Induced prismatic effects due to poorly fitting spectacle frames

To provide patients with the best vision possible practitioners undertake comprehensive visual examinations and optical dispensing procedures.  Ensuring proper frame alignment is an important part of the spectacle dispensing process.  Ideally,for maximum optical benefit, patients should look through the optical centers of their lenses.  Rays entering a lens at any point other than the optical center will be deviated as long as the lens has power, thus inducing prismatic effects.  These prismatic effects may lead to visual complaints such as asthenopia,blurry vision and headaches.  The aim of the study was to investigate the prevalence of induced prismatic effects due to poorly fitting spectacle frames.  A sample of 100 spectacle wearing subjects was selected as participants.  Questionnaires were completed and any symptoms experienced recorded.  The habitual spectacle position in the primary position of gaze was noted, pupil and optical centers marked and where relevant, induced prism was calculated.  Data was analysed using the ANOVA Kruskal-Wallis and Mann-Whitney tests.  On initial observation of frame position, about45% of subjects were wearing their spectacles incorrectly.  A comparison of the marked pupil centers in primary gaze and optical centers revealed that 100% of participants were found to not be looking through the optical centers of their lenses.  Fifty one percent were within horizontal and 3.12% within vertical ANSI tolerances.  Symp-toms were reported by 50% of subjects experiencing base-out, 0% base-in and 47% vertical induced prismatic effects.  However, no correlation existed between those subjects experiencing induced prism and symptoms reported.  Prism adaptation may account for some participants being asymptomatic.  Sixty three percent of subjects were not aware of the importance of properly fitted spectacle frames.  Proper optical dispensing with associated patient education is necessary to achieve optimal optical benefits of spectacles and careful attention should be given to this aspect by practitioners.  It is recommended that patients return periodically to their optometrists to have the frame alignment assessed and the fit modified if necessary. (S Afr Optom 2011 70(4) 168-174)

Glioma/glioblastoma-specific adenoviral gene expression using the nestin gene regulator

For glioma- and glioblastoma-specific gene expression, we utilized a nestin regulatory element whose activity was evaluated by the reporter gene lacZ. Nestin is a 38-kDa intermediate filament protein, and is expressed specifically in the neuroepithelial stem cells. Nestin is detected in gliomas and glioblastomas, but not in normal brain tissue. We constructed a nestin gene regulator by placing nestin's second intron before the 5' upstream region (2iNP). To obtain enhanced expression of this tissue-specific regulator, we utilized the adenovirus double-infection method with a Cre-loxP on/off switching system. We constructed a 'regulator' vector, Ax2iNPNCre, which expresses Cre recombinase under the control of the nestin regulatory element, 2iNP. A 'reporter' vector, AxCALNLNZK, expresses lacZ under the control of a strong CAG promoter when the stuffer sequence has been removed by Cre recombinase at a pair of loxP sites. We used seven human glioma/glioblastoma cell lines: U251, KG-1C, NGM5, U87 MG, LN-Z308, NP-2 and T98G. Of these, nestin was expressed highly in U251 and KG-1C, less in NGM5, and undetectably in the other four lines. With the use of the two adenovirus vectors, we found X-gal staining and high nestin regulator-promoted beta-galactosidase activities in four of the seven glioma/glioblastoma cell lines. Staining was strong in U251, KG-1C and NGM5, and less in U87 MG. LacZ expression was nearly undetectable in the non-glioma cell line, HeLa, but a little in COS-7. The adenovirus double-infection method, which uses a nestin regulator, is applicable for glioma/glioblastoma-specific expression.

[Cranial fasciitis of a neonatal case with massive intra- and extracranial extension]

We report a neonatal male case of cranial fasciitis in childhood. He was born with a large skull tumor in his left fronto-parietal region. The day after his birth, he was admitted to our hospital. On inspection, the mass was firm, non mobile, and had two humped peaks. The size of the mass was 7 x 5 x 4 cm, and it was located on the left coronal suture and fontanelle. The overlying skin was normal. Skull X-rays revealed osteolytic defect and linear bone remnant skirted the outer rim of the tumor. CT scan showed a slightly high-density large frontal mass with a low density area in the center of it and marked enhancement. MR images revealed a large mass with massive intra- and extracranial extension. Cerebral angiography showed the remarkable vascularization of the tumor. Preoperatively, the branches of the external carotid artery were partly embolized. On surgery, the profusely bleeding, elastic hard, yellowish-white mass arising from the dura was partially removed with the surrounding bone. A small mass remained subdurally. The boundary of the mass and the dura was not well demarcated. After the operation, no neurological deficits were seen. 16 months after the surgery, MRI revealed the unfolded brain with no evidence of tumor. Histological examination showed characteristic proliferation of spindle-shaped fibroblasts embedded in a collagenous stroma. Inflammatory lymphocytes and acidophils were also noted. Electron micrograph revealed a tumor cell rich in rough endoplasmic reticulum and nuclei with numerous indentations. Immunostaining confirmed that these cells were positive for vimentin but negative for smooth muscle actin, GFAP, S-100 protein, and desmin. No recurrence of this tumor has been detected at four years of follow-up.

Management of recurrent pilocytic astrocytoma with leptomeningeal dissemination in childhood

Two cases of recurrent pilocytic astrocytoma with leptomeningeal dissemination (LMD) are described. A 6-year-old boy presented with a cerebellar tumor, which was subtotally removed. Tumor recurrence with LMD occurred 4 years later. Reoperation for tumor removal followed by craniospinal irradiation stabilized the LMD over 5 years. A 4-year-old girl presented with a chiasmatic-hypothalamic tumor. Partial removal of the tumor was followed by radiation therapy. Tumor regrowth with LMD occurred 4 years later and was managed by reoperation, chemotherapy and radiotherapy. Tumor recurrence with LMD can be stabilized by multimodal treatment without tumor progression.

Assessment of malignancy of glioma by positron emission tomography with 18F-fluorodeoxyglucose and single photon emission computed tomography with thallium-201 chloride

The histological diagnosis and proliferative potential measured by bromodeoxyuridine (BrdU) labelling index (LI) were correlated with preoperative CT and contrast-enhanced, MRI, 18F-fluorodeoxyglucose positron emission tomography (PET) and 201T1 single photon emission computed tomography (SPECT) in 43 patients with various grades of glioma. 201T1 SPECT had slightly higher sensitivity to tumours with BrdU LI > or = 5% (showing 10/10) than 18F-FDG PET (7/8 tumours). 18F-FDG PET was better for identifying tumours of BrdU LI < 1% (13/15) than 201T1 SPECT (13/22). Accumulation of 201T1 in the tumour was slightly different from contrast enhancement on CT and/or MRI, and gave "false-positive" results in some low-grade gliomas. However, 201T1 SPECT, which is available in many hospitals and may cost less, provided useful information to supplement that from CT and MRI.

Clinicohistological study of oligodendroglioma and oligoastrocytoma

The clinical and histological characteristics of oligodendroglioma and oligoastrocytoma were investigated in patients, mainly adults with supratentorial tumors, who were treated with surgery and radiotherapy, and with chemotherapy for recurrent, anaplastic tumors, or both. The median survival time was 13.2 years for oligodendroglioma (four patients), 12.7 years for anaplastic oligodendroglioma (five patients), 13.5 years for oligoastrocytoma (seven patients), and 4.8 years for anaplastic oligoastrocytoma (four patients). Two of three recurrent oligodendrogliomas and two of two recurrent oligoastrocytomas showed malignant transformation. Minigemistocytes were sometimes recognized in recurrent tumors and had a sinister prognosis. Oligodendroglioma and oligoastrocytoma may transform into each other at recurrence.

Technetium-99m(V)-DMSA and thallium-201 in brain tumor imaging: correlation with histology and malignant grade

This study was performed to compare imaging ability between pentavalent 99mTc-DMSA and 201TlCl in primary and metastatic brain tumors and to evaluate the relationship between retention and histologic malignancy.

METHODS

Patients with a brain tumor were selected by MRI and/or CT. Dynamic, early and delayed static SPECT images of the brain were obtained immediately, 30 min and 3 hr after intravenous administration of approximately 555 MBq 99mTc(V)-DMSA and 111 MBq 201Tl-Cl, respectively. Both studies were performed on separate days within a week. Uptake ratios, retention ratio and retention index were calculated and compared with tumor histology and malignancy grade.

RESULTS

One-hundred six studies were performed on 100 patients and 118 lesions were demonstrated: 16 glioblastomas, 13 anaplastic astrocytomas (Grade III), 19 astrocytomas (Grade II), 29 meningiomas, 11 schwannomas and 14 metastases. Approximately 93% and 88%, respectively, of primary and metastatic brain tumors were demonstrated by 99mTc(V)-DMSA and 201TlCl. The early uptake ratios were closely related to the tumor vascularity, but had no statistically significant difference in the tumor histology or histologic malignancy on either radiopharmaceuticals. The delayed uptake ratio, retention ratio and retention index were higher in malignant tumors than benign ones on 99mTc(V)-DMSA, however, there was no statistically significant difference between benign and malignant tumors on 201TlCl.

CONCLUSION

Technetium-99m(V)-DMSA washout from the tumor was highly dependent upon its histology and histologic malignancy. The delayed uptake ratio, retention ratio and retention index significantly reflected tumor histology and clearly distinguished between benign and malignant tumors with a statistically significant difference. There was no statistically significant difference in 201TlCl uptake or washout among the brain tumors. Technetium-99m-DMSA is superior to 201TlCl in imaging quality, sensitivity to brain tumors and specificity for differentiating benign tumors from malignant ones. These results could suggest the clinical utility of 99mTc(V)-DMSA in imaging primary and metastatic brain tumors and differentiating their histological malignancy grade noninvasively.

A comparison of children with suprasellar germ cell tumors and craniopharyngiomas: final height, weight, endocrine, and visual sequelae after treatment

BACKGROUND

Although treatment results of craniopharyngiomas and germ cell tumors in children have been reported extensively, the relationship between various posttreatment sequelae and the nature of the tumor is not well understood.

METHODS

From 1968-94, 47 children with 23 suprasellar germ cell tumors and 24 craniopharyngiomas were treated at Gunma University Hospital, Japan. Forty survivors were assessed with regard to Karnofsky scores, visual scores, final height, final weight, and other endocrine sequelae as long-term functional prognostic indicators.

RESULTS

Kaplan-Meier life-table estimates and Karnofsky scores were not significantly different between the two histologic groups. The visual function of survivors did not differ significantly at diagnosis. However, the final visual function following treatment in the germ cell tumor group was better than in the craniopharyngioma group (p < 0.05). Antidiuretic hormone secretion was significantly impaired at diagnosis in the germ cell tumor group (p < 0.0001). However, there was only a marginally significant difference in posttreatment persistent diabetes insipidus. Craniopharyngioma children were shorter and more obese at diagnosis (p < 0.02), and became much more obese than germinoma children with the same hormone therapy (p < 0.003), although the height difference became insignificant following growth hormone treatment.

CONCLUSIONS

Children with craniopharyngiomas tended to have more visual disturbances, increased dwarfism and obesity, and less diabetes insipidus than patients with germ cell tumors despite adequate therapy. The method of quantifying visual function may in itself be useful.

Pathobiology of cerebral gliomas in children and the role of radiosurgery

Twenty-five gliomas of the cerebral hemisphere in children were examined. Most hemispheric gliomas in children have relatively clear margins and less infiltrative potential. Radiosurgery has a role in the treatment of these tumors in addition to reducing the risk of radiation injuries developing later. Fifteen patients were alive 1-27 years (mean 8.4) following treatment and 10 patients died. Histologic examination demonstrated 10 differentiated gliomas, 10 poorly differentiated gliomas and 5 other gliomas. Most tumors had relatively clear margins on computed tomography and/or magnetic resonance images, and peritumoral edema was slight. In 9 autopsy cases, tumor dissemination and/or metastasis were seen in 7. However, tumor infiltration was not extensive, and clear tumor margins were found in some cases. Thus, cerebral gliomas in children have relatively clear margins and low infiltrative potential. Radiosurgery has a role in the treatment of these tumors.

Gamma Knife radiosurgery for acoustic schwannoma: effects of low radiation dose and functional prognosis

The effects of relatively low dose Gamma Knife irradiation on acoustic schwannoma were evaluated in 29 patients followed over 2 years after treatment. The mean dose delivered to the tumor periphery was 12.1 Gy. Lowering of the magnetic resonance signal intensity in the tumor center appeared in 69% and signs of tumor shrinkage appeared in 59% of cases. The cyst in the tumor enlarged in 3 cases, and 2 cases developed hydrocephalus. The percentage of pure-tone hearing preservation was 82% at 3 months, 73% at 6 months, 68% at 12 months. 64% at 18 months and 59% at 24 months in 22 out of 29 cases. Relatively low dose Gamma Knife radiosurgery was effective in suppressing tumor growth, with preservation of hearing.

Radiobiological effects of gamma knife radiosurgery on brain tumors studied in autopsy and surgical specimens

To elucidate the radiobiological effect of Gamma Knife radiosurgery on brain tumors, we performed a histological study on nine cases. In two, the material was obtained at autopsy and in seven following surgery. In the central region of the radiation field, destructive changes occurred both in tumor cells and in vessels. In the peripheral area, destructive and proliferative vascular changes were intermingled with residual tumor tissue. Immunohistochemical staining of surgical specimens showed that the vascular proliferative changes consisted of pericytic proliferation with or without endothelial proliferation. These characteristic changes might suppress tumor growth, at least in the short-term.

Hypothalamic hamartoma: anatomic, immunohistochemical and ultrastructural features

Four patients with hypothalamic hamartoma were examined by CT and/or MR imaging, immunohistochemistry and electron microscopy. The hamartomas arose from the hypothalamus and extended inferiorly. LH-RH neurons were detected in three cases by immunohistochemistry. Electron microscopy revealed large myelinated axons, axon terminals containing dense-core vesicles and axon terminals with clear vesicles forming asymmetrical synapses. The development of hypothalamic hamartoma and its functional manifestations (precocious puberty and laugh attacks) are discussed in reference to the migration of LH-RH neurons from the olfactory placode.

Diagnosis and treatment of brainstem abscess using magnetic resonance imaging and microsurgical aspiration--case report

A 6-year-old boy presented with a pontine abscess initially misdiagnosed as brainstem glioma, but he deteriorated rapidly and developed new symptoms of respiratory distress. Magnetic resonance (MR) imaging revealed a rapidly growing mass lesion in the pons. Microsurgical evacuation of the abscess via a suboccipital retromastoid approach resulted in neurological improvement and resolution of the lesion on MR images. Brainstem abscess can be successfully treated with early, accurate diagnosis based on MR imaging and appropriate microsurgical and antibiotic management.

Calcified astrocytoma of the amygdalo-hippocampal region in children

Three pediatric cases of temporal lobe seizure due to calcified glioma of amygdalo-hippocampal region are described. Computed tomography and magnetic resonance imaging showed dense calcification with no postcontrast enhancement in the amygdalo-hippocampal region. Positron emission tomography showed low oxygen metabolism, low glucose metabolism, hypermetabolism of amino acids, and low regional cerebral blood flow in the tumors. Single photon emission computed tomography showed a high accumulation of 201Tl chloride and 123I-isopropyl iodoamphetamine in one tumor, but otherwise low radioisotope uptake. These studies indicated low-grade malignancies. The patients were treated by partial tumor removal and radiotherapy. Histological examination of the tumor specimens showed astrocytoma with interstitial calcification. One patient died due to tumor recurrence, while the others are doing well with minimal seizure. We recommended temporal lobectomy in similar cases to achieve complete remission.

Fractionated Gamma Knife radiosurgery for malignant gliomas: neurobiological effects and FDG-PET studies

Experimental single-dose neural irradiation was performed in rats and monkeys. Acute and 'early' late damage was observed following single high-dose treatments. By contrast, following a single low-dose treatment, neither 'early' nor 'delayed' late damage was noted. Based on these experiments, a clinical trial of fractionated Gamma Knife surgery for malignant gliomas was begun, and patients were followed by FDG-PET studies. An acute response of the tumor was obtained without damage to the surrounding brain. Fractionated Gamma Knife surgery is a potential alternative treatment for malignant gliomas.

[A juvenile case of radiation-induced meningioma two years after radiation for craniopharyngioma]

The patient was a 7-year-old boy who received radiation therapy of 50 Gy after total gross removal of a craniopharyngioma. After two years a follow up CT scan showed a new enhanced lesion in the right temporal tip within the previous irradiation field. Total removal of the tumor was performed and its histological examination showed it to be an atypical meningioma. This atypical meningioma satisfied Cahan's criteria. So we diagnosed this atypical meningioma as radiation-induced meningioma. Immunohistochemically this meningioma stained for Vimentin. An electron-microscopical examination showed neither desmosome nor interdigitation. The score of Ki-67 and BrdU-L. I. was very small. Compared with previously reported juvenile radiation-induced meningioma, the latency was very short. The patient received growth hormone (GH) replacement therapy. We suspected relation between GH replacement therapy and short latency. He was discharged without any new neurological deficits and we haven't detected tumor recurrence for two years.

Small gliomas: metabolism and blood flow

Eight patients with small gliomas (6 low-grade and 2 high-grade) localized in a single gyrus or less than 2 cm diameter were investigated using positron emission tomography and single photon emission computed tomography. All three tumors examined demonstrated hypermetabolism of amino acids. High-grade gliomas demonstrated hypermetabolism of glucose and high blood flow, but normal or low oxygen metabolism. High-grade gliomas also showed accumulation of 201Tl chloride and high or low accumulation of 123I-isopropyl iodoamphetamine. These indications allow preoperative diagnosis of the malignancy of small gliomas, which is important because small gliomas with high-grade malignancy need more extensive removal and adjuvant therapy.

Factors affecting functional prognosis in survivors of primary central nervous system germinal tumors

We evaluated 79 patients of whom 62 survived treatment for intracranial germinal tumors between 1964 and 1992. The survivors were assessed for their Karnofsky scores and intellectual and reproductive functions to verify factors associated with better prognosis. Thirty-one tumors were pineal, 17 were suprasellar, and ten were in the basal ganglia. These included 50 germinomas, five teratomas, and seven tumors of extra-embryonic origin producing alpha-fetoprotein or human chorionic gonadotropin. Although patients with germinoma or benign teratoma had better Kaplan-Meier survival rates than those with extra-embryonic origin tumors, the mean Karnofsky scores of the survivors did not differ significantly among the three histologic groups. On the other hand, although survival rates did not differ significantly among different tumor site groups, the mean Karnofsky score of the pineal group was higher than that of the suprasellar or basal ganglia group. Intellectual and reproductive functions were severely affected in the basal ganglia and suprasellar tumor groups, respectively. The Karnofsky score of survivors treated after 1977 was higher than for those treated before 1977. The score of patients who received less than 55 Gy irradiation was better than those who received more than 55 Gy. No patient who received less than 45 Gy developed a recurrence, suggesting that a lower dose may suffice for pure germinomas. Tumors of extra-embryonic origin, however, should be treated with combined chemotherapy to minimize subsequent irradiation. Factors affecting survivors' capabilities are discussed.

Delayed brain hemorrhage associated with prophylactic whole brain irradiation for pediatric malignant brain tumor: a case report

Intraparenchymal hemorrhage in the left frontal lobe suddenly occurred in a 7-year-old girl who had undergone partial removal of an undifferentiated brain stem glioma and received craniospinal (30 Gy) and posterior fossa booster (20 Gy) irradiation at the age of 20 months. The brain hemorrhage was thought to be delayed irradiation effect. Follow-up neuro-imaging at age 9 years showed two more small occult chronic and subacute hemorrhages in the brain. The possibility of repeated hemorrhage as a delayed reaction to brain irradiation is emphasized.

Small gliomas: clinicopathological study

The clinicopathological characteristics of small gliomas were investigated in nine patients with gliomas less than 2 cm in diameter. The tumor histology and proliferative activity were also examined. Three tumors occurred in the white matter and six at the corticomedullary junction. Histological diagnosis, Daumas-Duport's grading, bromodeoxyuridine labeling index, and proliferating cell nuclear antigen counts were well correlated. Most small gliomas were histologically benign, localized, and removable if not in eloquent areas of the brain. However, some cases showed high-grade glioma and invasive character at the early stage, resulting in a poor outcome.

Suprasellar germinomas; relationship between tumour size and diabetes insipidus

The clinical and neuro-endocrinological aspects of 17 suprasellar germinoma patients treated between 1972-1991 are reported. Surgical extirpation was not initially attempted, but all patients received irradiation with or without a biopsy. Sixteen of those have led useful lives with appropriate hormonal replacement therapy during a mean follow up of 8 years. Seven tumours at diagnosis were less than 2 cm in diameter (type 1), nine tumours more than 2 cm (type 2), and one double midline tumour was of unknown size. All 7 type 1 patients required 1-deamino-8-D-arginine-vasopressin (DDAVP) to control diabetes insipidus (DI), but only 2 of the 9 type 2 patients have needed DDAVP since completion of the treatment. Patients with smaller tumours required more DDAVP following tumour disappearance, than those with larger tumours. The prognostic indicators for the post-treatment course of DI and retarded growth appeared to be the tumour size and the age at diagnosis. We also emphasize the absence of metastasis in unoperated cases and the use of tumour markers as a diagnostic criterion which obviates surgical acquisition of tissue to make the diagnosis. Possible reasons are discussed and the literature reviewed.

Three-dimensional observations on microvascular growth in rat glioma using a vascular casting method

The microvascular growth of ethylnitrosourea-induced rat glioma was observed using vascular casting and scanning electron microscopy (SEM). Light microscopy showed central necrosis and marginal invasive tumor cell growth with increased vascularity, and suggested that adopted pre-existing circulation was dominant in the inoculated brain tumors. In SEM, numerous buds or nodular protrusions and a few large and tortuous vessels along the tumor margin were seen at the early stage. In the intermediate stage, microaneurysms, buds with septum formation and anastomotic arches appeared, and these tumor vessels became more tortuous and larger, and extended as the tumor grew. Several "potato-shaped" huge vessels and linear nodular large vessels also appeared. In the late stage, glomeruli appeared and potato-shaped huge vessels increased in number. The neovascularization and microvascular growth of the tumors was characterized by three patterns: (a) growth of the parent vessels forming buds, (b) vascular growth in a meshwork formation producing glomeruli, and (c) vascular enlargement without a definite pattern creating potato-shaped huge vessels. The tumor vessels gradually lost their natural three-dimensional structure.

Large dose fraction radiotherapy in the treatment of glioblastoma

Twenty-four adults with glioblastoma multiforme (astrocytoma, grade 4) underwent postoperative large dose fraction radiotherapy (LDFR; 5 Gy twice weekly) with Linac X-rays. The outcome in this group was compared with that of 26 patients who received conventional fractionated radiotherapy (CFR; 2 Gy 5 times weekly). The time, dose, and fractionation (TDF) factor was about 100 in both groups. The survival rates following LDFR and CFR were, respectively, 63% vs 65% at 1 year; 36% vs 8% at 2 years; 17% vs 4% at 3 years; and 4% vs 0% at 5 years. Although the survival curve for LDFR was superior to that for CFR, the difference was not statistically significant. Autopsies of nine LDFR and 13 CFR patients showed no residual tumor in one case and no cases, respectively; small residual tumor in three cases in each group; extensive coagulation necrosis of the tumor and surrounding brain tissue in one LDFR and four CFR patients; tumor proliferation in three LDFR and four CFR cases; and mixed glioblastoma and fibrosarcoma in one LDFR and two CFR patients. These results suggest that maximum tumor removal followed by LDFR may offer a better prognosis for patients with glioblastoma than that offered by surgery plus CFR.

[Histopathologic changes and tumor cell kinetics after hyperthermia and/or radiation therapy in a rat glioma model: bromodeoxyuridine (BUdR) labelling index]

Single and combined treatment of interstitial microwave hyperthermia (HT) and radiation therapy (RT) were delivered to rat glioma models. The animal model tumors were induced by intracerebral inoculation of a small piece of G-XII glioma tissue to 6-8 week-old rats. Heating to about 44 degrees C at the surface of the inserting antenna using a 2450 MHz microwave was carried on for 30 minutes. A single dose of 800 r to the whole head was delivered by deep X-ray apparatus. In combined treatment, heating immediately preceded irradiation. Following treatment, animals were sacrificed at 1, 3, 6, 12, 24, 48, 72 and 96 hours. BUdR was administered intraperitoneally 1 hour before sacrifice. Microscopically, in HT, tumor cells became eosinophilic and separated from each other. Some of them were necrotic. Macrophage infiltration in tumor tissue was recognized after 72 hours. BUdR labelling indices were less than 1% till 24 hours had passed, then became 25% at 48 hours, nearly equal to that of the control animals. In RT, ballooning of the tumor cells was prominent, and some of the tumors became necrotic. Lymphocyte infiltration of the tumor tissue was occasionally seen. BUdR labeling indices decreased slowly; less than 10% in 24 hours, but continued until 96 hours had passed. Combined treatment of HT and RT showed addictive effect of histological changes and suppression of tumor cell growth.

Clinical pathology of primitive gliomas in the cerebrum

To clarify the biological features of primitive gliomas in the cerebrum and clearly distinguish them from malignant or anaplastic gliomas and glioblastomas, we studied eight cases clinically and pathologically. Our evaluations included immunohistochemical and electron microscopic observations. We divided the patients into two groups, children and young adults. Most tumours appeared as ring-like, enhanced masses on computed tomography and avascular or ring-like, vascular masses on angiography. Macroscopically, the tumours were well demarcated and contained cysts. Occassionally we found tumour dissemination. Microscopically, the tumours were composed of small, round cells without remarkable structural features. Ependymal, astroglial, and oligodendroglial differentiation was evident, in varying proportions; tumours in which the differentiated areas constituted more than half of the mass were classified as poorly differentiated gliomas. By these criteria, this series comprised four undifferentiated and four poorly differentiated gliomas. Cell anaplasia and polymorphism were rare in both undifferentiated and differentiated areas of the tumours. Immunohistochemical and electron microscopic examinations also revealed glial differentiation. These primitive gliomas appear to be biologically similar, but not identical, to cerebellar medulloblastomas. In this series, five patients died because of recurrence or dissemination. Whole brain and spinal irradiation should be considered after total or subtotal surgical removal.

Diagnosis of germinal neoplasm in the thalamus and basal ganglia

Germinal neoplasms originating in the thalamus and basal ganglia were histologically verified by stereotactic biopsies in five cases and by other methods in three cases. Immunoperoxidase staining was performed on the tumors using antibodies against human chorionic gonadotropin and placental alkaline phosphatase. The presence of human chorionic gonadotropin was demonstrated in one germinoma and two mixed tumors, but not in three germinomas. Placental alkaline phosphatase was demonstrated to be present in four germinomas and one mixed tumor. Stereotactic biopsy specimens can be studied immunohistochemically, and the placental isoenzyme of alkaline phosphatase appears to be a new tumor marker for germinoma.

Successful treatment of a basilar aneurysm presenting as a brainstem hemorrhage

A case of large brainstem hemorrhage resulting from a basilar artery aneurysm is reported. This extremely rare disorder is fatal in a large majority of cases, and has usually been reported after autopsy. This case presents a successful recovery after clipping the aneurysm.

A suprasellar embryonal carcinoma producing alpha-fetoprotein and human chorionic gonadotropin; treated with combined chemotherapy followed by radiotherapy

A case of primary suprasellar embryonal carcinoma that produced alpha-fetoprotein and human chorionic gonadotropin in a 12-year-old girl is reported. Partial removal of the tumor and cis-platinum-based combined chemotherapy followed by local radiotherapy resulted in a definite regression of the tumor and improvement from clinical signs and symptoms. After these treatments, the concentrations of alpha-fetoprotein and human chorionic gonadotropin in both serum and cerebrospinal fluid decreased to undetectable levels. Serum basic fetoprotein, another tumor marker, can be a tool for evaluating the clinical course following postoperative chemotherapy.

Prazosin and clonidine for moderately severe hypertension

In a single-blind comparative study of the cases of 30 moderately hypertensive patients, clonidine hydrochloride and prazosin hydrochloride had similar effectiveness in lowering blood pressure. Neither agent had significant effects on the renin-aldosterone axis. Addition of polythiazide to prazosin and chlorthalidone to clonidine notably increased the antihypertensive effect of both drugs. Serum cholesterol levels were observed to decrease when prazosin and clonidine were given and to rise when the diuretics were added to the regimen. The patients treated with clonidine were troubled by side effects, particularly drowsiness and dry mouth. Prazosin was better tolerated, with side effects tending to diminish with time. The "first-dose" effect was seen in two patients given prazosin, but it did not limit treatment. Both diuretics induced notable hypokalemia.