The specificities of carbonic anhydrase isoenzyme C (CA C) and glial fibrillary acidic (GFA) protein as immunocytochemical markers for different glial cell populations in human brain and retina were studied using indirect immunofluorescence and peroxidase-antiperoxidase complex methods. With antibodies against CA C, only those cerebral cells that were morphologically oligodendrocytes and Müller cells of the retina showed positive immunostaining reaction, whereas antibodies against GFA protein selectively labeled cerebral astrocytes and a part of the glial cells and fibers in the inner layers of the retina. In double labeling, when both glial cell markers were successively localized in the same cerebral tissue sections, GFA protein immunofluorescence was never found in the immunoperoxidase-stained CA C-positive cells, which further supports the oligodendrocyte-specificity of CA C in human brain.
Widely diverging opinions on the optimal therapy for intracranial cerebrospinal fluid cysts (CSF), mainly arachnoid cysts and the Dandy-Walker cysts, exist. Excision of the cyst walls in the treatment of the Dandy-Walker cyst has been replaced by shunting procedures, but the recommended method for primary treatment of arachnoid cysts in childhood is still cyst wall excision. Membrane excision is, however, often complicated by recurrence, subsequently requiring shunting-procedures. In a series of 19 cases primary shunting of intracranial CSF cysts proved to be a reliable method. In those cases where hydrocephalus (ventricular dilatation) is present at the time of the primary operation the ventricles should be shunted as well as the cyst. The catheter from the ventricle and that from the cyst should be connected to the same valve, otherwise an increased risk of intracranial herniation exists. The prognosis for infants and children suffering from intracranial CSF cysts is in general good; in 17 out of 19 cases mental development was normal and in 15 out of 19 motor development was normal. The risk of permanent motor damage seems to be particularly high when an arachnoid cyst is located on the quadrigeminal plate.
A prospective and randomized trial has been performed in order to evaluate combined modality therapy in patients with astrocytomas grade 3 and 4. Follow-up information is available on 244 patients. One half of the series received radiation therapy twice a week (40.00 Gy/5 weeks), the other half five times a week (50.00 Gy/5 weeks). Misonidazole 1.2 g/m2 was given orally to one half of the patients in the first radiation treatment group 3 1/2 to 4 hours before the treatment. The other half received placebo. The second radiation treatment group was also divided in two halves, one receiving 0.48 g/m2 misonidazole and the other placebo 3 1/2 to 4 hours before radiation. The randomization also included a subdivision of the material into eight groups of which four were given CCNU and four no chemotherapy, beginning 3 months after operation. The dose of CCNU was 120 mg/m2 body surface every 6 weeks. All eight treatment groups showed practically identical periods of median survival, and no statistically significant differences were observed with regard to performance status, side effects, or complications. Another dosage and timing of misonidazole administration in relation to the irradiation schedule, and a consideration of effects of concomitant drugs like dexamethasone and phenytoin are discussed.
Neurosurgical resection of an epileptic focus was performed in eleven patients suffering from drug resistant focal epilepsy. The clinical result was favourable in nine cases and corresponds to the earlier results. The routinely processed biopsy specimens obtained from the brain resections were stained with haematoxylin-eosin and with specific antisera to GFAP, S-100, NSE, laminin, and fibronectin using the peroxidase-antiperoxidase technique. The main pathological finding was gliosis in eight cases, neuronal degeneration in two cases, and a vascular malformation in one case. The anti-GFAP as a specific marker of astrocytes made the astroglial proliferation clearly visible, demonstrating an astroglial scar in four cases and a moderately to strongly increased amount of astroglial cells in another four cases. Anti-S-100 and anti-fibronectin are not as specific markers. They stained both neurones and glial cells with comparable results to that of anti-GFAP but with a lower specificity and sensitivity. Anti-NSE showed decreased amounts of neurones in most of the heavily gliotic lesions and also stained glial cells in some cases. Anti-laminin stained the pial and vascular basement membranes and revealed an increased vasculature in two cases. From these results, it appears that GFAP immunostaining is a highly demonstrative means for the visualization of astrogliosis in epileptic lesions and may be of help in identifying slight focal changes. An exact demonstration of neuronal loss or other neuronal changes still waits for a more specific marker than NSE. A favourable clinical outcome after neurosurgery seems to be associated with the patients showing a clearly gliotic brain lesion in one temporal lobe.
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