The Monocyte/Macrophage Infiltrate in 35 Medulloblastomas: A Paraffin-Wax Study

We have studied formalin fixed, paraffin-wax embedded tissue from 35 medulloblastomas, collected over 23 years (27 non-desmoplastic and 8 desmoplastic) with KP1 and Mac387 two monoclonal anti-monocytes/macrophage (M/Ms) antibodies recommended for use on paraffin wax embedded tissue. In non-desmoplastic medulloblastomas, outside areas of necrosis, M/Ms were detected in 50% of cases with KP1 and 52% with Mac387. M/Ms were seen In 100% of desmoplastic medulloblastomas with both antibodies. Semiquantitative assessment revealed that, on average, desmoplastic tumors had at least three times as many Infiltrating M/Ms as non-desmoplastic tumors. There was no significant difference in the findings with the two antibodies or, between recently embedded and « older » tumors. The findings may be indicative of the presence of a host M/Ms immune response in medulloblastoma, which may be more accentuated in desmoplastic medulloblastomas. Furthermore, we conclude that these antibodies are quite suitable for the study of infiltrating M/Ms, thus lessening (but not obviating) the need for frozen tissue for immunohistological studies.

[Choroid plexus carcinoma: report of 15 cases]

Choroid plexus carcinoma (CPC) are rare central nervous system tumours derived from choroid plexus epithelium, affecting mainly children under 3 years of age. We present a clinical, epidemiological and histopathological study of 15 cases of CPC. Ten patients were male. Age ranged from 4 months to 21 years (mean=3,4). The lateral ventricles were affected in 73,3% of cases. Main symptom were: hydrocephalus (62.5%), intracranial hypertension (25%) and convulsion (12.5%). The patients were treated by surgery with partial resection in 75% of cases and total resection in 25%. There was one death due to surgical complication, 85.7% of patients had recurrence of tumours with mean survival rate of 13.6% months after diagnosis. Only one patient remain alive 5 years after initial treatment. These results support the poor prognosis and high mortality rate of CPC.

[Cardiopulmonary resuscitation. The effect of severe hypothermia on clinical outcome]

BACKGROUND

Evaluation of outcome after CPR in severe hypothermic patients.

DESIGN

Perspective study from October 1995 to April 1996.

SETTING

First aid team of Italian Red Cross, Busto Arsizio (Varese), Italy.

METHODS

A population of 22 patients in cardiac arrest in which CPR was performed immediately after rescue team's arrival is studied. ECG, core temperature, SpO2 and MAP were monitored whereas vital parameters were present during Basic Life Support. Outcome after CPR was evaluated with GOS scale.

RESULTS

It has been observed that severe hypothermia and time of cardiac arrest impact on the clinical outcome after CPR. The high mortality rate after CPR with BLS standard is worsened by a core temperature < or = 33 degrees C.

CONCLUSIONS

Severe hypothermia seems to have a dangerous effect upon outcome after cardiopulmonary resuscitation; heating systems for body temperature could prevent this situation improving CPR results.

Pituitary adenoma proliferative indices and risk of recurrence

Twenty unselected pituitary adenomas have been examined for proliferative indices (PIs), and anterior pituitary hormone expression. All but two of the tumours were non-functional with proliferative indices from less than 0.1 to 0.5%. Two tumours were null cell adenomas with PIs less than 0.1 and 0.2%. The PIs of the three recurrent tumours was less than 1.0%. Gonadotrophin and TSH immunoreactivity was heterogenous and was found in 12/20 (60%) of the tumours. There was no significant relationship between PI, hormone expression or any other measured parameter. The biological behaviour of pituitary adenomas with a PI of less than 0.1% is uncertain, but those with a PI of greater than 0.1% are more likely to recur although longer follow-up is needed to confirm this.

Oligodendrogliomas: a clinical, histological, immunocytochemical and lectin-binding study

We have studied 27 oligodendrogliomas with a panel of antibodies (vimentin, GFAP, S-100 protein, myelin basic protein, CAM 5.2) and of lectins (WGA, Con A, PNA, RCA, DBA, SBA) to different glycoproteins. There were 16 well-differentiated tumours, including one gliofibrillary and 11 anaplastic oligodendrogliomas, three of which were gliofibrillary. Four cases showed positivity for vimentin, three of which were anaplastic tumours. Fifteen cases were positive for S-100 protein (nine well-differentiated and six anaplastic tumours) and 13 contained GFAP-positive cells (three well-differentiated and 10 anaplastic tumours). WGA binding was positive in 75% of well-differentiated and 63% of anaplastic oligodendrogliomas, the corresponding figures were 50% and 45% for PNA, 37% and 81% for Con-A and 25% and 54% for RCA. On the basis of the results with lectin binding, we believe that there are changes in the spectrum of tumour cell-associated lectin-like proteins during malignant transformation. Our observations also suggest that the pattern of lectin expression can undergo substantial changes in the course of differentiation.

Two imported malaria cases from Switzerland

Two cases of falciparum malaria diagnosed in Italy, are described. The two patients, father and son, live in Geneva 3 kilometers away from the International airport. In July 1989, they left Switzerland for a short visit to Italy. Seven days after their arrival in Italy, they developed symptoms of malaria, subsequently microscopically confirmed. They had not been abroad for the past 25 years and therefore they had probably contracted the infection from an imported tropical mosquito carried to Geneva from the airport to or nearby their house.

Electrocardiographic abnormalities in childhood spinal muscular atrophy

Tremors of the isoelectric line in routine electrocardiograms have been described in patients with spinal muscular atrophy and have been interpreted as fasciculations of denervated muscles. In order to evaluate this phenomenon, 13 patients with spinal muscular atrophy have been studied (average age: 37.3 months). A first electrocardiogram was recorded routinely; a second tracing was then recorded with double sensitivity and double speed. In addition, all patients were evaluated clinically and had M-mode and cross-sectional echocardiography. Regular and constant spikes on the isoelectric electrocardiographic line were recorded in 12 patients (93.4%); their frequency ranged from 39 to 48 cycles/sec (average: 42.08 +/- 2.64). Contrary to previous reports, we found an "abnormal" electrocardiogram in all our patients with severe spinal muscular atrophy. The only patient with a normal electrocardiogram had a mild and clinically stable form of spinal muscular atrophy. We did not find any significant structural cardiac abnormality by clinical and echocardiographic evaluation. We conclude that continuous tremor on the isoelectric line of electrocardiogram represents a characteristic of spinal muscular atrophy in these patients. It is a result of muscle fasciculations and does not imply any abnormality of the heart.

Muscular abnormalities in children with muscular hypotonia and cerebral damage

Forty children with hypotonia and non progressive cerebral impairment were observed. In all cases muscle morpho-histometric and ultrastructural studies were performed, in 13 cases muscular acetylcholinesterase study was carried out. The Authors pointed out the high frequency (92% of cases) of muscle abnormalities: histochemical alteration of fibre type distribution (type 1 or type 2 fibres prevalence, type 2C persistence), diameter change (hypertrophy or hypotrophy of the fibres). In 37.5% of the cases, randomly distributed, were also present myofibrillar degeneration, Z band streaming, desalignment or marked destructuration of the sarcomeres. The muscular acetylcholinesterase study showed the same anomalous pattern of molecular forms (11 out of 13 cases), with increase of light (6S, 4S) and disappearance of heavy (16S) and medium forms (13S, 10S), without significant change of enzymatic activity. The possible alterated influence of CNS on muscle fibre differentiation and growth because of abnormal neural control is discussed. This hypothesis even if could be related with abnormal fibre typing and diameter, do not seem to explain the ultrastructural and biochemical abnormalities observed.

Muscle acetylcholinesterase in a familial myopathic disease

Three sisters with myopathy characterized by different degrees of weakness, hypotonia, cramps and a significant hypertrophy of the calves underwent clinical tests. Laboratory examinations (nerve conduction velocity, electromyography and serum enzymes), serial histochemical analyses of muscle specimens and tests for muscular acetylcholinesterase (AChE) activity and its molecular forms were performed. AChE activities did not differ significantly from those of controls, while sedimentation patterns evidenced the disappearance of 16 S, 13 S and 10 S molecular forms in the elder sisters. The genealogical tree of the patients is described and their cases compared to those of others with calf hypertrophy reported in the literature.

Kearns-Sayre syndrome. A case of the complete syndrome with encephalic leukodystrophy and calcification of basal ganglia

A case of a complete Kearns-Sayre syndrome, of early onset, associated with cerebral and cerebellar leukodystrophy and basal ganglia calcification is reported. The clinical, neurophysiological and morphological findings suggest multisystem involvement.

Congenital fiber type disproportion with fatal outcome: a case report

A child with congenital fiber type disproportion without structural changes in muscle fibres is reported. Although this pattern suggests a favorable prognosis, the clinical worsening followed by death at the age of 17 months shows that there is as yet no predictor for a benign course for this myopathy.