[Neoplasms of the base of the tongue. Evaluation with magnetic resonance]

The authors investigated MR capabilities in evaluating the neoplasms of the base of tongue. Thirty patients were examined. The images were obtained--at INI, Grottaferrata, Rome--using a 1.5 T superconductive Gyroscan unit by Philips. On T2-weighted images, the neoplasms were always hyperintense; in 10 patients edema could be distinguished from neoplasm. On T1-weighted scans the tumor exhibited the same signal intensity as the tongue muscle in 4 patients, while in the extant 26 cases it was hypointense. This pattern proved to be aspecific and could not be correlated with a specific histology. In 3 clinically symptomatic patients, MR imaging diagnosed the invasion of the internal pterigoid muscle. MR capabilities in identifying swollen lymph nodes was also evaluated on the basis of the signal intensities of the latter, as well as on their size. The authors' conclusion is that MR imaging is to be considered the method of choice in the staging of tumors at the base of tongue thanks to its high contrast resolution and multiplanar capabilities.

Prothrombin expression in the adult and fetal rabbit liver

Plasma prothrombin levels in newborn humans are lower than in adults. The same is true of many newborn and fetal mammals, including the rabbit. To determine if the lower levels are due to less expression of the protein, we have compared mRNA for prothrombin in fetal and adult rabbit liver. Northern blots were hybridized with a cDNA for rabbit prothrombin revealing a single mRNA of approximately 2 kb in both adult and fetal animals. mRNA specific for prothrombin was quantitated by slot blotting of RNA prepared from adults and fetuses aged 21 d to term (31 d). Prothrombin-specific mRNA in fetuses was greater than 50% of that in adults even when the fetal plasma prothrombin was only 15% of the adult level. This suggests that low plasma levels in the fetuses are not the result of less transcription. Examination of liver sections revealed that the predominant tissue in the fetus is hematopoietic, not hepatic. In the youngest fetuses, less than 20% of the liver consisted of hepatocytes, yet these fetuses expressed more than 50% of the adult level of prothrombin-specific mRNA. Thus, transcription of prothrombin mRNA may be proceeding at a greater rate in the fetal hepatocyte than in the adult, or hematopoietic cells may be expressing the protein. We conclude that in fetal rabbit liver, prothrombin is expressed at a high level relative to the hepatocyte content and that the cause of the low plasma levels is posttranscriptional.

Primary bone tumors. MR morphologic appearance correlated with pathologic examinations

Eighty-three MR studies for primary bone tumors, performed with both spin echo and short time inversion recovery (STIR) sequences, were reviewed. Twenty-six patients underwent surgery within 10 days after MR imaging. Specimens were cut and directly compared with MR images. In the remainder, pathologic slides were compared in order to obtain a better understanding of MR pattern. All MR images were examined with a traditional morphologic approach and, upon comparison with surgical macroslides and with pathology samples, some MR distinctive patterns were identified: the bulky appearance of osteosarcoma surrounded by muscle edema, the multilobular high signal intensity (SI) chondroid lesions, the subtle infiltration of Ewing's sarcoma, rarely accompanied by muscle edema and prone to MR underestimation, the well defined "multiple shells" pattern of giant cell tumor, and the ill defined "storiform" appearance of malignant fibrous histocytoma are all typical MR features strictly corresponding to pathologic findings. The chondroid origin tumors may be identified based on the lobular high SI pattern whereas a benign fibrous lesion was the only one in this series to be distinguished relying on the SI. Peritumoral soft tissue edema was found by the STIR sequence only in malignant tumors (69%) of this series, and particularly in osteosarcoma (96%), chondrosarcoma (83%), and giant cell tumor (100%): this associate finding may further contribute to the diagnosis.

MRI in primary bone tumors: therapeutic implications

The accuracy of preoperative MRI in detecting tumor extent has been evaluated in 35 patients with primary bone neoplasms; intra-osseous extent was measured on MR images and compared with macroslides of surgical specimens in 26 cases. An almost completely accurate prediction of tumor size was obtained with the combined employment of Spin-Echo (SE) and Short Inversion Time Inversion Recovery (STIR) sequences in the various tumors, with the exception of two Ewing's sarcomas. Changes in Signal Intensity (SI) and tumor morphology were identified in those cases which had undergone presurgical chemotherapy; the reduction in SI and in tumor size or the appearance of a more homogeneous signal was correlated with a positive response to cytotoxic therapy. MR imaging fully satisfies surgeon's preoperative requirements in the assessment of therapy-responding neoplasms as well as in local tumor staging in all types of neoplasms, with the exception of Ewing's sarcoma.

[Importance of CA-50 detection in malignant gynecologic tumors]

The role of Tumor Associated Antigens in the diagnosis of neoplasia is now actively investigated. The CA-50 antigen is known to be elevated in different types of gynecological neoplasia. In this study the CA-50 levels have been measured in 70 patients with ovarian, endometrial or cervical cancer. The data obtained show that the CA-50 levels, although elevated above normal in a high percentage of the patients studied, cannot be considered diagnostic for the presence of neoplasia.

Chemotherapy for advanced thymoma. Preliminary results of an intergroup study

OBJECTIVE

To determine the efficacy of combination therapy with cisplatin, doxorubicin, and cyclophosphamide alone or with radiotherapy for patients with extensive and those with limited unresectable thymoma.

DESIGN

Nonrandomized, prospective phase I-II trial.

SETTING

A Cooperative Oncology Group trial involving tertiary medical centers.

PATIENTS

Twenty of twenty-two patients with measurable, extensive or limited, unresectable thymoma were evaluable for response.

INTERVENTION

Patients were given cisplatin, 50 mg/m2 body surface area, doxorubicin, 50 mg/m2, and cyclophosphamide, 500 mg/m2, on day 1, with cycles repeated every 21 days until progression or until the maximally tolerated total doxorubicin dosage (for example, 450 mg/m2) was reached. Intravenous hydration with normal saline was administered during treatment courses. For responding patients with limited disease, 4500 cGy was administered to primary tumors after the second cycle of chemotherapy and before the initiation of the third cycle.

MEASUREMENTS AND MAIN RESULTS

Three complete and eleven partial remissions were seen in 20 evaluable patients, for a total response rate of 70% (95% CI, 46% to 88%). The median duration of remission was 13 months with three patients remaining continuously disease free for over 2 years. The median survival time of all eligible patients was 59 months (CI, 22 months to infinity). Four patients developed infections, including listerial and aseptic meningitides, mucocutaneous candidiasis, and cryptococcal pneumonia, that were indicative of a defect in cell-mediated immunity.

CONCLUSIONS

Combination therapy with cisplatin, doxorubicin, and cyclophosphamide frequently produces objective remissions in patients with advanced thymoma. Further experience with this treatment regimen is warranted to clarify potential prognostic factors in patients with unresectable thymoma.

Gadodiamide injection: nonionic gadolinium chelate for MR imaging of the brain and spine--phase II-III clinical trial

Seventy-three patients with clinically suspected central nervous system abnormalities (44 intracranial, 29 medullospinal) were studied with magnetic resonance (MR) imaging before and after administration of nonionic gadodiamide injection. MR imaging showed intracranial lesions in 37 patients. Eight patients had spinal tumors, and 21 had disk disease. Structural abnormalities were shown in 37 of 44 head studies and in all 29 spine studies. Lesions enhancement was seen in 31 head studies and 28 spine studies, and distinction of lesion(s) from associated edema was possible in 10 head studies and in one study of intrinsic cord tumor. Administration of gadodiamide injection provided improved definition of lesion borders in 19 of 44 head studies and 26 of 29 spine studies. The use of the contrast agent changed the diagnosis that was based on the unenhanced images in nine head studies and 13 spine studies. Early postcontrast, T1-weighted spin-echo images of postoperative spines were adequate in distinguishing epidural scar (enhancing) from herniated disk (nonenhancing). The contrast agent was well tolerated, and no drug-related adverse events occurred.

The role of magnetic resonance imaging in an oncology centre

Magnetic resonance (MR) imaging represents the growth area in radiology at present and for well into the 1990s. It has already established itself as the major emerging technique in neuroradiology. Its apparent risk-free application, noninvasiveness and patient comfort provide wide acceptability. This technique may play an important role in the evaluation of cancer patients. Experience with nearly 2,000 patients over a 32-month period demonstrates MR imaging to allow both a more accurate definition of tumor outline and tumor staging, thanks to its high soft-tissue contrast and multiplanar acquisitions. Moreover, MR imaging proves a valuable procedure for radiation treatment planning. Even though it is beyond realistic expectations to seek complete tissue characterization, MR imaging is likely to be increasingly demanded. With the use of specific paramagnetic contrast agents, this technique will eventually replace computer tomography (CT) in both staging and follow-up of several types of cancer.

Development of an interfacility transport program for critically ill cardiovascular patients

The expanding use of newer coronary artery intervention modalities in the treatment of critically ill cardiac patients has produced a profound change in the manner in which acute care is rendered to these patients. To meet the needs of community hospitals and to improve the safety of interfacility transport to tertiary care centers, a transport program was developed at The Hospital of the Good Samaritan, Los Angeles, California. Rapid transport by helicopter, fixed-wing aircraft or specialized ground ambulance services has been used to improve patient transit time and safety of transfer between the community hospital and tertiary care facility. Experience at The Hospital of the Good Samaritan (1,012 consecutive patients) compares favorably with other programs and proves to be safe and beneficial.

Treatment of cancer anorexia with megestrol acetate: impact on quality of life

The quality of life of patients with advanced cancer depends to a large degree on the presence of disease or treatment-related symptoms. Anorexia is frequent in cancer patients, but has received less attention than other symptoms such as pain or nausea. Yet, anorexia is important because it reduces caloric intake and leads to malnutrition. Further, lack of appetite can disrupt basic activities of daily living, such as eating, and may also interfere with family and social interactions. To test the efficacy of drugs that reverse anorexia, we need accurate and reliable parameters to quantitate this symptom. The effects of anorexia and its reversal on the patients' clinical progress, food intake, nutritional status, and quality of life need to be evaluated. Our ongoing studies demonstrate that megestrol acetate can reverse cancer anorexia and that appetite changes strongly correlate with changes in weight, food intake, and quality of life scores.

Enalapril in the treatment of hypertension associated with renal failure: results from a multicenter study

Forty-eight hypertensive patients affected by various levels of renal failure entered this open, non controlled study, lasting 12 weeks. Patients were divided into two groups according to baseline creatinine clearance: Group I (29 patients): creatinine clearance greater than or equal to 25 ml/min but less than 45 ml/min; Group II (19 patients): creatinine clearance greater than or equal to 10 ml/min but less than 25 ml/min. Patients in Group I started with enalapril 5 mg q.d. and patients in Group II with enalapril 2.5 mg q.d. Enalapril could be titrated up to 20 mg/day. At the end of the study in both groups of patients blood pressure normalization was reached in a high percentage of patients without any significant change in renal function parameters. Plasma potassium showed a significant increase during the study but no patient discontinued treatment due to hyperkaliemia. In conclusion this study shows antihypertensive therapy with enalapril during chronic renal insufficiency to be effective at low dosage (5-10 mg) in lowering blood pressure and to have a good safety profile.

Efficacy of almitrine-raubasine in cognitive disorders of aging: a double-blind, placebo-controlled, clinical and psychometric study

Early treatment of age-related cognitive impairment can be decisive in enabling elderly patients to remain at home. A double-blind, placebo-controlled trial of almitrine-raubasine was conducted in 40 elderly outpatients (25 women, 15 men; mean age: 73.5 years) with moderate cognitive impairment randomized into two groups, one receiving almitrine and raubasine, the other placebo, two tablets daily for 90 days. They were assessed at T0, T45 and T90 days, using the Toulouse-Pieron test, 8 subtests from the Wechsler Adult Intelligence Scale (WAIS) and the Sandoz Clinical Assessment for Geriatrics (SCAG). End-of-study results were significantly better in the almitrine-raubasine group in all tests: Toulouse-Pieron test (p less than 0.001), WAIS (p less than 0.001), and SCAG (p less than 0.001).

Staging of carcinoma of the uterine cervix: MRI-surgical correlation

Forty-six patients with carcinoma of the uterine cervix were examined with spin-echo magnetic resonance imaging (MRI) using a superconducting magnet operating at a field strength of 0.5 T. All subjects later underwent lymphadenectomy and, when appropriate, radical hysterectomy. Surgical-pathologic correlation was carried out in order to assess the accuracy of the imaging modality in the staging of the disease. In the detection of nodal involvement, the accuracy of MR was 76%. The accuracy in determination of tumour size approached 100%. In the assessment of parametrial and vaginal involvement, the accuracy was 85% and 100% respectively.

MR assessment of spinal metastases using the late 26 sequence

Ninety-two patients with suspected spinal involvement by systemic cancer underwent MR examinations using both conventional and phase-contrast (LATE 26) spin-echo pulse sequences. MR imaging was considered positive for metastatic disease in 73 cases. Implants were extradural in 69 patients and intradural in 4 patients. Nineteen cases had no MRI evidence of metastases and the abnormalities suspected were shown to be due to either inflammatory or degenerative changes. MR appearances during and after chemo- and/or radiotherapy were studied in 5 patients. The impact of the LATE 26 sequence in the assessment of metastatic spinal disease is evaluated.

Organization and expression of the cell cycle gene, ts11, that encodes asparagine synthetase

The human ts11 gene was isolated on the basis of its ability to complement the mutation of the BHK cell cycle ts11 mutant, which is blocked in G1 at the nonpermissive temperature. This gene has now been identified as the structural gene for asparagine synthetase (AS) on the bases of sequence homology and the ability of exogenous asparagine to bypass the ts11 block. The ts11 (AS) mRNA has a size of about 2 kilobases and is induced in mid-G1 phase in human, mouse, and hamster cell lines. We have studied the organization and regulation of expression of the ts11 gene. The human ts11 gene consists of 13 exons (the first two noncoding) interspersed in a region of about 21 kilobases of DNA. Transient expression assays using the bacterial chloramphenicol acetyltransferase reporter gene identified two separate promoters: one (ts11 P1) contained in a 280-base-pair region upstream of the first exon and the other (ts11 P2) contained in the first intron. ts11 P1 produced about sixfold more chloramphenicol acetyltransferase activity than did ts11 P2 and had features of the promoters of housekeeping genes: high G + C content, multiple transcription start sites, absence of a TATA box, and presence of putative Sp1 binding sites. ts11 P2 contained a TATA sequence and other elements characteristic of a promoter, but so far we have no evidence of its physiological utilization. The ts11 gene was overexpressed in ts11 cells exposed to the nonpermissive temperature. Addition of asparagine to the culture medium led to a drastic decrease in mRNA levels and prevented G1 induction in serum-stimulated cells, which indicated that expression of the AS gene is regulated by a mechanism of end product inhibition.

Chromosomal localization of human genes required for G1 progression in mammalian cells

Specific probes derived from the human genes that complement the mutations of two independent temperature-sensitive (ts) mutants of the BHK-21 hamster cell line were used to determine the chromosomal locations of the loci in the human genome. The ts11 gene, which complements a mutation that blocks progression through the G1 phase of the cell cycle and which has now been identified as the structural gene for asparagine synthetase, is a member of a small gene/pseudogene family with four members. In a rodent-human somatic cell hybrid panel, the ts11 genomic locus from which the genomic probe derives segregates with human chromosome region 7cen----7q35, proximal to the TCR beta locus. In situ hybridization maps this locus more precisely to the q21-31 region of chromosome 7. Two other members of the gene family detected by the ts11 probe segregate concordantly with chromosome region 8pter----8q24 and chromosome region 21pter----21q22. Similar experiments using the same rodent-human hybrid panel conducted with a probe identifying the tsBN51 gene, which also encodes a function necessary for G1 progression, mapped this locus to human chromosome 8, proximal to the large amplification unit encompassing the c-myc gene of Colo320 cells. Chromosomal in situ hybridization of the tsBN51 probe confirmed the localization of this gene to chromosome 8, with the most likely location of the gene being 8q21.

'Benign thoracic pain' syndrome: role of magnetic resonance imaging in the detection and localization of thoracic disc disease

The syndrome of 'benign thoracic pain' is seen in young women who have pain and tenderness in the mid-thoracic spine radiating around the chest and aggravated by spinal movement. Ten consecutive patients with this syndrome and 15 controls were evaluated with magnetic resonance imaging (MRI). This showed thoracic intervertebral disc dehydration with no associated prolapse in 90% of the patients and 13% of the controls. We postulate that the clinical features are due to impaired shock absorption of these degenerate discs rather than direct compression of surrounding structures. MRI is non-invasive and does not use ionizing radiation; it allows direct visualization of the entire thoracic spine and cord, and accurate detection of early disc degeneration. Thus, it is the imaging modality of choice for defining the subtle intervertebral disc abnormalities that characterize the 'benign thoracic pain' syndrome.