no tumor was found, in contrast to the diagnosis established by modern imaging techniques (CT, MRI). The necessity of confirming the diagnosis of intracranial lesions to optimize the treatment plan is pointed out. Low mortality and morbidity rates (0.6 and 3%) make this method acceptable for the patient, since misdiagnoses, mistreatment or omission of treatment can thus be avoided. The accuracy (0.6 mm) of CT stereotactic localization and biopsy makes the method reliable even for small lesions.
By means of new plastic stereotactic ring and head fixers, stereotactic procedures can be combined with MRI, with stereotactic coordinates obtained from the MRI images. The method was rechecked against CT stereotaxy and shows a good correspondence of the target coordinates. With MRI stereotaxy, structures near bony regions will be more accessible than with CT stereotaxy. Moreover, the MRI procedure seems to have advantages for functional therapy without the necessity of contrast ventriculography.
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Early components of lemniscal potentials after contralateral median nerve or mechanical stimulus are due to lemniscal pathways, whereas later components, after 70 msec appearing bilaterally and at higher stimulus intensities probably express extralemniscal activity. Evoked potentials in the central gray matter show much smaller amplitudes compared with somatosensory cortical evoked potentials (SSEP). The strongest component is a negative wave after 70--100 msec. Longer conditioning stimulation of the lemniscal system inhibits late components in the median nerve evoked cortical potentials. On the contrary, stimulation of the nonspecific periaqueductal gray matter produces inhibition of early components of cortical SSEP together with facilitation of late components.
Tissue changes were examined in detail via computerised tomography (matrix 160 X 160) in 28 patients with neurologically established encephalomyelitis disseminata. In the majority of cases, demyelinisation was not characteristic of the predominant pathologico-anatomical substrate, ventricular extension with diffuse atrophy but without demyelinisation being the leading sign. However, if the disseminated disease became manifest with foci of demyelinisation, these presented a preferably periventricular pattern.
The quantitative analysis of motion disorders of the upper extremities can be performed by means of a joystick connected with a minicomputer. Therefore a random squarewave curve is drawn on a computer display and the patient must follow it with the joystick. The deviation of the two curves are recorded, analysed and documented numerically and graphically.
The article describes a new method enabling the transfer of CT scan layers to the X-ray film with simple means.
The report deals with the 131I-hippuran swab test and its effectiveness as compared with other methods (X-ray techniques, Clinistix) in 123 patients with rhinoliquorrhea. Results in 32 patients with rhinoliquorrhea are correlated with those of various methods of examination and with the surgical reports. In frontal and ethmoidal lesions and in those of the middle part of the face the liquorrheas can be demonstrated with a greater probability and even in cases where other methods are ineffective. An exact diagnosis was made in 88% of the cases. This semi-quantitative method is also suitable for follow-up control since, in contrast to other techniques, even discrete liquorrheas can be identified considering that a subjectively observed cessation of flow may not be equated with an occlusion of the liquor fistula as shown by the 131I-hippuran swab test, which continues to be positive.
Cisternography with the water-soluble contrast medium metrizamide provides substantial advantages for CT demonstration: the discrimination and sharpness of definition of the basal cisterns can be considerably improved by the positive demonstration of the subarachnoid spaces. Studies of CSF dynamics make it possible to differentiate between a communicating hydrocephalus aresorptivus and a hydrocephalus within the scope of a brain atrophy. Brain substance defects and subarachnoid cysts can be clarified with respect to communication with the CSF space. Apart from providing static insights, the cisternographic use of metrizamide through repeated CT examinations also makes it possible to make conclusive statements about CSF dynamics.
In cases of stereotaxic irradiation of small tumors, CT makes possible a precise determination of tumor volume and dosage and permits exact positioning of the therapy probe. Iridium 192 wires are interstitially implanted in the tumor (mostly gliomas Grades I-III) after biopsy. The results with 98 CT-controlled patients (from a series of 213 implantations in midline tumors) have provided new information about the method of treating small cerebral gliomas.
Experimental investigations on the dimethyl-amino-stilbous carcino-sarcoma of the rat have led to a modified interstitial post-operative Curie-therapy of gliomas in the brain hemispheres following treatment with radio sensitizers. After treatment with the thymine-analogous radio-sensitizers 5-brom-2-desoxyuridine (BUDR) and 5-brom-2-desoxycytidine (BCDR) and desoxyguanosine as well as the anti-metabolites 5-fluor-uracile (FU) and methotrexate (Mtx), there is greater incorporation of the thymine analogues in the DNS of the tumour cells. More than any other combination, BUDR and Mtx effectively sensibilizes the tumour cells. Syncavit and actinomycine-D are also effective. After radio-sensitizing the post-iridium-192 contact irradiation apparatus on 133 patients with gliomas. This treatment lengthened postoperative survival times.