Biomedical subjects
Publications and source records attributed to J P Chandler.
We describe a case of cerebellar pleomorphic xanthoastrocytoma (PXA) occurring in a patient with neurofibromatosis type 1 (NF1). The histomorphology of this uncommon glial (astrocytic) neoplasm is discussed. The occurrence of this tumor within the posterior fossa is extremely rare. To our knowledge, this is the first reported case of a cerebellar PXA in a patient with NF1.
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OBJECTIVE AND IMPORTANCE: Effective treatment for unclippable giant vertebrobasilar aneurysms remains unclear. We present the first reported case of a giant vertebrobasilar aneurysm being successfully treated with trapping of the aneurysm and internal carotid artery to basilar artery bypass with a saphenous vein graft that was performed with the patient under hypothermic circulatory arrest. CLINICAL PRESENTATION: A 15-year-old female patient with a history of probable subarachnoid hemorrhage and chronic headaches presented with a relatively acute exacerbation of her headache, nausea, vomiting, and weakness. Imaging studies revealed a 4 x 4 x 3-cm vertebrobasilar aneurysm, supplied by an angiographically dominant right vertebral artery and causing significant brain stem compression. INTERVENTION: Initially, a petrosal approach with a hearing-preserving partial labyrinthectomy was used to perform a right external carotid artery to posterior cerebral artery bypass with saphenous vein. Delayed occlusion of the right vertebral artery with an intraluminal balloon was planned; however, intraoperative angiography revealed poor graft flow, presumably because of the small size of the posterior cerebral artery. Postoperative graft occlusion was anticipated. During this same time interval, the patient deteriorated neurologically. Brain imaging failed to reveal evidence of cerebral infarction. The patient underwent subsequent surgery. After a total petrosectomy, the aneurysm was trapped, an aneurysmectomy was performed, and, with the patient under deep hypothermic circulatory arrest, a new interposition saphenous vein graft was inserted between the internal carotid and basilar arteries. Excellent flow was observed angiographically. At her 4-month follow-up examination, the patient had improved to near baseline. CONCLUSION: We present a technically challenging but safe and definitive treatment option for an unclippable giant vertebrobasilar aneurysm. Using cranial base approaches and hypothermic circulatory arrest techniques, aneurysmal trapping and successful bypass grafting directly into the basilar artery was performed.
The unexpected rupture of an intracranial aneurysm is a potentially catastrophic event. Strategies to control intraoperative aneurysm hemorrhage are based on sound surgical principles and take into consideration such variables as the timing, location, and severity of the rupture. Proven, successful techniques to prevent or control complications during aneurysm surgery are discussed in this article.
This case describes another example of inappropriate implantable defibrillator shock. We also show that this phenomenon resulted from electromagnetic current traveling down a coronary wire during coronary angioplasty.
The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation. Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55). It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.
56 elementary teachers of physical education and 54 teachers of elementary music education responded to the Teacher Integration Attitudes Questionnaire which assesses teachers' attitudes regarding inclusion of children with disabilities into regular education settings. Analysis indicated that children with emotional and behavioral disorders were perceived less favorably by teachers of music education and children with orthopedic handicaps were perceived less favorably by teachers of physical education. The type and severity of disability appeared to influence teachers' attitudes towards including children with disabilities in regular education classrooms.
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Elemental diets are reported to decrease activity of patients with dermatitis herpetiformis. We tested the hypothesis that gluten, given in addition to an elemental diet, is responsible for the intestinal abnormalities, cutaneous immunoreactant deposition, and skin disease activity in dermatitis herpetiformis. At entry eight patients with dermatitis herpetiformis, who were consuming unrestricted diets, were stabilized on their suppressive medications at dosage levels that allowed individual lesions to erupt. Six patients were then given an elemental diet plus 30 of gluten for 2 weeks, followed by the elemental diet alone for 2 weeks. Conversely, two patients received an elemental diet alone for 2 weeks followed by an elemental diet plus gluten during the final 2 weeks. Small bowel biopsies, skin biopsies, and clinical assessments were done at 0, 2, and 4 weeks. Suppressive medication dose requirement decreased over the 4 weeks by a mean of 66%. Six of eight subjects significantly improved clinically during the gluten-challenge phase of the elemental diet and all were improved at the end of the study. The amount of IgA in perilesional skin did not change significantly, but the amount of C3 increased in five of seven evaluable subjects after gluten challenge. Circulating anti-gluten and anti-endomysial antibodies were not significantly affected by the diets. All subjects completing evaluable small bowel biopsies (seven of seven) demonstrated worsening of their villus architecture (by scanning electron microscopy and intraepithelial lymphocyte counts) during gluten challenge and improvement (six of six subjects) after 2 weeks of elemental dietary intake. We conclude that 1) there is a significant improvement in clinical disease activity on an elemental diet, independent of gluten administration, 2) small bowel morphology improves rapidly on an elemental diet, and 3) complement deposition but neither IgA deposition nor circulating antibody levels correlate with gluten intake. It seems likely that dietary factors other than gluten are important in the pathogenesis of the skin lesions in dermatitis herpetiformis.
A technique by which the retina can be isolated from the turtle eye is described. Scanning electron microscopy revealed morphological variability between preparations and also between regions of the same one. Large areas were often totally free of any pigment epithelial cells, yet contained a high proportion of photoreceptors with complete outer segments. However, adjacent regions may contain photoreceptors without outer segments or with fragmented ones. The physiological properties of the horizontal cells also demonstrated large variability between different preparations. In all cases, lowering calcium concentration from 2 mM to 0.1-0.5 mM depolarized the horizontal cells and augmented the amplitude of the maximum photoresponses. However, these effects were accompanied by changes in the photoresponse kinetics and by a reduction in the horizontal cell sensitivity to light. Moreover, prolonged exposure to low calcium induced permanent damage to the retina as was indicated by the reduction in the response amplitude after superfusion with 2 mM calcium solution had been resumed. The toxic effects of low calcium were most apparent when superfusion with 0.1-1.0 microM calcium concentration was performed. These solutions induced complex time-dependent effects on the resting potential of horizontal cells and on the amplitude and kinetics of the photoresponses. We conclude from these observations that the normal concentration of extracellular calcium in the turtle retina is in the 2 mM range.
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Canine transmissible venereal sarcoma (CTVS) is a naturally occurring contagious neoplasm which can be transplanted with intact viable cells across major histocompatibility (MHC) barriers within the species and even to other members of the canine family, such as foxes, coyotes, and wolves. After 2 to 4 months of progressive growth the tumour regresses spontaneously in adults but metastasizes in immunosuppressed hosts and neonates. The mechanisms of how the tumour cells manage to overcome histocompatibility barriers so successfully for such a long period and yet succumb later are not known. In the present study we found that CTVS cells were not stimulatory to the lymphocytes of normal or tumour-bearing animals in mixed lymphocyte-tumour reaction (MLTR), although the lymphocytes from tumour-bearing animals in mixed lymphocyte-tumour reaction (MLTR), although the lymphocytes from tumour-bearing hosts responded well to either phytohaemagglutinin (PHA) or third-party allogeneic lymphocytes. Immunofluorescent antibody (IFA) assay of MHC antigens by monoclonal antibodies (MoAb) to monomorphic Class I and Class II MHC antigens showed that progressor tumour cells lacked the expression of the antigens whereas 30 to 40% of regressor tumour cells expressed them.
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Damage to the rat septohippocampal pathway results in the growth of sympathetic axons from nearby blood vessels into the denervated hippocampal formation. Sympathohippocampal sprouting exhibits lesion specificity--that is, only injury to the septohippocampal projection elicits the sprouting response. Whether other perivascular fibers sprout in response to septohippocampal injury (response specificity) has been addressed in the present study. Using cathecholamine histofluorescence and acetylcholinesterase histochemical techniques, we determined the distribution and incidence of perivascular sympathetic and nonsympathetic fibers associated with parahippocampal blood vessels in normal rats and in rats sustaining medial septal lesions. We found that sympathetic fibers are more numerous than acetylcholinesterase-positive fibers at all septotemporal levels of the hippocampal formation and that both types are very rare at dorsal hippocampal levels in normal rats. Following medial septal lesions, however, there is a tremendous increase in the number of perivascular sympathetic fibers at dorsal hippocampal levels but no change in the number of acetylcholinesterase-positive fibers. Electron microscopic observations indicate that the increase in perivascular fibers is due to increases in the number of sympathetic axonal fascicles as well as the number of axons per fascicle. Furthermore, both light and electron microscopic data suggest that parahippocampal veins are normally not accompanied by perivascular fibers but are associated with sympathetic fibers following medial septal lesions. These results indicate that sympathetic sprouting in response to septohippocampal denervation exhibits specificity not only in terms of the lesion which elicits such sprouting but also in terms of the types of fibers that respond to the lesion.
Serum thiocyanate, antibody titers to thiocyanates, and serum immunoglobulins (IgM, IgG, IgA) were measured in 73 Liberian adults normally consuming diets of low, moderate, high, or no (control) cassava-derived cyanide (CN(-)). When control and low groups (n = 40; daily intake less than 0.60 mg CN(-) per kg body weight) were contrasted with moderate and high groups (n = 33; daily intake greater than or equal to 0.60 mg CN(-) per kg body weight), the authors observed that (1) one-time serum thiocyanate measurements were not sensitive to long-term cyanide intake; however, (2) antibody titers to thiocyanates were positively correlated with cassava-based cyanide intakes (r = .22, P = 0.05); and (3) serum IgM, IgG, and IgA levels were elevated in individuals regularly consuming moderate and high levels of dietary cyanide. Possible responsible mechanisms and health implications are discussed.
Using conventional electron microscopic techniques, we examined the sympathetic axons that invade the rat hippocampal formation following cholinergic denervation. We found fascicles of unmyelinated axons adjacent to parenchymal blood vessels. These fascicles were separated from the surrounding neuropil by a duplication of basal lamina. These results suggest that specific morphological changes accompany the invasion of the central nervous system by peripheral axons.
The intent of this study was to describe in detail the normal structure of the basilar papilla in the duck, Anas platyrhynchos, with light and electron microscopy. The cochlear duct is supported by a ring of dense periotic connective tissue, the limbus. Distribution of hair cells in the basilar papilla follows the general avian pattern. Tall hair cells occupy the neural margin of the papilla. Short hair cells cover the abneural margin from the proximal tip to the middistal area. Intermediate hair cells form a transition zone from genu to distal tip. Patterns of innervation are correlated with hair cell morphology, which supports the classification of hair cells in birds into three groups. Tall hair cells synapse with two to four large afferents and one efferent; intermediate hair cells synapse with one or two afferents and one or two efferents; short hair cells synapse with one small afferent and one or two large efferents. In this relatively primitive species of bird, cuticles in all classes of hair cells reach the plasmalemma on the neural side of the cell, a condition that supports the contention that tall hair cells are more primitive than short hair cells.
The intent of this study was to describe certain morphological aspects of cytodifferentiation of the basilar papilla in the duck, Anas platyrhynchos. The duck, with a longer incubation period than that of the chicken, has proven useful in identifying the earliest morphological changes during cyto-differentiation of the basilar papilla. Most of these changes occur first at the neural margin of the presumptive genu, at the site of initial contact by cochlear nerve fibers. A wave of differentiation of hair cells radiates abneurally, proximally, and distally, concurrent with the establishment of afferent innervation. Extracellular channels form in the papilla between cell bases just before the nerve fibers penetrate the basal lamina. Nerve fibers abut hair cell bases in the genu at the time the hair cells separate from the basal lamina on day 9. Hair cell bases contain granular vesicles and lie among the nuclei of supporting cells on day 10. Synaptic bodies are present opposite nerve endings on day 11. Efferent nerve endings appear on short hair cells in the genu on day 15 and on tall hair cells on day 17.