Clinical Neuroscience

[Interpretation of the resoults of DNA image analysis in astrocytomas - biology and prognosis]

SZŰCS István1, LEEL-ŐSSY Lóránt2, KINDLER Miklós2

SEPTEMBER 20, 1997

Clinical Neuroscience - 1997;50(09-10)

[Ploidy and proliferative activity of 72 astrocytomas (except glioblastomas) were examined with nuclear DNA content by computed image analysis. The majority of samples originated from paraffin embedded material but they were partly obtained from surgical biopsy by printing or smear technique. The 72 astrocytomas were classified according to Kernohan's grading system. Different areas of tumours were evaluated according to their ploidy (euploid, diploid, aneuploid and heterogenous ranges), proliferative parameters and DNA indices. The transitional zone sometimes revealed higher proliferative index with euploidy. The DNA distribution showed greater population even in the case of moderate malignancy. Uniform – single population - DNA distribution characterized the benign type in 79% with DNA index within the diploid range. The remaining 21% had aneuploidy with another population (heterogenous). The higher the malignancy the greater the population may be found with the higher percentage of S phase cells. The mitotic forms displayed higher DNA index as well as G 2 phase even in the transitional zone of the tumour. The heterogeneity with higher percentage of S- phase correlated well with the histological type of the tumour. The follow-up study of some astrocytomas sometimes did not show a good correlation with the DNA values. However a good correlation was found between the number of cells with higher S and G 2 phases and the type of histogram in the majority of cases studied. The different parts of the tumours also varied in these respects, which should be taken into consideration during needle biopsies.]


  1. Neuropatológiai Laboratórium, Szent Borbála Kórház, Patológiai Osztály, Tatabánya
  2. Borsod-Abaúj-Zemplén Megyei Kórház, I. Idegsebészeti Osztály, Miskolc



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Clinical Neuroscience

Management of cavernous angiomas of eloquent brain areas by means of image (MRI or CT) - guided key-hole craniotomy

KÖVÉR Ferenc, DÓCZI Tamás, VON JAKO C., BALÁS István

Details of neurosurgical management of four patients suffering from intractable epilepsy caused by cavernous angiomas of subcortical eloquent brain areas are presented. Two of four cavernomas were not visualized by CT or angiography but only by MRI. MRI or CT stereotactic image-guided key-hole craniotomy and resection of the lesion from the dominant anterior central gyrus (2 cases), from the dominant superior temporal gyrus or from the dominant supramarginal gyrus were performed without any morbidity. The postoperative hospital stay was 3-5 days and all four patients experienced improved seizure control. We conclude that stereotactic image-guided key-hole craniotomy and microsurgical resection offer significant advantages in the treatment of cavernous malformations. Surgical indications include medically refractory epilepsy, intracerebral haemorrhage and/or progressive neurological deficit.

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[Examination after the first epileptic seizure]


[106 patients were examined after the first epileptic seizure; they were divided into two groups based on the clinical data. The two groups were: the group of provoked seizure and the group of non-provoked (isolated) seizure. 95 patients were in these two groups. The others showed focal epileptiform EEG alterations or generalized epileptiform activity without seizures and, because of the very low number of patients, the author excluded them from the study. A questionnaire was used to study and to search for the history of the disease and provocative factors. The familial occurrence of epilepsy was quite often among the patients, similar to primary generali zed epilepsy (17.9%). There were no important previous illnesses, except the provoked seizure. The provocative factors played a significant role in the occurrence of the first seizure. The different provocative factors appeared in greater numbers in the different groups. The anxiety occurred as a possible provocative factor in the group of non provoked seizure. The EEG after the first epileptic seizure showed epileptiform activity in the lower percentage than was predictable from the literature. The mobile long term EEG was shown to be an effective method of examination for epileptiform activity.]

Clinical Neuroscience

[Suggestion for new classification of ischemic stroke]

KOPA János, RÁDAI Ferenc, SZÁSZ Krisztina, REPA Imre, HUSZÁR Péter, BESZTERCZÁN Péter, GYŐRBÍRÓ Zsolt

[The classifications of ischemic damage of the brain which have been in use cannot give a suitable orientation about the pathoanatomical background of this disease. As a result of this, the authors investigated the data of 1000 cerebrovascular indoor stroke patients who had been investigated by CT or MRI. The clinical and radiological data were compared. Their conclusion was: more than 80% of the cerebrovascular diseases are ischemic lesions. All of the ischemic patients have some vascular disturbances. In the cases of all patients having some ischemic event (transient ischemic attack, reversible ischemic neurological deficit, prolonged reversible ischemic neurological deficit, completed stroke) there are enduring ischemic lesions which can be demonstrated by CT or MRI. Comparing the neurological signs and the CT or MRI findings of the patients we could establish two groups of ischemic lesions: solitaire and multiplex infarcts. They can be divided into 3 subgroups. Among the solitaire infarcts is subgroup S-1: the patient has no neurological sign and in the CT or MR pictures there is only one lesion under 10 mm in diameter. S-2: mild neurological signs with one infarcted lesion about 15 mm in diameter; as a partial lesion in the territory of a cerebral vessel; S-3: severe neurological signs with total or almost total damage in the territory of a cerebral vessel. Among the multiple infarcted patients there is subgroup M-1: the patient has no neurological sign, but in the CT or MR pictures there are many small (under 5 mm in diameter) infarcted zones; M-2: the patient has mild neurological signs and multiple infarcted zones (5-15 mm in diameter) can be seen in the CT, MRI picture; M-3: the patient has very severe neurological signs and/or dementia. The infarcted areas consist of small and one or more sites of partial or total damage in the territory of a cerebral vessel. This classification is better in showing the state of the patients and the pathoanatomical distur bances. The authors have used this classification in clinical practice without any problems for a year.]

Clinical Neuroscience

Analysis of IQ and genotype in duchenne and becker muscular dystrophy

LÁSZLÓ Aranka, PÓR Erzsébet, CSEPREGI Zsuzsa, ENDERFFY Emőke, RASKÓ István

The authors analysed the association of genotype and the intelligence quotient (IQ) examined with age dependent psychological methods (Wechsler, Vineland, Binet, Raven IQ tests) in 41 Duchenne (DMD), 2 intermediate MD, and 14 Becker type muscular dystrophic (BMD) patients (mean age2.5-37 y). ln 61.4% of the DMD/BMD exon deletion of dystrophin gene was found, while in 38.6% no deletion was detected. The assessment of the genotype was made by using multiple PCR method, examining the most frequent deletion of 18 exons and the muscle specific promoter. Among the deletion patients the distribution of mentol retardation was 28.5%, among patients with non deletion 22.7%. ln 21.4% of BMD patients and in 29.2% DMD patients mentol retardation was detected, the differences were not significant. Similar to the findings of other authors in 4 patients having exon deletions near the 5' end of the gene no mentol retardation was found, but in 14 of 30 patients having deletions near the 5' end of the gene there was. One patient with the largest deletion (exons 12-44) proved to be debil.

Clinical Neuroscience

[Diastematomyelia a rare dysraphic lesion of the spine]

KISS Marianna, BUZA Zoltán, VÖRÖS Erika

[A split cord malformation may be either diastematomyelia or diplomyelia. The former is characterized by two dural sacs and an osseous or osseocartilaginous septum, while the latter has two hemicords within a single dural sac and a nonrigid septum. Consequently, both require a specific neurosurgical technique. The featured case emphasizes the importance of radiological investigations in the differential diagnosis of these rare entities. The 25 year old woman experienced progressive worsening of sensation of her left foot, lower leg atrophy on the same side and gait disturbance. The findings upon physical examination were slight weakness of the left peroneal muscles, diminished touch sensation over the left foot and position sense in the left toes, and an absent ankle jerk reflex. SSEP of the left lower extremity yielded 3-5 ms P40 peak latency. The plain X-ray films and CT images revealed multiple congenital osseous anomalies: scoliosis, lumbalization of s 1 vertebra, hemiblock of the L 1-3 vertebral bodies, spina bifida at the Th 4-5, L 2-5 and S 1 and a bony median septum at L 2-3. The Il and T2 weighted axial, sagittal and coronal MR images showed sagittal spinal cord cleft with asymmetrical hemicords at L 2-4, and rejoining of them below 14. Low position of the conus, tethered cord and lipomatous infiltration of the filum were also detected. The earlier the detection of a split cord malformation, the better the surgical outcome. From the technical point of view, the preoperative classification with CT and MR is paramount.]

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[Reoperation of recurrent supratentorial lobar gliomas (astrocytoma, glioblastoma)]

ÁFRA Dénes, SIPOS László

[Hundred-nine patients with recurrent supratentorial gliomas were reoperated during the last 15 years at the National Institute of Neurosurgery, Budapest. The patients were grouped according to the WHO classification based on the first histology. Fifty patients with low grade (A 2), 30 with anaplastic astrocytoma (A 3) and 29 with glioblastoma multiforme (GM) were reoperated on. Nine patients with low grade astrocytoma were irradiated following the first operation. They survived 5 to 14 months (median value 7 months). Those 22 patients who were irradiated after the reoperation survived longer despite the malignant tranformation of their tumour. The median survival time was 24 months. Twenty-four patients with anaplastic astrocytoma received radiotherapy after the first operation in a total dose from 50 to 60 Gy. Six patients did not give their consent. The median survival after the second operation was 5.5 months. Four patients also received chemotherapy and 1 of them is still alive 4 years after the reoperation. Out of the 29 patients operated on with glioblastoma 20 were irradiated. The median survival after the reoperation was 3 months, and only a few patients lived longer than 6 months. Chemotherapy itself did not influence the survival time significantly in either group. The survival time was influenced significantly by the first histology. Radiotherapy after the reoperation prolonged the survival time significantly, especially in the group of patients with primary low grade astrocytoma. Reoperation of patients with malignant astrocytoma who were irradiated immediately after the first operation extended the survival time slightly.]

Lege Artis Medicinae


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[The incidence of colorectal cancer has dramatically increased in the past decades, rendering it the second most frequently diagnosed cancer in the Western world. Disease outcome can be improved both by early diagnosis, e.g., through the introduction and extension of screening programs, and by increased therapeutic efficiency. The latter is achieved by increasing the radicality of interventions in surgical oncology to total mesorectal excision, thereby significantly decreasing the frequency of local recurrence. High ligation of the inferior mesenteric artery aims to enhance the efficiency of lymphadenectomy. With the introduction of techniques that spare vegetative nerves, the quality of life will not be adversely affected by the increased radicality. Another direction of progress in colorectal surgery is the increased use of minimally invasive approaches, such as local excision by transanal endoscopic microsurgery or laparoscopic methods. Increased acceptance of a multimodality approach, i.e., combined application of surgical and oncological methods in the treatment of colorectal cancer, has been a great step forward recently. Beyond the long-applied adjuvant treatments, the pre-surgical use of neoadjuvant chemo-radiotherapy has become standard for locally advanced rectal cancers. Adjuvant and neoadjuvant chemotherapy also supplements the surgery of metastases with improving results and impressive long-term survivals. A very important prerequisite for tailored multimodality treatment is reliable staging, which is facilitated by the wider availability of endorectal ultrasound.]

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[Symptomatic subependymomas of the ventricles. Review of twenty consecutive cases]


[Background and purpose - Intraventricular subependymomas are rare benign tumors, which are often misdiagnosed as ependymomas. To review the clinicopathological features of subependymomas. Patient selection and methods - Retrospective clinical analysis of intraventricular subependymomas and systematic review of histological slides operated on at our center between 1985 and 2005. Results - Twenty subependymomas presented at the median age of 50 years (range 19-77). Two (10%) were found in the third, three (15%) in the forth, and 15 in the lateral ventricles. There was male preponderance (12 vs. 8). Ataxia (n=13) and papilledema (n=7) were the most common clinical presentations. Fifteen patients underwent gross total resection, and five had subtotal resection. None of the cases showed mitotic figures, vascular endothelial proliferation or necrosis. Cell proliferation marker MIB-1 activity (percentage of positive staining tumor cells) ranged from 0 to 1.4% (mean 0.3). Two cases were treated with preoperative radiation therapy (50 Gy) before the CT era, three other patients received postoperative radiation therapy for tumors originally diagnosed histologically as low grade ependymomas. Three patients (15%) died of surgical complication between one and three months postoperatively, and three patients died of unrelated causes in eight, 26 and 110 months. Fifteen patients were alive without evidence of tumor recurrence at a median follow-up time of 10 years. Conclusion - Subependymomas are low-grade lesions and patients do well without adjuvant radiotherapy. Small samples from more cellular areas may be confused with low grade ependymomas, and unnecessary radiotherapy may follow. Recurrences, rapid growth rates should warrant histological review, as hypocellular areas of ependymomas may also be a source of confusion.]

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[Advances in the diagnostics of spinal muscular atrophy]


[The three most common types of childhood spinal muscular atrophy (SMA) are type I or Werdnig Hoffmann disease, type II or intermediate form, and type III or Kugelberg-Welander disease. The clinical features of these three types are characteristic, profound limb hypotonia, wasting of muscles and areflexia. All three forms of SMA reveal an autosomal recessive mode of inheritance. The gene responsible for all three types of SMA is located on the long arm of chromosome 5 in the region of 5q11.2-913.3. Starting from 1993 blood samples were collected from 87 Hungarian families with all 3 types of SMA. DNA samples of all family members were analysed with the currently available highly informative microsatellite DNA markers in the locus 5q11.2 q13.3. Moreover, affected persons and their family members have been analysed for deletions of the survival of motor neuron gen (SMN). Prenatal diagnoses were performed in 28 cases at the request of the affected families. The possibility of prenatal diagnosis is a major step forward in helping these families, as the risk of recurrence of this devasting, untreatable disease is 25% in affected families.]

Clinical Neuroscience

[Characterization of human gliomas by the OITI C3-11 monoclonal antibody]

SIPOS László, TOSHIHIKO Wakabayashi, SZEIFERT György, FAZEKAS Ilona, ÁFRA Dénes

[OITI C3-11 monoclonal antibodies were produced against GFAP positive human glioblastoma tumour cells. The specificity of these antibodies was tested on different type of brain tumours and on normal adult brain both on tissue cultures and paraffin-embedded sections. Such OITI C3-11 monoclonal antibodies reacted with 16 of 18 malignant and 1 of 6 benign gliomas but did not react with meningioma, pituitary, adenoma, metastatic brain tumours and normal adult brain tissue.]