Cognition and white matter changes on magnetic resonance imaging in dementia

In a prospective magnetic resonance imaging and cognitive study of 38 demented patients and 15 control subjects, 11 of 27 patients with Alzheimer's disease and 8 of 11 patients with vascular dementia had significant periventricular hyperintensities. Memory and language testing in the early investigation of dementia is useful to distinguish patients with or without periventricular hyperintensities on magnetic resonance imaging. Patients without periventricular hyperintensities are worse on memory and conceptualization tests than patients with periventricular hyperintensities, who tend to be worse on comprehension and attention tests. These differences in cognitive pattern are present between patients with different pathogenesis who are otherwise matched for dementia severity. Language and some nonverbal cognitive deficits correlate with the extent of cortical and ventricular atrophy in Alzheimer's disease.

Assessment of children's Type A behavior: relationship with negative behavioral characteristics and children and teacher demographic characteristics

Thirty-two teachers rated Type A behavior, using Matthews Youth Test for Health, (MYTH) and negative characteristics of hyperactivity, negative peer relations, social withdrawal, and depression in 105 children, between the ages of 6 and 11, from lower to middle class Black and White families. Children's age, gender, race, and socioeconomic status (SES) and teachers' gender, grade taught, and years of teaching experience were not related to teachers' MYTH ratings. However, White teachers rated children higher on Type A behavior than Black teachers. Controlling for teacher race effects, MYTH total scores, rather than reflecting a global negative view of the child, showed a strong overlap with hyperactivity and were differentiated from social withdrawal and depression. The MYTH Impatience/Aggression factor was highly related to hyperactivity and negative peer interactions; the Competitiveness factor was associated with a lack of social withdrawal. The conclusions verify the multidimensional nature of children's Type A behavior pattern and the importance of rater demographic characteristics in the assessment of children's behavior.

Terodiline: a dose titrated, multicenter study of the treatment of idiopathic detrusor instability in women

Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes. Treatment initially is conservative and often includes drug therapy. Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects. Theoretically, by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents. A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol. Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation, standardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial. Terodiline has been demonstrated to be a safe, well tolerated and effective drug in the treatment of idiopathic detrusor instability. Drug treatment led to significant decreases in urinary frequency and incontinence episodes. Pre-micturition symptoms, such as urgency, were markedly reduced and the voided volume was significantly increased. Although there were consistent trends towards greater improvement in the urodynamic measurements, when the terodiline and placebo groups were compared these did not reach statistical significance, partly due to a large improvement in the placebo group. Nevertheless, terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability.

High-dose, double alkylating agent chemotherapy with DTIC, melphalan, or ifosfamide and marrow rescue for metastatic malignant melanoma

Thirty-seven patients with widely metastatic malignant melanoma were treated with one of three chemotherapy regimens, incorporating high-dose dacarbazine (DTIC). The chemotherapy was followed by autologous bone marrow rescue which was harvested under local anesthesia in 25 of the patients. The three regimens comprised a 24-hour infusion of DTIC (Regimen A for patients less than 45 years of age, 4.3 to 10.5 g/m2; B, if greater than 45 years of age 2.7 to 4.0 g/m2; and later C, if greater than 45 years of age 7.0 to 8.0 g/m2). The second alkylating agent was given at +8 and +16 hours from the start of DTIC. The total doses of the melphalan ranged from 60 to 130 mg/m2 for Regimen A and 30 to 40 mg/m2 for Regimen B. Ifosfamide 5.0 to 8.0 g/m2 was given instead of melphalan in Regimen C. The response rates for the regimens were 81% (25% CR) for A, 27% (11% CR) for B, and 20% (with no complete responders) for Regimen C. There was no statistically significant difference between the three regimens for survival with a median value of 6 months. One of the 16 patients treated with the very high dose Regimen A died of septicemia and three of ten patients in Regimen C died within the first 2 weeks of treatment. There was statistically significant greater myelosuppression, stomatitis, and diarrhea in the very high dosage DTIC and melphalan (Regimen A) compared with the other two regimens. No significant difference in response rate or toxicity was observed for the different dosages escalated within each of the three regimens. Although hematologic and gastrointestinal toxicity were very severe, no unusual side effects were noted except for one episode of severe acute renal failure in the high-dose DTIC and melphalan, Regimen A. Responses occurred mainly in nonvisceral, nodal, and cutaneous sites and occasionally in pulmonary metastases. The Karnofsky performance improved 4 to 6 months after treatment notably with the high-dose DTIC and melphalan therapy. No survival benefit for the combination chemotherapy despite the high dosages was detected and such an approach currently cannot be recommended.

The relationship between hostility and blood pressure in children

The relationship between two dimensions of hostility and resting blood pressure was examined in 98 children aged 7 to 10 years. The children completed the expressive and experienced hostility subscales of the Buss-Durkee Hostility Inventory and one week later had blood pressure and obesity levels assessed. Multiple regression analyses and analyses of variance showed that expressive hostility was positively associated with blood pressure, although this relationship became marginally significant when the effects of obesity were controlled. A significant inverse relationship was found between experienced hostility and systolic blood pressure. These results are discussed as they relate to findings in adults on hostility and cardiovascular disease and the relationship between hostility, blood pressure, and obesity.

The use of bone marrow cells grown in long-term culture for autologous bone marrow transplantation in acute myeloid leukaemia: an update

Eleven patients with acute myeloid leukaemia have been transplanted with autologous marrow grown in long-term bone marrow culture. In the high risk group (six patients who had all previously relapsed) the procedure induced a remission in two patients who were in florid relapse at the time of the transplant. Five patients were transplanted in first remission and they remain well and disease-free between 150 and 12 weeks after their autologous transplant.

Goblet cell isolation from cat trachea: a comparison of methods

Goblet cell hyperplasia and metaplasia may be important in the pathogenesis of many respiratory diseases. To study the intracellular mechanisms of mucin synthesis, a purified goblet cell preparation is necessary. We have compared different methods of cell dissociation using cat trachea, a source rich in goblet cells. The most successful method used EDTA to loosen the basement membrane and 1% pronase to dissociate the epithelial cells. Goblet cells recovered from a linear Percoll gradient showed preservation of their ultrastructural detail, trypan blue exclusion, oxygen consumption, and synthesis of a high molecular weight compound resistant to hyaluronidase degradation, consistent with mucous glycoprotein. This method allows the isolation of adequate numbers of purified goblet cells for further study of goblet cell synthetic processes.

Periventricular and subcortical hyperintensities on magnetic resonance imaging. 'Rims, caps, and unidentified bright objects'

Magnetic resonance imaging hyper-intensities were classified as periventricular rim, caps, and unidentified bright objects (UBOs). These were quantitated in 100 acute stroke and 23 hemorrhage patients and 59 control subjects selected from 590 consecutive scans. The rims, caps, and ventricular size were rated on a scale from 0 to 3 for severity, and the UBOs were counted. The results indicated that the rim is also frequent in control subjects and increases with age. Unidentified bright objects, caps, and severe rims usually signify pathology, occurring much more frequently in patients with strokes and hemorrhages than in control subjects. Hypertension is a significant risk factor in UBOs and caps, but in rims, the incidence of diabetes is higher. The clinical and pathologic significance of these hyperintensities and their relationship to Binswanger's disease, lacunar state, and "état criblé" is discussed.

Expression of human CD antigens, including CD1 and CD25, by human x mouse interlineage leukaemia hybrids

The expression of human cell-membrane antigens by hybrid cell lines derived by fusing a human B-ALL and mouse BW 5147 T-lymphoma cells has been studied. Using monoclonal antibodies (mAb), the phenotypes of 19 of the 24 hybrids which grew 11-44 days post-fusion have been analysed by indirect membrane immunofluorescence (IF). These uncloned hybrid cells were assayed early after outgrowth, prior to extensive human chromosome and antigen loss. Nonetheless, cytogenetic analysis showed that all hybrids contained variable numbers of human chromosomes. Phenotypic analysis showed that the hybrids could be grouped as follows: a high frequency expressing CD25 (IL-2 receptor), human T200, HLA class I alpha and beta 2microglobulin, and reacting with the mAb H207 and 12E7; an intermediate frequency expressing CD1 and CD2; and a low frequency expressing CD3, CD4, CD5, CD7, CD8 and CD9. This pattern of antigen expression resembled the frequency of these cells in the human B-ALL parent line. Cell sorting was used to immunoselect hybrids expressing CD1 and CD2, but CD1 expression was unstable during subsequent culture.

The sensitivity and specificity of MRI in stroke

We compared MRI and CT in a study of 175 patients; 87 infarcts within a week, 40 from 1 to 40 weeks, 25 a year after onset, and 23 hemorrhages, 18 within 2 weeks and 5 in 4 to 8 weeks. Fifty-nine infarcts and eight hemorrhages had sequential scanning. MRI is more sensitive than CT in the early detection of cerebral infarcts. CT is the method of choice to rule out intracerebral bleeding, but MRI is more specific in later stages of hemorrhage. Periventricular hyperintensity is seen more frequently with diabetes than without. Hyperintense white matter patches are often unrelated to clinical events. MRI is useful in following the evolution of strokes and distinguishing acute and chronic infarcts without contrast agents.

Study of childhood renal tumours using peroxidase conjugated lectins

Six peroxidase conjugated lectins were used to compare their ability to bind to formalin fixed paraffin embedded tissue sections of childhood renal tumours (Wilms' tumour, mesoblastic nephroma, renal carcinoma, rhabdoid renal tumour, and bone metastasising renal tumour of childhood (BMRTC) with fetal and normal children's kidney. Lectins were found to be helpful in the differential diagnosis of renal tumours. Another important finding was that the mesenchyme of renal tumours showed differences in its reactivity among various types of kidney tumours. The results of lectin binding were not helpful in establishing the origin of kidney tumours.

An unusual presentation of non-Hodgkin's lymphoma (NHL) in a child

A rare case of a primary early T-cell non-Hodgkin's lymphoma (NHL) in the bronchus of a 10 year old boy is presented. Although histological examination of the biopsied material was compatible with the diagnosis of NHL or carcinoma, the use of monoclonal antibodies showed it to be an early T-cell NHL and not carcinoma. Accordingly the child was treated using a chemotherapy protocol of the UKCCG for NHL. The patient responded so well to his treatment regime that within 2 weeks of the initiation of chemotherapy there was re-expansion of the collapsed lobe. Six weeks later bronchoscopy was entirely normal with no evidence of residual tumour and now 15 months after the time of diagnosis he remains very well with normal chest X-ray.

Dorsal midbrain syndrome in multiple sclerosis with magnetic resonance imaging correlation

We describe the clinical characteristics and a series of magnetic resonance imaging (MRI) studies in a patient with the features of dorsal midbrain syndrome occurring in the setting of multiple sclerosis. A T2-weighted MRI study revealed a discrete abnormality in the tectum of the midbrain whereas a high volume delayed computed tomography (CT) scan was uninformative. In parallel with remission of the clinical findings, the MRI abnormality diminished over time and was no longer visible at one year suggesting that some MRI detected MS lesions can completely disappear with time. This report demonstrates the use of MRI to detect and to follow sequentially sites of known disease activity in MS.

Study of childhood renal tumours using antisera to fibronectin, laminin, and epithelial membrane antigen

Using a peroxidase-antiperoxidase staining procedure, formalin fixed paraffin embedded sections of fetal and normal kidney; benign (mesoblastic nephroma); and malignant tumours (Wilms' tumour, clear cell renal carcinoma, rhabdoid renal tumour, and bone metastasising renal tumour of childhood (BMRTC] were examined for their reactivity with antisera to fibronectin, laminin, and epithelial membrane antigen. Mesoblastic nephroma contained fibronectin but no laminin. Most Wilms' tumours lacked both fibronectin and laminin; 50% of rhabdoid renal tumours were positive for fibronectin and laminin--rhabdoid tumours as recognised morphologically may, in fact, be two separate entities. BMRTC and clear cell renal carcinoma lacked both fibronectin and laminin. Epithelial membrane antigen was present in most of the tubular Wilms' tumour but absent in blastemal Wilms' tumours. The presence of epithelial membrane antigen in rhabdoid tumours was surprising, as histologically, this type of tumour shows no sign of epithelial differentiation. Epithelial membrane antigen antiserum stained clear cell renal carcinomas: epithelial membrane antigen is found in the distal and not the proximal tubules of fetal and normal kidneys. Thus an obvious interpretation is that clear cell renal carcinomas originate from distal rather than from proximal tubules, as has always been thought. On the basis of these results and data from other published findings some possible histogenetic origins of childhood renal tumours were proposed.

Nuclear magnetic resonance imaging, a new approach to the investigation of refractory temporal lobe epilepsy

Nuclear magnetic resonance is a noninvasive technique of imaging the brain using signals produced by magnetic fields and radiowaves. Sixteen patients with refractory temporal lobe epilepsy (TLE) had magnetic resonance imaging (MRI) during investigation for possible surgical management. These images plus those of 10 normal controls, were interpreted blind and the results from the TLE patients compared to the EEG and computerized tomographic (CT) scan findings. Fourteen patients compared with one normal control had one or more of the following: small temporal lobe, small mesial temporal structures, small hemisphere, and focal mesial temporal prolonged spin-spin relaxation time. These findings correlated with the electrographically determined seizure focus in 11 patients. Enlarged or asymmetrical temporal horns were seen with equal frequency in patients and controls and did not correlate with the seizure focus. CT scans were less likely to show these changes than MRI. Correlation of the MRI changes with histopathology of resected temporal lobes was poor. MRI reveals structural and possibly functional alterations which may aid in the localization of the seizure focus in the temporal lobes of patients with refractory complex partial seizures.

Mesoblastic nephroma contains fibronectin but lacks laminin

Non-metastatic mesoblastic nephromas from four young children were shown to contain fibronectin but not laminin using an immunoperoxidase staining procedure. In contrast, one metastasising spindle celled sarcomatous tumour from a neonate was laminin positive. During embryogenesis primitive nephrogenic mesenchyme contains only fibronectin and no laminin; metanephric blastema (permanent kidney) is positive for laminin. The staining for fibronectin and laminin may help to ascertain the histogenesis of different types of renal tumour.

A scoring system for Wilms' tumour: pathological study of the second Medical Research Council (MRC) trial

The second MRC nephroblastoma trial was devised to determine whether more intensive chemotherapy in the early stages and multiple chemotherapy in the poorer prognosis groups would give improved results. As a separate study the pathological and clinical aspects were assessed to see whether information may be obtained concerning the behaviour of individual tumours of the 159 cases included, 142 were regarded as nephroblastoma. Significant features were the age of the patient, clinical stage at diagnosis, tubular status of the neoplasm and the presence or absence of anaplasia. A scoring system has been devised to take account of these factors.

Human lung tumour cell line adapted to grow in serum-free medium secretes angiogenesis factor

A human lung tumour cell line has been grown in serum-free medium for 12 months and during this period cells were subcultured every 4 days. The culture medium contained an angiogenesis factor which has been purified and shown to be similar to that isolated from other sources including solid tumours. This is the first report that demonstrates de novo synthesis and secretion of angiogenesis factor by a cell line adapted to grow in a serum-free medium.

Angiogenesis factor from human myocardial infarcts

5 of 8 infarcted human myocardial tissues were shown to contain an angiogenesis factor which resembles that obtained from solid tumours. The concentration of angiogenesis factor, measured by radioimmunoassay, was similar to that in tumours. It is suggested that the myocardial-infarct angiogenesis factor modulates collateral enlargement or ingrowth of new blood vessels in the infarcted tissues.