Pain as a symptom of peripheral nerve sheath tumors: clinical significance and future therapeutic directions

Tumors arising from the supporting cells of peripheral nerve sheaths are relatively uncommon neoplasms, and as such many clinicians are unfamiliar with the details of their presentation, diagnosis and management. Further, little is known regarding the pathogenesis of these tumors, how they cause symptoms, and how to treat these symptoms. One classic symptom of peripheral nerve tumors is pain, however there has been little formal discussion regarding the significance of pain in this setting. Here we present a brief review of the clinical significance of pain, its relevance in pre-operative planning for the treatment of these tumors, and what is known regarding the molecular mechanisms of pain generation by these tumors

Large falcine meningioma fed by callosomarginal branch successfully removed following contralateral interhemispheric approach

We report the case of a highly vascular facline meningioma removed following surgical ligation of a large callosomarginal feeding branch via a contralateral interhemispheric approach. Successfully addressing this vessel via a contralateral interhemispheric approach prior to any debulking allowed for en bloc Simpson Grade 1 tumor removal with minimal blood loss and short term tumor control without evidence of recurrence at 2 year follow up. A 56 year old man presented with first time generalized tonic-clonic seizure. Imaging revealed a right sided 5 cm falcine meningioma. The patient underwent pre-operative embolization of feeding branches, however, the most significant supply, arising from the right callosomarginal artery, could not be occluded. A bipartite frontotemporal craniotomy was performed. From a left sided interhemispheric approach the pericallosal and callosomarginal arteries were identified and the large callosomarginal tumor feeding branch were occluded using a straight Yasargil aneurysm clip. From the right the superior sagital sinus was ligated anteriorly and posteriorly. The sinus, falx, and adherent tumor were then removed en bloc. We present the case of a highly vascular falcine meningioma with a large callosomarginal feeding branch which was successfully occluded using surgical clipping of this vessel via a contralateral interhemispheric approach. This case provides an excellent example of one approach to directly dealing with large, deep interhemispheric feeding vessels unsuitable for embolization. A 3D animation of the surgical approach is provided for instructional purposes

Color preferences in clothing of a selected group of retired women 65 years of age and over

Call number: LD2668 .R4 1966 S94

An investigation of the effects of an inner-city student teaching experience on the attitudes, values, and dogmatisms of student teachers

The purposes of the investigation were (1) to determine whether differences in attitudes, values, an dogmatisms exist between volunteers for an inner-city student teaching experience and other student teachers prior to a student teaching experience; (2) to determine whether differences in attitudes, values, and dogmatisms exist at the completion of student teaching between the experimental group and a control group composed of student teachers assigned to suburban schools

Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma

Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma (VS) microsurgery. In this study, we examined the significance of previously implicated prognostic factors (age, tumor size, the extent of resection and the surgical approach) on post-operative facial nerve function. We selected all VS patients from prospectively collected database (1984–2009) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction (House-Brackman [HB] score 3 or higher) were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as “facial nerve preservation.” A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months (OR 1.27, 95% CI 1.09–1.49, p < 0.01; OR 1.35, 95% CI 1.10–1.67, P < 0.01, respectively). We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size (when extent of resection and surgical approach were included in the regression analysis). Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted

Immunological considerations of modern animal models of malignant primary brain tumors

Recent advances in animal models of glioma have facilitated a better understanding of biological mechanisms underlying gliomagenesis and glioma progression. The limitations of existing therapy, including surgery, chemotherapy, and radiotherapy, have prompted numerous investigators to search for new therapeutic approaches to improve quantity and quality of survival from these aggressive lesions. One of these approaches involves triggering a tumor specific immune response. However, a difficulty in this approach is the the scarcity of animal models of primary CNS neoplasms which faithfully recapitulate these tumors and their interaction with the host's immune system. In this article, we review the existing methods utilized to date for modeling gliomas in rodents, with a focus on the known as well as potential immunological aspects of these models. As this review demonstrates, many of these models have inherent immune system limitations, and the impact of these limitations on studies on the influence of pre-clinical therapeutics testing warrants further attention