Neurosurgery
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To improve the prognosis for primary malignant tumors of the central nervous system, new therapeutic strategies are needed. Antisense oligodeoxynucleotides (ODNs) offer the potential to block the expression of specific genes within cells. The proto-oncogene c-myc has long been implicated in the control of normal cell growth and its deregulation in the development of neoplasia. We therefore reasoned that a strategy using ODNs complementary to c-myc messenger ribonucleic acid would be a potent inhibitor of glioma cell proliferation. ⋯ These results suggest that c-Myc plays a critical role in glioma cell proliferation and demonstrate that antisense ODNs can suppress proto-oncogene expression and inhibit the proliferation of glioma cells. Our results indicate that the antiproliferative activity of these ODNs was mediated predominantly through sequence-specific antisense mechanisms, but that sequence-specific nonantisense effects may also contribute to the strongest effects demonstrated. These findings support a potential role for antisense strategies designed to inhibit c-myc expression in the treatment of malignant gliomas.
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Review Case Reports
Intraradicular lumbar disc herniation: case report and review of the literature.
Intradural or intraradicular herniation of a lumbar disc is a rare complication of disc disease. The mechanism of the tearing of the dura mater by a herniated disc is not known with certainty. Only six cases of intraradicular disc herniation have been reported. By reporting the seventh case of this rare neurosurgical entity, we emphasize its importance and review the literature on intraradicular disc herniation. ⋯ The patient was immediately relieved of pain and was discharged on the 7th day after the operation with normal muscle strength. It seems probable that in some patients with "failed back syndrome," intraradicular or intradural disc herniation is the cause of failure.
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During an 8-year interval, we evaluated the survival benefit of stereotactic radiosurgery performed in 64 patients with glioblastomas multiforme (GBM) and 43 patients with anaplastic astrocytomas (AA). ⋯ In comparison to historical controls, improved survival benefit after radiosurgery was identified for patients with GBM and patients with AA. Although this survival benefit may be related to our selection of patients for radiosurgery based on their having smaller tumor volumes, no selection was made based on location. We observed that radiosurgery was safe and well tolerated. Its effectiveness as an adjuvant therapy deserves a properly stratified randomized trial.
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Marfan's syndrome is a heritable connective tissue disorder that has been associated with intracranial aneurysms. However, the prevalence of intracranial aneurysms in Marfan's syndrome is unknown and pathological studies of affected vessels have not been reported. We therefore examined the neuropathological findings in a group of patients with Marfan's syndrome. ⋯ These findings confirm an association between Marfan's syndrome and intracranial aneurysms. Microscopic involvement of cerebral arteries in Marfan's syndrome may be variable, even among those with intracranial aneurysms.
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This study was undertaken to elucidate the pattern of vascular innervation in areas of pial angiomatosis in Sturge-Weber disease (SWD) and eventually correlating it with the pathophysiology of the disease, namely its chronic ischemic changes. ⋯ These results demonstrate that nerve supplying cortical vessels in SWD are arranged in a distribution pattern similar to the one observed in human normal cortical veins and suggest that these abnormal vessels are innervated only with noradrenergic sympathetic nerve fibers. This represents a clear difference from the pattern of innervation observed in both normal cortical arteries and veins, and is the consequence of the anatomic and functional dysangiogenic process characteristic of the affected cortical areas in SWD.