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differentiating the tumor from cerebral lymphoma, which otherwise may give a similar appearance The spinal uid is acellular, with slight elevation of protein Treatment These tumors are too infrequent for categorical judgments to be made regarding therapy, but the overall response to any treatment has been disappointing and the prognosis, as mentioned, is very poor Corticosteroids have little clinical effect, possibly because of a paucity of edema Most trials have suggested a bene t of radiation treatment, but the absolute prolongation of life has been only several weeks (Leibel et al) The addition of chemotherapy may confer a marginal further bene t when survival at one year is considered When a large region is in ltrated, particularly in the temporal lobe, surgical debulking may prolong life, but otherwise surgery is futile Oligodendroglioma This tumor was rst identi ed by Bailey and Cushing in 1926 and described more fully by Bailey and Bucy in 1929 The tumor is derived from oligodendrocytes or their precursor cells and may occur at any age, most often in the third and fourth decades, with an earlier peak at 6 to 12 years It is relatively infrequent, constituting about 5 to 7 percent of all intracranial gliomas From the time of its original descriptions, it was recognized as being more benign than the malignant astrocytoma Males outnumber females 2:1 In some cases the tumor may be recognized at surgery by its pink-gray color and multilobular form, its relative avascularity and rmness (slightly tougher than surrounding brain), and its tendency to encapsulate and form calcium and small cysts Most oligodendrogliomas, however, are grossly indistinguishable from other gliomas, and a proportion up to half in some series are mixed oligoastrocytomas, suggesting that their precursor cell is pluripotential The neoplastic oligodendrocyte has a small round nucleus and a halo of unstained cytoplasm ( fried egg appearance) The cell processes are few and stubby, visualized only with silver carbonate stains Some of the glio brillary oligodendrocytes have intense immunoreactivity to glial brillary acidic protein (GFAP), similar to normal myelin-forming oligodendrocytes Microscopic calci cations are observed frequently, both within the tumor and in immediately adjacent brain tissue The most common sites of this tumor are the frontal and temporal lobes (40 to 70 percent), often deep in the white matter, with one or more streaks of calcium but little or no surrounding edema Sometimes the tumor presents in a lateral ventricle; it is rarely found in other parts of the nervous system By extending to the pial surface or ependymal wall, the tumor may metastasize distantly in ventricular and subarachnoid spaces, accounting for 11 percent of the Polmeteer and Kernohan series of gliomas with meningeal dissemination (less frequent than medulloblastoma and glioblastoma; see also Yung et al) The tumor does not lend itself to the glioma grading scale, but malignant degeneration, evidenced by greater cellularity and by numerous and abnormal mitoses, and necrosis occur in about one-third of the cases Such anaplastic tumors are sometimes called oligodendroblastomas In the oligoastrocytomas, either cell type may be anaplastic The typical oligodendroglioma grows slowly As with astrocytomas, the rst symptom in more than half the patients is a focal or generalized seizure; seizures often persist for many years before other symptoms develop Approximately 15 percent of patients enter the hospital with early symptoms and signs of increased intracranial pressure; an even smaller number have focal cerebral signs (hemiparesis) Much less frequent are unilateral extrapyramidal ri-.

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zxing/core/src/com/google/zxing/ pdf417 /decoder/Decoder. java . Find file Copy path ... Construct a parser to read the data codewords and error-correction level.
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gidity, cerebellar ataxia, Parinaud syndrome, intratumoral hemorrhage, and meningeal oligodendrogliosis (cranial-spinal nerve palsies, hydrocephalus, lymphocytes and tumor cells in CSF) The appearance on imaging studies is variable, but the most typical is a hypodense mass near the cortical surface with relatively well-de ned borders Calcium is seen in CT scans in more than half the cases and is a helpful diagnostic sign (Fig 31-6), but it should also raise the possibility of an arteriovenous malformation, a low-grade astrocytoma, or a meningioma Oligodendrogliomas generally do not demonstrate contrast enhancement, but anaplastic ones and the mixed tumors may do so In recent years, a remarkable degree of progress has been made in understanding the genetic aberrations within these tumors and the relationship of these genes to the prognosis and response to therapy Speci cally, loss of certain alleles on chromosome 1p is predictive of a high degree of responsiveness to the belowdescribed PCV chemotherapy regimen, and a similar loss on chromosome 19p is associated with long survival Treatment Surgical excision followed by radiation therapy has been the conventional treatment for oligodendroglioma However, because of uncertainty as to the histologic classi cation of many of the reported cases, it is not clear whether radiation therapy is attended by longer survival Well-differentiated oligodendrogliomas should probably not receive radiation The discovery by Cairncross and MacDonald of considerable importance, as mentioned earlier, is that many oligodendrogliomas, especially anaplastic ones, respond impressively to chemotherapeutic agents, particularly to a PCV regimen a combination of procarbazine, lomustine (CCNU), and vincristine given in approximately six cycles Mixed oligodendrogliomas and astrocytomas should generally be treated like astrocytomas, with the addition of chemotherapy to manage the oligodendroglial component as recommended in some

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As indicated in Chap 43, the peripheral nerves may be affected by a wide variety of toxins, including metals, drugs, organophos-

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