Signal intensity patterns in intraspinal dermoids and epidermoids on MR imaging

Retrospective evaluation of MR images of nine intraspinal dermoid (n = 4) and epidermoid (n = 5) tumours was undertaken. T1-weighted images were available in all the patients while proton density (PD) and T2-weighted images were available in seven patients. Except for one lesion (only T1-weighted images were available in this case), all the lesions were clearly delineated on MR images. Most (5 out of 7) were better appreciated on T1- and PD-weighted images than on T2-weighted images. On T1-weighted images, the epidermoids were either iso- to mildly hypointense to the cord (n = 3), isointense to CSF (n = 1) or markedly hyperintense (n = 1). On the PD images, the epidermoids were either isointense to cord (n = 3) or markedly hyperintense (n = 1). All the lesions were iso- to hyperintense to CSF on T2-weighted images. Of the four dermoids three showed a mixed intensity pattern on all sequences; the dominant component gave short T1 and short T2 values, consistent with fat. The fourth lesion showed homogenous material with a signal intensity intermediate between that of CSF and cord on T1-weighted images. Dermal sinus tracts were present in four of the nine patients; three patients had an intraspinal component. This study shows that although MR imaging is excellent for their detection, it cannot differentiate the two tumour types.

19F nuclear magnetic resonance studies of free calcium in heart cells

19F nuclear magnetic resonance is used in conjunction with 5,5'-difluoro-1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (5FBapta), a fluorinated calcium chelator, to report steady-state intracellular free calcium levels ([Ca2+]i) in populations of resting, quiescent, isolated adult heart cells. 31P nuclear magnetic resonance shows that 5FBapta-loaded cells maintain normal intracellular high-energy phosphates, pH, and free Mg2+. The intracellular free calcium concentration of well perfused, isolated heart cells is 61 +/- 5 nM, measured with 5FBapta, which has a dissociation constant (Kd) for calcium chelation of 500 nM. A similar value is obtained with Quin-MF, another fluorinated calcium chelator with Kd and maximum calcium sensitivity at 80 nM. We find that the steady-state level of intracellular free calcium is increased by decreased extra-cellular sodium concentration, omission of extracellular magnesium, decreased extracellular pH, hyperglycemia, and upon treatment with lead acetate. Further, extracellular ATP caused a large transient increase in [Ca2+]i. Thus, while heart cells maintain a very low level of intracellular free Ca2+, acute alterations in extracellular environment can cause derangement of calcium homeostasis, resulting in measurable increases in [Ca2+]i.

Adrenal tumor complicating untreated 21-hydroxylase deficiency in a 5 1/2-year-old boy

OBJECTIVE

A 5 1/2-year-old boy presenting with virilization was diagnosed as having classic 21-hydroxylase deficiency complicated by an adrenal tumor. We attempted to document a reduction in the size of the tumor with glucocorticoid therapy.

DESIGN

Case study.

SETTING

Referral center.

INTERVENTION

Glucocorticoid therapy was instituted for congenital adrenal hyperplasia. Surgery for the adrenal mass was deferred, and the size of the mass was monitored by serial ultrasonography.

RESULTS

Baseline values of serum 17 alpha-hydroxyprogesterone (186.6 nmol/L) and testosterone (24.7 nmol/L [7.1 ng/mL]) were elevated. After instituting steroid treatment, 17 alpha-hydroxyprogesterone was suppressed (13.0 nmol/L), and testosterone remained undetectable on follow-up. However, the size of the mass increased during 6 months. Unilateral adrenalectomy performed at that time revealed a well-encapsulated adenoma in a hyperplastic gland.

CONCLUSIONS

Untreated classic congenital adrenal hyperplasia may be complicated by an adrenal tumor even at a young age. Suppression of adrenal androgens by glucocorticoid therapy was not accompanied by regression of the tumor in our patient.

Cytodiagnosis of pseudomyxoma peritonei in cases suspected of ovarian tumours

The cytologic features in four cases of pseudomyxoma peritonei are described in ascitic fluid specimens which were received from female patients suspected of ovarian masses. The findings in the fluid included cells of mesothelial origin and spindle-shaped fibroblasts with a significant amount of background mucin. This was confirmed by mucicarmine and Alcian blue stains. A cytologic diagnosis of pseudomyxoma peritonei was possible in all four cases. The above findings were further substantiated since mucinous ovarian neoplasms were found in all the cases.

31P-NMR study of transient ischemia in rat hippocampal slices in vitro

Intracellular high energy phosphates (HEP) were monitored in rat hippocampal slices in vitro by 31P-NMR during continuous superfusion, no flow and reperfusion in order to model the changes which occur during cerebral ischemia and reperfusion in vivo. With continuous superfusion, stable intracellular HEP resonance signals were observed for over 4 h. When superfusion was stopped, there were rapid decreases in pH and phosphocreatine levels followed by slower loss of ATP. These changes are similar to those observed during cerebral ischemia in vivo by 31P-NMR. Upon reperfusion, the pH returned to normal, but the extent of HEP recovery depended on the length of time superfusion was halted. Following a 10 min ischemic period HEP levels returned to greater than 90% of preischemic values, while following a 16 min ischemic period there was only 60% recovery. Superfusion with low calcium, high magnesium medium significantly improved the recovery of HEP following 16 min of ischemia to 80% of preischemic levels. These data support the hypothesis that calcium influx during and following ischemia can disrupt energy metabolism in the hippocampus, and that magnesium can have a protective action on cellular energy status, perhaps by further blocking calcium influx.

Epstein-Barr virus infection and bcl-2 proto-oncogene expression. Separate events in the pathogenesis of Hodgkin's disease?

The present study was undertaken to investigate whether Epstein-Barr virus-(EBV) encoded latent membrane protein (LMP) induces the expression of BCL-2 in Hodgkin and Reed-Sternberg (HRS) cells of Hodgkin's disease (HD) and thereby provide a possible mechanism for the role of EBV in the pathogenesis of this disease. Fifty-three cases of HD were studied for the presence of EBV using EBV-encoded RNA in situ hybridization and LMP immunohistochemistry. Immunostaining for BCL-2 on paraffin material was performed using microwave treatment of tissue sections before the application of the primary monoclonal antibody. EBV was located in HRS cells in 16 cases (30%). All cases that were EBV-encoded RNA in situ hybridization positive, also expressed LMP. BCL-2 expression in HRS cells was detected in 16 cases (30%), but only two of these were also EBV-positive. In both of these cases, only occasional HRS cells expressed BCL-2, in contrast to LMP, which was detected in nearly all such cells. BCL-2 staining was predominantly cytoplasmic with some membrane pattern. These results demonstrate that BCL-2 expression can be detected in HRS cells in routinely processed HD tissue and that whereas EBV does not induce the expression of BCL-2 in HD, BCL-2 may have a role in the pathogenesis of EBV-negative cases of HD.

Effect of ASTA-Z 7575 (INN Maphosphamide) on human lymphokine-activated killer cell induction

Recent studies combining chemotherapeutic agents with various biological response modifiers for the treatment of cancer have shown promising results. Cyclophosphamide (Cy) is the most widely used alkylating agent and a major constituent of combination chemotherapy regimens for many neoplastic diseases. It has been reported that Cy is a cytotoxic drug, which becomes immunosuppressive at higher doses. A synthetic metabolite of Cy, ASTA-Z, has recently been produced. ASTA-Z is more active and stable by itself and does not need to be metabolically converted to an active compound. The combined effect of Cy and interleukin-2 (IL-2) on the induction of lymphokine-activated killer (LAK) cells is not known. Therefore, we decided to investigate the effect of ASTA-Z on the induction and function of LAK. The coculture of peripheral blood mononuclear cells (PBMC) with various concentrations of ASTA-Z (0, 10(-6), 10(-5), 10(-4), and 10(-3) dilution) and IL-2 (50 U/ml) for 4 days produced significant suppression of cytotoxicity and lytic ability of the LAK cells against NK-sensitive (K562) and NK-resistant (M14) tumor cell lines. The lower doses of ASTA-Z did not affect the generation of LAK cells, its cytotoxicity and lytic ability of ASTA-Z against both NK-sensitive and NK-resistant tumor cell lines. Furthermore, the ASTA-Z produced dose-dependent suppression of the proliferative response of LAK cells. The significant therapeutic benefit in the cancer patient may be achieved by the low dose regimen of Cy and IL-2 because it has no deleterious effect on the induction and function of LAK cells.

Low extracellular magnesium induces intracellular free Mg deficits, ischemia, depletion of high-energy phosphates and cardiac failure in intact working rat hearts: a 31P-NMR study

Hemodynamic and 31P-NMR spectroscopic studies were performed on intact, perfused working rat hearts exposed to low (0.3 mM) extracellular Mg([Mg2+]o). Low [Mg2+]o perfusion resulted in rapid and significant falls in cardiac output, coronary flow, stroke volume, developed pressure and the rate-pressure product. Concomitant with this O2 consumption decreased and lactate production increased. Hearts perfused with 0.3 mM, instead of 1.2 mM, [Mg2+]o exhibited significant reductions in [ATP], [PCr], intracellular free Mg ([Mg2+]i), and pHi; a marked rise in intracellular Pi corresponding to a precipitous fall in the cytosolic phosphorylation potential was seen. Reintroduction of 1.2 mM [Mg2+]o failed to reestablish either normal hemodynamics, or high-energy phosphates and intracellular Pi, suggesting irreversible myocyte injury. These observations are consistent with the tenet that low [Mg2+]o can result in marked reduction in oxygen and substrate delivery to the cardiac myocytes, probably as a result of coronary vasoconstriction.

Aspiration cytodiagnosis of mucinous cystadenocarcinoma of the pancreas

A case of mucinous cystadenocarcinoma of the pancreas is described in which the cytodiagnosis was made from aspirated material which was obtained under computed tomography (CT) guidance. The case presented further supports the view that aspiration cytodiagnosis of mucinous cystadenocarcinoma (an uncommon pancreatic tumor) can be made with confidence when performed with imaging assistance.

Mitoxantrone and cytosine arabinoside as treatment for acute myelogenous leukemia (AML) at first recurrence

A total of 107 patients with newly diagnosed acute myeloblastic leukemia (AML) were referred to the ICRF Department of Medical Oncology at St Bartholomew's Hospital between August 1986 and July 1989. Of those referred, 92 (87%) were treated with remission induction chemotherapy comprising: Adriamycin, cytosine arabinoside (ara-C) and 6-thioguanine if aged < 60 years (57 patients) or mitoxantrone (MTN) and ara-C if aged > 60 years (35 patients). Of those treated, 54 (58%) entered complete remission (CR). Recurrent AML developed in 38 out of these 54 patients (70%) of whom 25 aged 19-73 years (median 50 years) subsequently received MTN and ara-C as reinduction therapy. The 19 younger patients (under 60 years old) received MTN at 12 mg/m2, intravenously, daily for 5 days and ara-C at 100 mg/m2, intravenously, twice daily for 7 days. The six older patients received the same ara-C schedule but the dose of MTN was reduced to 10 mg/m2 for 5 days. Second CR was achieved in 16 out of 25 patients (64%) [12/19 (63%) and 4/6 (67%) for patients aged under or over 60 years, respectively]. Eight of the patients in whom second CR was achieved were aged under 50 years and were thus eligible for additional consolidation comprising myeloablative therapy with autologous bone marrow transplantation (ABMT). Four patients actually received the latter treatment: two remain in second CR at 21 and 46 months. Three of the remaining eight patients aged > 50 years in whom second CR was achieved remain in second CR 8 to 43 months later. Censored for myeloablative therapy + ABMT, the overall median duration of second CR was 5 months. Although remissions tended to be short, in younger patients the possibility of proceeding to myeloablative therapy with autologous bone marrow support makes the regimen worthwhile and, even in older patients, it was sometimes possible to achieve prolonged second remissions.

Multiple pituitary hormone deficiencies in a patient with spinocerebellar ataxia: magnetic resonance imaging and hormonal studies

Degenerative spinocerebellar ataxia has a rare association with hypogonadotropic hypogonadism. In this report we present the results of the detailed endocrine evaluation and magnetic resonance imaging in one such patient. A 20-year-old male with progressive cerebellar ataxia, hypogonadism, and short stature was investigated. Basal testing revealed hypogonadotropic hypogonadism (LH < 5 mU/L, FSH < 5 mU/L, testosterone 2.5 nM/L). There was no rise in LH after stimulation with LHRH, peak LH level being < 5 mU/L. Insulin hypoglycemia testing was consistent with GH deficiency, with peak GH being 3.2 mU/L. On TRH stimulation, there was no significant rise in prolactin, though the TSH response was normal. Magnetic resonance imaging revealed cerebellar atrophy. The anterior pituitary was atrophic, with a height of 1.4 mm. The posterior pituitary and the pituitary stalk were normal in size and position. This patient with degenerative spinocerebellar ataxia had multiple pituitary hormone deficiencies. The results of our endocrine evaluation and MR imaging lead us to believe that these deficits may result from a lesion at the level of the pituitary gland.

Cytodiagnosis of Coats' disease from an ocular aspirate. A case report

This paper describes the cytologic findings in a rare condition, Coats' disease, which was diagnosed from a sample of ocular aspirate in a 19-month-old boy. The cytologic findings were characterized by the presence of numerous cholesterol crystals, rare foamy macrophages, several pigment-laden macrophages, pigment-bearing epithelial cells and free pigment, which stained positive for melanin by Schmorl's stain. The case was unusual in that the clinical diagnosis was persistent hyperplastic primary vitreous, and other diagnoses, such as Coats' disease, were unsuspected. The cytologic findings suggested Coats' disease and seemed to exclude retinoblastoma or another malignancy, although the negative findings with the presence of cholesterol crystals and macrophages were regarded as somewhat nonspecific for unequivocally excluding any of the above.

Needle aspiration cytology, immunocytochemistry, and electron microscopic study in a case of carcinoid of the male breast

The diagnosis of a primary carcinoid of breast in a 68-yr-old male was initially made from a sample of needle aspirate. The cytodiagnosis was supported by histochemical and immunocytochemical studies which showed positivity for argyrophilic granules by Grimelius stain and positive staining for chromogranin. A subsequent cell block of the aspirate and biopsy of the tumour confirmed the cytodiagnosis. Electron microscopic study of the material further demonstrated the presence of neurosecretory granules in the malignant cells. Mastectomy with axillary node dissection was performed and showed no residual or metastatic tumour. No primary tumour was found elsewhere. This case illustrates the importance of needle aspiration cytology in the diagnosis of carcinoid tumour which is very rare in the male breast.

Problems with the "dural tail" sign

Prominent enhancement of the dura mater, the "dural tail" adjacent to a peripherally located mass on gadolinium-enhanced MRI has been described as being characteristic of meningiomas. We present a cerebral glioma showing the classical "dural tail".

p53 protein expression in Reed-Sternberg cells of Hodgkin's disease

Hodgkin's disease (HD) is perceived to be a malignant disease of the lymphoid system. One of the main obstacles into the investigation of the cell biology of Hodgkin's disease is the relative paucity of Reed-Sternberg cells (or variants), the presumed neoplastic component of this condition, which often make up less than 1% of the total cell number.

Intracellular and extracellular magnesium depletion in type 2 (non-insulin-dependent) diabetes mellitus

To investigate alterations of magnesium metabolism in Type 2 (non-insulin-dependent) diabetes mellitus, we utilized a new magnesium-specific selective ion electrode apparatus to measure serum ionized magnesium (Mg-io) in fasting subjects with and without Type 2 diabetes, and compared these values to levels of serum total magnesium, and of intracellular free magnesium (Mgi) analysed by 31P-NMR spectroscopy. Both Mg-io (0.630 +/- 0.008 vs 0.552 +/- 0.008 mmol/l, p < 0.001) and Mgi (223.3 +/- 8.3 vs 184 +/- 13.7 mmol/l, p < 0.001), but not serum total magnesium, were significantly reduced in Type 2 diabetes compared with non-diabetic control subjects. Furthermore, a close relationship was observed between serum Mg-io and Mgi (r = 0.728, p < 0.001). We suggest that magnesium deficiency, both extracellular and intracellular, is a characteristic of chronic stable mild Type 2 diabetes, and as such, may predispose to the excess cardiovascular morbidity of the diabetic state. Furthermore, by more adequately reflecting cellular magnesium metabolism than total serum magnesium levels, Mg-io measurements may provide a more readily available tool than has heretofore been available to analyse magnesium metabolism in a variety of diseases.

Hydrogen-1, sodium-23, and carbon-13 MR spectroscopy of cartilage degradation in vitro

Viable bovine nasal cartilage was examined with magnetic resonance (MR) spectroscopy. Digestion of the proteoglycan matrix by papain or trypsin was accompanied by substantial changes in carbon-13, sodium-23, and hydrogen-1 MR spectra and relaxation parameters, with C-13 MR spectra showing the most pronounced changes. These results indicate the potential of MR spectroscopy (and imaging) for noninvasive evaluation of cartilage disease and monitoring of patients with degenerative joint diseases.

Mutagenic potential of nitroguanidine and nitrosoguanidine in the Drosophila melanogaster sex-linked recessive lethal assay

Nitroguanidine (NG) and its degradation product nitrosoguanidine (NSG) were evaluated for their mutagenic potential by using Drosophila melanogaster sex-linked recessive lethal (SLRL) assay. Following 72 h of feeding exposure, NG and NSG at concentrations of 4-8 micrograms ml-1 and 15-20 mg ml-1, respectively, were not mutagenic in the test system. The frequencies of mutations for NG and the negative control were 0.188% and 0.096%, respectively. The frequencies of mutations for NSG and the negative control experiments were 0.049% and 0.05%, respectively. The positive control mutation frequencies were 15% and 17.8% for the two assays. The differences between the mutation frequencies of NG and NSG and their negative controls were not significant.

Determinants of release rate of tetanus vaccine from polyester microspheres

Controlled-release formulations based on poly(lactic) (PLA) and poly(lactic/glycolic) acid (PLGA) microspheres containing tetanus vaccine were designed. The polymers forming the microspheres were L-PLA of different molecular weights and DL-PLGA, 50:50. These microspheres were prepared by two solvent elimination procedures, both using a double emulsion, and were characterized for size, morphology, and toxoid release kinetics. The influence of formulation variables such as polymer type, vaccine composition, and vaccine/polymer ratio was also investigated. Both techniques yielded microspheres with similar size, morphology, and release properties. Microsphere size was dependent on the type of polymer and the presence of the surfactant L-alpha-phosphatidylcholine, which led to a reduction in microsphere size. On the other hand, the release kinetics of encapsulated protein were affected by the polymer properties (ratio lactic/glycolic acid and molecular weight) as well as by the vaccine composition, vaccine loading, and microsphere size. Moreover, for some formulations, a decrease in microsphere size occurred simultaneously, with an increase in porosity leading to an augmentation of release rate. The changes in the PLA molecular weight during in vitro release studies indicated that release profiles of tetanus toxoid from these microspheres were only marginally influenced by polymer degradation. A significant fraction of protein (between 15 and 35%) was initially released by diffusion through water-filled channels. In contrast, the decrease in the PLGA molecular weight over the first 10 days of incubation suggested that erosion of the polymer matrix substantially affects protein release from these microspheres. Among all formulations developed, two differing in microsphere size, polymer hydrophobicity, and release profile were selected for in vivo administration to mice.(ABSTRACT TRUNCATED AT 250 WORDS)

Scan-negative neurocysticercosis

An 11-year-old child was diagnosed as having benign intracranial hypertension on basis of clinical examination and normal CT scan. Magnetic resonance imaging demonstrated multiple lesions in both cerebral hemispheres, some of which showed nodular scolex characteristic of cysticerci.