Rhabdomyosarcoma or Fibrosarcoma? A Case of Large Ulcerated and Necrotic Lesion on the Forearm of a Newborn

Congenital infantile fibrosarcoma (CIFS) is a rare malignant soft tissue tumor. The incidence of fibrosarcoma is estimated to be 0.3 per 100 000 population per year, and it accounts for less than 1% of all soft tissue sarcomas. We present a case of a 7-day-old newborn with a large ulcerated and necrotic lesion on the left forearm, which was initially misdiagnosed as rhabdomyosarcoma. Magnetic resonance imaging (MRI) revealed a soft tissue mass with cystic components affecting the forearm and distal humerus muscles. Fine-needle biopsy was performed and initially diagnosed as rhabdomyosarcoma but later confirmed as low-grade fibrosarcoma with positive immunostaining for vimentin. The patient underwent a transhumeral amputation with follow-up chemotherapy at a specialized oncology center. This case underscores the importance of interdisciplinary collaboration and specialized care in managing complex medical conditions in infants. Early detection and appropriate management of these tumors are essential for improving outcomes and reducing morbidity and mortality. Despite the rarity of this case, it serves as a reminder of the importance of considering neoplastic lesions in the differential diagnosis of soft tissue masses in newborns.

Hughes syndrome and epilepsy: when to test for antiphospholipid antibodies?

Epilepsy and seizures are reported among the neurological manifestations of antiphospholipid syndrome (APS) at a prevalence rate of approximately 8%, which is nearly 10 times the prevalence of epilepsy in the general population. The association of seizures with antiphospholipid antibodies (aPL) is even more significant in the presence of systemic lupus erythematosus (SLE). In this review, we discuss the epidemiological, pathophysiological, laboratory, clinical, and radiological aspects of this association, and derive suggestions on when to consider testing for aPL in epileptic patients and how to manage seizures secondary to APS based on literature data. Epilepsy due to APS should be considered in young patients presenting with seizures of unknown origin. Temporal lobe epilepsy seems to be particularly prevalent in APS patients. The pathogenesis is complex and may not only involve micro-thrombosis, but also a possible immune-mediated neuronal damage. Patients with seizures and positive aPL tend to develop thrombocytopenia and livedo racemosa more frequently compared with those without aPL. Magnetic resonance imaging (MRI) remains the imaging modality of choice in these patients. The presence of SLE and the presence of neurological symptoms significantly correlate with the presence of white matter changes on MRI. In contrast, the correlation between aPL positivity and the presence of white matter changes is very weak. Furthermore, MRI can be normal in more than 30–40% of neuropsychiatric lupus patients with or without aPL. aPL testing is recommended in young patients presenting with atypical seizures and multiple hyper-intensity lesions on brain MRI in the absence of other possible conditions. New MRI techniques can better understand the pathology of brain damage in neuro-APS. The therapeutic management of epileptic APS patients relies on anti-epileptic treatment and anticoagulant agents when there is evidence of a thrombotic event. In the absence of consensual recommendations, the decision of lifelong anticoagulation is discussed on a case-by-case basis. The anti-thrombotic benefit of hydroxychloroquine and statins is supported by several studies.

Overdiagnosis and mistreatment of malaria among febrile patients at primary healthcare level in Afghanistan: observational study

OBJECTIVE

To assess the accuracy of malaria diagnosis and treatment at primary level clinics in Afghanistan.

DESIGN

Prospective observational study.

SETTING

22 clinics in two Afghan provinces, one in the north (adjoining Tajikistan) and one in the east (adjoining Pakistan); areas with seasonal transmission of Plasmodium vivax and Plasmodium falciparum.

PARTICIPANTS

2357 patients of all ages enrolled if clinicians suspected malaria.

INTERVENTIONS

Established (>5 years) microscopy (12 clinics in east Afghanistan), newly established microscopy (five clinics in north Afghanistan), and no laboratory (five clinics in north Afghanistan). All clinics used the national malaria treatment guidelines.

MAIN OUTCOME MEASURES

Proportion of patients positive and negative for malaria who received a malaria drug; sensitivity and specificity of clinic based diagnosis; prescriber's response to the result of the clinic slide; and proportion of patients positive and negative for malaria who were prescribed antibiotics. Outcomes were measured against a double read reference blood slide.

RESULTS

In health centres using clinical diagnosis, although 413 of 414 patients were negative by the reference slide, 412 (99%) received a malaria drug and 47 (11%) received an antibiotic. In clinics using new microscopy, 37% (75/202) of patients who were negative by the reference slide received a malaria drug and 60% (103/202) received an antibiotic. In clinics using established microscopy, 50.8% (645/1269) of patients who were negative by the reference slide received a malaria drug and 27.0% (342/1269) received an antibiotic. Among the patients who tested positive for malaria, 94% (443/472) correctly received a malaria drug but only 1 of 6 cases of falciparum malaria was detected and appropriately treated. The specificity of established and new microscopy was 72.9% and 79.9%, respectively. In response to negative clinic slide results, malaria drugs were prescribed to 270/905 (28.8%) and 32/154 (21%) and antibiotics to 347/930 (37.3%) and 99/154 (64%) patients in established and new microscopy arms, respectively. Nurses were less likely to misprescribe than doctors.

CONCLUSIONS

Despite a much lower incidence of malaria in Afghanistan than in Africa, fever was substantially misdiagnosed as malaria in this south Asian setting. Inaccuracy was attributable to false positive laboratory diagnoses of malaria and the clinicians' disregard of negative slide results. Rare but potentially fatal cases of falciparum malaria were not detected, emphasising the potential role of rapid diagnostic tests. Microscopy increased the proportion of patients treated with antibiotics producing a trade-off between overtreatment with malaria drugs and probable overtreatment with antibiotics.

Anaplastic ganglioglioma of the brainstem in an adult

Gangliogliomas are neoplasms with neuronal and glial components. The most common location is the temporal lobe and for that reason those patients have seizures as the major complaint. Gangliogliomas with anaplastic features are uncommon. A 33-year-old man presented with a two-year history of progressively worsening right-sided weakness and contractures. Physical examination demonstrated right-sided weakness and contractures involving the upper and lower extremities. Magnetic resonance demonstrated multiple nodules involving the tegmental pons with a small projection into the prepontine cistern on the left, midbrain tegmentum on the left in the subthalamic region. The patient was studied by MRI on T1WI, T2WI, FLAIR, DWI, and magnetic resonance spectroscopy. He underwent a craniotomy and biopsy of the mass. Histological examination of the specimen revealed glial proliferation. Based on these findings the pathologic diagnosis was anaplastic ganglioglioma. Only one previous report of an anaplastic astrocytoma in the cerebello-pontine angle in an adult has been published. In children three cases were reported, only one with magnetic resonance. Our case showed multiple nodular structures hypointense on T1 and hyperintense on T2 and FLAIR with enhancement on T1 after injection of paramagnetic contrast. Only in this contribution T2 value were diffusion-weighted and ADC characteristics and (1)H spectroscopy analyzed.

An Atlas of Infectious and Parasitic Diseases of the Central Nervous System. A Cooperative Study of SILAN (Sociedad Iberolatinoamericana de Neurorradiologia)

Infectious diseases of the central nervous system vary in frequency in different locations in America and Europe. What is common in Brazil can be a sporadic presentation in Europe. Cooperative work gathering experiences from neuroradiologists working in various places can be achieved and will help to identify uncommon cases that can present in our daily practice.

Neurocytome central

We report four cases of central neurocytoma we operated on at our institution, between 1994 and 2002. This uncommon lesion occurred in young patients, was located in the lateral ventricules and was revealed by signs of intracranial hypertension. The tumor was totally removed in three cases and subtotally in one. Immunohistochemistry provided useful information to distinguish neurocytoma from other nervous system tumors. Prognosis was excellent in two patients. One patient developed tumor recurrence seven years after surgery, without any progression on further follow up evaluation. In the last patient, the tumor showed a more aggressive progression requiring the adjunction of radiosurgery.

Protective effect of taurine against free radicals damage in the rat myocardium

Free radicals are highly cytotoxic to the heart and are involved in ischemia/reperfusion injury. In this study, we tested the ability of taurine to neutralize the deleterious effects of free radicals generated ex vivo and in vitro. Taurine was added at a concentration of 0.1 mM to the drinking water of experimental rats during 6 months. The animal hearts were then isolated and submitted to regional ischemia and reperfusion; ventricular fibrillation was significantly reduced as compared to a control group of non-treated animals. Moreover, at a concentration of 1 mM, taurine provided significant cardio-protection against the deleterious effect of free radicals generated by the electrolysis of Krebs-Henseleit buffer. When isolated hearts were perfused with electrolysed buffer, extensive fiber necrosis occurred, as observed by staining with nitro blue tertrazolium, a soluble dye which yields a dark blue formazan stain in the presence of reducing agents This stain was barely detectable when taurine was added to the perfusing electrolysed buffer. To further understand the protecting mechanism of taurine, we used xanthine-xanthine-oxidase as a superoxide (O2-) generating system and monitored the O2- through yield O2--dependent cytochrome c reduction. We demonstrated that taurine did not affect this system, which indicated that it did not scavenge O2- directly. On the other hand, taurine inhibited the auto-oxidation of adrenaline to adrenochrome at pH 7.8 where this auto-oxidation is O2--independent and superoxide dismutase insensitive. We thus conclude that taurine acts as a potent, but non-specific, scavenger of free radicals that cause heart damage and protects against reperfusion-induced ventricular

Treatment of HCC with pravastatin, octreotide, or gemcitabine--a critical evaluation

BACKGROUND/AIMS

New perspectives in the treatment of advanced hepatocellular carcinomas have recently been inaugurated with the application of hydroxymethylglutaryl coenzyme A reductase inhibitors i.e. pravastatin, the somatostatin analogue octreotide, or the cytidine analogue gemcitabine. The present study aimed to evaluate these substances in patients with progressive tumor growth.

METHODOLOGY

A total of 58 patients either received 3 x 200 microg/day octreotide for 2 months followed by 20mg octreotide LAR every 4 weeks (n=30) or 40-80 mg pravastatin (n=20) or 80-90 mg/m2 gemcitabine over 24 hours weekly in cycles of 4 weeks (n=8). Kaplan-Meier survival curves and the log-rank test were used for univariate comparison of sur vival.

RESULTS

The median overall survival of patients receiving octreotide was 5 months, of patients receiving pravastatin 7.2 months and of patients receiving gemcitabine 3.5 months. The difference between the pravastatin and the gemcitabine groups was significant. No WHO grade 3 or 4 side effects were seen in either group of patients.

CONCLUSIONS

These results do not confirm those of former studies. Neither pravastatin, nor octreotide, nor gemcitabine did prolong the patients' median overall survival as compared to control groups reported by other authors. New therapeutic strategies have to be found for patients with advanced hepatocellular carcinomas.

Catalytic enantioselective synthesis of 18F-fluorinated α-amino acids under phase-transfer conditions using (s)-NOBIN

We describe a new method for the asymmetric synthesis of [(18)F]fluorinated aromatic alpha-amino acids (FAA) under phase transfer conditions using achiral glycine derivative NiPBPGly and (S)-NOBIN as a novel substrate/catalyst pair. The key alkylation step proceeds under mild conditions. Substituted [(18)F]fluorobenzylbromides were prepared using nucleophilic [(18)F]fluoride and were used as alkylation agents. Two important FAA, 2-[(18)F]fluoro-L-tyrosine (2-FTYR) and 6-[(18)F]fluoro-L-3,4-dihydroxyphenylalanine (6-FDOPA), were synthesized with an ee of 92 and 96%, respectively. The total synthesis time was 110-120 min and radiochemical yields (d.c.) were 25+/-6% for 2-FTYR and 16+/-5% for 6-FDOPA.

Three 5'-variant mRNAs of anion exchanger AE2 in stomach and intestine of mouse, rabbit, and rat

AE2 is one of three known isoforms of the anion exchanger (AE) gene family. The use of alternative promoters, resulting in a tissue-specific transcript pattern, was reported for all AE genes. Three N-terminal variant AE2 subtypes are described: AE2a, AE2b, and AE2c. Although the basolaterally located parietal cell anion exchanger is known to be an AE2, the molecular identity of the basolateral and apical anion exchangers throughout the gut are still unknown. This article summarizes functional, immunohistochemical, and Western blot data demonstrating the basolateral localization of the gastric and intestinal AE2 in rabbit, mouse, and rat, and showing the AE2 subtype mRNA expression pattern in the stomach and along the intestine of rabbit and mouse: AE2a is expressed in all studied tissues, but most strongly in the colon; AE2b is expressed mainly in the stomach; and AE2c is detected nearly exclusively in the stomach. Further investigation is necessary to characterize the apical anion transport protein involved in NaCl absorption and HCO3- secretion in the gut.

Different regulation by pHi and osmolarity of the rabbit ileum brush-border and parietal cell basolateral anion exchanger

1. The purpose of this study was to look for evidence of a pH-sensitive modifier site on the parietal cell basolateral anion exchanger, determine the pH range in which allosteric regulation takes place, investigate the effect of the osmolarity on internal pH (pHi) dependence and compare it with that of the ileum brush-border anion exchanger. 2. When the pHi in parietal cell basolateral membrane (BLM) vesicles was increased, the rate of Cl(-)-gradient-driven 36Cl- uptake increased from 6.03 +/- 2.24 to 38.09 +/- 3.33 nmol (mg protein)-1 with the steep increase in anion exchange rates occurring within a narrow pH range between pHi 7.0 and 7.5. This was due to allosteric activation by internal OH- and not due to a change in driving force, since the driving force for maximal exchange rates was provided by the outwardly directed Cl- gradient. 3. The pHi dependency curve of parietal cell BLM anion exchange rates was shifted to the left by 0.25 pH units by increasing the osmolarity of the intra- and extravesicular solutions from 300 to 380 mosmol l-1. Thus cell shrinking may activate the parietal cell anion exchanger without a change in pHi and without phosphorylation of the anion exchanger protein. 4. In ileum brush-border membranes, the pHi-dependent increase in the rate of Cl(-)-gradient-driven 36Cl- uptake was more gradual and the half-maximal anion exchange rate was attained at lower pHi (pH 6.5). Increasing the osmolarity from 300 to 500 mosmol l-1 had no effect on pH dependence. 5. We conclude that the parietal cell basolateral and ileum brush-border anion exchangers possess an internal modifier site for allosteric activation by OH-, but the pH range in which allosteric regulation occurs differs between the two exchangers, as does the effect of an increase in osmolarity. Since current evidence suggests that both the parietal cell basolateral and the ileum brush-border anion exchanger are encoded by the AE2 gene, the differences in pHi dependence between the two may be due to alternative splicing, post-transcriptional modification, or the different membrane environment. 6. The pHi range for allosteric activation found in this study would suggest that for both the ileum and the parietal cell anion exchanger, but especially for the latter, a potentiating effect of the allosteric activation and the HCO3- availability occurs within the physiological pHi range and can cause dramatic increases in maximal anion exchange rates with increasing pHi.

Effects of buprenorphine, methadone and naloxone on acquisition of behavioral chains

Buprenorphine, methadone and naloxone were administered to pigeons key pecking under a repeated acquisition procedure. Under this procedure subjects are required to emit a new sequence of responses each session to receive access to food. All three drugs reduced overall key pecking rates although naloxone's rate-reducing effect was limited to the highest dose (30 mg/kg). The dose-effect curves for overall key pecking rate under buprenorphine and methadone were similar though the effective dose range for buprenorphine appeared wider. Methadone increased percentage of total errors at the highest doses, but neither buprenorphine nor naloxone affected total error levels very much. Within-session errors were increased early in the session under high methadone doses. Low buprenorphine doses also showed some tendency to increase errors early in the session. Buprenorphine and methadone reduced the number of chains completed in a dose-dependent manner. Buprenorphine was also administered daily at the most behaviorally disruptive dose (10 mg/kg/day). Under this dosing schedule, the behavior-suppressing effects of buprenorphine returned to base-line levels within 4 days. Error rates were unaffected by daily buprenorphine administration.

Effects of imipramine on responding reduced by methadone

Interactions between methadone and acute and chronic imipramine were studied in pigeons key pecking under a multiple variable interval 15-sec variable interval 150-sec schedule of food presentation. Both drugs decreased response rates at the highest doses. The VI 15-sec schedule was slightly more sensitive to acute drug administration than was the variable interval 150-sec schedule. Acute combinations of the two drugs neither ameliorated nor exacerbated the effects of either drug alone. Chronic imipramine alone had no lasting effect on responding. Unlike acute combinations, chronic imipramine lessened the rate reducing effect of methadone.