Changes of the visual field with cerebral tumors]

Neurosurgical material of 1,746 tumours is reviewed for the relations between operative and post mortem localization of cerebral tumours and pathological findings of isopteric perimetry; and the incidence of defects of the visual field with the different localizations of tumours is discussed. The aim was to localize the tumours as accurately as possible. At least in brain tumour patients the defect of the visual field does not allow conclusions on the level of lesions to the visual pathway. Only the superior quadranopsia is important for the temporal localization.     

Results of cerebral computer tomography in the diagnosis of tumors of the sella region

Computer tomography (CT) is an important aid to the diagnosis of sella tumours because it images the tumour directly and delineates it from the healthy tissues. The tumour type can be identified to a certain extent, but angiography is necessary to distinguish tumours from aneurysms. The study is based on 140 surgical and histological examinations, the results of which were compared wit those obtained by CT. Suprasellar inflammations could always be identified by CT. Although intrasellar tumours may be identifiable by CT if full use is made of the potential of the equipment, negative CT results do not necessarily mean that there is no tumour. The diagnostic validity of the method is restricted by the absence of "standards", against which the variable images of intrasellar structures can be judged, and the restricted resolution of CT.     

Lesion-symptom mapping of language impairments in people with brain tumours: The influence of linguistic stimuli

People with tumours in specific brain sites might face difficulties in tasks with different linguistic material. Previous lesion-symptom mapping studies (VLSM) demonstrated that people with tumours in posterior temporal regions have more severe linguistic impairments. However, to the best of our knowledge, preoperative performance and lesion location on tasks with different linguistic stimuli have not been examined. In the present study, we performed VLSM on 52 people with left gliomas to examine whether tumour distribution differs depending on the tasks of the Aachen Aphasia Test. The VLSM analysis revealed that single-word production (e.g. object naming) was associated with the inferior parietal lobe and that compound and sentence production were additionally associated with posterior temporal gyri. Word repetition was affected in people with tumours in inferior parietal areas, whereas sentence repetition was the only task to be associated with frontal regions. Subcortically, word and sentence production were found to be affected in people with tumours reaching the arcuate fasciculus, and compound production was primarily associated with tumours affecting the inferior longitudinal and inferior fronto-occipital fasciculus. Our work shows that tasks with linguistic stimuli other than single-word naming (e.g. compound and sentence production) relate to additional cortical and subcortical brain areas. At a clinical level, we show that tasks that target the same processes (e.g. repetition) can have different neural correlates depending on the linguistic stimuli used. Also, we highlight the importance of left temporoparietal areas.     

Changes of visual fields in intracranial tumors outside the cerebral hemispheres]

Based on neurosurgical material of 1,746 brain tumours, the changes of the visual field determined by isopteric perimetry are discussed with their significe with regard to tumours of corpus callosum, lateral ventricles, brain stem ganglia, IIIrd ventricle, region of the sella and adjacent areas as well as posterior fossa. The proportion of unilateral blindness with primary opticus atrophy and of skotomas is strinkingly high, so that in cases of loss of vision, not readily explicable by ophthalmology, as well as in unilateral defects of the visual field, intracranial processes must be thought of.     

Quality of Life,Anxiety and Depression in Soft Tissue Sarcomas as Compared to More Common Tumours: An Observational Study

The aim of this study is to compare the quality of life and the levels of anxiety and depression in a relatively large group of subjects undergoing chemotherapy for soft tissue sarcoma and a control group of subjects undergoing chemotherapy for the most common types of cancer. 56 soft tissue sarcoma affected patients and 56 patients with common tumours, homogeneous in regards to stages of disease and sociodemographic characteristics, were enrolled in two oncological centres in Turin, Italy. Quality of life was assessed by Functional Assessment of Cancer Therapy-General and anxiety and depression by Hospital Anxiety and Depression Scale. All patients had ongoing chemotherapy. The comparison between the two groups shows no difference in either quality of life or in anxiety and depression. There are instead gender differences, since females in the group of common tumours show higher levels of anxiety in comparison to those affected by sarcomas, while males show, at a lower degree, the opposite trend. This study suggest that levels of Quality of Life, anxiety and depression are similar in rare and common tumours. The majority of patients are able to cope with the disease in an adaptive manner. However, for some patients the disease poses a threat to their physical and mental integrity; psychological support of these patients may reduce the development of significant morbidity and help patients to better manage the course of the disease and the effects of the treatment.     

A proposed regional hierarchy in recovery of post-stroke aphasia

Activation studies in patients with aphasia due to stroke or tumours in the dominant hemisphere have revealed effects of disinhibition in ipsilateral perilesional and in contralateral homotopic cortical regions, referred to as collateral and transcallosal disinhibition. These findings were supported by studies with selective disturbance of cortical areas by repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers and in patients with focal brain lesions. Both, collateral as well as transcallosal disinhibition might be relevant for the compensation of lesions within a functional network. From these data a hierarchical organization of recovery of aphasia after stroke and of compensation of language defects due to brain tumours can be deduced, by which the reactivation of undamaged network areas of the ipsilateral hemisphere usually lead to better outcome than the involvement of homotopic contra-lateral regions. rTMS can be used to identify areas relevant for speech production and might play a role in treatment strategies targeted at modulating the activity of contralateral homotopic areas of the functional network which might interfere with language recovery.     

A qualitative study of the impact of living with neurofibromatosis type 2

Neurofibromatosis type 2 (Nf2) is an inherited autosomal dominant syndrome characterised by the development of nervous system tumours, ocular abnormalities and skin tumours. Symptoms of Nf2 can vary depending on the size and location of the tumour and include hearing loss, balance deficits and facial palsy. This study explored the physical, emotional and social impact of Nf2. Six patients were recruited through a neurofibromatosis clinic and underwent a semi-structured interview. Interviews were recorded and analysed using Framework analysis. Participants spoke of the negative impact of Nf2 on daily activities, including work. Social isolation resulted from the avoidance of social situations and was often a consequence of difficulties with communication due to loss of hearing. Patients expressed a range of negative emotional reactions in response to their diagnosis and the impact of the disease. Furthermore, the findings highlighted the important role of partners and family who were relied on for physical as well as emotional and psychological support. Patients also expressed frustration at the limited awareness of Nf2 among health professionals and a desire for improved access to information on Nf2 within their local community.     

The Relation of Social Support and Coping to Positive Adaptation to Breast Cancer

Survivors of childhood cancer are at risk of compromised physical and psychological functioning as a result of disease and treatment. However, survivors experiencing similar physical problems vary considerably in their self-reported Quality of Life (QOL) raising questions about the processes underlying adjustment and maintenance of QOL. Seventy seven survivors of either Acute Lymphoblastic Leukaemia (ALL) or tumours of the Central Nervous System (CNS) completed a standardised measure of QOL and semi-structured interview. Based on theoretical assumptions that QOL reflects a difference between what survivors can, and would like to be able to do, interviews were coded for reports of discrepancies and any coping strategy employed. Survivors of tumours of the CNS reported worse QOL and more discrepancies than survivors of ALL. A significant relationship was found between QOL measured by questionnaire and number of reported discrepancies. Five kinds of strategies to reduce discrepancies were identified: changing activity, devising a “plan of action”, emotional denial, making social comparisons, and seeking social support. Survivors who reported neither discrepancies nor strategies had better QOL than those who reported both discrepancies and strategies or discrepancies but no strategies. Data are discussed in terms of rehabilitation of survivors of childhood cancer.     

Radiological pictures of the skull following brain-tumor surgery]

In 90 patients, the majority of whom was operated upon for a brain tumour, we have systematically controlled the post-operative x-ray pictures of the skull. Clips set in during surgery, calcified epiphysis and changes of the sella due to pressure were the most important signs. To complete the follow-up of tumours we should like to propose to use clips not only as a hemostyptic measure, but also to have marks in cases of possible relapses.     

Normal cerebrospinal fluid findings in spinal tumors--an analysis of 503 cases

Till now almost nothing has been published about normal liquor findings in spinal cord tumours. Out of 503 cases there were normal findings of total proteins and cells in 30 cases (6 per cent). A connection with the severity of the compression-syndrome was not evident. Nevertheless liquor examinations are important in diseases of the medulla spinalis. This is especially useful in the differential diagnostical demarcation of inflammable spinal cord diseases, accompanying reactions or bleedings into the spinal channel.     

超声诊断肝癌认识的扩展与深化

超声显像诊断肝癌经历了简单描述其回声特点、这些声学特征瑟病理的联系,阐述肝癌血供到从恶性肿瘤侵袭性的角度来理解肝癌原发和继发性超声征象等的认识层次不断深化扩展的过程。     

Acute non-traumatic transverse syndrome from a neurosurgical standpoint]

With a seventh of 233 neuro-surgical patients operated on in the area of the spinal canal, an acute or sub-acute transverse syndrome had become manifest before operation. The analysis of these cases shows that 2 out of 12 cervical, and 12 out of 100 lumbar cases of dislocation of the disk cause an acute or sub-acute transverse lesion of the cord with paraplegia. In 56 cases of intradural extra-medullary tumours, no acute development was observed. However, this was seen in 55% of the extra-dural tumour growths. The role of a vasal component in the event of speedy development of the transverse symptomatology in such cases is mentioned.     

Causation and melanoma classification

In this article, I begin by giving a brief history of melanoma causation. I then discuss the current manner in which malignant melanoma is classified. In general, these systems of classification do not take account of the manner of tumour causation. Instead, they are based on phenomenological features of the tumour, such as size, spread, and morphology. I go on to suggest that misclassification of melanoma is a major problem in clinical practice. I therefore outline an alternative means of classifying these tumours based on causal factors. By analogy with similar systems that have recently emerged for other cancers, I suggest that this causal classification is likely to be both workable and helpful, even in the absence of a full causal-mechanistic understanding of the aetiology of the tumour.     

Clinical and pathol-anatomic findings in corpus callosum deficiency, enlarged cavum septi pellucidi, and septal defect]

A comparison is made of the pathological changes of the median line structures such as corpus deficiency, enlarged cavum septi pellucidi (Csp.) and septal defects in 10,457 pneumo-encephalography (PEG) examinations of neurological and psychiatric patients, and in 11,016 general autopsy cases. Clinical peculiarities in corpus deficiency and other development anomalies of the median line structures are discussed along with case reports. A predominance of the male sex in cases of enlarged Csp. together with frequent combinations with neurological and psychiatric illness were noticeable, particularly oligophrenia, behavioral disorders, epilepsy and cerebral tumours. Thus, certain inferiority of the dysrhaphic mutation of the central organ can be assumed.     

Individual and collaborative implementation intentions and the promotion of breast self-examination

Implementation intentions, plans relating to when and where behaviours will be performed, have been effective in increasing health behaviour. Two studies are reported that test the impact of this strategy in promoting breast self-examination (BSE), a behaviour shown to aid the early detection of tumours. In study 1, 457 participants were randomly allocated to either implementation intention or control conditions. Implementation intentions significantly increased the likelihood of BSE at one month. The effect of the intervention was marginally significant at six months. Study 2 (N?=?101) tested the efficacy of a collaborative implementation intention intervention that required female participants to plan, with a partner, collaborative BSE performance. Results indicated that both implementation intentions and partner involvement were associated with BSE performance at one month, whilst the collaborative implementation intention intervention showed a 100% success rate. Collaborative implementation intentions may reduce forgetfulness. Interventions that encourage partner involvement in planning and enacting behaviour appear to enhance implementation intention utility.     

Atypical crossmodal emotional integration in patients with gliomas

The relevance of emotional perception in interpersonal relationships and social cognition has been well documented. Although brain diseases might impair emotional processing, studies concerning emotional recognition in patients with brain tumours are relatively rare. The aim of this study was to explore emotional recognition in patients with gliomas in three conditions (visual, auditory and crossmodal) and to analyse how tumour-related variables (notably, tumour localisation) and patient-related variables influence emotion recognition. Twenty six patients with gliomas and 26 matched healthy controls were instructed to identify 5 basic emotions and a neutral expression, which were displayed through visual, auditory and crossmodal stimuli. Relative to the controls, recognition was weakly impaired in the patient group under both visual and auditory conditions, but the performances were comparable in the crossmodal condition. Additional analyses using the ‘race model’ suggest differences in multisensory emotional integration abilities across the groups, which were potentially correlated with the executive disorders observed in the patients. These observations support the view of compensatory mechanisms in the case of gliomas that might preserve the quality of life and help maintain the normal social and professional lives often observed in these patients.     

Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour

Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen long-term after surgical treatment for childhood PFT, unselected for the presence of post-operative mutism (mean time post-surgery = 6y10 m, range 1;4-12;6 years, two had post-operative mutism), and examine factors affecting outcome. Twenty-six age- and sex- matched healthy controls were recruited for comparison. Participants in both groups had speech assessments using detailed perceptual and acoustic methods. Over two-thirds of the group (69%) with removal of PFT had a profile of typically mild dysarthria. Prominent speech deficits included consonant imprecision, reduced rate, monopitch and monoloudness. We conclude that speech deficits may persist even up to 10 years post-surgery in participants who have not shown mutism in the acute phase. Of cases with unilateral lesions, poorer outcomes were associated with right cerebellar tumours compared to left, consistent with the notion based on adult data that speech is controlled by reciprocal right cerebellar/left frontal interactions. These results confirm the important role of the cerebellum in the control of fine speech movements in children.     

Consequences of brain tumour resection on emotion recognition

Emotion processing impairments are common in patients undergoing brain surgery for fronto-temporal tumour resection, with potential consequences on social interactions. However, evidence is controversial concerning side and site of lesions causing such deficits. This study investigates visual and auditory emotion recognition in brain tumour patients with the aim of clarifying which lesion sites are related to impairments in emotion processing from different modalities. Thirty-four patients were evaluated, before and after surgery, on facial expression and emotional prosody recognition; voxel-based lesion–symptom mapping (VLSM) analyses were performed on patients’ post-surgery MRI images. Results showed that patients’ performance decreased after surgery in both visual and auditory modalities, but, in general, recovered 3 months after surgery. In facial expression recognition, left brain-damaged patients showed greater post-surgery deterioration than right brain-damaged ones, whose performance specifically decreased for sadness and fear. VLSM analysis revealed two segregated areas in the left hemisphere accounting for post-surgery scores for happy (fronto-temporo-insular region) and surprised (middle frontal gyrus and inferior fronto-occipital fasciculus) facial expressions. Our findings demonstrate that surgical removal of tumours in the fronto-temporal region produces impairment in facial emotion recognition with an overall recovery at 3 months, suggesting a partially different representation of positive and negative emotions in the left and right hemispheres for visually – but not auditory – presented emotions; moreover, we show that deficits in specific expression recognition are associated with discrete lesion locations.     

A comparison of general and illness-related locus of control in Russians, ethnic German migrants and Germans

General and illness-related locus of control play an immensely important role in the adherence and cooperation of patients in their therapy. Until now, culture-specific aspects of these subjective theories have rarely been investigated. However, in view of the growing proportion of migrants in the German population, they are becoming increasingly significant. In a project supported by the Volkswagenstiftung (Volkswagen Foundation), a total of 607 healthy people were surveyed. The sample includes 307 ethnic German migrants from the successor states of the former Soviet Union (descendents of German origin who had emigrated to Russia during the 18th and 19th centuries) and 300 native Russians in Russia. They were compared with 100 Germans (matched from a previous study). The data were collected using questionnaires entitled "Multidimensional Health Locus of Control (MHLC)" and "Illness-related Locus of Control". The ethnic German migrants differed from the Russian sample in their health beliefs and attitudes towards medicine. However, in the first 18 months after migration, hardly any changes were observed. Fatalistic factors played only a minor role. Locus of health control was associated with beliefs about recovery from myocardial infarcts and tumours. Socio-demographic variables were of varying significance in the individual cultures. Gender influences on health beliefs were different in the subsamples. The level of education had only a minor influence on health attitudes. For those individuals who were acquainted with an ill person, internal factors in treatment of myocardial infarct and external psychosocial factors in cure of cancer played a larger role.     

Fatigue following Paediatric Acquired Brain Injury and its Impact on Functional Outcomes: A Systematic Review

Fatigue is a commonly reported sequela following an acquired brain injury (ABI), and can have a negative impact on many areas of a child’s life. However, there is minimal research that focuses on fatigue specifically, and so factors such as its occurrence, duration, and impact on functioning remain uncertain. This systematic review aims to provide a comprehensive summary of the research to date, bringing together a number of studies with a focus on paediatric ABI and fatigue. Terms were searched in relevant databases (PsycInfo, Medline, CINAHL), and articles were included or excluded based on specified criteria. Of the 1177 papers identified in the original search, a total of 9 papers met inclusion criteria, and were categorised as traumatic brain injury (TBI; n?=?4), meningitis and meningococcal disease (n?=?2), brain tumours (n?=?2), and mixed ABI group (n?=?1). Key findings suggest that fatigue is a problem encountered by a significant proportion of patients in all the studies reviewed, and often occurred regardless of the cause; fatigue was also associated with poor academic achievement, limited physical activity, and social and emotional problems. Injuries of greater severity were associated with higher levels of fatigue and worse outcomes. Several management options were suggested, though their efficacy was not reported. Future research is required with a suggested focus on using multiple time points to better understand the trajectories of fatigue following childhood ABI, and to build an evidence base to determine which management options are most suitable.