Metallic plates are known for their passive intraosseous transmission in the growing skull. To avoid plate removal, resorbable material with strength comparable to that of metallic plates and predictable resorption would be desirable. This should be accomplished without causing inflammatory complications and foreign body reactions often seen with highly crystalline poly-L-lactic acid or pure polyglycolic acid implants. In an animal experiment in four young Göttingen minipigs, the resorbable poly-L-lactic acid/polyglycolic acid copolymer LactoSorb was tested previously. In addition to testing the mechanical properties, the process of degradation and sub- versus epi- or supraperiosteal application of the miniplate device LactoSorb was evaluated using a frontal cranioosteoplasty model. Furthermore, LactoSorb was used in 10 patients with craniosynostosis or craniofacial trauma. During degradation, the absorbable poly-L-lactic acid/polyglycolic acid miniplates acted like metal plates because they also displayed passive intraosseous transmission in the growing animal model. Degradation took 12 to 18 months and was not delayed by bony incorporation. Their mechanical properties proved to be sufficient in craniofacial surgery. Epiperiosteal plating prolonged the passive intraosseous transmission effect during the first 3 months after surgery. There were no major inflammatory reactions seen in the experimental and/or in the clinical study.

Aim of our clinical study was to evaluate suitability and usefulness of the Stealth system(TM) in a variety of indications. II intraoperative image guided procedures were performed for anterior or lateral skull base lesions. The most common clinical findings were headache, malformation, mass, visual loss and seizure. The most common neurosurgical approaches included frontal, bifrontal and parietal temporal ones. Neuronavigation supported the neurosurgeon to achieve a gross tumor resection in 6 out of 7 patients and facilitate the reconstruction for the oral and maxillofacial surgeon thus achieving radiologically symmetric and clinically satisfying results. There was no permanent postoperative deficit in our patients but one case of blindness due to a continuity defect of the optical nerve caused by a bone fragment. The precise intraoperative feed back proved to be very helpful for orientation in the surgical site, led to more accurate recognition of tumor landmarks and was especially helpful in the reconstruction of bony structures, which had to be removed during tumor resection or had to be repositioned following malpositioning during primary reduction of the fracture.

Proceedings of the 42nd Annual ASTRO Meeting 301 survivals from metastasis for patients receiving and not receiving WBRT were 13 months and 9 months, respectively (p = 0.69).Three of the patients that initially received WBRT later required additional treatment with GK-SRS.Seven of the patients that did not receive WBRT later required additional treatment for brain control, 3 with GK-SRS and 4 with WBRT.Of patients with metachronous brain metastases, 4 patients with uncontrolled primary disease had a 2 month median survival from time of metastasis, while patients with controlled primaries had a 13 month median survival from time of metastasis (p = 0.0X).Median survival from the time of primary diagnosis was 12 months for patients with synchronous brain metastasea and was 35 months for patients with metachronous brain metastases (p = 0.003). Conclusion:For patients with NSCLC and solitary brain metastasis, survival from the diagnosis of metastasis appears similar following GK-SRS vvhether the metastasis was synchronous or metachronous.This result supports the continued consideration of aggressive brain therapy with GK-SRS even for patients with synchronous solitary brain metastases.2072 Radiation therapy and daily concomitant temozolomide in newly diagnosed glioblastoma multiforme: A safe and promising regimen Purpose: In spite of progress with radiotherapy (RT) and surgery for patients newly diagnosed with glioblastoma multiforme (GBM), their prognosis remains poor.Temoaolomide (TMZ), a recently approved oral alkylating agent, has shown encouraging activity against recurrent GBM and anaplaaic astrocytoma.Oral bioavailability of TMZ is approximately 100%.and it has good central spinal fluid penetration.Thus, it seems logical to combine TMZ with RT in patients with newly diagnosed GBM. Materials and Methods:A phase II trial with TMZ and concurrent RT was initiated in our 2 institutions.Forty-five patients (19 F, 26 M) with newly diagnosed GBM (WHO grade IV) received TM2 (75 mg/m") daily for 6 weeks during postoperative RT. followed by 6 cycles of adjuvant therapy (200 m&n' X 5 days.every 28 days).Radiation therapy was provided to a total dose of 60 Gy (2 Gy per fraction.5 days a week); the volume comprised the contrast-enhanced lesions with a 2-3 cm margin.Conformal radiation with 3D-planing and 6-18 MV photons was used in all cases.Median age was 53 years (24-70).and median Karnofsky performance status was 90% (60%100%).Tumor resection Was considered complete in 25 patients, incomplete in IO patients: a biopsy only was performed in 10 patients.Results: During the 6-week TMZ schedule in combination with RT, treatment was well tolerated by most patients with none or mild toxicity; rare nausea was controlled with antiemetic drugs.During adjuvant therapy with the S-day TMZ schedule, patients received antiemetic prophylaxis with a 5-HT3 antagonist.The following grade III/IV events were observed: neutro-1.

Previous studies have suggested that activation of the adenylyl cyclase - cAMP system in meningiomas results in decreased mitosis. We have used meningioma cell culture to further investigate this phenomenon and to examine the potential role played by interleukin-6 (IL6). Incubation of cultured meningioma cells for 4-6 days with cholera toxin and theophylline, both of which increase intracellular cAMP levels, markedly stimulated IL6 secretion and inhibited cell growth rate. Similar effects were observed with 8-bromo-cAMP. In contrast, a neutralising polyclonal antibody against IL6 significantly stimulated meningioma proliferation and reduced the inhibitory effects of 8-bromo-cAMP. These results support the concept that IL6 acts as an autocrine / paracrine inhibitory factor for meningioma proliferation, and that the inhibition exerted by elevated intracellular cAMP levels may be at least partially mediated via increased secretion of the cytokine.

Neuroendocrine tumors with somatostatin receptor expression may be localized by 111In-octreotide scintigraphy. This study examines those thyroid conditions where 111In-octreotide uptake could be observed also in the thyroid gland. 26 consecutive patients who underwent 111In-octreotide scintigraphy for tumor localization were additionally examined for thyroid disease by sonography and 99mTc-pertechnetate scintigraphy. 12 of these patients had no significant thyroid uptake and had an euthyroid normal-sized thyroid gland 14 patients with 111In thyroid uptakes had endemic goiters, two of them with thyroid autonomy and one with Graves' disease. Thus, 111In-octreotide thyroid uptake was predominantly seen in patients with endemic goiter with or without thyroid autonomy.

Zur Frage der Beteiligung von Änderungen der Dopamin-D2-Rezeptorsensitivität als Wirkprinzip beim Schlafentzug wurde die Prolaktinantwort nach Sulpirid vor und nach Schlafentzug bei Respondern und Nonrespondern verglichen. Hypothese war, daß die Prolaktinantwort bei Schlafentzugsrespondern erhöht sei aufgrund einer postulierten Heraufregulation postsynaptischer Dopamin-D2-Rezeptoren.

Total sleep deprivation (TSD) has a well-established nonpharmacological antidepressant effect in depressed patients (Wu and Bunney 1990); however, the mechanisms of therapeutic action have not been fully characterized, We addressed the question whether dopaminergic pathways are involved in the antidepressant response to TSD by comparing the response of pmlactin (PRL) to sulpiride injection in TSD responders and nonrespond-

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In 20 healthy subjects (10 female and 10 male) and 17 patients undergoing presurgical epilepsy evaluation with intracranial EEG electrodes, circadian variations of serum prolactin (PRL) were measured. A comparison between the peak values found in normals with the postictal rises in patients, led us to consider 700 μU/ml to be the threshold of diagnostic value and the observed rises above this level to be all induced by seizures. In order to asses the clinical value of this threshold, PRL was measured postictally in a further 30 patients with epilepsy and in 11 patients with psychogenic seizures. In none of the latter group did PRL rises exceed 700 μU/ml, while they did so in 39% of the complex partial seizures and in 80% of the tonic-clonic seizures. There was no significant difference with respect to sex (a rise over 700 μU/ml in 42% in male and in 55% in female patients). Based on the findings in 17 patients investigated by means of intracranial electrodes, we were not able to establish different criteria for different focus localisations: in 66% of both temporal as well as frontal lobe seizures the 700 μU/ml level was exceeded. As a trend, in the period preceeding an epileptic seizure we found a slightly decreasing PRL level, whereas in healthy persons the PRL concentrations gradually increased in the 40 minutes before the maximum spontaneous peak was reached.

The prolactin concentration profile over 24 hours was determined in three men, aged 19, 27 and 43 years, who suffered from treatment-resistant complex-partial and (or) grand mal seizures of frontal lobe origin. All three patients were examined in the course of preoperative epilepsy diagnosis, the seizures being classified by video-EEG recordings, including subdural and sphenoidal foramen ovale electrodes. Seizures were recorded in all three patients (4 grand mal; 2 complex-partial), each of them followed by a rise in serum prolactin concentration (over 700-mu-U/ml). These findings contradict the theory that prolactin concentration rises only after temporal, not after frontal seizures. Knowing the postseizure serum prolactin concentration may help to distinguish frontal epileptic from psychogenic seizures.

The prolactin concentration profile over 24 hours was determined in three men, aged 19, 27 and 43 years, who suffered from treatment-resistant complex-partial and (or) grand mal seizures of frontal lobe origin. All three patients were examined in the course of preoperative epilepsy diagnosis, the seizures being classified by video-EEG recordings, including subdural and sphenoidal foramen ovale electrodes. Seizures were recorded in all three patients (4 grand mal; 2 complex-partial), each of them followed by a rise in serum prolactin concentration (over 700 microU/ml). These findings contradict the theory that prolactin concentration rises only after temporal, not after frontal seizures. Knowing the postseizure serum prolactin concentration may help to distinguish frontal epileptic from psychogenic seizures.

BUCHFELDER, M.; BROCKMEIER, S.; PICHL, J.; SCHRELL, U.; FAHLBUSCH, R. Author Information

Female sex steroid receptors were examined in 50 human cerebral meningiomas. For estrogen receptors, high-affinity binding sites (dissociation constant (Kd): 0.05 to 0.2 nM) were found in the cytosolic fraction with a capacity of less than 4 fmol/mg protein in 10 meningiomas using a dextran-coated charcoal (DCC) assay. In the same cytosolic fraction, the solid-phase enzyme immunoassay revealed only one cytosol with a positive colorimetric reaction equal to 5 fmol/mg protein. However, in the nuclear compartment, none of the tumors stained positively for estrogen receptors with immunohistochemical techniques. In addition, the most convincing evidence for the absence of estrogen receptors was obtained by in situ hybridization using an oligonucleotide probe complementary to a fraction of the human receptor messenger ribonucleic acid (mRNA). In none of the 50 meningiomas was the expression of estrogen mRNA coding for the estrogen receptor detected. For progesterone receptors, high-affinity binding sites (Kd: 0.3 to 2.6 nM) were found in 49 of the 50 tumors using a DCC assay. In the same cytosols, solid-phase enzyme immunoassay revealed that each tumor was positive for progesterone receptors. However, in the nuclear compartment, only five tumors had partially positive staining for progesterone receptors with immunohistochemical techniques. Within the confines of this study, it is concluded that: 1) the estrogen receptor is generally absent in meningioma tissue, and 2) the progesterone receptor is mainly absent in the nuclear compartment, leading to the conclusion that the cytosolic progesterone receptor may be an inactive form. This study suggests that female sex steroid receptors are not primarily involved in the proliferative rate of cerebral meningiomas and that they are of no current significance as markers for adjuvant medical therapy of most meningiomas.

A coexistence of pituitary adenomas and meningiomas is very rare. We have reported on three of our own cases and reviewed the 17 cases reported in the literature. One has to differenciate between the coexistence of a pituitary adenoma and a meningioma without previous irradiation, and the occurrence of a meningioma following the irradiation of a pituitary adenoma. In the cases without irradiation, the adenoma and the meningioma are diagnosed simultaneously. On the other hand meningiomas arising after irradiation of a pituitary tumour are usually diagnosed only after a long latent period. The coexistence of pituitary tumours and meningiomas resulting from hormone dependent growth as well as the induction of growth of meningiomas by irradiation are discussed.

Journal Article Biochemical and immunological markers for the outcome of acromegaly after pituitary surgery Get access M Glück, M Glück Abt. Innere Medizin I, Medizinische Klinik und Poliklinik, Universität Ulm Search for other works by this author on: Oxford Academic Google Scholar W A Scherbaum, W A Scherbaum Abt. Innere Medizin I, Medizinische Klinik und Poliklinik, Universität Ulm Search for other works by this author on: Oxford Academic Google Scholar U Schrell, U Schrell Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar R Fahlbusch, R Fahlbusch Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar E F Pfeiffer E F Pfeiffer Abt. Innere Medizin I, Medizinische Klinik und Poliklinik, Universität Ulm Search for other works by this author on: Oxford Academic Google Scholar Acta Endocrinologica (Norway), Volume 120, Issue 3_Supplement, Jun 1989, Page S74, https://doi.org/10.1530/acta.0.120S074 Published: 01 June 1989

A total of 52 patients (38 women, 14 men) with a primary "empty" sella syndrome underwent dynamic endocrine testing consisting of insulin-induced hypoglycaemia and a combined anterior pituitary stimulation test utilizing GnRH and TRH. The diagnosis of an "empty" sella turcica was made on the basis of thin collimation CT reconstructions and in addition either metrizamide cisternography or magnetic resonance (MR) imaging. Only 16 of the patients presented with endocrine problems. Hyperprolactinaemia was the most common endocrine disturbance detected, and was found in 17 individuals. Panhypopituitarism was found in 3 patients. Nine other patients had some degree of partial pituitary insufficiency, but only two of them required replacement therapy. However, 31 patients had no evidence of endocrine dysfunction.

Journal Article Effects of steroids and EGF on the growth of meningiomas Get access E F Adams, E F Adams Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar U Schrell, U Schrell Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar J Honegger, J Honegger Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar M Buchfelder, M Buchfelder Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar R Fahlbusch R Fahlbusch Neurochirurgische Klinik, Universität Erlangen Search for other works by this author on: Oxford Academic Google Scholar Acta Endocrinologica (Norway), Volume 120, Issue 3_Supplement, Jun 1989, Pages S239–S240, https://doi.org/10.1530/acta.0.120S239 Published: 01 June 1989