Childhood medulloblastoma in Denmark 1960-1984. A population-based retrospective study

Medulloblastoma is a common paediatric brain tumour, located in the cerebellum and in the IV ventricle, surpassed in frequency only by astrocytomas. 180 children below the age of 15 with a medulloblastoma of the posterior fossa were treated in Denmark in the 25-year period from 1960 to 1984 and followed up until the end of 1996, or until death. During the 25 years they accounted for 20% of all intracranial tumours in children in Denmark. All tumours were histologically verified. The mean annual incidence was 6.4x10(-6), decreasing slightly with a factor of 0.12x10(-6) per year. The male/female ratio was 2.1 - twice that of the background population of children (1.05). The 5-year survival rate following diagnosis, surgery and radiotherapy was 23%, and the 25-year survival rate was 16%. The 5-year survival rate was 8% in the first 5-year period of 1960-1964, increasing to 36% in the last period 1980-1984. Presumably the increase in survival depends on many factors, e.g. improved diagnostic methods and neuroanaesthesia, better operative technique (microscope), improvements in radiotherapy and the introduction of chemotherapy. The best predictive factors of a good prognosis were preoperative CSF shunting, radical tumour removal and complete radiotherapy, i.e. irradiation of the brain, tumour bed and spinal cord. The survival rate in the last five-year period was seven times higher than the survival rate found in a comparable Danish study from the years 1935-1959. Most of the children followed Collins law of risk index. The results of treatment in children with medulloblastoma remain unsatisfactory. Accordingly, participation in international prospective studies of multimodal treatment should be encouraged, possibly using chemotherapy prior to surgery.

Epidemiology and prognosis in children treated for intracranial tumours in Denmark 1960-1984

A total of 911 Danish children under 15 years of age were treated for an intracranial tumour in the 25-five year period 1960-1984. All cases were followed up to the end of 1994 or to emigration or death if one of these came sooner. The mean annual incidence was 32.5 per million children with a slight increase over the 25 years. The male/female ratio was 1.15 and close to the M/F ratio for the entire Danish population of children. Of the tumours, 46% were located in the supratentorial and 54% in the infratentorial compartment, and 94% were verified histologically. In order of frequency the most common types were astrocytomas (all grades, 35%), medulloblastomas (20%), ependymomas (14%), and craniopharyngiomas (5%). Total removal of the tumour was performed in 277 and partial removal, including biopsy, in 490 children. In 57 patients a shunt operation only was performed, and 87 children did not have an operation or died before the correct diagnosis was established. Radiotherapy was administered in 55%. The outcome depended on extent of removal, radiation, location and histology of the tumour. Most (784 or 86%) of the children survived more than 1 month after diagnosis or operation, and 353 children (39% of the whole series, 47% of those alive more than 1 month after diagnosis) were alive at follow-up. Of the survivors 29% had a tumour in the supratentorial midline, 26% one in the lateral part of the supratentorial area, 31% a cerebellar tumour and 13% a IV ventricle tumour. It was possible for 66% of the survivors with supratentorial and 90% of those with infratentorial tumours to lead a normal life. The long-term prognosis was especially good for children with cerebellar and supratentorial astrocytomas and optic chiasma tumours. Children with juvenile cerebellar astrocytoma had the best prognosis: 90% were alive at the end of the follow-up period, as against 20% of those with medulloblastoma and 6% of those with glioblastoma. A comparison of the data from the present series and from a similar Danish series of intracranial tumours in 533 children seen in the years 1935-1959 shows no significant differences in location or histology, a slight increase in annual incidence, and improved survival rates during the 50 years in question.

Dorsal root gangliopathia presenting with rapidly progressing sensory polyneuropathy

A 52-year-old woman developed progressive sensory polyneuropathy leading to death in 1.5 years. Electromyography and peripheral nerve biopsy had revealed severe axonal degeneration. Neuropathological examination showed involvement of all dorsal root ganglia with loss of the bipolar nerve cells, degeneration of the remaining nerve cells, Nageotte's residual nodules, and scattered lymphocytes. The posterior columns of the spinal cord and the sensory spinal roots revealed secondary loss and degeneration of the nerve fibers. The etiology is unknown but an autoimmune-mediated reaction effecting the nervous system is strongly suggested.

Cerebral magnetic resonance spectroscopy in Rett syndrome. Failure to detect mitochondrial disorder

A total of eight girls with Rett syndrome were examined, by 31phosphorous magnetic resonance spectroscopy (31P MRS) (4 girls), proton MRS (1H MRS) (4 girls), muscle biopsying (2 girls), and determination of pyruvate and lactate in plasma (5 girls), to investigate the hypothesis of a mitochondrial malfunction as the etiology for this neurologic disorder. Almost all examinations, including electron microscopy in search of structural mitochondrial abnormalities, gave normal results, the only exception being the not unexpected finding of slight neurogenic atrophy in the muscle biopsy specimen from a 15-year-old girl.

Prader-Willi syndrome and central nervous system calcifications: chance or fundamentally related findings?

The central nervous system of a 16 8/12-year-old boy with Prader-Willi syndrome is described. Extensive calcifications of the central nervous system were observed at autopsy as grittiness of the brain slices and verified by X-ray and microscopy. The encrustations were particularly localized in the leptomeninges, the first and second layer of the cerebral and cerebellar cortex and along the ventricular system. We suggest that the alterations are nonspecific and perhaps secondary to a fundamental metabolic disorder in the central nervous system.

Central nervous system calcifications following tap water rinsing in autopsy material from children. A pitfall

CNS from 80 children collected consecutively at the Institute of Forensic Medicine, Aarhus, were investigated. Owing to peculiar calcifications of the first 41 CNS examined, we gradually came to suspect that some external factors had influenced the results. Different fixation methods used on the CNS, rinsed or not rinsed in tap water, led us to suggest that the relatively high calcium content in the tap water in our part of the country was the cause. The non-pathologic calcification could presumably mimic metabolic diseases.

Stereological estimates of nuclear volume and other quantitative variables in supratentorial brain tumors. Practical technique and use in prognostic evaluation

The use of morphometry and modern stereology in malignancy grading of brain tumors is only poorly investigated. The aim of this study was to present these quantitative methods. A retrospective feasibility study of 46 patients with supratentorial brain tumors was carried out to demonstrate the practical technique. The continuous variables were correlated with the subjective, qualitative WHO classification of brain tumors, and the prognostic value of the parameters was assessed. Well differentiated astrocytomas (n = 14) had smaller estimates of the volume-weighted mean nuclear volume and mean nuclear profile area, than those of anaplastic astrocytomas (n = 13) (2p = 3.1.10(-3) and 2p = 4.8.10(-3), respectively). No differences were seen between the latter type of tumor and glioblastomas (n = 19). The nuclear index was of the same magnitude in all three tumor types, whereas the mitotic index was significantly increased in glioblastomas (2p = 0.01). Three-dimensional, shape-independent estimates of macroscopical tumor volume were not different in anaplastic astrocytomas and glioblastomas (2p = 0.39). Histological type of tumor and mitotic index were of significant prognostic value (2p = 8.2.10(-6) and 2p approximately 0.05, respectively). Age above the median and short duration of symptoms were significantly associated with short survival (2p = 0.01). Further investigations of larger series of patients are needed to define the clinical usefulness of these objective, reproducible, and quantitative techniques in the prognostic evaluation of primary brain tumors.

Incomplete development of the brain in a newborn with methylmalonic aciduria

The investigation of the brain from a seven-day-old girl who died from a disorder in the metabolism of methylmalonic acid revealed a severe reactive gliosis of the cerebral white matter and the deeper layers of the cortex, incomplete development of the fetal granular layer of the cerebellum and the Bergmann glial cells, and delayed myelination of the cerebellum, the brainstem, and the cervical spinal cord. We suggest that some of the described neuropathological findings are an immediate consequence of a disturbed methylmalonic acid metabolism starting in utero, and not exclusively a secondary phenomenon due to accumulation of metabolites and acidosis postpartum.

Juvenile ceroid-lipofuscinosis and calcifications of the CNS

The post-mortem brains and spinal cords of 20 juvenile ceroid-lipofuscinosis (JC-L) cases from 1973 to 1987 were investigated. Clinical course of the disease was characterized by impaired vision from the age of 5-8 years, progressive dementia, seizures, somatic retardation, and early death (16-29 years of age). Microscopy showed classic intracytoplasmic autofluorescent lipopigment in the nerve cells throughout the CNS and viscera. Immunoperoxidase staining for glial fibrillary acidic protein (GFAP) showed marked gliosis with enlarged reactive astrocytes mainly in the superficial layers of the cerebral cortex. Calcifications of the nervous system principally along the outer and inner brain surfaces were demonstrated by X-ray, macroscopic examination and microscopy. We suggest that the calcifications are secondary to a suspected generalized metabolic error.

The concentration of the Na,K-pump in skeletal and heart muscle in congestive heart failure

Na,K-ATPase (or the Na,K-pump) is essential for excitability and contractility of muscle tissue. Previous studies have shown a decrease in the concentration of this pump in endomyocardial biopsies from patients with dilated cardiomyopathy. The effect of congestive heart failure on the concentration of Na,K-ATPase in skeletal muscle was assessed in 16 patients by measurement of binding of 3H-ouabain to biopsies of the vastus lateralis muscle. Ten patients had impaired left ventricular function with an ejection fraction of 0.32 +/- 0.03 and a concentration of the Na,K-pump of 229 +/- 15 pmol/g wet weight in the skeletal muscle, whereas 6 patients had an ejection fraction of 0.66 +/- 0.05 (P less than 0.001) and a concentration of 307 +/- 17 pmol/g wet weight (P less than 0.01). In endomyocardial biopsies, the concentration of Na,K-ATPase was 340 +/- 37 and 500 +/- 39 pmol/g wet weight (P less than 0.025) in patients with impaired and normal ventricular function, respectively. There was a significant correlation between the concentration of the Na,K-pump in the biopsies of the skeletal muscle and ejection fraction, as well as between its concentration in the endomyocardial and skeletal muscular biopsies (r = 0.56, P less than 0.025 and r = 0.72, P less than 0.005, respectively). The decrease in concentration of the pump in skeletal muscle may contribute to the limitation of exercise capacity in congestive heart failure.

Morphology of tracheal scar after resection with CO2-laser and high-frequency cutting loop. A study in normal pigs

In 6 pigs a bronchoscopical resection of the tracheal mucosa was performed using CO2-laser on one side, and an electric high-frequency cutting loop (ECL) on the other. The pigs were sacrificed 3 months later. On macroscopic examination the tracheal mucosa appeared almost normal on the laser-resected side, while severe deformation was seen after ECL treatment. Microscopically the respiratory epithelium had regenerated irrespective of the instrument used. After laser resection the subepithelial tissue had a normal width and consisted of collagen fibrils with few vessels and sparse fragmented elastic tissue. The cartilage showed necrosis and pericellular fibrosis. The scar tissue after ECL was a broad cellular and richly vascularized connective tissue. The content of elastic fibres was markedly greater than after laser resection. The cartilage showed small irregular necroses lined by pyknotic nuclei. In neither case had the gland regenerated. Both CO2-laser and ECL caused severe (but not identical) damage to the tissue, clearly visible after 3 months. However, the deformation caused by ECL was not seen at the laser-resected sites, which makes the laser technique seem preferable--where economy permits.

Deficiency of reticular fibers in cerebral arteries. On the etiology of saccular aneurysms in childhood

A 5-year-old, previous healthy, girl developed a large hematoma of the right cerebral hemisphere and died. An aneurysm was strongly suggested. As previously found in adult aneurysm patients, histological and morphometric investigations showed an abnormality of the reticular fibers of the cerebral arteries. We suggest that arterial deficiency of reticular fibers is of importance in formation and rupture of saccular aneurysm, also in childhood.

Lethal autosomal recessive arthrogryposis multiplex congenita with whistling face and calcifications of the nervous system

Three children from a sibship of four had congenital contractures, scarce facial expressions, central nervous system dysfunction, and early death. Extensive deposits of calcium compounds were found at postmortem examination of the nervous system and of skeletal muscle. The disorder in these sibs is presumably inherited as an autosomal recessive trait. The metabolic basis for the calcium deposition has yet to be discovered.

Late nervous system disorders in cured malignant lymphoma: a clinical and neuropathological study

A 53-year-old woman was treated for and cured of low grade malignant lymphoma, localized to the neck, by irradiation and chemotherapy. One year later she developed signs of damage to the spinal cord with slight paraparesis of the lower extremities, which remained stationary for seven years. Then, new and rapidly progressive central and peripheral neurological symptoms developed. About one year later the patient died. At autopsy a malignant glioma of the right temporal lobe and radiation damage to the spinal cord were found. Lymphocytic infiltrations in the peripheral nerves and muscles of the lower extremities were also seen. A severe neurogenic atrophy was present but no relapse of malignant lymphoma was found. Depressed immune defense is suggested to be the cause of the pathological changes of the nervous system in this case. The inflammation of the peripheral nerves might be due to activation of a latent virus infection.

Calcification of the central nervous system in a new hereditary neurological syndrome

A case of a new hereditary neurological condition with extensive calcifications of the central nervous system is described. The calcium deposits were especially localized to the leptomeninges, the first layer of the cerebral and cerebellar cortex, and along the ventricular wall. The neuropathological findings were in accordance with the clinic. The case was familial and the pedigree suggested an X-linked recessive inheritance.

Lafora's disease and brain calcifications

The brain from a 22-year-old man with progressive myoclonal epilepsy (Lafora's disease) was examined. Besides widespread inclusion bodies in the nerve cells calcifications were seen on the inner and outer surface of the brain. No gliosis was present but the astrocytes were enlarged. They were unrelated to the inclusion bodies, as demonstrated in combined stainings with glial fibrillary acidic protein (GFAP)-PAS or GFAP-Bodian. A transport of an abnormal metabolic product is suggested.

Sudden death from cerebral cysticercosis

A case of sudden death from cysticercosis cerebri is described. A 38-year-old Ecuadorian woman suffered from headache for a few weeks which was interpreted as migraine. Later she developed extremely severe headache with seizures and died. A forensic autopsy showed normal organs. Neuropathologic examination revealed cysticercosis racemosus with reactive chronic ependymitis and meningitis and secondary hydrocephalus.

Postmortem Menkes diagnosis from carrier testing of female relatives

A boy who died at 6 months of age was noted to have sparse, stubby and light hair, pili torti were observed microscopically, and his skin was dry and redundant. As a suspicion of Menkes disease was first raised after his death, serum copper and ceruloplasmin in serum were not measured. Unfortunately, no fibroblasts were available - only fixed and paraffin-embedded samples of brain, spleen and liver. The copper contents of the brain and the liver were lower than in an age-matched control. Fibroblast cultures from the mother, the maternal grandmother, and a maternal aunt of the index patient were analysed for 64Cu-uptake. All these females showed the uptake values expected for Menkes carriers, thus supporting the clinical suspicion of Menkes disease in the index patient. From the above-mentioned results it was highly likely that the index patient had suffered from Menkes disease. Adequate genetic counseling could thus be offered to the family, and in the next pregnancy a first trimester prenatal diagnosis was performed.

Astrocytes in the prenatal central nervous system. From 5th to 28th week of gestation. An immunohistochemical study on paraffin-embedded material

The CNS from 30 normal fetuses aged 5-28 weeks were studied in GFAP stained paraffin-embedded material. The technique of preparation, autopsy and fixation is described in details. GFAP reacting glial cells developed first in the spinal cord at 7 weeks, and appeared in all regions of CNS during fetal life in a systematic way but with a temporal variation. The supporting and guiding properties of the fibrillary astrocytes are stressed.

Astrocytes in the postnatal central nervous system. From birth to 14 years of age. An immunohistochemical study on paraffin-embedded material

The postnatal development of the fibrillary astrocyte in 25 children without any anamnestic or post mortem signs of disease were studied. The investigation was performed on basis of the immunoperoxidase method for glial fibrillary acidic protein (GFAP). The supporting function of the external glial limiting membrane, the glial vascular limiting membrane and the metabolic role of the astrocytes are stressed. During the postnatal myelination of the white matter the immature astrocyte changed into the mature form and a dense fibrous network developed. The radially oriented glial processes of the Bergmann astrocytes of the cerebellum guided the fetal external granular cells during the migration. In the brainstem we found minor variations of the dense fibrous astrocytic network both in children dead after accidents and in sudden infant death syndrome. These findings presumably demonstrate a normal pattern.

Familial centronuclear myopathy: a clinical and pathological study

A congenital myotubular myopathy in a family is presented. An elderly woman, her daughter and her granddaughter showed the characteristic clinical and histological pattern of the disease. It is still a matter of debate whether the disease is of myopathic or neuropathic origin. The similarity of the muscle fibre with a myotube of the fetus might point towards an arrest of the maturation after 20th week of gestation perhaps caused by a lack of a trophic factor from the motor nerve.

Histological and morphometric observations on the reticular fibers in the arterial beds of patients with ruptured intracranial saccular aneurysms

Histological and morphometric studies on the collagenous, reticular, and elastic fibers of the tunica media were performed on the middle cerebral and brachial arteries of patients with ruptured intracranial saccular aneurysms and controls. There was no difference between aneurysm patients and controls in the amount of collagenous and elastic fibers. The amount of reticular fibers was, however, reduced about 35% in aneurysm patients within both the middle cerebral artery (P less than 0.01) and the brachial artery (P less than 0.02). The reticular fibers were irregularly distributed and often appeared shorter and coarser than normally. The observations point to a generalized abnormality of the arterial bed in some patients with rupture of saccular aneurysms.

A simple mechanical model using a piston to produce localized cerebral contusions in pigs

A simple mechanical model using a piston to produce localized cerebral contusions in pigs, is presented. The precision and reproducibility of the method are described by the biomechanical and pathological results. There are only pathological changes with haemorrhage and laceration close to the place of entry of the piston. The changes in the physiological parameters also indicate that the damage is focal. In this model, when kept intact, the dura mater offers considerable protection as no pathological changes in the brain are observed even when the energy at the time of the contusion is increased to twice the values which, when the dura is open, cause considerable damage.

Herpes zoster ophthalmicus and the mesencephalic nucleus. A neuropathological study

The ganglion Gasseri and the brainstem were examined in three old patients with herpes zoster without predisposing diseases with special reference to the mesencephalic trigeminal nucleus. The primary lesions in the semilunar ganglion vary with the length of the course. Secondary changes in the brainstem were as expected from pons to the second cervical segment of the cord. Besides, we observed degeneration, inflammation and glial nodules in the mesencephalic trigeminal nucleus in two patients. According to Brodal this nucleus presumably corresponds to the semilunar and spinal ganglia. As herpes zoster virus is prone to attack the sensory nuclei our findings support this hypothesis.

Central pontine myelinolysis. A case report with typical neuropathological findings

A case of central pontine myelinolysis (CPM) in an alcoholic patient with severe electrolyte changes is presented. Data in the literature suggest that it is safe to correct severe symptomatic hyponatremia to a value of 125-130 mEq/1 in 24 h. At the present time acute severe hyponatremia carries a bad prognosis if not treated with hypertonic NaCl solution. Electrolyte abnormalities are not the sole cause of CPM.

Diffuse muscle fiber atrophy in newly diagnosed diabetes

Muscle fiber dimensions were studied in six newly diagnosed insulin-dependent young diabetic males and in four age, sex and weight matched controls. Three of the patients had never received any antidiabetic medication before biopsy and the others had been treated with insulin for a few days only. Mean fiber caliber of the anterior tibial muscle was smaller in diabetics than in controls, the values being 61.8 +/- 4.3 micron (SD) versus 77.8 +/- 9.1 micron (2p less than 0.01). The size-frequency distribution of fiber calibers showed that a considerable part of the fiber population was reduced in size. No significant changes were found in sarcomere length, number of muscle or interstitial cell nuclei or number of capillaries. The observation of an over-all reduction of muscle fiber size following a few weeks of severe hyperglycemia is in accordance with previous experimental studies. We conclude that the catabolism associated with a sustained and uncorrected diabetic state in man leads to muscle fiber atrophy.

Preservation of the nucleus X-pelvic floor motosystem in amyotrophic lateral sclerosis

Fourteen cases of amyotrophic lateral sclerosis (ALS) were investigated neuropathologically, emphazising the sacral spinal cord which contains Onuf's nucleus X. The nucleus innervates the pelvic sphincters. In two cases, small striated pelvic muscles were studied. No changes characteristic of ALS were observed in Onuf's nucleus X, not even in 8 cases in which other caudal motoneuron nuclei presented a severe loss of neurons. The striated sphincters proper demonstrated no signs of neurogenic atrophy in contrast to muscles in the limbs. The bulbo- and ischiocavernosus muscles, also supposedly innervated by Onuf's nucleus, were without pathological changes. Moreover, the latter two muscles were found to have a composition very similar to that of the sphincters. This indicates that a characteristic morphology of the nucleus X-innervated muscles exists. A review of the clinical records of all the cases revealed, that although 8 demonstrated severe involvement of the lower extremities, only one presented vesico-rectal dysfunction which could be ascribed to ALS. But even in this case, the pelvic closure mechanisms appeared to be intact. The preservation of continence in ALS is related to the neuropathological findings, and the observations are compared with previous neuropathological studies concerning Onuf's nucleus X as well with experimental studies including this nucleus. It is pointed out that structural and biochemical differences must exist between nucleus X neurons and other motoneurons.

Fiber types in the striated urethral and anal sphincters

Seven normal human striated urethral and anal sphincters obtained by autopsy were examined using histochemical techniques. In both the urethral sphincter and the subcutaneous (s.c.) and superficial part of the anal sphincter a characteristic pattern with two populations of muscle fibers, abundant connective tissue, and numerous intramuscular nerves are seen. No spindles are observed. The muscle fibers, particularly the predominant type 1 fibers are very small (about 15 micron in diameter). The fiber characteristics of the sphincters indicate that these muscles have a capacity to produce sustained contractions and to react in stress conditions with fast increase in tension.

A neuropathological and neuropsychological study of Turner's syndrome

A neuropathological study was made in 2 women with Turner's syndrome. Neuropsychological investigation in one of them correlated with what has previously been found in Turner's syndrome as well as with the localization of the most pronounced neuropathological aberration which was of atherosclerotic nature, most pronounced in the right temporo-parietal area. These findings as well as the findings of acidophile hypoplasia of the pituitary gland are discussed.

Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features

The clinical characteristics of facial pain in patients with trigeminal neuralgia (TN) and associated multiple sclerosis (MS) were studied. Among 900 patients with TN 22 (2.4%) had associated MS. Sixteen patients had typical TN, while six had atypical TN. Facial pain commenced at a younger age (P less than 0.005) and a significantly higher proportion had bilateral facial pain (P less than 0.01) in the group with MS compared to TN patients without MS. In three patients TN was the first manifestation of MS, in the remainder facial pain occurred on an average of 12 years after onset of MS. Seventeen patients had associated signs of brain-stem involvement. The facial pain was, however, indistinguishable from the pain in patients without brain-stem deficits. While sclerotic plaques in the central nervous system probably are of etiological significance for development of TN neither clinical nor neuropathological findings suggest that this is due to affection of trigeminal nuclei complex in the brain-stem.

Familial progressive myoclonic epilepsy. A clinical, genetical, biochemical and patho-anatomical study of a family with a 6-year follow-up

Six siblings, including 4 cases of myoclonic epilepsy, their parents and 2 grandmothers were subjected to systematic investigation, and the patients were followed-up. The genetic studies revealed in the mother's family a patient with Lafora bodies demonstrated at autopsy. No chromosome abnormalities were found nor any linkage to the HLA system. The affected family members were characterized biochemically by an increased excretion of total glycosaminoglycans and/or an abnormal electrophoretic pattern of urinary glycosaminoglycans with an increased proportion of low-sulfated glycosaminoglycans. In the healthy family members this pattern of electrophoresis could also be demonstrated in the father and the paternal grandmother. Based on the biochemical results and the genetic studies it is suggested that the family members with progressive familial myoclonic epilepsy present a combination of at least 2 hereditary defects. The course of the disease has been relatively benign and treatment with sodium valproate, baclofen and clonazepam has shown quite satisfying results. In consequence of the biochemical findings combined treatment with A and E vitamins has been initiated.

Cardiac involvement in juvenile amaurotic idiocy--a specific heart muscle disorder. Histological findings in 13 autopsied patients

Juvenile amaurotic idiocy (JAI) is a rare disorder of autosomal recessive inheritance. It belongs to the so called ceroid lipofuscinoses and the central nervous system is the largest organ. Only very few reports refer to the accumulation of lipopigment in the heart of JAI patients. This study describes the morphology of the heart from all 13 patients with JAI in Denmark who died within a seven year period; electrocardiographic findings are related to structural changes. All compartments of the heart were involved, including the conduction system. Not only very substantial deposition of lipopigment was found in the myocytes, but we have also observed striking amounts of calcium and cholesterol compounds indicating a restrictive type of heart muscle disorder. These structural changes are uniform from case to case. Because of the nature of the disease only rather poor information of the cardiac state is available in JAI patients. 11 patients showed some cardiac enlargement. In 6 patients abnormal P-waves were recorded in the ECG suggesting increased atrial and ventricular diastolic pressure. 2 patients had bradycardia, probably due to sinus node involvement, and one patient developed complete right bundle branch block. However, in the 4 patients in whom the cardiac conduction system could be examined histologically no evidence of disturbance of cardiac impulse formation and conduction was seen in the few standard ECG strips available in spite of extensive deposition of abnormal material throughout the conduction system. There seems to be a discrepancy between the relatively minor functional disturbances observed and the heavy morphological changes of the entire heart. This aspect, however, may well be altered by an intensified clinical observation and examination of JAI patients.

Diagnostic aid of aspiration biopsy cytology in brain lesions

In a series of 28 neurosurgical cases we tried to assess the value of aspiration biopsy cytology from brain lesions during the operation. Cytological aspirates during craniotomy were compared with simultaneously performed frozen section biopsies. Cytology was correct in 24 out of 28 cases (86%). It is concluded that aspiration cytology permits a safe microscopic diagnosis provided the specimens are cellular and representative. Cases are mentioned where this technique can be very useful and/or the only way to obtain microscopic evidence of a malignant tumour before treatment.

Obstructive hydrocephalus following Pantopaque myelography

A case with delayed development of obstructive hydrocephalus most probably caused by Pantopaque myelography is reported. At autopsy it was found that the foramina of Magendi and Luschka were occluded by granulation tissue in which the most common findings were multinucleated giant cells containing calcareous and unstained vacuoles, frequently surrounding empty hollows, many lymphocytes and plasma cells. As compared with two other similar cases and several animal investigations this shows that the reaction of the tissue is typical of a Pantopaque reaction.

DNA content of meningiomas

Flow cytometric DNA analysis was carried out in 35 meningiomas. Thirty-three had diploid stem lines while two were aneuploid having a triploid DNA mode. Both aneuploid meningiomas were grossly huge nodular tumours and one had malignant histologic features. Flow cytometry in meningiomas is a rapid means of determining the DNA modes and adds objective information to microscopy. Appropriate cases may be selected for further cytogenetic studies.

Incidence and long term survival of children with intracranial tumours treated in Denmark 1935-1959

The total number of children under 15 years of age with intracranial tumours in Denmark during the years 1935-1959 was found to be 533. The average incidence was 21 new cases/10(6) children/year during the 25-year period in question, and 25/10(6) children/year during the first 17 years of Danish cancer registration. The sex ratio (290 boys to 243 girls) was not significantly different from that of the child population in Denmark. In 219 cases the tumour was located in the supratentorial and in 314 in the infratentorial space. 93% of the tumours were histologically verified, with the following order of frequency for the most usual types: astrocytomas (all grades), medulloblastomas, ependymomas, and craniopharyngiomas. Follow-up was 100%. For the 345 children who survived for more than one month after operation or diagnosis, 36% were alive after 15 years. 119 patients were alive in April 1974 and these were all observed between 15-40 years after diagnosis and operation. Of these 44 had tumours in the supratentorial and 75 in the infratentorial space. 66% of the survivors with supratentorial and 90% with infratentorial tumours led a normal life. Most of the survivors had had a cerebellar astrocytoma, a supratentorial astrocytoma, an apendymoma or oligodendroglioma, but other histological diagnoses were also represented, especially in the supratentorial group. The long-term prognosis was especially bad for children with brain-stem tumours, infratentorial ependymomas and medulloblastomas.

Intracranial lipoma. Report of a case and differentiation from other tumours of the cerebellopontine angle

Teratomata of the cerebellopontine angle are rare. A case of a lipoma of this localization occurring in a 50-year-old man with an interesting case history is reported. The differential diagnosis of tumours of the internal auditory meatus and the surrounding structures is discussed. In cases with an uncharacteristic clinical history suggesting involment of the VIIIth cranial nerve, it is important to focus attention on the existence of rare lesions of the internal acoustic porus. The diagnosis can only be established with operation and biopsy.

Flow cytometry in tumours of the brain

Flow cytometry was used for studying the distribution of single cell DNA content in biopsy material from 85 patients with benign and malignant lesions of the brain and spinal cord. In inflammatory lesions and in most benign tumours, cells with diploid DNA values were observed, sometimes with additional smaller amounts of tetraploid DNA. Cells from malignant tumours were characterized by marked hyperploid DNA values. Flow cytometry is found a rapid and valuable method adding important information to the biological nature of tumours of the central nervous system.

Enzyme and protein studies of demyelination in diabetes

Neuropathological evidence of demyelination was found in the brain and sciatic nerve of diabetic patients at autopsy. The activity of acid proteinase was somewhat increased in the white matter but decreased in the gray matter of diabetic patients. No increase was observed in the activity of neutral proteinase in diabetic white and gray matter. The activities of beta-glucuronidase and 2',3'-cyclic nucleotide-3'-phosphohydrolase (CNP) were of the same level as those of the controls. The activities of all 4 enzymes appeared to be increased in the diabetic nerve, with the possible exception of CNP which was measured from only 1 nerve. Furthermore, the amount of total protein was markedly decreased in diabetic peripheral myelin. The encephalitogenic basic protein of diabetic brain myelin was normal in the disc gel electrophoretic patterns of brain myelin proteins. However, the basic proteins of peripheral myelin were reduced in a number of diabetic patients. The present biochemical findings for diabetic white and gray matter were largely normal. Instead, the increased activities of at least the proteinases and beta-glucuronidase in diabetic peripheral nerve, together with the loss of basic proteins, indicate extensive biochemical damage of the peripheral nervous system in diabetes. They suggest that demyelination and other phenomena observed in diabetic peripheral nerve are not caused only by angiopathy and impaired circulation.

Hypokalemic myopathy during treatment with diuretics

Two male patients with severe reversible muscle weakness and excessive potassium deficiency associated with alkalosis during treatment with diuretics are presented. The case reports are further illustrated by the morphologic changes as seen in light and electron microscopic examination of muscle biopsies. Hypokalemia and muscle dysfunction are discussed in relation to other investigations of altered potassium metabolism and myopathy during treatment with certain diuretics.