Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches

Tumors of the hypophysis are often managed surgically by the neurosurgeon and the otolaryngologist. Three widely used anterior routes to the sella are the endonasal (transcolumellar) transsphenoidal, sublabial transsphenoidal, and transethmoidal approaches. We reviewed the charts of 60 patients who underwent surgery, 42 transcolumellar and 18 sublabial, for sellar and parasellar adenomas and compared the two transsphenoidal approaches. None of the patients in our study underwent the transethmoidal approach. Furthermore, 26 of the patients underwent an extensive interview to assess postoperative progress. Clinically, neither approach had any significant complications, and none of the patients in either group reported significant postoperative morbidity. On the basis of these results, we believe there is minimal difference in patient subjective reports and objective morbidity when comparing the sublabial and transcolumellar approaches.

Serotonin function following remission from bulimia nervosa

Abnormal serotonergic regulation in bulimia nervosa is thought to contribute to recurrent binge eating, depressed mood, and impulsivity. To follow-up on previous studies showing decreased neuroendocrine responses in symptomatic patients, this study assessed serotonin-mediated prolactin responses in individuals who had remitted from bulimia nervosa. Subjects included 21 women with a history of bulimia nervosa and 21 healthy female controls, as well as an additional comparison group of 19 women with current bulimia nervosa. Placebo-controlled neuroendocrine response studies utilized a single oral dose (60 mg) of the indirect serotonin agonist d,l-fenfluramine. For the bulimia nervosa remitted group, the fenfluramine-stimulated elevation in serum prolactin concentration was not significantly different from the response in healthy controls, but was significantly larger than the response in patients with current bulimia nervosa (p < .01). These findings suggest that diminished serotonergic neuroendocrine responsiveness in bulimia nervosa reflects a state-related abnormality. The results are discussed in relationship to recent reports indicating that some alterations in central nervous system serotonin regulation may persist in symptomatically recovered individuals.

Changes in bedrail prevalence during a bedrails-reduction initiative

OBJECTIVE

To examine the prevalence of bedrails and observe whether use of bedrails can be decreased during a bedrails-reduction initiative.

DESIGN

A serial, cross-sectional, observational study of bedrail use.

PATIENTS AND SETTING

An 816-bed not-for-profit nursing facility with academic affiliation and closed medical staff. Median age of residents was 88.1 (range 62-108); 74% were women and 26% were men.

MEASUREMENTS

Observed use of bedrails with classification of bedrail configurations into Enclosure Levels based on percentage of bedsides enclosed; serial census of bedrail use during a restraint-reduction effort.

RESULTS

Bedrail configurations fell into five Enclosure Levels based on percentage of the bed enclosed. Over 9 months, total bedrail prevalence increased from 50 to 56%; however, the highest Enclosure Levels decreased from 7.7 to 3.9%.

CONCLUSIONS

Bedrail configurations can be placed on a continuum of enclosure, and highest Enclosure Levels can be decreased during a bedrails-reduction program.

Activation and proliferation of endogenous oligodendrocyte precursor cells during ethidium bromide-induced demyelination

The adult brain contains a large population of glial cells with the properties of oligodendrocyte precursor cells (OPCs). The functions of this newly recognized class of glial cells in normal animals are unknown. Here, we analyzed the reactions of OPCs to a transient demyelination of the rat brainstem induced by the injection of ethidium bromide (EB) into the fourth ventricle. Within 22 h after EB injection, there is a 21% decrease in the number of OPCs within affected fiber tracts such as the spinal tract of the trigeminal nerve, most likely reflecting the toxic actions of EB. The surviving OPCs had enlarged cell bodies with fewer long processes and many membrane blebs. By 2 days after EB injection, these reactive OPCs had incorporated BrdU and increased in number. The increase in OPC cell number reached a maximum between 6-10 days after EB injection, at which time demyelination was complete. Myelin-specific marker antigens reappeared beginning at 12 days postinjection and the remyelination continued for up to 40 days. During remyelination, OPCs displayed a normal stellate morphology with an increased number of thin processes, many of which were closely associated with neurofilament-positive axonal profiles. The transient increase in the number of reactive OPCs within the demyelinated tissue and subsequent decrease in OPC number during remyelination demonstrates that the endogenous oligodendrocyte precursor population responds rapidly to the pathophysiological state of the brain. Demyelination generates a sufficient number of OPCs to participate in the repair of the demyelinated lesions.

Bedrails: choosing the best alternative

This article discusses the importance of resident assessment in the decision to use bedrails, highlights the importance of an interdisciplinary approach to decision-making, and offers a compendium of care plan interventions and devices that serve as alternatives to bedrails.

Comparing astrocytic cell lines that are inhibitory or permissive for axon growth: the major axon-inhibitory proteoglycan is NG2

Astrocytes, oligodendrocytes, and oligodendrocyte/type 2 astrocyte progenitors (O2A cells) can all produce molecules that inhibit axon regeneration. We have shown previously that inhibition of axon growth by astrocytes involves proteoglycans. To identify inhibitory mechanisms, we created astrocyte cell lines that are permissive or nonpermissive and showed that nonpermissive cells produce inhibitory chondroitin sulfate proteoglycans (CS-PGs). We have now tested these cell lines for the production and inhibitory function of known large CS-PGs. The most inhibitory line, Neu7, produces three CS-PGs in much greater amounts than the other cell lines: NG2, versican, and the CS-56 antigen. The contribution of NG2 to inhibition by the cells was tested using a function-blocking antibody. This allowed increased growth of dorsal root ganglion (DRG) axons over Neu7 cells and matrix and greatly increased the proportion of cortical axons able to cross from permissive A7 cells onto inhibitory Neu7 cells; CS-56 antibody had a similar effect. Inhibitory fractions of conditioned medium contained NG2 coupled to CS glycosaminoglycan chains, whereas noninhibitory fractions contained NG2 without CS chains. Enzyme preparations that facilitated axon growth in Neu7 cultures were shown to either degrade the NG2 core protein or remove CS chains. Versican is present as patches on Neu7 monolayers, but DRG axons do not avoid these patches. Therefore, NG2 appears to be the major axon-inhibitory factor made by Neu7 astrocytes. In the CNS, NG2 is expressed by O2A cells, which react rapidly after injury to produce a dense NG2-rich network, and by some reactive astrocytes. Our results suggest that NG2 may be a major obstacle to axon regeneration.

Transforming Individuals into Groups: Some Hallmarks of the SDS Approach to Small Group Research

During the past 25 years, Davis's social decision scheme (SDS) model, designed to clarify how individual-level characteristics combine to create group-level products, has had a major impact on small group research. Using formal, mathematical models, Davis and his colleagues first construct predictions, or theoretical baselines, about group products based on assumptions about members' characteristics and interactions and then compare these predictions to the performances of real groups. The SDS approach has been valuable in clarifying how group performance is affected by such variables as task characteristics, group size, individual differences (e.g., member status), procedural factors (e.g., straw polling, agendas), and temporal changes in social parameters. Copyright 1999 Academic Press.

Loss of p27Kip1 function results in increased proliferative capacity of oligodendrocyte progenitors but unaltered timing of differentiation

In many tissues, progenitor cells permanently withdraw from the cell cycle prior to commitment towards a differentiated phenotype. In the oligodendrocyte lineage a counting mechanism has been proposed, linking the number of cell divisions to growth arrest and differentiation. A direct prediction of this model is that an increase in the number of cell divisions would result in a delayed onset of differentiation. Since the cell cycle inhibitor p27Kip1 is an essential component of the machinery leading to oligodendrocyte progenitor growth arrest, we examined the temporal relationship between cell cycle withdrawal and expression of late differentiation markers in vivo, in mice carrying a targeted deletion in the p27Kip1 gene. Using bromodeoxyuridine to label proliferating cells, quaking (QKI) to identify embryonic glial progenitors, NG2 to identify neonatal oligodendrocyte progenitors, and myelin basic protein to label differentiated oligodendrocytes, we found an increased number of proliferating QKI- and NG2-positive cells in germinal zones of p27Kip1(−/−) mice at the peak of gliogenesis. However, no delay was observed in these mice in the appearance of the late differentiation marker myelin basic protein in the developing corpus callosum and cerebellum. Significantly, a decrease in cyclin E levels was observed in the brain of p27Kip1 null mice coincident with oligodendrocyte growth arrest. We conclude that two distinct modalities of growth arrest occur in the oligodendrocyte lineage: a p27Kip1-dependent mechanism of growth arrest affecting proliferation in early phases of gliogenesis, and a p27Kip1-independent event leading to withdrawal from the cell cycle and differentiation.

The NG2 chondroitin sulfate proteoglycan: role in malignant progression of human brain tumours

The expression and function of NG2, a transmembrane chondroitin sulfate proteoglycan was studied in human gliomas of various histological types in culture using immunocytochemistry and flow cytometry. NG2 was differentially expressed in the neoplasms, with higher expression in high compared to low-grade gliomas. In acutely isolated cells from human biopsies, NG2 +ve and NG2 -ve populations were morphologically distinct from each other, and NG2 +ve cells were more proliferative than NG2 -ve cells. The mitogens platelet derived growth factor (PDGF-AA) and basic fibroblast growth factor (bFGF) added in combination to serum-free medium (SFM) upregulated NG2 expression on glioblastoma multiforme cells in culture but had little effect on NG2 expression on the anaplastic astrocytoma cells. Furthermore, NG2 was colocalised with the platelet derived growth factor alpha receptor (PDGFalphaR) and antibody blockade of the PDGF-alphaR ablated NG2 expression on the glioblastoma multiforme cells, suggesting that increased NG2 expression in the presence of PDGF-AA is mediated via the PDGF-alphaR. Assays of migration and invasion indicate that NG2 +ve glioma cells migrated more efficiently on collagen IV and that NG2 -ve cells were more invasive than their NG2 +ve counterparts. The results indicate that NG2 may be, respectively, positively and negatively related to the proliferative and invasive capacity of glioma cells. Thus, expression of the NG2 proteoglycan may have major implications for malignant progression in glial neoplasms and may prove a useful target for future therapeutic regimens.

A light and electron microscopic study of NG2 chondroitin sulfate proteoglycan-positive oligodendrocyte precursor cells in the normal and kainate-lesioned rat hippocampus

The adult brain contains a large population of oligodendrocyte precursor cells that can be identified using antibodies against the NG2 chondroitin sulfate proteoglycan. The functions of this newly recognized class of glial cells in the normal or pathological brain are not well understood. To begin to elucidate these functions, we have examined the morphology and distribution of oligodendrocyte precursor cells in the hippocampus and neocortex of normal and kainate-lesioned rats by anti-NG2 immunocytochemistry using light and electron microscopy. Large numbers of oligodendrocyte precursor cells were present in all layers of the neocortex and hippocampus. These cells differed in their morphology from astrocytes, oligodendrocytes and microglia. The processes of these cells often surrounded unlabeled areas of clear cytoplasm. At the electron microscopic level, some of the profiles that were enclosed by oligodendrocyte precursor cell processes contained synaptic vesicles. Other enclosed profiles were dendrites or dendritic spines. NG2-immunopositive processes were also observed to interpose between axon terminals containing round vesicles and dendrites with thick postsynaptic densities. After kainate injection, the NG2-positive oligodendrocyte precursor cells in the hippocampus displayed reactive changes characterized by swollen cell bodies, an increased number of small, filopodial-like processes, and higher levels of immunodetectable NG2. Both viable and degenerating oligodendrocyte precursor cells were observed with electron microscopy. These observations emphasize the dynamic nature of the oligodendrocyte precursor cell and suggest that, in addition to participating in the glial reactions to excitotoxic damage, oligodendrocyte precursor cells may regulate the stability, structure and function of synapses in the normal central nervous system.

Salivary gland enlargement and elevated serum amylase in bulimia nervosa

BACKGROUND

Clinical reports have described salivary gland enlargement in bulimia nervosa, particularly in patients with elevated serum amylase concentration. The goal of the current study was to provide a controlled comparison of salivary gland size in patients with bulimia nervosa and healthy volunteers.

METHODS

Subjects included 17 women with bulimia nervosa and 21 healthy female control subjects. Dimensions of the parotid and submandibular salivary glands were estimated by ultrasonography. Blood samples for amylase measurement were obtained after overnight fast.

RESULTS

Parotid gland size was enlarged 36% in patients with bulimia nervosa in comparison to control subjects (p < .01). For the patient group, salivary gland size was significantly correlated with frequency of bulimic symptoms and with serum amylase concentration.

CONCLUSIONS

These results provide new quantitative data demonstrating increased salivary gland size in bulimia nervosa. Further studies are needed to evaluate factors responsible for salivary gland enlargement and hyperamylasemia in this disorder.

Generation of oligodendroglial progenitors in acute inflammatory demyelinating lesions of the rat brain stem is associated with demyelination rather than inflammation

Remyelination is an extremely efficient process in the adult rodent central nervous system yet the source of new oligodendroglia that appear following primary demyelination is still subject to much debate. Using a reliable marker for oligodendroglial progenitor cells in vivo, the NG2 chondroitin sulphate proteoglycan, we have evaluated the response of endogenous NG2(+) cells in the adult rat brain stem and cerebellum to inflammatory demyelinating lesions in an experimentally induced animal model of multiple sclerosis (MS), antibody augmented experimental allergic encephalomyelitis (ADEAE). We have manipulated T-cell mediated EAE in Lewis rats by injecting in addition, either anti-myelin/oligodendroglial glycoprotein (MOG) antibodies to induce inflammatory demyelination, or non-specific mouse immunoglobulins to induce an inflammatory response without demyelination. We have examined the relationship of NG2(+) progenitor cells to microglia (OX-42(+)), astrocytes (GFAP(+)) and mature oligodendroglia (CNP(+)), in the normal and demyelinated CNS. In the normal CNS NG2-expressing cells are closely intermingled with other glia but represent a distinct cell population. A prominent inflammatory response, identified by the presence of large perivascular and periventricular accumulations of reactive OX42(+) macrophages/microglia, occurred in animals with ADEAE at 7-9 days post injection (DPI), coinciding with severe clinical symptoms. In animals injected with anti-MOG antibodies inflammation was followed by the appearance of large areas of demyelination at 11-14 DPI, at which point the animals had recovered clinically. The response of NG2(+) cells was different depending on whether the inflammation was accompanied by demyelination. In the presence of inflammation, NG2(+) cells responded by an increase in immunoreactivity and an alteration in their morphology, exhibiting enlarged cell bodies and an increased number of intensely stained processes. In areas of demyelination NG2(+) cells had fewer intensely stained processes reminiscent of progenitor cells seen during development. Quantitative analysis revealed a 3-fold increase in the number of NG2(+) cells in demyelinated lesions at 11 DPI, whereas no change was observed in areas of inflammation in the absence of demyelination. Mitotic figures were only seen in NG2(+) cells in areas of demyelination. NG2(+) cell numbers appeared to return to control levels following remyelination. These results suggest that endogenous oligodendroglial progenitors divide and/or migrate, in response to signals triggered by demyelinating rather than inflammatory events, to generate a large progenitor population sufficient to promote the rapid and successful remyelination observed in this model.

Cells expressing the NG2 antigen contact nodes of Ranvier in adult CNS white matter

The NG2 antibody, which recognises an integral membrane chondroitin sulphate, labels a significant population of cells in adult CNS white matter tracts of the rat optic nerve and anterior medullary velum (AMV). Adult NG2+ cells are highly complex with multiple branching processes and we show by EM immunocytochemistry that they extend perinodal processes, which contact nodes of Ranvier. NG2+ cells do not react to conventional immunohistochemical markers for adult glia and so we reservedly term them NG2P cells. In vitro, NG2 labels oligodendrocyte-type-2 astrocyte (O-2A) progenitors that can give rise to oligodendrocytes or type-2 astrocytes, depending on the culture medium. Thus, it is possible that NG2P cells may be derived from the same stem cells as oligodendrocytes. Interestingly, NG2+ cells identified previously in adult CNS displayed phenotypic characteristics of O-2Aadult progenitors and it is possible that, like them, NG2P cells might retain the capacity of generating oligodendrocytes in the adult CNS. This may be an important role of NG2P cells in demyelinating diseases such as multiple sclerosis. It is significant therefore that the perinodal processes of NG2P cells contact the only sites of exposed axolemma in myelinated axons, so that NG2P cells are ideally situated to detect and respond to changes in axonal function during demyelination. A further implication of our finding is that NG2P cells may perform functions at nodes of Ranvier previously attributed to perinodal astrocytes, including the clustering and maintenance of sodium channels in the axon membrane at nodes, during development and following demyelination.

Multiple classes of the oligodendrocyte lineage are highly vulnerable to excitotoxicity

We have recently shown that galactocerebroside (Gal-C)-expressing oligodendrocytes are highly vulnerable to (AMPA)/kainate receptor-mediated death. Here we examined the vulnerability of cells at different developmental stages of the oligodendrocyte lineage to AMPA/kainate receptor-mediated excitotoxicity. Oligodendrocyte precursor cells, pre-oligodendrocytes and mature oligodendrocytes were killed by 24 h exposures to low concentrations of kainate (30-100 microM). Death was attenuated by the AMPA/kainate receptor antagonist 6-nitro-7-sulfamoylbenzo(f)quinoxaline-2,3-dione (NBQX). The high vulnerability of oligodendrocytes and their precursors to AMPA/kainate receptor excitotoxicity may represent an important mechanism of white matter damage resulting from trauma or ischemia in the perinatal and adult central nervous system (CNS).

Reactions of oligodendrocyte precursor cells to alpha herpesvirus infection of the central nervous system

Adult animals harbor an abundant population of oligodendrocyte precursor cells (OPCs) whose functions, other than providing a pool of precursors for oligodendrocytes, are unknown. Previous studies have demonstrated that these unusual glial cells, which can be identified by virtue of their expression of the NG2 chondroitin sulfate proteoglycan, react to traumatic brain injury. To determine the generality of the ability of OPCs to react to neuropathological insults, we have examined the reactions of OPCs to infection of the brainstem with virulent and attenuated strains pseudorabies virus (PRV). When motor neurons within the dorsal vagal complex are infected with PRV, OPCs immediately adjacent to the infected neurons display dramatic reactive changes. These changes are characterized by (1) cell bodies that stain more heavily with antibodies against NG2 than do non-reactive OPCs, (2) an increased density of processes, and (3) the appearance of fine filopodia on the cell body and processes. The onset of these morphological changes was rapid, and they occurred simultaneously with the appearance of viral antigens in motor neurons. At late stages of infection, the soma of OPCs elaborated fewer processes. A small number of the reactive OPCs contain viral antigens. These findings extend the range of neuropathological situations to which OPCs react indicating that this cell population is extremely dynamic. They also suggest that the reaction of OPCs and the consequences of these reactions to brain function must be considered in any procedure, either experimental or clinical, in which viruses are introduced into the central nervous system.

Dynamic behavior of the ends of growing parallel fibers in early postnatal rat cerebellum

The molecular layer of the cerebellum contains parallel fibers, the axons of granule neurons. We have examined the morphology and behavior of parallel fiber growth cones in the early postnatal rat cerebellum using the fluorescent tracer DiI. Parallel fiber growth cones distributed into three categories based on size and shape: short torpedo-like, long torpedo-like, and lamellopodial in form. The torpedo-like growth cones were modified by the addition of lamellopodia and/or filopodia, and the lamellopodial growth cones were often decorated with a filopodium. These three different growth cone morphologies were found throughout the growing region of the molecular layer. The nascent axons elaborated by premigratory granule neurons differed form the longer axons of more developed neurons in that they often had forked growth cones and extensive lamellopodial decoration along the axon shaft. Growth cones in living slices closely resembled those observed in the fixed preparations. The living growth cones exhibited frequent lamellopodial rearrangement and a side-to-side headwaving movement. The axon proximal to the growth cone was also dynamic. The axons curved and undulated, and mobile swellings formed along the axon shaft. These observations show that the growth cones of parallel fibers are similar to growth cones described for axons in other developing systems in terms of size, morphological characteristics, and dynamic behavior.

Response of the oligodendrocyte progenitor cell population (defined by NG2 labelling) to demyelination of the adult spinal cord

Elucidation of the response of oligodendrocyte progenitor cell populations to demyelination in the adult central nervous system (CNS) is critical to understanding why remyelination fails in multiple sclerosis. Using the anti-NG2 monoclonal antibody to identify oligodendrocyte progenitor cells, we have documented their response to antibody-induced demyelination in the dorsal column of the adult rat spinal cord. The number of NG2+ cells in the vicinity of demyelinated lesions increased by 72% over the course of 3 days following the onset of demyelination. This increase in NG2+ cell numbers did not reflect a nonspecific staining of reactive cells, as GFAP, OX-42, and Rip antibodies did not co-localise with NG2 + cells in double immunostained tissue sections. NG2 + cells incorporated BrdU 48-72 h following the onset of demyelination. After the onset of remyelination (10-14 days), the number of NG2+ cells decreased to 46% of control levels and remained consistently low for 2 months. When spinal cords were exposed to 40 Grays of x-irradiation prior to demyelination, the number of NG2+ cells decreased to 48% of control levels by 3 days following the onset of demyelination and remained unchanged at 3 weeks. Since 40 Grays of x-irradiation kills dividing cells, these studies illustrate a responsive and nonresponsive NG2+ cell population following demyelination in the adult spinal cord and suggest that the responsive NG2+ cell population does not renew itself.