Multi-Cellular Immunological Interactions Associated With COVID-19 Infections

To rapidly prognosticate and generate hypotheses on pathogenesis, leukocyte multi-cellularity was evaluated in SARS-CoV-2 infected patients treated in India or the United States (152 individuals, 384 temporal observations). Within hospital (<90-day) death or discharge were retrospectively predicted based on the admission complete blood cell counts (CBC). Two methods were applied: (i) a "reductionist" one, which analyzes each cell type separately, and (ii) a "non-reductionist" method, which estimates multi-cellularity. The second approach uses a proprietary software package that detects distinct data patterns generated by complex and hypothetical indicators and reveals each data pattern's immunological content and associated outcome(s). In the Indian population, the analysis of isolated cell types did not separate survivors from non-survivors. In contrast, multi-cellular data patterns differentiated six groups of patients, including, in two groups, 95.5% of all survivors. Some data structures revealed one data point-wide line of observations, which informed at a personalized level and identified 97.8% of all non-survivors. Discovery was also fostered: some non-survivors were characterized by low monocyte/lymphocyte ratio levels. When both populations were analyzed with the non-reductionist method, they displayed results that suggested survivors and non-survivors differed immunologically as early as hospitalization day 1.

Recurrent Epithelioid Hemangioendothelioma of Calcaneum: A Case Report of a Rare Tumor

Epithelioid hemangioendothelioma (EHE) is an uncommon malignant vascular tumor characterized by epithelioid or histiocytoid endothelial appearance. Here we present the case of a 65-year-old female with recurrent EHE of the left calcaneum. The patient had developed soft-tissue swelling over the lateral aspect of the left hindfoot three years ago, which was previously managed by excisional biopsy as per medical records and the histopathological examination (HPE) had revealed an EHE. A year later, she again developed a painful swelling with superficial ulceration over the same region and presented to us. A plain radiograph of the foot showed a soft-tissue swelling with cortical breach over the lateral aspect of calcaneum. MRI revealed a mass encasing peroneus tendons, with extension into the lateral surface of calcaneum. CT angiography revealed a mass eroding the lateral cortex of calcaneum and receiving blood supply from calcaneal branches of peroneal artery. PET-CT scan did not reveal any other primary or metastatic site. Core needle biopsy of calcaneum was suggestive of EHE. Limb salvage was difficult as the tumor was recurrent and involved the skin and the weight-bearing part of the calcaneum. The patient was managed with trans-tibial amputation. Immunohistochemical (IHC) staining of the excised tissue was positive for CD34, Vimentin, SMA, and Fli-1. The margins were negative for any tumor cells and she did not require any adjuvant therapy. At two years follow-up, she was free of any further recurrence or metastasis. Recurrent tumors of this variety are fast-growing with metastatic potential and may cause mortality. Hence, they need to be managed aggressively.

Winging of Scapula: An Uncommon Presentation of a Common Tumor

Neuromuscular causes of winging of scapula are well known, but winging and snapping of scapula may rarely be caused by space-occupying lesion of the thoracic wall. Although osteochondroma of scapula is rare, it is the most common neoplasm of scapula, and osteochondroma of ventral scapula may lead to pseudo-winging, snapping, and rib erosion on the same side. Owing to its rarity, we report two cases of osteochondroma of ventral scapula with complains of difficult scapulothoracic movement (snapping scapula) and pseudo-winging. After initial clinical and radiological investigations, wide local excision was done and diagnosis confirmed histopathologically. In a two-year follow-up, there is no recurrence, and symptoms of snapping and pseudo-winging disappeared completely. Pertaining to its asymptomatic nature and rare location, diagnosis of osteochondroma may be missed initially searching for some other neuromuscular disorders, and these cases should be reported to increase awareness and to execute proper surgical management.

Osteoblastoma of Talus: A Diagnostic Dilemma

The critical biomechanical importance of talus and nonspecific clinical features of talus lesion warrants a meticulous diagnostic work-up for specific management, particularly when the talus lesion is associated with concomitant soft tissue and joint abnormalities. We present a rare case of osteoblastoma of talus with concomitant tenosynovitis of tibialis anterior, ankle joint effusion, varicose vein and moderate distal arterial stenosis.

The high pressure gas capabilities at Oak Ridge National Laboratory's neutron facilities

The study of samples subjected to high pressure gas is an important asset in materials research and has consequently been a priority of the sample environment development at the Oak Ridge National Laboratory's (ORNL) neutron program. Such effort has resulted in the availability of an extensive combination of pressure cells and gas intensifiers (both commercially available and custom made). These resources are available across both neutron facilities at ORNL: the Spallation Neutron Source and the High Flux Isotope Reactor. Current capabilities include, for example, in situ measurements up to 6 kbar and a 3 kbar hydrogen-capable intensifier with a gas recovery feature. In this communication, we will review the existing suite of high pressure gas capabilities, with special emphasis on recent in-house developments. A number of examples will be presented to illustrate how such capabilities are being deployed on neutron beamlines to enable frontier science.

Esophageal Melanocytosis - An Unusual Melanocytic Entity

Esophageal melanocytosis is a rare benign condition characterized by melanocytic proliferation in esophageal squamous epithelium and melanin deposition in the mucosa. Because of its uncommon nature, pathologists and gastroenterologists lack experience with this entity. We present a case of esophageal melanocytosis in a 66 years old male patient who presented with atypical chest pain and dysphagia. Endoscopic guided biopsy was done, provisional diagnosis of esophageal melanocytosis was made. Bleaching and immunohistochemistry confirmed the diagnosis.

Dynamic free energy surfaces for sodium diffusion in type II silicon clathrates

Earth abundant semiconducting type II Si clathrates have attracted attention as photovoltaic materials due to their wide band gaps. To realize the semiconducting properties of these materials, guest species that arise during the synthesis process must be completely evacuated from the host cage structure post synthesis. A common guest species utilized in the synthesis of Si clathrates is Na (metal), which templates the clathrate cage formation. Previous experimental investigations have identified that it is possible to evacuate Na from type II clathrates to an occupancy of less than 1 Na per unit cell. This work investigates the energetics, kinetics, and resulting mechanism of Na diffusion through type II Si clathrates by means of biased molecular dynamics and kinetic Monte Carlo simulations. Well-tempered metadynamics has been used to determine the potential of mean force for Na moving between clathrate cages, from which the thermodynamic preferences and transition barrier heights have been obtained. Kinetic Monte Carlo simulations based on the metadynamics results have identified the mechanism of Na diffusion in type II Si clathrates. The overall mechanism consists of a coupled diffusive process linked via electrostatic guest-guest interactions. The large occupied hexakaidechedral cages initially empty their Na guests to adjacent empty large cages, thereby changing the local electrostatic environment around the occupied small pentagonal dodecahedral cages and increasing the probability of Na guests to leave the small cages. This coupled process continues through the cross-over point that is identified as the point where large and small cages are equally occupied by Na guests. Further Na removal results in the majority of guests residing in the large cages as opposed to the small cages, in agreement with experiments, and ultimately a Na free structure.

Tetra-phocomelia: a rarest of rare case

We present a rarest of rare case of Tetra-Phocomelia evaluated by antenatal Ultrasonography. It is a condition seen in 0.62 per 100,000 live births. An ultrasonogram was done at 18 wk of pregnancy to assess the fetus and after termination gross specimen was evaluated and X-ray infantograms were done to confirm the findings. The case showed classic Tetra-Phocomelia with limbs like flippers of a seal. Our findings make it rarest of rare as only few cases have been so far reported.

Ovarian development in Wistar rat treated prenatally with single dose diisobutyl phthalate

Phthalates are a class of industrial compounds with an array of toxicological properties used in day to day life. Diisobutyl phthalate on (DIBP) is used as an additive to keep the plastics soft or flexible (plasticizer) in nitrocellulose plastic, nail polish, explosives, lacquer manufacturing etc. Although DIBP exposure in humans is generally low, people in adhesive industries and pharmaceutical industries are exposed to higher levels. The aim of this study was to determine the effect of single dose of DIBP on developing ovary of Wistar rat. One hundred and eight adult pregnant Wistar rats were divided into control and experimental groups. Rats in experimental group were given DIBP on day 10, 12 and 14 of gestation at 0.375, 0.75 and 1.25 ml/kg body weight dose intraperitoneally in a single dose. Sections of ovaries collected on day 21 of gestation were stained with hematoxylin and eosin and examined and Masson's trichrome histologically. Sections belonging to the control group showed the presence of oocytes in clusters separated by thin fibrous septa. Degeneration oocytes, empty follicles surrounded by follicular cells without gonocytes in the center were observed in ovarian stroma. Blood vessels in the ovarian stroma were prominent and congested. Around a bunch of follicles total architectural disarray was observed although on special staining fibrosis was not evident. As pregnant women are constantly exposed, effect of DIBP on ovary of a developing fetus would denote the long term consequence in future generations (Fig. 5, Ref. 39).

Laparoscopic Management of Tubo-Ovarian Stitch Abscess after Tubal Sterilization

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In few cases, it can occur as a result of direct contamination at the time of tubal sterilization. We describe two rare cases of “tubo-ovarian stitch abscess” after post-partum tubal sterilization and managed successfully by laparoscopy at a tertiary care teaching hospital.

Unreamed interlocking nailing in open fractures of tibia

PURPOSE

To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the unreamed intramedullary nailing.

METHODS

Between June 1999 and May 2000, a total of 60 cases of open tibial shaft fractures were operated on with unreamed interlocking nails at Safdarjung Hospital, New Delhi, India. Records of 56 patients (4 women and 52 men) were available for study. Only injuries associated with the tibial shaft were included. Traffic accidents were the cause of fractures in all patients. All fractures were classified according to Gustilo and Anderson system for open fractures. There were 30 (53.6%) type-I, 18 (32.1%) type-II, 4 (7.1%) type-IIIA, and 4 (7.1%) type-IIIB fractures. After thorough debridement under anaesthesia, an unreamed interlocking nail was inserted with assistance by an image intensifier. All nails were statically locked with one screw each proximally and distally.

RESULTS

The patients were followed up for a mean period of 20 months (range, 18-24 months) and were evaluated according to the modified Ketenjian's criteria. Results were good to excellent in 85.8% cases, and poor in 10.7% cases. Only 2 of 8 patients with type-III fractures had good results. Two of 4 type-IIIA and all 4 type-IIIB fractures had chronic osteomyelitis. Of 56 patients, 6 had early infection, 6 had delayed union, 6 had infected non-union, 2 had nail breakage, 8 had screw breakage, and 10 had anterior knee pain.

CONCLUSION

Unreamed interlocking tibial nailing can be safely used for type-I and type-II open injuries even with delayed presentation. Use of unreamed nailing in those type-III fractures with delayed presentation was not recommended, because of high incidence of complications.

Inflammatory pseudotumor of the heart causing aortic regurgitation

Inflammatory pseudotumor is a tumor-like reactive lesion of unknown etiology that rarely affects the heart. We describe an unusual case of a cardiac inflammatory pseudotumor that involved the aortic valve and caused regurgitation in a 62-year-old man. The lesion was excised and the aortic valve was replaced, resulting in a favorable outcome for the patient.

Comparative evaluation of agar gel precipitation, counterimmunoelectrophoresis and passive haemagglutination tests for the diagnosis of Dicrocoelium dendriticum infection in sheep and goats

The sensitivity and specificity of the agar gel precipitation test (AGPT), counter immunoelectrophoresis (CIEP) and passive haemagglutination test (PHT) were evaluated for the diagnosis of Dicrocoelium dendriticum infection in naturally infected sheep and goats. Two hundred and forty five sheep and goat sera samples were tested using phosphate buffered saline, pH 7.2 extracted adult fluke antigen. CIEP detected 69.8% of the infected animals and was found to be the most sensitive, followed by PHT which detected 50.0% of the infected sheep and goats. AGPT was found to be the least sensitive, detecting only 23.8% of the infected animals. The specificity of

Calbindin-D28k in subsets of medulloblastomas and in the human medulloblastoma cell line D283 Med

OBJECTIVE

To evaluate the antigenic expression of calbindin-D28k in surgically resected cerebellar medulloblastomas and the human medulloblastoma cell line D283 Med in relation to glial neoplasms, the human glioblastoma (U-251 MG) and rat glioma (C-6) cell lines, and other primary and metastatic brain tumors.

DESIGN

Immunohistochemical staining was performed using an antiserum and a monoclonal antibody against calbindin-D28k on (1) formalin-fixed, paraffin-embedded human, predominantly posterior fossa, brain tumor specimens (49 medulloblastomas, 59 glial and mesenchymal primary central nervous system tumors, 1 posterior fossa rhabdoid tumor, and 34 metastatic tumors); (2) formalin-70% alcohol-, or Bouin's-fixed tumor cell lines (D283 Med, U-251 MG, and C-6) maintained in a three-dimensional gelatin foam (Gelfoam matrix) system, with or without treatment with dibutyryl cyclic adenosine monophosphate; and (3) formalin-fixed, paraffin-embedded C-6 glioma cells transplanted intracerebrally to rats.

RESULTS

Calbindin-D28k immunohistochemical staining was detected in 20 of 49 cerebellar medulloblastomas and in cells of the human medulloblastoma cell line D283 Med grown in gelatin Gelfoam matrices, with or without treatment with dibutyryl cyclic adenosine monophosphate. In surgical resection specimens, calbindin-D28k reactivity was evident in populations of poorly differentiated cells of classic (non-nodular) medulloblastomas (16/20) and in mature Purkinje neuronlike phenotypes in medulloblastomas with ganglion cells (4/6) but was absent in desmoplastic medulloblastomas, including in areas of neoplastic neuritogenesis ("pale islands") (0/23). Calbindin-D28k staining was also present in D283 Med explants for up to 29 days in vitro. Reactivity was more widespread in dibutyryl cyclic adenosine monophosphate-treated cultures, coinciding with neuronal morphologic alterations of cultured cells. Focal calbindin-D28k stainig was present in neural-like cells of an embryonal cerebellar tumor with divergent mesenchymal, epithelial, and neuroectodermal/neuroendocrine differentiation suggestive of a malignant rhabdoid tumor. No calbindin-D28k staining was obtained in primary glial and mesenchymal (intra- and extra-axial) brain tumors (0/59), in explants of human glioblastoma cell line U-251 MG, or in the rat glioma line C-6 maintained in Gelfoam matrices or transplanted intracerebrally. Among 34 epithelial and mesenchymal tumors metastatic to the posterior fossa, only subpopulations of cells in two small-cell (neuroendocrine) carcinomas originating in the lung were calbindin positive.

CONCLUSION

Calbindin-D28k expression in classic medulloblastomas, medulloblastomas with ganglion cells, and in the human medulloblastoma cell line D283 Med (which was derived from a metastatic classic medulloblastoma) suggests a phenotypic kinship between subsets of this tumor and neuronal progeny of the ventricular neuroepithelium, thus conferring additional support for its neuroblastic nature.

A cytomorphological scheme of differentiating neuronal phenotypes in cerebellar medulloblastomas based on immunolocalization of class III beta-tubulin isotype (beta III) and proliferating cell nuclear antigen (PCNA)/cyclin

This immunohistochemical study compares the localization of the neuronal class III beta-tubulin isotype (beta III) to that of the proliferating cell nuclear antigen (PCNA)/cyclin in 46 cerebellar neuroblastic tumors (medulloblastomas). Both class III beta-tubulin (beta III) and PCNA/cyclin reactivities were present in all tumors, but the topographic distribution and cytomorphologic features of stained cells varied considerably between classic and desmoplastic medulloblastomas. Four neoplastic phenotypes, representing gradations of neuronal differentiation, were identified: [Allegranza 1991] apolar, blast-like PCNA/cyclin(+) cells devoid of beta III reactivity (Nb1); [Bravo et al. 1987] apolar, often binucleated and/or fusiform, PCNA/cyclin (+) cells with pronounced beta III staining in their protoperikarya and their growth cones (Nb2); [Burger et al. 1987] beta III-immunoreactive immature polar neurons with varying degrees of neuritic development, reading to significant neuritogenesis in the "pale islands" of desmoplastic medulloblastomas (Nb3). The majority of Nb3 phenotypes were PCNA/cyclin (-), although subpopulations of such polar tumor cells exhibiting PCNA staining were also identified; and [Burger et al. 1991] beta III-immunoreactive, PCNA/cyclin (-) mature ganglion-like cells (Nb4). A high PCNA/cyclin labeling index (> 80%) was obtained in 20 poorly differentiated classic medulloblastomas while, significant intratumoral staining heterogeneity was observed in 23 cases of desmoplastic medulloblastomas and 3 cases of "medulloblastomas with ganglion cells": A high labeling index (LI)(> 80%) in the reticulin-impregnated poorly differentiated areas of tumor contrasted with sharp decline of PCNA staining and a very low LI (< 10%) in areas of overt neoplastic neuritogenesis ("pale islands") displaying strong beta III reactivity. Neoplastic ganglion cells were beta III (+)/PCNA (-). Our findings indicate that the majority of differentiating neuronal phenotypes undergoing cytomorphological changes of neuritic development (Nb3), and all neoplastic ganglion cells (Nb4 phenotypes) are PCNA (-), in contrast to actively proliferating, poorly differentiated, tumor cells that are PCNA (+). Although PCNA staining corresponded in part, to beta III (-) blast-like elements (Nb1), a co-expressive pattern of staining for beta III and PCNA/cyclin also was observed in subpopulations of poorly differentiated tumor cells (Nb2), indicating that transformed neuroblasts are capable of expressing differentiation-associated neuronal cytoskeletal proteins while still remaining in the proliferative compartment of the cell cycle. Our observations suggest that only neuritogenesis and acquisition of ganglionic phenotype are significant maturational events in medulloblastomas (indicating entry into the quiescent phase of the cell cycle) and provide further support for the neuronal lineage and differentiation potential of these cerebellar embryonal tumors.

Thallium imaging for brain tumors with results measured by a semiquantitative index and correlated with histopathology

BACKGROUND

The optimal management of patients with brain tumors requires knowledge of the tumor characteristics upon presentation and the discovery of recurrence after therapy. Thallium-201 (Tl-201) chloride has shown varying uptake in tumors, depending on their viability and the type and degree of malignancy. This study explores the diagnostic potential of thallium imaging in patients with brain tumors.

METHODS

Forty-three Tl-201 single photon emission computed tomographic scintigrams were performed on 40 patients with intracranial neoplasms, nearly equally divided between patients with no prior treatment and patients who had prior treatment and were suspected to have recurrent tumor and/or radiation necrosis. A thallium tumor index was calculated as the ratio of counts for a region of interest drawn in the lesion area and its mirror image in normal brain tissue. A two-tailed Student's t test was performed to compare the thallium index and histopathologic findings.

RESULTS

A value of 1.5 for the thallium tumor index allowed for the best correlation between the prediction of malignancy and the histopathologic results. In the pretreatment group, a thallium tumor index greater than 1.5 correlated with high grade malignancy, and less than 1.5 correlated with either a well differentiated astrocytoma or benign cyst. In the posttreatment group, a thallium tumor index greater than 1.5 correlated with recurrent and/or residual malignant tumor.

CONCLUSIONS

For those patients undergoing initial evaluation, the thallium study can help in the differential diagnosis of an intracranial mass lesion and offers confirmation of results of biopsy. For those patients who already have received treatment, the study can be used to detect recurrent or residual tumor.

Lobar pilocytic astrocytomas of the cerebral hemispheres: I. Diagnosis and nosology

This study provides neuropathological and neuroradiological observations on 11 cases of lobar pilocytic astrocytomas of the cerebral hemispheres, reappraising potential diagnostic caveats. These tumors may show variable degrees of contrast enhancement on computed tomography, as well as gadolinium uptake on magnetic resonance imaging, making them indistinguishable from malignant gliomas. Histopathologically, although typically pilocytic, they may exhibit areas of increased cellular density with protoplasmic and multinucleated glial elements (pilo-protoplasmic astrocytoma). The presence and particularly the abundance of distinct gliodegenerative structures, i.e. eosinophilic granular bodies (EGBs) and to a lesser degree Rosenthal fibers, in conjunction with collateral clinical, histologic and imaging parameters may facilitate oncotypic diagnosis. Mixed pilocytic and fibrillary astrocytomas are recognized, while malignant change may also rarely occur in longstanding lobar pilocytic astrocytomas.

Lobar pilocytic astrocytomas of the cerebral hemispheres: II. Pathobiology--morphogenesis of the eosinophilic granular bodies

This study provides new immunocytochemical observations on the so-called eosinophilic granular bodies (EGBs), seen predominantly (but not exclusively) in pilocytic astrocytomas. Using combined immunohistochemical and immunoelectron microscopic approaches on formalin-fixed, paraffin-embedded tissues, we have demonstrated that (1) EGBs exhibit pronounced reactivity with antibodies to serine protease inhibitors alpha-1-antichymotrypsin and alpha-1-antitrypsin; by immunoelectron microscopy, the reaction product is localized either in the form of diffuse floccular densities, or larger conglomerates of amorphous, globular material; (2) an antiserum to ubiquitin-protein conjugates, codistributes in the EGBs at the light microscopic level, while ultrastructurally is either localized in diffuse, finely granular deposits, and/or fragmented filamentous particles; and (3) that a monoclonal antibody to beta-amyloid precursor protein (beta-APP) stains smaller EGBs. The detection of serpin-like and beta-APP-like staining in EGBs may be a reflection of acute phase reactant activity in response to tumor-produced proteases. We postulate that EGBs contain complexes of serpins and hitherto unknown protease(s), which are in turn probably degraded via ubiquitin mediated mechanism(s). Although EGBs typify pilocytic astrocytomas, they may be exceptionally present in malignant astrocytomas, calling for cautious interpretation of their biologic as well as prognostic import.

Novel immunohistochemical localization of 28,000 molecular-weight (Mr) calcium binding protein (calbindin-D28k) in enterochromaffin cells of the human appendix and neuroendocrine tumors (carcinoids and small-cell carcinomas) of the midgut and foregut

Calbindin-D28k is a highly conserved 28,000 (dalton) molecular-weight (Mr) calcium binding protein with broad tissue distribution, yet cell-type-specific expression predominantly in subpopulations of central and peripheral nervous system neurons, distal tubular cells of the kidney, and enteric neuroendocrine cells. A polyclonal antiserum against rat renal calbindin-D28k and a monoclonal antibody to calbindin-D28k purified from chicken intestine (clone CL-300) were used for immunohistochemical evaluation of formalin-fixed, paraffin-embedded tissues from multiple areas of the human small and large intestines and 93 primary neoplasms of the gastrointestinal tract (foregut, midgut, and hindgut derivatives) and the lung (foregut derivative). Calbindin-D28k immunostaining was obtained in a minority of enterochromaffin (neuroendocrine) cells, predominantly of the appendix and small intestine, as well as in autonomic neurons of the neural plexuses. Focal cytoplasmic Golgi-type staining was obtained with monoclonal antibody CL-300 in the appendiceal surface epithelium and dendritic macrophages confined to the appendiceal lymphoid follicles. Epithelial progenitor cells in enteric crypts and absorptive, goblet, and Paneth cells were calbindin-D28k negative, while no immunoreactivity was demonstrated in the mucosae of the colon and rectum. Calbindin-D28k staining was consistently detected in subpopulations of neuroendocrine phenotypes in midgut (appendiceal/ileal) and foregut (bronchial) carcinoids and small-cell carcinomas, but was absent in adenocarcinomas, squamous cell carcinomas, leiomyomas/leiomyosarcomas, schwannomas, and lymphomas. Our observations suggest that calbindin-D28k is a novel adjuvant neuroendocrine marker that is potentially useful in diagnostic tumor immunohistochemistry.

The role of gallium-67-citrate in the detection of phenytoin-induced pneumonitis

A patient with a history of cardiac transplant presented with a fever of undetermined etiology. The patient had been on multiple medications, including phenytoin, which can occasionally cause allergic or hypersensitivity pneumonitis. A chest x-ray and CT scan of the chest revealed no active disease. A 67Ga study was obtained after intravenous administration of 377.4 MBq (10.2 mCi) of 67Ga-citrate. The images showed diffuse intense lung uptake bilaterally. Bronchoscopic biopsy revealed hypersensitivity pneumonitis. Phenytoin was withdrawn and corticosteroid was started in therapeutic doses. A follow-up gallium study obtained 25 days after the baseline demonstrated marked improvement in the lungs with concurrent clinical recovery. This case illustrates the usefulness of 67Ga in the detection of drug-induced pneumonitis and in the follow-up of response to therapy.

Indium-111-labeled anti-EGFr-425 scintigraphy in the detection of malignant gliomas

BACKGROUND

The monoclonal antibody anti-epidermal growth factor receptor (EGFr) antibody-425, against the epidermal growth factor receptor, has the potential to bind specifically to gliomas and not normal brain tissue. A prospective study was conducted (1986-1988) to evaluate the use of Indium-111 (111In)-labeled anti-EGFr-425 in the localization of gliomas before radioimmunotherapy with Iodine-125 (125I)-labeled anti-EGFr-425.

METHODS

Twenty-eight patients with intracranial neoplasms were injected intravenously with an average dose of 2.2 mCi 111In-labeled anti-EGFr-425. Planar and single-photon emission computed tomography scans were performed after 48 and 72 hours. Control studies also were performed in two cases with 111In-labeled Co 17-1A (an antibody to colorectal cancer) and in one case with unlabeled 111In chloride.

RESULTS

The immunoscintigraphic findings were generally in good agreement with computerized tomographic findings. The definitive diagnosis was established by biopsy findings: 23 gliomas (1 Grade I, 5 Grade II, 6 Grade III, and 11 Grade IV), 1 meningioma, and 4 metastatic lesions. The localization of gliomas with 111In-labeled anti-EGF-425 had a sensitivity of 0.96, a specificity of 0.60 and an accuracy of 0.90.

CONCLUSION

Immunoscintigraphy with 111-In labeled anti-EGFr-425 can be useful in the management of malignant gliomas, especially before radioimmunotherapy with 125I-labeled anti-EGFr-425.

Paradoxical changes in iodine-131 scintigraphic findings in advanced follicular thyroid cancer

We present the findings on iodine-131 (131I) scintigraphy, thallium-201 (201Tl) scintigraphy and quantitative thyroglobulin (QTG) estimation in two patients with follicular carcinoma of the thyroid with extensive metastases. The lesions were initially seen on 131I scintigraphs, but were not subsequently visualized with scanning doses of 131I (5 mCi), while retaining their ability to produce increasing amounts of thyroglobulin and take up 201Tl. Implications in choosing the appropriate diagnostic tests in the management of differentiated thyroid cancer are discussed.

The role of iodine-131 and thallium-201 imaging and serum thyroglobulin in the management of differentiated thyroid carcinoma

BACKGROUND

A prospective study was conducted to evaluate the use of iodine-131 sodium scintigraphy, thallium-201 chloride scintigraphy, and quantitative serum thyroglobulin estimation in the detection of differentiated thyroid carcinoma after thyroidectomy and iodine-131 sodium ablative therapy.

METHODS

Thirty-one patients with a median age of 45.6 years (range, 20-73 years) were included in the study. After optimal endogenous thyroid-stimulating hormone stimulation (> 50 mU/ml), 53 pairs of iodine-131 and thallium-201 scans were performed. Concomitant serum thyroglobulin levels were available for 32 pairs of scans. The presence or absence of thyroid cancer was established by clinical, radiologic, and/or biopsy findings.

RESULTS

The concordance between iodine-131 and thallium-201 scan findings in the presence of disease (25 scan sets) was 36%. The concordance in the absence of disease (28 scan sets) was 82%. Iodine-131 scanning was found to be significantly better (P < 0.05) than thallium-201 scanning, in terms of sensitivity (0.8 versus 0.6), specificity (0.96 versus 0.82), accuracy (0.89 versus 0.72), and the predictive value of a positive test (0.95 versus 0.75). The measurement of serum thyroglobulin had a low sensitivity (0.3) in the study but had a specificity of 1.0.

CONCLUSION

It was concluded that iodine-131 sodium scintigraphy is superior to thallium-201 scintigraphy and serum thyroglobulin estimation for the detection of residual or metastatic differentiated thyroid carcinoma. However, the use of combined modalities provides a higher diagnostic yield. Thallium-201 scintigraphy was especially useful in cases in which iodine-131 scintigraphy was negative and quantitative thyroglobulin levels were elevated.

Abnormal intracerebral thallium localization in a bacterial brain abscess

A 56-yr-old man with a prior history of renal cell carcinoma had moderately intense abnormal localization of 201Tl-chloride in a solitary brain lesion which was discovered to be a bacterial abscess. The organisms isolated by culture included Actinomycosis odontolyticus, Peptostreptococcus and Hemophilus aphrophilus. Because of the clinical presentation, MRI characteristics and thallium scintigraphic findings, the lesion had been felt to represent either a primary or a metastatic neoplasm. This case illustrates the need for caution in the interpretation of thallium brain scintigram.

An outbreak of aflatoxicosis in Angora rabbits

An outbreak of aflatoxicosis in Angora rabbits involving a large number of rabbitries was investigated. Mortality was more in weaners than in adults. Affected animals showed anorexia, dullness and weight loss followed by jaundice in terminal stages. Death occurred within 3-4 d of the appearance of clinical signs. Livers were moderately to severely congested, icteric and were hard to cut. Gall bladders were distended and had inspissated bile. Liver sections showed degenerative changes of hepatic cells along with dilatation and engorgement of sinusoids. Bile ducts had mild to severe periportal fibrosis. Focal areas of pseudolobulation and regenerative foci were also predominant. The level of aflatoxin B1 in feed samples from various farms submitted at the time of the investigation varied from 90 to 540 ug aflatoxin B1/kg of feed. Withdrawal of feed and supplementary therapy resulted in gradual disappearance of signs and mortality.

Investigation of "mysterious" disease in livestock: hydrocyanic acid poisoning

An investigation of "mysterious" disease due to hydrocyanic acid (HCN) poisoning in livestock in this state was carried out. Detailed clinicopathological and pathological studies were conducted. Characteristic signs of acute tympany followed with profuse frothing, convulsions and dyspnea were recorded. Cynosis of the mucosa with characteristic anoxemic tissue changes and a high concentration of HCN in rumen content, feed and skeletal muscles were recorded. These were sufficient to establish the diagnosis. Successful treatment with a specific antidote was achieved, and further morbidity and mortality was checked.

Erythrocyte glutathione and its metabolizing enzymes in bovine urinary bladder cancer

Glutathione and its metabolizing enzymes were studied in erythrocytes of cattle suffering from urinary bladder cancer and associated hematuria. The concentration of glutathione (GSH) and GSH peroxidase activity were subnormal in the affected animals, whereas activities of GSH reductase and GSH S-transferase were not altered. Decreased GSH and GSH peroxidase are likely to make erythrocytes of the affected animals more susceptible to oxygen-induced injury and the radiomimetic effect of bracken fern.

Erythrocyte membrane alterations in enzootic bovine hematuria

Erythrocyte membrane enzymes and chemical constituents were studied in animals presenting enzootic bovine hematuria (EBH) and in normal animals. Mg2+-ATPase, Na+, K+, Mg2+-ATPase and ouabain insensitive Na+, K+, Mg2+-ATPase activity were decreased significantly in the affected animals. Cholesterol:phospholipid and sialic acid:phospholipid ratios also decreased in animals suffering from EBH. No significant changes were found in acetylcholinesterase, sialic acid, sulfhydryl groups and cholesterol in membranes of affected animals.

Toxicity of lantana (Lantana camera L) leaves and isolated toxins to rabbits

Oral administration of lantana leaves (6 g/kg body weight) and isolated toxins (125 mg/kg body weight) to rabbits caused ictericity, anorexia and decrease in fecal output. There was increased size of the kidneys, and the livers were ochre-colored and fragile but there was no hepatomegaly. Histopathologically, lantana-intoxicated rabbits had swellings of hepatic cells, portal fibrosis, dilatation of bile canaliculi and biliary hyperplasia. Kidneys had proliferation of mesenchymal cells in glomerular tufts, degeneration of tubules, swelling of tubular epithelial cells and pyknosis of nuclei. The intoxicated animals had elevated levels of conjugated and unconjugated bilirubin in plasma, the major increase being in the conjugated form (suggestive of obstructive jaundice). There were marginal changes in the activities of acid phosphatase and glutamate oxaloacetate transaminase in the plasma.

The enzymatic profile of urine and plasma in bovine urinary bladder cancer (enzootic bovine haematuria)

The enzymatic profile of urine and plasma in field cases of bovine bladder cancer was studied. Urinary lactate dehydrogenase activity was significantly altered along with the isoenzyme pattern. Activity of alkaline phosphatase and beta-glucuronidase was decreased in the affected animals. No significant changes were observed in acid phosphatase, or arylsulphatase A and B activity. In plasma, lactate dehydrogenase activity was elevated without any change in the isoenzyme pattern. No significant changes were observed in the other plasma enzymes studied or in the sialic acid concentration.