The fourth edition of the World Health Organization (WHO) classification of tumours of the central nervous system, published in 2007, lists several new entities, including angiocentric glioma, papillary glioneuronal tumour, rosette-forming glioneuronal tumour of the fourth ventricle, papillary tumour of the pineal region, pituicytoma and spindle cell oncocytoma of the adenohypophysis. Histological variants were added if there was evidence of a different age distribution, location, genetic profile or clinical behaviour; these included pilomyxoid astrocytoma, anaplastic medulloblastoma and medulloblastoma with extensive nodularity. The WHO grading scheme and the sections on genetic profiles were updated and the rhabdoid tumour predisposition syndrome was added to the list of familial tumour syndromes typically involving the nervous system. As in the previous, 2000 edition of the WHO ‘Blue Book’, the classification is accompanied by a concise commentary on clinico-pathological characteristics of each tumour type. The 2007 WHO classification is based on the consensus of an international Working Group of 25 pathologists and geneticists, as well as contributions from more than 70 international experts overall, and is presented as the standard for the definition of brain tumours to the clinical oncology and cancer research communities world-wide.

https://link.springer.com/content/pdf/10.1007%2Fs00401-007-0243-4.pdf

The 2007 WHO Classification of Tumours of the Central Nervous System

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

To assess the efficacy of surgical resection of brain metastases from extracranial primary cancer, we randomly assigned patients with a single brain metastasis to either surgical removal of the brain tumor followed by radiotherapy (surgical group) or needle biopsy and radiotherapy (radiation group). Forty-eight patients (25 in the surgical group and 23 in the radiation group) formed the study group; 6 other patients (11 percent) were excluded from the study because on biopsy their lesions proved to be either second primary tumors or inflammatory or infectious processes. Recurrence at the site of the original metastasis was less frequent in the surgical group than in the radiation group (5 of 25 [20 percent] vs. 12 of 23 [52 percent]; P less than 0.02). The overall length of survival was significantly longer in the surgical group (median, 40 weeks vs. 15 weeks in the radiation group; P less than 0.01), and the patients treated with surgery remained functionally independent longer (median, 38 weeks vs. 8 weeks in the radiation group; P less than 0.005). We conclude that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.

A Randomized Trial of Surgery in the Treatment of Single Metastases to the Brain

The Blood-Brain Barrier in Health and Chronic Neurodegenerative Disorders

A critical issue in physiology of bone is whether or not ion concentrations in bone are regulated by a functional membrane that separates extracellular fluid of bone from extracellular fluid of blood. The evidence for the existence of a functional membrane in bone is based in part on in vitro experiments (9, 21) and in part on hypothesis (17, 18, 23). Ramp and Neuman (21) found that both metabolic poisoning of tissue cultures of tibias from Leghorn chick embryos and splitting of the embryonic bone increased the mineral content of the bone. These data were interpreted to indicate that disruption of intact bone led to loss of membrane compartmentalization and allowed accumulation of mineral in bone. Geisler and Neuman’s (9) observation of selective concentration of potassium in bone also suggests membrane activity. The membrane in bone is not well defined. Talmage (23) has considered it to be a continuous layer of cells composed of active and resting osteoblasts and the cells lining the vascular channels of bone, while Neuman and Ramp (17) expressed the opinion that membrane compartmentalization in long bone is effected by periosteum, endosteum, and the walls of the blood vessels in the bone.

If there is a functional membrane in bone, it seems likely that a carrier would exist for transport of minerals that concentrate in bone. For example, Lehninger (14) has provided evidence for Ca2+ carrier transport in mitochondria, and others have observed carrier-type kinetics in erythrocytes, squid nerve axon, kidney tubules, and muscle cells, some of which have been reviewed by Bassingthwaighte and Reuter (1). In agreement with Williams’ (26) suggestion, based on theory, that a phosphorylated protein may serve as a carrier, Wasserman et al. (24) have described a calcium-binding protein for calcium transport across the intestinal epithelium, and MacLennan and Wong (15) have identified, in the sarcoplasmic reticulum of rabbit skeletal muscle, a phosphorylated Ca2+ transporting protein (an ATPase) and a nonphosphorylated binding or sequestering protein.

Lanthanides may compete for Ca2+ and Sr2+ binding sites on the cell membrane (8) or on a carrier protein (16). Williams (26) pointed out that the similarity in size of this trivalent ion to that of Ca2+ is the main basis for its ability to substitute for Ca2+ at binding sites. Experimentally, Mela’s (16) data on Ca2+ uptake in liver mitochondria suggest that La3+ blocks a phosphorylated carrier. Blockage of a carrier by La3+ implies that it binds to the transport site more strongly than do Sr2+ and Ca2+ and also suggests that the carrier may not transport La3+ across the membrane, because of its larger size. Reuter (22) showed and reviewed evidence that La3+ blocks Ca2+ conductance in cardiac muscle, presumably by attaching to the transport site.

This study was performed to determine if La3+ (as LaCl3) will alter deposition of 85Sr and 47Ca in bone. One possibility is that La3+ might cause an increased deposition of 45Ca or 85Sr if it blocked efflux from bone. This probably would not be evident in the early stages of uptake of tracer because the tracer is diluted so greatly in the large calcium pool of bone (3). Inhibition of tracer entry into bone seems more likely, because blockage of facilitating transport sites, whether they be on the capillary membrane or on a specialized bone membrane, would inhibit transport unless there are large, readily permeated, passive diffusion channels that would effectively bypass the cells. A subsidiary aspect was to determine if graded doses of KCN affect deposition of 85Sr and 47Ca ions, an effect that might occur if the transport system were tightly coupled to energy sources dependent on the hydrogen acceptor system.

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Inhibition of transport of 47Ca and 85Sr by lanthanum in canine cortical bone.

A retrospective analysis was performed in 30 patients who underwent computer-assisted stereotactic resection of intra-axial mass lesions with intractable partial epilepsy. Mean follow-up was 4.1 years

Surgical outcome in computer-assisted stereotactic resection of intra-axial cerebral lesions for partial epilepsy.

This report describes a Computer based method for stereotactic biopsy of intracranial lesions detected by CT scanning. Points within a tumor or an entire interpolated tumor volume are created from digitized CT slices and suspended within a 3-dimensional Computer matrix. Vessel segments from digitized stereoscopic cerebral angiograms obtained under stereotactic conditions may also be included in the Computer matrix. The Computer calculates the mechanical adjustments on an arc-quadrant stereotactic frame which place the center of a tumor volume or digitized point within the tumor into the focal point of the frame and define an avascular trajectory by which the tumor may be biopsied. Stereotactic biopsies have been performed on eighty-six (86) patients without mortality or neurologic morbidity.

Computer Assisted Stereotactic Biopsies Utilizing CT and Digitized Arteriographic Data

THE VIETNAM WAR touched a generation of Americans with its human tragedy, sacrifice, and strife. In terms of casualties, it was the fourth most costly war in American history. However, despite a monumental military effort and modern technology, the war was lost as support from the American public and its elected officials waned. Now, in the aftermath of September 11, 2001, as we embark on what might well be another protracted war, lessons from the Vietnam experience become relevant. On a positive note, a refined system for the triage, management, and evacuation of wounded military personnel evolved in Vietnam. A wounded soldier could actually be at a well-equipped base hospital within minutes after injury. At those facilities, casualties had a more than 90% chance of survival, despite some of the most horrific wounds in the history of warfare.

Patrick J. Kelly

Papers

Inhibition of transport of 47Ca and 85Sr by lanthanum in canine cortical bone.

Surgical outcome in computer-assisted stereotactic resection of intra-axial cerebral lesions for partial epilepsy.

Computer Assisted Stereotactic Biopsies Utilizing CT and Digitized Arteriographic Data

Vietnam, 1968-1969: a place and a year like no other.

Intertrochanteric osteotomy for degenerative arthritis of the hip.