Pharmacokinetics of the PDGF-antagonist trapidil in patients with and without renal impairment

BACKGROUND: From July 1989 to February 1996, 130 patients underwent stereotactic radiosurgery. We report the results of the first 50 patients eligible for a minimum of three years of follow-up. METHODS: Twenty women and 30 men, (mean age: 37.5 years) were treated by dynamic rotation on a 6 MV linear accelerator. Prior treatment was embolization in seventeen, surgery in three and embolization and surgery in six. All had DSA and enhanced CT scanning, while some had MRI. Forty-seven treatments used a single isodose. Restricting eloquent normal tissue to 15 Gy, margin doses (at 50-90% isodose) were 12 Gy (one patient); 15 Gy (sixteen patients); 20 Gy (31 patients); 25 Gy (two patients). Maximum diameters were: < 1.5 cm (12 patients); < 2.0 cm (nine patients); < 2.5 cm (twelve patients); < 3.0 cm (thirteen patients; 3.0 cm (four patients). RESULTS: Forty-five patients were evaluable at three years, with thirty-nine having angiography. Twenty-five had angiographically confirmed obliterations; two had parenchymal AVMs obliterated but with residual dural components; four had MRI evidence of obliteration (refused angiography). One patient acutely had a seizure; one patient (with hemorrhages, resection, and embolizations preceding two applications of radiosurgery, separated by 3.5 years) had worsening of memory. CONCLUSIONS: Our uncorrected (five patients unevaluable at three years) and corrected angiographically confirmed obliteration rates are 54% and 60% respectively. Our follow-up (98% accounting of cohort; 78% angiographic rate) and explicit derivation of denominators help delineate the efficacy of radiosurgery at these doses.     

Factor structure of the Wechsler Memory Scale—Revised within a comprehensive neuropsychological battery.

Performed 2 principal factor analyses to examine the construct validity of the Wechsler Memory Scale—Revised (WMS—R) and to determine whether abstraction and memory factors can be extracted from the Halstead-Reitan Neuropsychological Test Battery (HRNB) results. Results from 237 patients support the validity of the verbal memory, delayed recall, and attention and concentration indices of the WMS—R but not the visual memory indices. No separate abstraction factor was found, and none of the HRNB measures loaded substantially on the memory factors defined by WMS—R subtests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Level versus pattern of neuropsychological performance among schizophrenic and diffusely brain-damaged patients.

Differences in both mean level and pattern of neuropsychological test performance were examined among groups of carefully screened schizophrenic and acute and chronic diffusely brain-damaged patients (24 Ss in each group). This was done separately for the WAIS subtests and the 12 average impairment rating (AIR) variables derived from the Halstead-Reitan Neuropsychological Test Battery. The schizophrenics performed at a significantly higher level than brain-damaged Ss on both test batteries. Subsequent deficit pattern analyses and coefficients of profile pattern similarity revealed very little difference among the 3 groups in their patterns of performance on the WAIS and AIR batteries. Discriminant function analyses were employed to estimate the diagnostic utility of level vs pattern of performance on the WAIS and AIR in discriminating schizophrenics from brain-damaged Ss. Results suggest that mean level of performance can be used to discriminate clearly defined schizophrenic and diffusely brain-damaged groups, but that pattern analysis offers little additional information. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship Between Neuropsychological Measures and Employment Problems in Outpatients With Substance Abuse.

Objective: To determine the relation between standard clinical neuropsychological tests and employment problems in persons with substance abuse. Participants: Sixty-four patients enrolled in an intensive outpatient substance abuse treatment program. Measures: Employment Problem Severity Score (EPSS) of the Addiction Severity Index and a comprehensive neuropsychological evaluation, including standard measures of attention, executive function, and memory. Results: Multiple regression analyses showed that response latency on the Vigilance trial of the Gordon Diagnostic System and scores on list acquisition and long-delay free recall of the California Verbal Learning Test were significant predictors of EPSS. Performance on measures of executive function did not predict EPSS. Conclusions: Neuropsychological tests may help to identify individuals at risk for employment problems, thereby improving outcomes for patients with substance abuse problems and cognitive deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serial neuropsychological assessment and magnetic resonance imaging analysis in multiple sclerosis

OBJECTIVE: To assess the correlation between cognitive dysfunction and disease burden in multiple sclerosis (MS) during a 1-year period. DESIGN: The Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis was performed at entrance and 1 year. Patients underwent at least 20 proton density (range, 20-24) and T2-weighted axial magnetic resonance imaging (MRI) brain scans except for stable patients who were scanned monthly. Magnetic resonance imaging was evaluated using computer-automated, 3-dimensional volumetric analysis. SETTING: A research clinic of a university hospital. PATIENTS: Forty-four patients with MS of the following disease categories: relapsing-remitting (14), relapsing-remitting progressive (12), chronic progressive (13), and stable (5). MAIN OUTCOME MEASURES: The relationships between scores on the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and brain to intracranial cavity volume ratio) were assessed using linear regression. These MRI measures were also compared with cognitive status at 1 year using analysis of variance. RESULTS: Overall, there was no decline in mean cognitive test performance during 1 year. Significant correlations were found between baseline neuropsychological test scores of nonverbal memory, information-processing speed, and attention and both MRI measures. Patients with chronic progressive MS demonstrated the strongest correlations. At 1 year, change in information-processing speed and attention correlated with change in total lesion volume. The mean increase in total lesion volume was 5.7 mL for 4 patients whose cognitive status worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable. CONCLUSIONS: During a 1-year period mean cognitive performance did not worsen. Automated volumetric MRI measures of total lesion volume and brain to intracranial cavity volume ratio correlated with neuropsychological performance, especially in patients with chronic progressive MS. Worsening MRI lesion burden correlated with cognitive decline.     

Risk analysis of linear accelerator radiosurgery

PURPOSE: To evaluate the toxicity of stereotactic single-dose irradiation and to compare the own results with already existing risk prediction models. METHODS AND MATERIALS: Computed tomography (CT) or magnetic-resonance (MR) images, and clinical data of 133 consecutive patients treated with linear accelerator radiosurgery were analyzed retrospectively. Using the Cox proportional hazards model the relevance of treatment parameters and dose-volume relationships on the occurrence of radiation-induced tissue changes (edema, localized blood-brain barrier breakdown) were assessed. RESULTS: Sixty-two intraparenchymal lesions (arteriovenous malformation (AVM): 56 patients, meningioma: 6 patients) and 73 skull base tumors were selected for analysis. The median follow-up was 28.1 months (range: 9.0-58.9 months). Radiation-induced tissue changes (32 out of 135, 23.7%) were documented on CT or MR images 3.6-58.7 months after radiosurgery (median time: 17.8 months). The actuarial risk at 2 years for the development of neuroradiological changes was 25.8% for all evaluated patients, 38.4% for intraparenchymal lesions, and 14.6% for skull base tumors. The coefficient: total volume recieving a minimum dose of 10 Gy (VTREAT10) reached statistical significance in a Cox proportional hazards model calculated for all patients, intraparenchymal lesions, and AVMs. In skull base tumors, the volume of normal brain tissue covered by the 10 Gy isodose line (VBRAIN10) was the only significant variable. CONCLUSIONS: These results demonstrate the particular vulnerability of normal brain tissue to single dose irradiation. Optimal conformation of the therapeutic isodose line to the 3D configuration of the target volume may help to reduce side effects.     

Sex differences in the neuropsychological functioning of epileptics.

Compared the performance of 137 male and 113 female epileptics on a comprehensive neuropsychological test battery (e.g., WAIS, 3 Wide Range Achievement Test subtests, a modified Halstead-Reitan Neuropsychological Test Battery, and Babcock Story Recall Test). Significant differences were found for 12 of 33 test comparisons, with the pattern of results resembling sex differences found among neurologically normal Ss. Although the most pronounced differences were obtained on motor speed and strength measures, an illustration was provided of how subtle effects found for more complex tasks may affect diagnostic decisions. Theoretical implications of these findings for the Sex by Functional Brain Asymmetry interaction noted by other investigators are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Neuropsychological assessment of memory in the elderly": Erratum.

Reports an error in "Neuropsychological assessment of memory in the elderly" by Donald E. Read (Canadian Journal of Psychology Revue Canadienne de Psychologie, 1987[Jun], Vol 41[2], 158-174). On p. 171: The last sentence of the first paragraph should read "This finding has now been replicated in a follow-up study with the same subjects (Read, 1986)." (The following abstract of the original article appeared in record 1988-30166-001.) Administered 3 tests designed for the neuropsychological assessment of older people. The tests focus on evaluating the storage abilities of the brain for both explicit and implicit aspects of memory. Ss were volunteers in 3 age groups: 89 males and 153 females (aged 50–59 yrs); 122 males and 181 females (aged 60–69 yrs); and 77 males and 112 females (aged 70–79 yrs). The tests were (1) the Supermarket Test, designed to measure both immediate and delayed episodic memory for test items, plus episodic recall of the spatial location of the same items; (2) the Visual Closure Test, designed to measure implicit and explicit memory; and (3) the Sequential Geometric Design Test, designed to measure visuoperceptual ability and nonverbal memory. Findings show the tests to work well with patients suffering from mild to severe memory loss and with those in the early stages of dementia. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate

During the authors' initial 4-year experience with radiosurgery using the Leksell cobalt-60 gamma unit, they treated 121 patients with cerebral arteriovenous malformations (AVMs). The radiosurgical dose to the margin of the nidus was 20 Gy for lesions less than 2.0 cm in diameter (volume < or = 4.2 cm3); 18 Gy for malformations 2.1 to 3.0 cm in diameter (volume 4.2-14.1 cm3); and 16 Gy for malformations greater than 3.0 cm (volume > 14.1 cm3). Fifty-one patients underwent follow-up angiography between 1 and 3 years after treatment, and complete obliteration of the nidus was confirmed in 38 (74.5%) of these patients. Thirty-two (74.4%) of 43 AVMs with volumes of 10 cm3 or less and six (75%) of eight larger AVMs (volume 11-30 cm3) showed complete obliteration. Analysis of the time course of AVM nidus shrinkage and obliteration showed that most of the radiosurgically induced effect had occurred by 36 months after treatment. Retrospective analysis of the dose plans for 10 AVMs that were not obliterated by 36 months after gamma knife radiosurgery at the authors' institution (eight cases) or elsewhere (two cases) revealed that six AVMs had not been covered completely by the prescribed isodose. Six (5%) of the 121 patients developed neurological deficits as a direct result of radiosurgical treatment. The authors infer from these data that malformations up to 30 cm3 in volume (approximately 4.0 cm in average diameter) can be treated effectively with an acceptably low complication rate using a radiosurgical dose of 16 Gy to the margin of the nidus. The obliteration rate for the larger malformations that were treated with a dose of 16 to 18 Gy appears to be similar to that for smaller ones treated with 18 to 20 Gy. As more experience accrues using radiosurgery to treat AVMs, patient selection criteria and the variables associated with successful obliteration of the nidus should become more clearly defined.     

Effects of gamma knife radiosurgery for brain tumors: clinical evaluation

BACKGROUND: Gamma knife radiosurgery is a safe and effective alternative to microsurgery in the management of selected intracranial lesions. In our initial three-year experience with gamma knife radiosurgery, 431 patients were treated using this method. This report presents the treatment results for three different types of brain tumors: benign meningiomas, malignant metastases and gliomas. METHODS: A retrospective study was performed to analyze a consecutive series of 71 meningiomas, 31 metastatic tumors and 21 gliomas treated by gamma knife radiosurgery between March 1993 and May 1996. The treatment results were investigated using regular magnetic resonance examinations and tumor volume measurement at six-month intervals to observe sequential changes of the tumors. Patients with meningiomas were further divided into three groups according to the peripheral radiation doses: high-dose (20-17 Gy, n = 18), medium-dose (16-15 Gy, n = 33) and low-dose (14-12 Gy, n = 20). The Generalized Estimation Equation was applied to compare treatment results in these three groups with different doses and tumor volumes. RESULTS: Volume measurements of the 71 meningiomas showed that 76% decreased in size, 16% stabilized and 8% increased in size. The volumes increased most frequently in the early stage (6-12 months) after treatment and subsequently regressed after the twelfth month. The tumor control rate for meningiomas in our three-year follow-up was over 90%. For meningiomas, the statistical analysis showed that both the radiation dose and tumor volume were significantly related to the development of adverse radiation effects (p < 0.05). In metastatic tumors, rapid tumor regression after radiosurgery was found in 87% of the patients. In gliomas, radiosurgery effectively inhibited tumor growth in selected patients with small, circumscribed, less infiltrative tumors. Ependymomas and low-grade astrocytomas had more favorable outcomes than other gliomas. CONCLUSIONS: Gamma knife radiosurgery is effective for controlling tumor growth in benign meningiomas for up to three years after surgery. In selected cases of malignant metastasis and gliomas, most patients appeared to benefit from the treatment with symptomatic improvement and prolonged survival. Treatment strategy and dose selection in radiosurgery should be adjusted to optimize tumor control and avoid adverse radiation effects.     

Preventive effects of an antiallergic drug, pemirolast potassium, on restenosis after percutaneous transluminal coronary angioplasty

PURPOSE: Radiosurgery is an effective treatment for cerebral arteriovenous malformations. We conducted the present study to investigate the feasibility and efficacy of gamma knife radiosurgery for dural arteriovenous fistulas (DAVFs) of the cavernous sinus. METHODS: Eighteen patients (12 women and six men; 29-75 years old [mean age, 55 years]) with DAVFs of the cavernous sinus (Barrow's type B:1, C:7, and D:10) treated by gamma knife radiosurgery were enrolled in the study. DAVFs were bilateral in six patients and unilateral in 12. Stereotactic X-ray angiography and MR imaging were performed for targeting the radiosurgery. Areas of arteriovenous communication targeted for irradiation were first outlined on the X-ray angiograms. The target regions were then transferred to and displayed on the MR images. Dose planning was based on findings on the integrated images. Prescribed maximum target doses were 22 to 38 Gy (mean, 28 Gy). The targets were covered by 50% to 90% isodose levels. Radiation doses to the surrounding optic apparatus were kept to less than 8 Gy. The patients were followed up with color Doppler sonography and MR imaging. When noninvasive imaging suggested obliteration, X-ray angiography was performed to verify the results. RESULTS: The DAVFs were totally obliterated in 12 (80%) of the 15 patients. In the other three, one was almost completely obliterated at 14 months and two were partially obliterated at 19 and 27 months, respectively, after radiosurgery. No complications or symptom worsening occurred during the follow-up period. CONCLUSION: Gamma knife radiosurgery is a feasible, effective, and safe treatment for DAVFs of the cavernous sinus. Integration of stereotactic X-ray angiography and MR imaging not only aids treatment efficacy but also protects the relevant vital structures, especially the optic apparatus, from the hazards of radiation.     

Factors associated with successful arteriovenous malformation radiosurgery

OBJECTIVE: To analyze the clinical and angiographic variables that affect the results of arteriovenous malformation (AVM) radiosurgery and to propose a new method of reporting patient outcomes after AVM radiosurgery. This method incorporates both the obliteration status of the AVMs and the postoperative neurological condition of the patient. METHODS: Patient outcomes were defined as excellent (nidus obliteration and no new deficits), good (nidus obliteration with a new minor deficit), fair (nidus obliteration with a new major deficit), unchanged (incomplete nidus obliteration without a new deficit), poor (incomplete nidus obliteration with any new deficit), and dead. Two hundred twenty patients who underwent AVM radiosurgery at our center before 1992 were subjected to a multivariate analysis with patient outcomes as the dependent variable. RESULTS: Multivariate analysis determined four factors associated with successful AVM radiosurgery: smaller AVM volume (P=0.003), number of draining veins (P=0.001), younger patient age (P=0.0003), and hemispheric AVM location (P=0.002). Preradiosurgical embolization was a negative predictor of successful AVM radiosurgery (P=0.02). CONCLUSION: AVM obliteration without new neurological deficits can be achieved in at least 80% of patients with small volume, hemispheric AVMs after single-session AVM radiosurgery. Future studies on AVM radiosurgery should report patient outcomes in a fashion that incorporates all the factors involved in successful AVM radiosurgery.     

Neuropsychological deficits, learning disability, and violent behavior.

Examined the relationship between neuropsychological functioning, learning disability, and violent behavior in 110 Ss solicited from 2 prison facilities. Ss were administered the Luria-Nebraska Neuropsychological Battery. 60 Ss were also administered the Wide Range Achievement Test and Arithmetic, Vocabulary, Block Design, and Picture Arrangement subtests from the WAIS. Results indicate that (a) violent offenders tended to have serious neuropsychological deficits and that (b) Ss classified as brain damaged had a significantly higher rate of violent criminal activity than did the non-brain-damaged group. Findings are consistent with previous physiological research. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol use disorders and cognitive abilities in young adulthood: A prospective study.

The effect of alcohol use disorder (AUD) on cognitive and neuropsychological abilities was investigated in a prospective study of 68 freshmen who met past-year criteria for AUD on 2 or more occasions during their college years and 66 matched controls. At baseline, participants were administered a total of 14 subtests from the Wechsler Adult Intelligence Scale--Revised, Wechsler Memory Scale, and Halstead-Reitan Neuropsychological Battery. At 7-year follow-up, most measures were readministered, along with the Reflective Judgment Interview, Watson-Glaser Critical Thinking Appraisal, and Plant Test. Analyses revealed few differenced between AUD and control groups. However, visuospatial deficits may be present among AUD participants with poor baseline visuospatial performance. Alcohol exposure measures yielded similar patterns to those shown with AUD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of hemangioblastomas in von Hippel-Lindau disease with linear accelerator-based radiosurgery

OBJECTIVE: Stereotactic radiosurgery is increasingly being used to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. The purpose of this study was to retrospectively evaluate the effectiveness of radiosurgery in the treatment of hemangioblastomas. METHODS: From 1989 to 1996, 29 hemangioblastomas in 13 patients with von Hippel-Lindau disease were treated with linear accelerator-based radiosurgery. The mean patient age was 40 years (range, 31-57 yr). The radiation dose to the tumor periphery averaged 23.2 Gy (range, 18-40 Gy). The mean tumor volume was 1.6 cm3 (range, 0.07-65.4 cm3). Tumor response was evaluated in serial, contrast-enhanced, computed tomographic and magnetic resonance imaging scans. The mean follow-up period was 43 months (range, 11-84 mo). RESULTS: Only one (3%) of the treated hemangioblastomas progressed. Five tumors (17%) disappeared, 16 (55%) regressed, and 7 (24%) remained unchanged in size. Five of nine patients with symptoms referable to treated hemangioblastomas experienced symptomatic improvement. During the follow-up period, one patient died as a result of progression of untreated hemangioblastomas in the cervical spine. Three patients developed radiation necrosis, two of whom were symptomatic. CONCLUSION: Although follow-up monitoring is limited, stereotactic radiosurgery provides a high likelihood of local control of hemangioblastomas and is an attractive alternative to multiple surgical procedures for patients with von Hippel-Lindau disease.     

Correction to Prigatano, Parsons, Wright, Levin, and Hawryluk.

Reports an error in the original article "Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease" by George P. Prigatano et al. (Journal of Consulting & Clinical Psychology, 1983[Feb.] Vol 51[1] 108-116). On page 116, the reference Rennick, P. M, should read as follows: Lewis, R. R., & Rennick, P. M. Manual for the Repeatable Cognitive-Perceptual- Motor Battery. Grosse Pointe Park, Mich.: Axon, 1979. (The following abstract of this article originally appeared in record 1983-13068-001) Previous research has demonstrated neuropsychological deficits in moderately to severely hypoxemic, chronic obstructive pulmonary disease (COPD) patients. The present article reports on the neuropsychological functioning of mildly hypoxemic COPD patients. 100 patients (mean age 61.5 yrs) and 25 controls (mean age 59.6 yrs) matched on relevant variables were given extensive neuropsychological tests including the WAIS, Wechsler Memory Scale, and Halstead-Reitan Neuropsychological Test Battery. Mild neuropsychological impairment was observed in the COPD Ss, with overall indexes of neuropsychological dysfunction correlating with resting partial pressure of oxygen. Depression and motivation to perform could not account for the results. Long-term reduced oxygen supply to the brain may account for these observed deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of parental and health care professional preferences for the acellular or whole cell pertussis vaccine

PURPOSE: To evaluate the efficacy and toxicity of gamma knife radiosurgery in the treatment of melanoma metastases to the brain. PATIENTS AND METHODS: We retrospectively reviewed 55 patients with single or multiple intracranial melanoma metastases treated at the University of California, San Francisco, with gamma knife radiosurgery from 1991 through 1995. Sixteen patients were treated with gamma knife radiosurgery for recurrence following previous radiation therapy, 11 received radiosurgery as a boost to whole-brain radiation therapy, and 28 had radiosurgery alone for initial management of brain metastases. The median minimum radiosurgery tumor dose for 140 treated lesions was 19 Gy (range, 10-22 Gy) prescribed at the 35% to 90% isodose contour (median, 50%). The median total target volume per patient was 6.1 cc (range, 0.25-28.3 cc). RESULTS: With a median follow-up of 75 weeks in living patients, the median survival times were 35 weeks overall: 35 weeks for patients with solitary metastases versus 33 weeks for those with multiple metastases. A factor that was significant in univariate analysis of survival was total target volume treated. This parameter remained significant on multivariate analysis. The actuarial median freedom from progression analyzed by lesion for 113 lesions in 46 patients with imaging follow-up was 89 weeks with 6-month and 1-year actuarial freedom from progression rates of 89% (95% confidence interval, 80%-95%) and 77% (95% confidence interval, 62%-87%). In univariate analysis, improved freedom from progression was associated with smaller target volume treated, smaller maximum diameter, or higher prescribed dose. Four patients (7%) developed acute Radiation Therapy Oncology Group grade > or = 2 morbidity, and five patients (9%) developed late grade > or = 2 morbidity. DISCUSSION: Median survival and freedom from progression in patients treated with radiosurgery for melanoma metastatic to the brain are comparable to results in published radiosurgery series of grouped histologies. For melanoma patients, total intracranial tumor volume appears to be of greater prognostic significance than the absolute number of metastases treated. We conclude that gamma knife radiosurgery is effective and should be considered among various management strategies.     

Changes in neuropsychological functioning over 10 years following adolescent substance abuse treatment.

Previously, Anderson, Ramo, Cummins, and Brown (2010) described six distinct patterns of alcohol and other drug (AOD) use during the decade following adolescents' treatment for alcohol and other substance use disorders (A/SUD). This time period represents a phase of significant neurodevelopment, and the influence of substance use on the brain is a concern. In the present study, we examined patterns of neuropsychological function over these 10 years in relation to the AOD trajectories identified for youth as they transition into their twenties. Participants were part of a longitudinal research project following adolescents with and without A/SUD who received neuropsychological examinations at baseline and up to 7 times thereafter spanning 10 years (N = 213; 46% female at baseline). Neuropsychological trajectories were significantly related to substance involvement patterns over time on measures of verbal learning and memory (ps = .011 to p = .0002), and verbal attention/working memory (p = .020), with heavier use patterns generally followed by poorer cognition. Heavy use of alcohol alone was independently associated with poorer verbal memory over time. Furthermore, substance withdrawal symptoms during each follow-up time point were related to poorer verbal learning and memory scores (ps     

Neuropsychological impairment from acute low-level exposure to carbon monoxide

OBJECTIVE: To investigate the effects of acute low-level exposure to carbon monoxide on higher cognitive functions in healthy humans. DESIGN: An empirical study of the effects of low-level exposure to carbon monoxide on higher cognitive functions in young healthy volunteers and a matched nonexposed control group. SETTING: A dormitory at the Hebrew University campus in Jerusalem, Israel. PARTICIPANTS: Forty-five student volunteers who were exposed to carbon monoxide from residential kerosene stoves for 1.5 to 2.5 hours (air carbon monoxide concentrations of 17-100 ppm; mean +/- SD, 61 +/- 24 ppm) served as the experimental group and 47 nonexposed students served as the control group. MAIN OUTCOME MEASURES: A battery of neuropsychological tests was administered to each participant including digit span, the revised Wechsler Memory Scale for verbal and figural memory, Trail-Making Test parts A and B, digit symbol, block design, and the Rey Auditory Verbal Learning Test. RESULTS: Venous blood carboxyhemoglobin (Hbco) levels in participants of the study group ranged from 0.01 to 0.11 (mean +/- SD, 0.04 +/- 0.03) and correlated with air carbon monoxide concentrations (r = 0.39; P = .01). The experimental group scored significantly lower than controls on the following tests: digit span forward (P = .02), short-term (P = .008) and long-term semantic memory (P = .008), digit symbol (P = .004), block design (P = .009), recall of figural memory (P = .02), and Trail-Making part A (P = .04). No significant differences were found between the experimental and control groups in other tests. CONCLUSIONS: The lower scores on neuropsychological tests indicate dysfunctions in memory, new learning ability, attention and concentration, tracking skills, visuomotor skills, abstract thinking, and visuospatial planing and processing. These dysfunctions correspond with previous reports of carbon monoxide neurotoxic effects in patients with moderate carbon monoxide poisoning. Low-level exposure to carbon monoxide results in impairment of higher cognitive functions. Neuropsychological testing appears to be sensitive in the detection of subtle neurologic dysfunctions resulting from carbon monoxide poisoning.     

Stereotactic radiosurgery for tentorial meningiomas

Radical microsurgical resection is the procedure of choice for tentorial meningiomas. Despite advances in microsurgery, tentorial meningiomas continue to challenge surgeons and patients. To evaluate the response of tentorial meningiomas, we evaluated 41 patients who had Gamma knife stereotactic radiosurgery during a 9 year period. Patient age varied from 32 to 79 years. Headache, trigeminal neuralgia, or facial paraesthesia were the most common presenting symptoms. Sensory deficits in the distribution of the trigeminal nerve were the most common finding. Eighteen patients (44%) had undergone between 1 and 5 (mean, 1.9) resections prior to radiosurgery; 23 had tumors diagnosed by neuroimaging. The average tumor diameter in this series was 20 mm. The maximum tumor dose varied from 24 to 40 Gy (mean, 30.5 Gy), and the tumor margin dose varied from 12 to 20 Gy (mean, 15.3 Gy). During the average follow-up interval of 3 years (range, 1-8 years), 19 patients had clinical improvement, 20 remained stable, and 2 patients deteriorated. Follow-up imaging showed a reduction in tumor size in 18 patients, no further tumor growth in 22, and an increase in tumor size in one (overall tumor control rate of 98%). Stereotactic radiosurgery using the Gamma Knife was a safe and effective primary or adjuvant treatment for patients with tentorial meningiomas.