David A. Cech

Steroid hormone binding macromolecules in meningiomas. Failure to meet criteria of specific receptors.

Cytoplasmic estrogen and progesterone binding proteins were assayed in 26 meningiomas using an assay developed for the measurement of estrogen and progesterone receptors in human target tissue. The steroid specificity of the binding proteins was studied in both individual and pooled meningioma tissue by competitive binding assays. Eight meningiomas contained significant amounts of estrogen‐binding protein and 18 contained significant amounts of progesterone‐binding protein. There was no correlation between the amount of hormone‐binding protein and patient age, sex, menstrual status or presentation, or tumor occurrence, location, or pathologic features. The competition studies demonstrated a lack of steroid specificity for these hormone‐binding proteins. Therefore, the authors conclude that, contrary to recent reports, the hormone‐binding proteins found in meningiomas are unlikely to be specific steroid receptors.

Intravenous cocaine abuse and subarachnoid haemorrhage: Effect on outcome

A retrospective study of subarachnoid hemorrhage associated with intravenous cocaine injection was undertaken in a large urban hospital. Patients who used intravenous cocaine had significantly poorer outcomes when compared with subarachnoid haemorrhage patients with no known exposure to the drug.

Epidemiological characteristics of subarachnoid hemorrhage in an urban population

Several risk factors for unfavorable outcome from subarachnoid hemorrhage (SAH) have been identified. The prevalence of such risk factors varies among ethnic groups and among men and women. The influence of ethnic background and gender as factors in the outcome after SAH has not been adequately studied and is the focus of the present investigation. Outcome in 145 consecutive patients was dichotomized as good and moderately disabled vs severely disabled, vegetative, and dead. A multiple logistic regression model was used to examine the factors of gender, ethnic group (white and non-white), age, admission neurological grade, pre-existing hypertension, and intravenous drug abuse. Our data reveal that hypertensive, white males, with a history of intravenous drug abuse, have a high risk of unfavorable outcome following SAH. These observations are important for the design and interpretation of future studies relating to SAH.

Giant intracranial and extracranial meningioma: case report and review of the literature.

Large extracranial extensions of intracranial meningiomas are rare. We report the case of a 63-year-old man with a giant parietal occipital meningioma, which was removed successfully without significant complications. The tumors total 2600-g mass makes it one of the largest of central nervous system origin ever resected. We detail the problem of dealing with such a tumor and review similar cases.

Paraganglioma of the thoracic spinal cord

Paraganglioma arising in the thoracic extradural space is an uncommon tumor, with only four cases previously reported. The authors review the clinical and pathological features of thoracic paraganglioma and compare them to the more common paraganglioma of the cauda equina.

Sacral radiculopathy due to cement leakage from percutaneous sacroplasty, successfully treated with surgical decompression

Percutaneous sacroplasty is a procedure adapted from vertebroplasty, which is designed to ameliorate the painful morbidity associated with sacral insufficiency fractures without the invasiveness of open surgery. Early estimates of efficacy, according to several case reports and small series, appear promising, but the procedure is not without risk. Several cases of radiculopathy due to nerve root compression by extravasated polymethylmethacrylate (PMMA) have been reported. The authors present a case of radiculopathy caused by cement leakage from sacroplasty, treated with surgical decompression of the compromised nerve root. The patient presented with left S-1 radiculopathy and was found on CT to have a left S-1 nerve root completely encased in PMMA over a portion of its length. The patient underwent sacral laminectomy with the removal of PMMA and experienced pain relief and the return of function postoperatively. Surgical removal of PMMA extravasated during sacroplasty is feasible and should be considered when nerve root compression or canal stenosis causes pain or neurological deficit refractory to conservative therapy.

Recurrent visual loss due to muslin-induced optochiasmatic arachnoiditis

Introduction: Delayed visual loss may occur in patients who have undergone surgical treatment for intracranial aneurysms due to an inflammatory foreign body reaction known as optochiasmatic arachnoiditis. This inflammatory process may be induced by muslin wrapping of intracranial aneurysms. Case report: A 61-year-old female underwent clipping of a right paraophthalmic artery aneurysm followed by wrapping with muslin. The patient developed recurrent visual loss over several years due to an inflammatory suprasellar mass and optochiasmatic arachnoiditis induced by the muslin. Results: The patient required two surgical decompressions of the optic nerves and chiasm and experienced a partial recovery of visual function after removal of the suprasellar mass. Histopathology of the mass revealed inflammatory cells and muslin. Conclusion: Ophthalmologists should be aware of the risk of optochiasmatic arachnoiditis due to muslin, and neurosurgeons should avoid the use of muslin, if possible, for aneurysms adjacent t...

Intrathecal and Intraventricular Morphine for Pain in Cancer Patients: Initial Study

Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. Initially, 1 mg of lumbar intrathecal morphine resulted in pain relief for 10 to 14 hours, and 2.5 to 4.0 mg of intraventricular morphine gave relief for 12 to 24 hours. This treatment was continued for 3 to 7 months in three of the adults. Morphine requirements gradually increased. Side effects were minimal, and there were no complications.