James Ewing (1866–1943): “the chief”

“It is a growing conviction that to know cancer in man, one must study the disease most carefully in the human subject. Personally, I do not look for any startling advances or sensational discoveries, since it is much more likely that a steady reduction in the mortality from cancer will come chiefly from a large number of separate factors, of which the most significant appear to be increased control of the conditions leading to cancer, more general recognition of the preliminary stages of the disease, early diagnosis, and treatment of the established disease. From the consideration of these various functions of the modern cancer research hospital, I think that it must be evident that such an institution not only can justify its existence, but fills a very urgent need without which, progress of cancer research would be handicapped, and much relief that might early be extended to cancer victims would be unavailable. Nor is there any doubt that the function of supporting such an institution is properly exercised by the State, which support should be continuous and liberal”—James Ewing [2]. © 1993 Wiley-Liss, Inc.     

Consultant’s corner: the “breakthrough” seizure

Seizures are a common cause of emergency department visits. This article provides an algorithm for evaluation and management of the patient with a known seizure disorder who presents with a breakthrough event. If the seizure represents a significant deviation from the usual pattern or the patient has an established pattern of episodes of status epilepticus, early involvement of the consultant neurologist is warranted. Otherwise, the first step is to search for provocative influences such as fever, intercurrent illness, or non-compliance with prescribed anti-epileptic drugs. Measurement of drug levels will guide the next rational phase of management. The overwhelming majority of patients can be managed following this logical framework.     

Nutritional concerns of survivors of childhood cancer: A “First World” perspective

Childhood cancer survivor (CCS) numbers are increasing as a result of advances in both treatment and supportive care. This positive outcome is tempered by the recognition of a high burden of chronic health conditions. Here, we review the nutritional concerns of CCS, including dietary habits after treatment and the factors during treatment that may contribute to chronic health conditions. Dietary interventions that have been conducted in CCS will be summarized along with focused goals of these interventions. We will also address the need to leverage these interventions to reduce the risk of chronic disease in CCS.     

“Marden-Walker Syndrome”: Neuropathologic Findings in Two Siblings

Neuropathologic examination of two siblings with phenotypic features consistent with Marden-Walker syndrome revealed central nervous system abnormalities which include reduction in the number of spinal anterior horn cells. The occurrence of these changes in a sibling pair provides strong evidence for a genetic etiology. The relationship between the neuropathologic changes and other phenotypic manifestations in this syndrome and in the closely related syndrome of Pena-Shokeir are discussed.     

“One Gets So Afraid”: Latino Families and Asthma Management—An Exploratory Study

INTRODUCTION: This study explored Latino family experiences, issues, and needs in caring for a child with asthma as expressed by Latino parents of children with asthma. METHODS: Eight families represented by 7 women and 2 men, primarily of Mexican descent, participated in the study. All families had at least one child enrolled in preschools in the East Los Angeles area. The study had an exploratory design and used ethnographic group and individual interview techniques to discover the parents' experiences in managing their child's asthma and the meaning asthma has for their families. All interviews were conducted in Spanish. RESULTS: Several common themes emerged from the data: (a) fear, "I got scared"; (b) the acute care experience, "I was not told what to do, nothing"; (c) knowledge, "I did not know anything about asthma"; and (d) parent alternative strategies or strengths, "We want to do what is best. ... we need to be prepared." DISCUSSION: Strength emerged from fear. The parents were resourceful and began developing alternative strategies to assist them in their care for their child with asthma. The findings emphasize the need for more opportunities for culturally sensitive asthma education and community health care resources such as mobile asthma treatment centers and promotora programs.     

“Nasal Gliomas” and Related Brain Heterotopias: A Pathologist's Perspective

Brain heterotopias arc rare congenital malformations embryologically related to encephaloceles. They present as a mass in or about the nose (nasal glioma) or in the nasopharynx. We present the clinical and pathological features of 5 cases of heterotopic brain tissue. Four nasal gliomas consisted of mature neuroglial tissue, including neurons in 2 cases, embedded in a fibrovascular stroma. A nasopharyngeal brain heterotopia showed histologic features of mature neuroglial tissue including neurons and ependymal-lined cystic structures. The finding of mature neuroglial tissue in a mass from the head and neck region raises three differential diagnostic possibilities: teratoma, encephalocele, or heterotopic tissue. A teratoma can be ruled out by examination of the entire specimen. Encephaloceles and brain heterolopias can be distinguished only after correlation with the patient's clinical and radiologic findings.