Radiology of Castleman disease: the pivotal role of imaging in diagnosis, staging, and response assessment of this rare entity

Castleman Disease (CD) is a rare entity that typically presents as an enhancing nodal mass in the mediastinum or head and neck region on computed tomography (CT). It may manifest as unicentric or multicentric regions of lymph node enlargement. A key clinical issue in the context of CD is delayed diagnosis, which contributes adversely to patient outcome, given that accurate diagnosis facilitates earlier treatment of this curable disease. This article will address relevant imaging aspects, with reference to typical and atypical imaging features of CD, illustrated using examples from our specialist centre; the imaging journey for patients with CD; and will provide practical pointers to radiologists in differentiating CD from other benign and malignant causes of enhancing lymphadenopathy, including lymphoma and neoplastic adenopathy. We will also review current classification tools and staging challenges with reference to World Health Organization guidelines, International Working Group guidelines as well as the Lugano classification. Finally, we will discuss the potential role of additional imaging techniques in CD, highlighting novel imaging methods and expanded utilities from our specialist centre.

Different cleft conditions, facial appearance, and speech: relationship to psychological variables

OBJECTIVE

The purpose of this investigation was to study the adjustment and learning characteristics of children with different types of clefts. The hypotheses were that there may be different relationships among cleft variables (speech and appearance) according to the cleft types.

DESIGN

The study compared three cleft groups on behavior rating, anxiety scales, depression scales, and self-perception (analyses of variance) and examined the influence of facial and speech ratings on self-perception (multiple regression analyses).

SETTING

All patients were treated at a university hospital cleft palate clinic.

PATIENTS

Sixty-five children aged 8 years to 17 years were selected based on nonsyndromic cleft (unilateral cleft lip and palate [ULP], bilateral cleft lip and palate [BLP], and cleft palate only [CPO]) and no significant neurological condition or hearing loss.

RESULTS

The findings indicated children with CPO showed greater problems with parent- and teacher-reported depression, anxiety, and learning related to speech than children with ULP or BLP. The later two groups showed fewer problems and a greater relationship of problem to facial appearance. The children with ULP self-reported lower levels of depression than the other two groups.

CONCLUSIONS

Children with cleft show relatively good overall adjustment, but some problems appear related to speech and facial appearance. Subgroups may need to be studied separately.

Acute infantile hemorrhagic oedema

Acute infantile hemorrhagic oedema (AIHO) was first described in 1913 but, despite frequent reports in the European literature, it is not well recognized in the English language literature. It is considered by many to be a variant of Henoch Schonlein Purpura (HSP) because of similarities in cause and histopathology. However, because of the benign nature of this condition and frequent absence of IgA associated with HSP, it may be sensible to consider this as a distinct variety of cutaneous small vessel vasculitis (CSVV). We report this case to highlight the condition and emphasize its benign nature.

Brief report: cleft lip and palate: longitudinal behavior and relationships of cleft conditions to behavior and achievement

Analyzed longitudinal behavior ratings (ANOVAs) for 44 children (ages 4-12) with cleft lip and palate and cleft palate only (CLP) and examined the relationship of speech, hearing, and facial disfigurement at age 9 in predicting behavioral characteristics and school achievement (multiple regression). Results indicate increasing levels of social inhibition over age for girls with CLP, but less so for boys. There were also increasing levels of conduct problems for older girls with CLP with variable age fluctuation for boys. Attempts to relate speech, hearing, or facial disfigurement to prediction of behavior or achievement at age 9 were not revealing and further analysis with larger samples is indicated.

Choice-making treatment of young children's severe behavior problems

The choice-making behavior of 5 young children with developmental disabilities who engaged in aberrant behavior was studied within a concurrent operants framework. Experimental analyses were conducted to identify reinforcers that maintained aberrant behavior, and functional communication training packages were implemented to teach the participants to gain reinforcement using mands. Next, a choice-making analysis, in which the participants chose one of two responses (either a mand or an alternative neutral response) to obtain different durations and qualities of reinforcement, was conducted. Finally, treatment packages involving choice making via manding were implemented to decrease inappropriate behavior and to increase mands. The results extended previous applications of choice making to severe behavior disorders and across behaviors maintained by positive and negative reinforcement.

Use of component analyses to identify active variables in treatment packages for children with feeding disorders

We evaluated the separate components in treatment packages for food refusal of 4 young children. First, treatment packages were implemented until food acceptance improved. Next, a component analysis was conducted within a multielement or reversal design to identify the active components that facilitated food acceptance. The results indicated that escape extinction was always identified as an active variable when assessed; however, other variables, including positive reinforcement and noncontingent play, were also identified as active variables for 2 of the children. The results suggest that the component analysis was useful for identifying variables that affected food acceptance.

Brief hierarchical assessment of potential treatment components with children in an outpatient clinic

Seven patients conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these 6 children, improved behavior occurred with changes in treatment components. Our results extend previous studies of direct assessment procedures conducted in outpatient clinic settings.

A brief component analysis of potential treatment packages in an outpatient clinic setting with young children

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.

Analysis of the effects of task preferences, task demands, and adult attention on child behavior in outpatient and classroom settings

Two studies were conducted with children who displayed behavior problems to evaluate the effects of task preference, task demands, and adult attention on child behavior. In Study 1, we conducted brief functional analyses in an outpatient clinic to identify variables that facilitated appropriate behavior. For 8 of 10 children, distinct patterns of performance occurred; 3 children displayed improved behavior with changes in task demands, 1 child displayed improved behavior with a preferred task, and 4 children displayed improved behavior with changes in adult attention. In most cases, the children's parents carried out the assessments with adequate procedural integrity. In Study 2, we applied similar assessment methods to a classroom setting over an extended period of time. We identified independent variables controlling appropriate, on-task, and academic behavior for 2 children on two tasks, with slightly different treatment procedures across tasks for both children. In addition, the results of brief functional analyses for both children corresponded to the extended classroom assessments.