Long-term survival after diagnosis of hepatic metastatic VIPoma: report of two cases with disparate courses and review of therapeutic options.

This report describes two patients with pancreatic cholera caused by vasoactive intestinal polypeptide (VIP)-producing tumors, which originated in the pancreas and showed metastases in both hepatic lobes at time of diagnosis. However, the two tumors displayed remarkably disparate clinical courses. Due to the protracted but progressive course over more than 10 years, a multifaceted therapeutic approach was performed to control symptoms and to improve quality of life.

Functional outcome after aneurysmal subarachnoid hemorrhage.

The introduction of the operating microscope, the principle of early surgery, specialized intensive care units, the calcium antagonist nimodipine, the sophisticated pre- and postoperative management and an aggressive antiischemic pharmacological management have substantially reduced morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). In spite of this progress, many patients after rupture and surgical repair of an intracranial aneurysm exhibit substantial cognitive deficits and emotional problems although their neurological outcome was rated as good according to the Glasgow Outcome Scale (GOS = I). Therefore, a comprehensive neuropsychological examination is called for in order to evaluate the factual functional outcome after SAH.

The combined use of image-guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts.

The objective of the study was to report the initial experiences with the combined use of an infrared-based frameless stereotactic navigation device and neuroendoscopy. Ten hydrocephalic patients underwent endoscopic third ventriculostomy and two patients with intracranial cysts underwent cystoventriculostomy. The trajectory of the rigid endoscope and target point were planned by frameless stereotaxy.

Modification of a mechanical twist drill trephine for craniostomy in trauma patients.

A commercially available mechanical twist drill system was modified and evaluated in 35 craniotomies for frontal ventriculostomy in 31 trauma patients. The modified mechanical twist drill enabled faster and seemingly easier and safer craniotomy. It can be used as a safer alternative to common mechanical twist drill trephines, and is particularly recommended in difficult emergency conditions.

Multiple intraluminal electrical impedancometry for recording of upper gastrointestinal motility: current results and further implications.

This review focuses on current aspects of the novel technology of multiple intraluminal electrical impedance measurement. It presents methodological features, summarizes current results, and discusses potential implications for further research. The impedance technique assesses a bolus transport and its associated peristalsis.

Experience with a new multifunctional articulated instrument holder in minimally invasive navigated neurosurgery.

A new multifunctional articulated instrument holder for use in minimally invasive navigated neurosurgery is presented. The instrument holder is secured to the Mayfield clamp, yielding permanent fixation and guidance of instruments. Thus, surgical conditions with the advantages of both conventional and frameless stereotaxic neurosurgery are created without sacrificing the relevant advantages of both methods.

Methodological issues of human experimental research with hallucinogens.

Human experimental research with hallucinogenic drugs is potentially able to identify linking variables between the psycho(patho)logical conditions and neurobiological alterations involved in both pharmacologically induced and naturally occurring acute psychotic states. A number of methodological aspects should be considered when planning modern experimental studies with hallucinogenic drugs. The issues of subject selection, repeated measures, and adequate control groups are discussed in this paper.

History, rationale and potential of human experimental hallucinogenic drug research in psychiatry.

Systematic scientific interest in psychedelic substances has a tradition of about 100 years. Numerous human experimental studies have confirmed the existence of a common nucleus of experiences in hallucinogen-induced states and the acute stages of schizophrenic psychoses. However, the degree of resemblance between endogenous and drug-induced psychotic states has been an issue of controversial debate.

The computer-assisted localizer, a navigational help in microneurosurgery.

The computer-assisted-localizer (CAL) achieves a direct linkage between preoperative radiological images and individual intraoperative anatomical findings. Experiences with our system demonstrate that CAL improves the intraoperative orientation and facilitates the neurosurgical procedure. The system described here consists of a mechanical articulated robot arm with six degrees of freedom and a three-dimensional image processor.

Dynamic Gd-enhanced MR imaging of hepatic hemangioma: is high temporal resolution requisite for characterization?

We assessed the value of high temporal resolution in the dynamic characterization of hepatic hemangioma with use of magnetization-prepared gradient-echo (MP-GRE) imaging. Single-level inversion recovery incremental flip angle MP-GRE images were obtained in 26 patients with 34 hemangiomas before and at a repetition rate of 30 images/min after injection of Gd-DTPA without breath-holding. Enhancement patterns and temporal changes thereof were analyzed.

Transdiaphragmatic leakage of ascites in cirrhotic patients: evaluation with ultrafast gradient echo MR imaging and intraperitoneal contrast enhancement.

The utility of intraperitoneal instillation of Gd-DTPA and ultrafast MR imaging in the diagnosis of transdiaphragmatic leakage of ascites was assessed in two cirrhotic patients with right-sided pleural effusion. Contrast-enhanced serial snapshot-FLASH reliably demonstrated the communication between the peritoneal and the pleural cavities in both patients. In one case, a right-sided diaphragmatic defect could be exactly localized.

Incremental flip angle snapshot FLASH MRI of hepatic lesions: improvement of signal-to-noise and contrast.

Incremental flip angle (IFA) snapshot fast low angle shot (FLASH) is a new modification of inversion recovery snapshot FLASH MR imaging. The method changes the flip angle incrementally from low to high during data acquisition and was applied in the evaluation of 16 focal hepatic lesions in 10 patients. Sequence comparisons were performed with a fixed flip angle inversion recovery snapshot FLASH sequence (standard), a T1- and T2-weighted spin-echo (SE) sequence, and a T1-weighted breath-hold FLASH sequence.

Hepatic focal nodular hyperplasia: diagnosis by ultrafast Gd-DTPA enhanced FLASH MR.

The utility of gadolinium-enhanced ultrafast MR imaging in the diagnosis of focal nodular hyperplasia (FNH) of the liver was assessed in one patient. Contrast-enhanced serial snapshot-FLASH with a frequency of 30 images/min demonstrated the typical hemodynamic appearance of FNH known from CT studies.

Constant and variable domains of different disaccharide structure in corneal keratan sulphate chains.

Four peptidokeratan sulphate fractions of different Mr and degree of sulphation were cut from the pig corneal keratan sulphate distribution spectrum. After exhaustive digestion with keratanase, the fragments were separated on DEAE-Sephacel and Bio-Gel P-10 and analysed for their Mr, degree of sulphation and amino sugar and neutral sugar content. It was found that every glycosaminoglycan chain is constructed of a constant domain of non-sulphated and monosulphated disaccharide units and a variable domain of disulphated disaccharide units.