Magnetic resonance imaging in head and neck cancer

The scans of 120 patients with proven head and neck cancer who underwent magnetic resonance imaging (MRI) at Mt. Vernon hospital were reviewed and, where possible, compared with their clinical, computed tomography (CT) and histological findings. MRI was generally superior to both clinical examination and CT in the detection of cervical lymphadenopathy and in the assessment of primary tumour extent, particularly in the tongue base, nasopharynx and parotid gland. Small intracranial tumour extensions were more readily detected by MRI than CT. MRI was no better than CT in distinguishing between malignant and inflamed tissues and was generally inferior to CT in spatial resolution, patient acceptance and examination cost.

Tissue plasminogen activator administration and nursing considerations

Intravenous thrombolytic therapy is rapidly gaining acceptance in the care of acute myocardial infarction (AMI) patients. There are several thrombolytic agents in use; however, this article will focus on tissue type plasminogen activator (t-PA). A thorough understanding of the benefits and risks associated with thrombolytic administration will be critical in the successful utilization of this form of therapy. Recent data show that infarct size is linked to mortality. In the 1980s, therapy for acute myocardial infarction patients is directed at salvaging myocardium and limiting infarct size. Prior to this, therapy consisted mainly of supportive care that resulted only in minor effects on the patients prognosis. Intracoronary thrombus has recently been recognized as the cause in most cases of acute myocardial infarction. Thrombolytic therapy represents a method of dissolving a thrombus and reestablishing blood flow to the previously occluded coronary artery. Early reperfusion of ischemic myocardial tissue can limit the amount of damage caused by evolving myocardial infarction. Intervention with thrombolytic therapy in the early hours of acute myocardial infarctions has been associated with reduction in the infarct size, improvement in left ventricular function and reduction in mortality. Nursing plays a critical role in ensuring the successful use of thrombolytic therapy by early identification of appropriate patients and accurate administration of the thrombolytic agent.

Immunohistochemical localization of secretogranin II in the rat cerebellum

Secretogranin II (chromogranin C) is a peptide related to chromogranin A and secretogranin I (chromogranin B) which is secreted by a regulated pathway from both neurons and endocrine cells. In the present study we have determined by light microscopic immunocytochemistry its distribution in the cerebellum and in adjacent brain stem regions. Secretogranin II was found to be widely distributed throughout the gray matter of these regions. Highly immunoreactive structures in the cerebellar cortex included the majority of climbing fibers, a large number of mossy fibers, sparse varicose fibers in the molecular layer and a subpopulation of neuronal perikarya in the granule cell layer. The location and shape of these neurons are very similar to those of a novel type of cerebellar neurons which has been recently described. A moderate level of immunoreactivity was observed on fibers travelling among Purkinje cells and parallel to the pial surface in the Purkinje cell layer. A variable, but in general low, degree of immunoreactivity was also detectable in the perikarya of Purkinje cells. In the deep cerebellar nuclei a loose network of secretogranin II-positive fibers was visible. Neurons of the nuclei, however, were non-immunoreactive. A dense network of highly immunoreactive fibers was found throughout the brain stem regions adjacent to the cerebellum. Our results indicate that secretogranin II has in the cerebellum and adjacent regions a distribution more widespread than that of known regulatory peptides and suggest that the peptide-mediated signaling in the cerebellum plays a role more important that has been acknowledged so far.

Analysis of RAS oncogene mutations in human lymphoid malignancies

We investigated the frequency of mutations activating RAS oncogenes in human lymphoid malignancies, including B- and T-cell-derived acute lymphoblastic leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma. By the polymerase chain reaction/oligonucleotide hybridization method, DNA from 178 cases was analyzed for activating mutations involving codons 12 and 61 of the HRAS, KRAS and NRAS genes and codon 13 of the NRAS gene. Mutations involving codons 12 or 13 of the NRAS gene were detected in 6 of 33 cases of acute lymphoblastic leukemia (6/33, 18%), whereas no mutations were found in non-Hodgkin lymphoma or chronic lymphocytic leukemia. Direct nucleotide sequence analysis of polymerase chain reaction products showed that the mutations involved a G----A transition in five of the six cases of acute lymphocytic leukemia. In four cases the mutations seemed to occur in only a fraction of the neoplastic cells, and one case displayed two distinct NRAS mutations, most likely present in two distinct cell populations. These results indicate the following: (i) RAS oncogenes are not found in all types of human malignancies, (ii) significant differences in the frequency of RAS mutations can be found among subtypes of neoplasms derived from the same tissue, (iii) in lymphoid neoplasms the NRAS mutation correlates with the most undifferentiated acute lymphocytic leukemia phenotype, and (iv) NRAS mutations present in only a fraction of malignant cells may result from either the selective loss or the acquisition of mutated alleles during tumor development.

Randomized phase II evaluation of iproplatin (CHIP) and carboplatin (CBDCA) in lung cancer. A Southeastern Cancer Study Group trial

Cisplatin-containing regimens have shown activity in both small and non-small cell lung cancer. We therefore conducted a randomized Phase II trial of the new platinum congeners iproplatin and carboplatin in bronchogenic carcinoma. The overall response rate in chemotherapy-naive non-small cell patients with iproplatin was 3/48 (6%; 95% confidence interval 2-18%) and with carboplatin 6/50 (12%; 95% confidence interval 5-25%). The response rates in previously treated small cell patients were 0/16 and 1/18, respectively. Overall, neither agent has pronounced activity in bronchogenic carcinoma.

Treatment protocols: practical considerations for hospital implementation of thrombolytic therapy with tissue plasminogen activator

Treatment protocols are critical to the delivery of rapid nursing assessment and prompt patient intervention. These protocols must be developed to ensure patient standardization and quality of care. The key points to include in treatment protocols are guidelines for triage; inclusion-exclusion criteria; pretreatment and posttreatment standing orders; patient care management guidelines; and, if applicable, transport to a tertiary center and cardiac catheterization instructions.

Cyclosporin neurotoxicity in cardiac transplant recipients

Cyclosporin toxicity may produce a wide range of neurological disorders. We report three patients whose neurological problems developed while taking cyclosporin following cardiac transplantation, but resolved rapidly when the drug was discontinued. In two cases, MRI revealed abnormalities which disappeared with clinical recovery. Blood cyclosporin concentrations were not markedly increased, and it is possible that the neurotoxic effects of cyclosporin are mediated by metabolites, through an effect on the blood-brain barrier.

MR imaging of lymphomas: impact on therapy

Seventy-six patients with either Hodgkin disease or non-Hodgkin lymphoma underwent magnetic resonance (MR) imaging as part of their evaluation. In this report the unique and common MR findings of these neoplasms are reviewed in each of the major anatomic sites. Further, the impact of these findings on therapy decisions and follow-up is emphasized.

Magnetic resonance imaging of the abdomen--1988

This article reviews the current clinical use of magnetic resonance imaging (MRI) in the abdomen with regard to recent technological advances, organ analysis and the integration of MRI in diagnostic imaging. The authors conclude that while MRI is not at present establishing itself as a leading diagnostic imaging method in the abdomen, if MRI machines were to become more widely available, abdominal applications could become a reality.

Bilirubin in cerebrospinal fluid: an indicator of blood-brain barrier disruption in asphyxiated rats

To evaluate the relationship of serum cerebrospinal fluid (CSF) and brain total bilirubin levels in asphyxia, an experiment was designed with 5 to 6-week-old Sprague-Dawley rats. The rats were randomized into control and experimental groups. All rats received intravenously 30 mg/kg of bilirubin. Four hours later the experimental group was asphyxiated. Forty-eight hours after asphyxiation, the bilirubin concentrations in blood, CSF, and brain were measured in both study groups. Mean CSF and brain bilirubin levels were significantly higher in the experimental compared to the control group; however, mean serum bilirubin levels were not different. Moreover, in the experimental group a significant correlation existed between CSF and brain bilirubin concentrations. In conclusion, an asphyxiatic insult resulted in disruption of both the blood-brain and the blood-CSF barriers.

Isolation of the human gene that complements a temperature-sensitive cell cycle mutation in BHK cells

We have cloned the human genomic DNA and the corresponding cDNA for the gene which complements the mutation of tsBN51, a temperature-sensitive (Ts) cell cycle mutant of BHK cells which is blocked in G1 at the nonpermissive temperature. After transfecting human DNA into TsBN51 cells and selecting for growth at 39.5 degrees C, Ts+ transformants were identified by their content of human AluI repetitive DNA sequences. Following two additional rounds of transfection, a genomic library was constructed from a tertiary Ts+ transformant and a recombinant phage containing the complementing gene isolated by screening for human AluI sequences. A genomic probe from this clone recognized a 2-kilobase mRNA in human and tertiary transformant cell lines, and this probe was used to isolate a biologically active cDNA from the Okayama-Berg cDNA expression library. Sequencing of this cDNA revealed a single open reading frame encoding a polypeptide of 395 amino acids. The deduced BN51 gene product has a high proportion of acidic and basic amino acids which are clustered in four hydrophilic domains spaced at 60- to 80-amino-acid intervals. These domains have strong sequence homology to each other. Thus, the tsBN51 protein consists of periodic repetitive clusters of acidic and basic amino acids.

An oncogene isolated by transfection of Kaposi's sarcoma DNA encodes a growth factor that is a member of the FGF family

We recently reported the cloning of a rearranged human oncogene following transfection of DNA from Kaposi's sarcoma into NIH 3T3 cells. To identify the protein(s) encoded in two novel mRNAs of 3.5 and 1.2 kb expressed in NIH 3T3 transformants, we constructed a cDNA library. One of the cDNA clones isolated (KS3) corresponded to the 1.2 kb mRNA and transformed NIH 3T3 cell when inserted into a mammalian expression vector. The 1152 nucleotide KS3 cDNA encodes a protein of 206 amino acids with significant homology to the growth factors basic FGF and acidic FGF. Expression of the KS3 product as a bacterial fusion protein or in COS cells allowed us to determine that both proteins had significant growth-promoting activity and that the COS cell protein was glycosylated. Thus one of the mRNAs transcribed from the KS oncogene encodes a growth factor that could transform cells by an autocrine mechanism and appears to represent a new member of the FGF family.

Early-Onset Diagnosis of Lung Toxicity Caused by Cyclophosphamide, Melphalan and Procarbazine Therapy

Lung function studis were performed in 33 patients with lymphomyeloproliferative diseases (25 cases of multiple myeloma and 8 cases of Hodgkin's disease) who received cyclophosphamide, procarbazine, and melphalan therapy. Lung function was investigated by spirometric tests, indicative tests of small airways disease, and diffusing capacity of the lung for carbon monoxide (DUCO). Indicative tests of small airways disease and other lung function tests such as forced expiratory volume in 1 second (FEY,), vital capacity (VC), total lung capacity (TLC) etc. were markedly improved in 18 patients (55%), whereas 24 patients (73%) showed a decreased diffusing capacity of the lung for carbon monoxide. Furthermore, most of the patients (77% – 83%) showed contemporaneous involvement of spirometric tests and DUCO. The DUCO was also found more constantly impaired than other function tests because it had decreased with and without other spirometric tests. Impaired lung function tests were found to be related to a cumulative dose of antineoplastic drugs. The absence of increased lung toxicity was found to be related to several drugs administered in combination. In view of the absence of previous bronchopathies, lung involvement signs in multiple myeloma (25, 26) or lymphoma, and concomitant bronchopneumonias, the impaired functional tests could be ascibed to drug-induced lung toxicity. In the absence of clinical symptoms, roentgenographic and pathologic features, impaired lung function tests may play a role as early-onset signs of drug-induced lung toxicity.

Molecular cloning of a gene that is necessary for G1 progression in mammalian cells

We have cloned a human cDNA that complements the mutation of ts11, a temperature-sensitive (ts) mutant of the BHK hamster cell line that at the nonpermissive temperature is blocked in progression through the G1 phase of the cell growth cycle. After transfecting human chromosomal DNA into ts11 cells and selecting for cells that had acquired a non-ts phenotype, we screened a genomic library constructed in the EMBL3 lambda vector from a secondary non-ts transformant and isolated a recombinant phage containing human DNA sequences that were uniformly present in primary and secondary non-ts transformants. Genomic probes that recognized an mRNA of about 2 kilobases in human cells were used to isolate from a cDNA expression library two cDNA plasmids that could efficiently transform ts11 cells to a non-ts phenotype. Sequencing of one of these cDNAs revealed a single open reading frame, which could encode a 540 amino acid protein. The ts11 gene has at least two other homologs in human DNA and thus it appears to be part of a small gene/pseudogene family. Experiments with serum-synchronized cells indicate that the expression of the ts11 gene, which is necessary for G1 progression, is itself cell-cycle regulated, being induced in approximately mid-G1.

Rifaximin, a rifamycin derivative for use in the treatment of intestinal bacterial infections in seriously disabled patients

This study reports the results of an evaluation of the effectiveness and tolerability of rifaximin, an intestinal topical antibiotic. It was administered using a nasogastric tube in patients with severe enterocolitis and bacterial superinfections causing intestinal inflammatory diseases and portosystemic encephalopathy. The drug proved highly effective clinically and produced neither local nor systemic side-effects.

Ileocolic intussusception in large cell lymphoma of the terminal ileum. Report of a case

A case of an adult patient with ileocolic intussusception secondary to a lymphoma of the terminal ileum is reported. On the computed tomograms, a target mass, with the outer rim representing the annular tumour of the terminal ileum and the eccentric rim of low attenuation representing the mesentery, is described. Ultrasound patterns are those of parallel hypoechoic areas separated by hyperechoic stripes seen on longitudinal sections, and of a rounded mass of low echogenicity, exhibiting two hyperechoic concentric ring-like areas within it, on transverse scans. The appearances of the barium examinations are also described. The English literature is reviewed.