Tenascin-C (TN-C) is an extracellular matrix protein which participates in different processes like normal fetal development, wound healing, inflammation, keloids and rheumatoid arthritis. Furthermore, the immunostaining for TN-C is seen in the stroma of various malignant tumors as in glioblastoma multiforme (GBM), however, the significance of these findings is still not clear. In this study 62 GBM samples were analyzed immunohistochemically for distribution patterns of TN-C and correlated with angiogenesis and tumor cell proliferation. Tenascin-C in GBM localizes in two compartments, perivascular and intercellular space. Intercellular tenascin-C (TN-C ic) showed focal distribution in 66%, and diffuse one in 34% of cases. Perivascular tenascin-C (TN-C pv) showed strong correlation with microvascular density (MVD) and vascular endothelial growth factor (VEGF) expression. Moreover, it seems that TN-C pv enhanced the effect of VEGF. Intercellular TN-C did not correlate with MVD and VEGF expression, but showed strong correlation with proliferation index. Furthermore, tumors with diffuse TN-C ic expression had higher proliferation indices than tumors with focal TN-C expression. Our results indicate that TN-C plays a role in angiogenesis and tumor cell proliferation, but beside the intensity of expression, the distribution patterns are also important in these processes. This study also suggests that perivascular and intercellular TN-C compartments have probably different sources and different roles in GBM.

The median nerve was explored in 100 hands and the variations classified by the Lanz system. Only 47.7% of hands showed the standard anatomy described in textbooks. Rare variations were also found. Knowledge of the variable anatomy of the nerve could help to avoid incomplete decompression at operations for carpal tunnel entrapment and injury to the thenar branch of the nerve. The possibility of double thenar innervation must be considered in preoperative evaluation and in the follow up of median nerve injuries.

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Patients with anterior cervical spine fixation (ACSF) after acute spinal cord injury often require tracheostomy for prolonged ventilatory support and upper respiratory tract clearance. The authors report two patients with ACSF who underwent a successful ultrasonographically guided percutaneous tracheostomy with dilatation forceps technique. Possible advantages of the ultrasonographically guided method with dilatation forceps in patients with ACSF are discussed.

Our preliminary data demonstrate that ultrasound-guided PDT as regards to complications is at least equally safe as ST; at the same time, it is much quicker method, probably with less late infections of the stoma, which could be an important advantage in patients with ACSF.