Diagnosis and treatment of solid brainstem tumors in adults.

ＤｉａｇｎｏｓｉｓａｎｄｔｒｅａｔｍｅｎｔｏｆｓｏｌｉｄｂｒａｉｎｓｔｅｍｔｕｍｏｒｓｉｎａｄｕｌｔｓＸｕＱｉｗｕ徐启武，ＢａｏＷｅｉｍｉｎ鲍伟民ａｎｄＭａｏＲｅｎｌｉｎｇ毛仁玲ＯｂｊｅｃｔｉｖｅＴｏｅｖａｌｕａｔｅｔｈｅｄｉａｇｎｏｓｉｓａｎｄａｇ...     

Surgical treatment of bone tumors in conjunction with microwave-induced hyperthermia and adjuvant immunotherapy. A preliminary report.

OBJECTIVE To develop an alternative approach in conjunction with microwave-induced hyperthermia.

METHODS Thermotherapy with microwave intracorporeal irradiation was used to treat 73 patients with bone tumors. The series was composed of 58 patients with malignant tumors and 15 with benign tumors: most of tumors occurred about knee joints (53/73 = 72.6%). The surgical procedure included separating the tumor bearing segment from surrounding normal tissues with a safe margin, cooling the normal tissues including the neurovascular bundle and the intraarticular structures with a water circulation system, while heating the tumor with the antenna array of a microwave system and providing an adequate soft-tissue cover for the dead bone. Postoperatively, an immune therapy regimen was carried out regularly. The patients' immunologic functions were monitored by assay of the subpopulation of T cells, IL-2 and sIL-2 R (soluble IL-2 receptor).

RESULTS Follow-up varied from 3 to 38 months (mean 19 months). Excluding 3 patients with malignancy in the vertebrae treated for palliation, 70 were evaluated according to oncological and orthopedic criteria. Five patients had local recurrence and required amputation. The remaining 65 had excellent local control. In 6 of the 55 patients with malignancy of the extremities, lung metastasis occurred one to two years after surgery. The oncological results were similar to those obtained by other limb-saving procedures. Pathological fracture occurred at devitalized bone in 5 patients. In 72.5% of the patients (29 of 40 tumor-free cases followed more than one year), knee joints functioned well, being stable and painless with almost full range of motion. Single photon emission computered tomography (SPECT) for 16 patients revealed revascularization of the devitalized tumor bearing bone segment could accomplish in one year or more. The immune states were improved in various extends after thermotherapy plus immunotherapy in the majority of patients.

CONCLUSIONS These results show that the use of microwave hyperthermia and adjuvant immunotherapy in conjunction with the surgical treatment of bone tumors can be considered a definitive procedure, which is safe and well-tolerated. The oncological and orthopedic results are encouraging.

     

The diagnosis of idiopathic thrombocytopenic purpura in adults: does bone marrow biopsy have a place?

OBJECTIVE: To assess the value of routine bone marrow biopsy (BMB) in adult patients less than 65 years of age with suspected idiopathic thrombocytopenic purpura (ITP). DESIGN: Retrospective analysis. Data were collected from hospital medical records and laboratory results. SETTING: Large tertiary-level metropolitan teaching hospital, Victoria. PARTICIPANTS: Sixty-six patients who had undergone BMB for investigation of isolated thrombocytopenia between January 1992 and May 1997, according to defined eligibility criteria. RESULTS: Sixty-one of the 66 patients had BMB findings consistent with ITP (i.e., normal or increased numbers of megakaryocytes and other haemopoietic lineages normal). Three of these patients' biopsies incidentally showed reduced or absent iron stores. In the remaining five patients, BMB in four showed mild hypocellularity and the subsequent course in these patients was consistent with chronic ITP. The fifth patient had neutrophil hypersegmentation and giant band cells on BMB, the cause of which was unclear. The subsequent course in this patient has also been consistent with chronic ITP. CONCLUSIONS: Our data suggest that the routine performance of BMB for the diagnosis of ITP is not useful, provided that a thorough clinical history and physical examination are undertaken and that the blood count and peripheral blood smear show no abnormalities apart from thrombocytopenia.     

A study of haematological and bone marrow changes in symptomatic patients with human immune deficiency virus infection with special mention of?functional iron deficiency,anaemia of?critically ill and haemophagocytic lymphohistiocytosis

Background

Haematological abnormalities are among the most common complications of HIV. These involve all lineages of blood cells. Bone marrow studies form integral part of complete workup of the HIV positive patients specially when they present as case of pyrexia of unknown origin (PUO), refractory anaemia and pancytopenia.

Method

55 HIV infected symptomatic patient requiring bone marrow examination were included in the study. Relevant clinical history, baseline haematological investigations including full blood count, CD4 cell counts using flow cytometry were recorded.

Results

Median ANC values in males were found to be significantly lower than females (p = 0.046). CD4 cell count statistically significantly correlated with age, TLC, ANC & platelet count. Anaemia was present in 45 patients and out of which 66.66% patients had normocytic normochromic anaemia. Iron deficiency anaemia was present in (37.77%) patients and anaemia of chronic disease in (62.22%) patients. 2 patients had anaemia of the critically ill.Two patients had non-Hodgkin''s lymphoma (NHL) and showed lymphoma deposit in the bone marrow. Gelatinous degeneration was seen in 3 patients. Ill formed epithelioid cell granulomas were seen in 7 cases, and 2 cases were positive for acid fast bacilli (AFB). Haemophagocytosis was seen in 8 cases; two cases later diagnosed as a case of infection induced HLH. Leishmania donovani (LD) bodies seen in 2 cases.

Conclusions

Bone marrow study is an important investigation in HIV infected symptomatic patients with peripheral haematological abnormalities.     

Detection of rotavirus antigen in tracheal aspirates of infants and children with pneumonia.

Clinical manifestations of respiratory tract infection often precede or coincide with rotavirus gastroenteritis in infants and children. To investigate the possible association between respiratory tract manifestations and rotavirus infection, the authors determined human rotavirus (HRV) antigen and respiratory syncytial virus (RSV) antigen in tracheal aspirates of 58 children with clinically diagnosed pneumonia by enzyme-linked immunosorbent assay (ELISA) and immunofluorescent antibody techniques. HRV antigen was detected in 16 out of the 58 cases (27.6%) and RSV antigen was found positive in 27 cases (46.5%). In four cases both HRV and RSV antigens were detected. The results of our study suggest that rotavirus may occasionally by one of the etiologic agents of acute lower respiratory infections of infants and children and that rotavirus infection may be transmitted via respiratory route. However, further extensive studies are needed for confirmation of the association between rotavirus and respiratory tract infection.

     

Photodynamic treatment of subcutaneous tumors in mice with photofrin II and Argon ion laser.

OBJECTIVE To investigate the combined effects of photofrin (Pf) II and laser irradiation on mice bearing subcutaneous tumors.

METHODS Ehrlish ascites tumor cells (1 x 10(7)) were implanted subcutaneously into the breast area of ICR mice. The tumors, when grew up to 0.55 +/- 0.15cm3, was administered of laser irradiation (514.5nm, 112.5mW/cm2 for 11.12 min with a total energy 75j/cm2) after intraperitoneal injection of Pf II (5, 7.5, 10 and 15mg/kg body weight) once a day for three successive days.

RESULTS The mortality rate (MR120) in the tumor control was 93.7% and the mean survival time (MST120) was 46.6 days. The best therapeutic effect (50% mortality rate, 53.8% tumor control rate and mean survival time 86 days) was observed in the group treated with 7.5mg of Pf II per kg of body weight and total irradiation energy of 75J/cm2 (112.5mW/cm2 for 11.12 min) with 514.5nm argon ion laser light.

CONCLUSIONS The effect on the survival rate of tumor cells and synthetic rates of DNA, RNA and protein were obviously inhibited, as the dose of pf II and laser irradiation increased.

     

Significance of pre-S2 protein and its antibody in children with HBV infections.

Pre-S2 protein and its antibody were detected in 130 children with hepatitis B virus (HBV) infection and 30 with T6 hepatitis B (HB) vaccination. The results showed that pre-S2 was positive in most chronic persistent hepatitis (CPH) and chronic active hepatitis(CAH) patients, while anti-pre-S2 was positive in only 8% (2/92 cases) and 11.5% (3/26 cases) respectively. The positive rate of anti-pre-S2 was 78.9% (15/19 cases) in cases at the convalescent stage of acute hepatitis B, 91.7% (55/60 cases) in cases with T6 HB vaccination and 83.3% (25.30 cases) in naturally acquired anti-HBs children, while pre-S2 was not noted. Anti-pre-S2 was negatively related to ALT and positively to anti-HBs (P less than 0.01). The positive relation of pre-S2 to HBsAg was observed. These results suggest that pre-S2 could be a marker for HBV infection, and anti-pre-S2 may indicate a favourable prognosis of HBV infection. There was no correlation between anti-pre-S2 and pathogenic damages induced by HBV.

     

Vitamin D and calcium metabolism in children with nephrotic syndrome of normal renal function.

This study demonstrates that there are distinct abnormalities of vitamin D and calcium metabolism in children with nephrotic syndrome (NS) and normal renal function. In patients with active NS, serum calcium, ionized calcium, 25-OHD3 and CT were decreased, plasma PTH level was increased and serum ALP was elevated. These abnormalities returned to normal in remission. Serum 1,25-(OH)2D3, although normal in absolute value during both active and remission stage, may be inappropriately low for the hypocalcemia and hyperparathyroidism during the active stage. Therefore, children with active NS are at the risk of developing metabolic bone disease. The treatment with a high dose of vitamin D3 may correct the abnormalities, which suggests vitamin D3 should be used in children with protracted active NS.

     

Polymorphisms of vitamin D receptor gene and its association with bone mineral density and osteocalcin in Chinese.

ＰｏｌｙｍｏｒｐｈｉｓｍｓｏｆｖｉｔａｍｉｎＤｒｅｃｅｐｔｏｒｇｅｎｅａｎｄｉｔｓａｓｏｃｉａｔｉｏｎｗｉｔｈｂｏｎｅｍｉｎｅｒａｌｄｅｎｓｉｔｙａｎｄｏｓｔｅｏｃａｌｃｉｎｉｎＣｈｉｎｅｓｅＺｈａｏＪｉｎｘｉｕ赵金秀，ＺｈｏｕＸｕｅｙｉｎｇ周学瀛，...     

Hemiparkinsonism in monkeys following unilateral common carotid artery infusion of MPTP. A study of behavior, biochemistry and histology.

After local surgical exposure, we administrated 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) directly into the right common carotid artery of 5 rhesus monkeys. All the monkeys manifested akinesia, rigidity and postural tremor of the contralateral limbs, and spontaneous circling toward the MPTP treated side. These disturbances began to appear 3-4 days after injection, peaking at one month, and continued until the day of sacrifice. After treatment with madopar and apomorphine, marked improvements of the motor impairments appeared and a striking reversal of the direction of rotation away from the MPTP-treated side occurred in a dose-dependent manner. The ipsilateral neurotoxicity was confirmed biochemically by 99% reduction in the caudate-putamen dopamine levels and histologically by selective cell loss in the substantia nigra of the MPTP-treated side. It is concluded that this primate model of hemiparkinsonism is easy to reproduce and life is maintained with good health otherwise. So it may be more feasible for behavioral and pharmacological studies of Parkinson's disease.

     

Histological types of spindle cell carcinoma of the cornea and conjunctiva. A clinicopathologic report of 8 patients with ultrastructural and immunohistochemical findings in three tumors.

We analysed the clinical and pathological features of 8 patients with spindle cell carcinoma of the conjunctiva and/or cornea. Four tumors arose from the cornea of atrophic eyes that had previous corneal ulcers. The tumors could be divided into 3 types according to their histopathological findings: fibrosarcomatous type, fibro-histiocytomatous type, and rhabdomyosarcomatous type. The 8 patients were misdiagnosed clinically and pathologically. Careful retrospective histopathologic examination using serial sections and in some tumors the addition of ultrastructural and immunohistochemical studies revealed the correct diagnosis. Follow-up data were obtained in 5 patients. Four of them were alive for 20, 10, 3, and 2 years respectively after surgery. One conjunctival tumor recurred 10 months after local excision.

     

Does secondary smoke exposure increase the incidence and/or severity of asthma in children?

Pediatric asthma is a significant health problem in the United States. Up to 26,000 new asthma cases are identified every year. Seventeen percent of all pediatric emergency department visits are attributable to asthma. There are no universally agreed upon diagnostic criteria for asthma. Because no single agent has been identified as causing asthma and because no pathologic feature is entirely unique to asthma, the disease can more easily be described than defined. Asthma is diagnosed clinically based upon recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night in the absence of other causes. Asthma is considered a chronic inflammatory disorder associated with airflow obstruction, which is often reversible either spontaneously or with treatment. This inflammation exacerbates bronchial hyper-responsiveness to a variety of environmental stimuli including allergens and irritants. Due to inconsistency of diagnostic criteria for asthma, it is easier to measure asthma severity or to study events such as hospitalizations or deaths, rather than to measure incidence. Since a randomized controlled trial of the effect of cigarette exposure on asthma would be unethical, we must rely on either randomized trials of reduction of cigarette exposure or epidemiological studies to determine associations between secondary exposure to cigarette smoke and asthma.     

Local changes in aluminium, calcium and phosphorus content of bone caused by alumina implant.

Thirty rabbits were divided equally into 5 groups randomly. A hole, 6 mm in diameter and 2 mm deep, was bored on each iliac crest. Two pieces of alumina were implanted into the hole of one side, while the opposite side served as control. These rabbits were killed on 10, 20, 40, 60 and 90 days after operation. Calcium, phosphorus and aluminium contents of iliac bone on both sides were determined by Inductively Coupled Plasma--Atomic Emission Spectrometry. The results showed that the aluminium content of the implanted side in each group was higher than that of the control and difference was significant in 10, 40 and 60 day groups (P < 0.05). This shows that the implant releases aluminium into the bone. Moreover, the calcium and phosphorus contents were significantly lower on the implanted side than on the control side in 10 and 20 day groups (P < 0.05-0.001). Apparently, the aluminium released from the implant in the early stage can interfere with the local calcium and phosphorus metabolism and delay the mineralization of the bone.

     

The combination of melphalan, cyclophosphamide and cytosine arabinoside as a conditioning regimen for autologous bone marrow transplantation for acute leukemia.

OBJECTIVE To explore more effective and less toxic conditioning regimen without total body irradiation for autologous bone marrow transplantation (ABMT) for acute leukemia (AL).

METHODS Twenty patients with AL were treated with ABMT, including 13 cases of acute myelocytic leukemia (AML) and 7 cases of acute lymphocytic leukemia (ALL). A median of 1.06 (range, 0.69-1.75) x 10(8) nucleated BM cells/kg was harvested and stored in normal salt solution containing heparin at 4 degrees C. The conditioning regimen (MAC) consisted of high-dose melphalan (M, 140-160 mg/m2), cyclophosphamide (CY, 120 mg/kg) and cytosine arabinoside (Ara-C, 2.0 g/m2). These 3 drugs were administered within 25 hours and the unpurged autologous marrow infusion began after another 24-hour interval.

RESULTS MAC regimen could result in myeloblastic efficacy in a week. All marrow cells were reinfused within 56 hours after the harvest so that hemopoietic reconstitutions could occur in all the patients. The median time to reach a neutrophil count of > 1.0 x 10(9)/L and a platelet count of > 50 x 10(9)/L was 20 and 26 days respectively. With a median observation period of 25 months, the median duration on continuous complete remission in our patients was 22 months, and the longest reached 56 months. The median survival was 33 months, and the longest was over 6 years. The event-free survival at 2 years had reached 72%. In seven patients with leukemic relapse, six (86%) relapsed within 8 months after ABMT. The relapse rate and mortality in AML patients were significantly lower than those in ALL patients. In 7 patients with M3, relapse had not yet been observed. The nonhematologic toxic effects of MAC conditioning regimen occurred mainly in the gastrointestinal tract.

CONCLUSIONS The preliminary results indicated that the ABMT using MAC conditioning regimen had some advantages in stronger antileukemic efficacy, less extrahematologic toxicity and earlier recovery of platelet and could greatly prolong the duration of remission and survival in some patients with AL.

     

Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.     

Therapeutic effects of photosensitizers in combination with laser and ACNU on an in vivo or in vitro model of cerebral glioma.

This study investigated the independent and combined effects of photodynamic therapy (PDT), laser photodynamic hyperthermia (LPDH) and 1-(4-amino-2-methyl-5-pyrimidinyl) methy1-3-(2-chloroethyl) -3-nitrosourea hydrochloride (ACNU) in a rat 9L induced gliosarcoma model. The mortality rate (MR60), mean survival time (MST60), and increasing life span (ILS60) within 60 days were determined to evaluate the therapeutic effect in vivo. The MR60 and MST60 of the gliosarcoma tumor control were 100% and 16.2 days. The ILS60s of PDT and ACNU were 72.84% and 49.81%, respectively, but MR60 of both were 86.72%. All combined treatments produced significantly prolonged survival (P<0.01). The combined effects of LPDH and ACNU, MR60, MST60, and ILS60 were 60%, 43 days, and 165.4%, respectively. The ILS60 of PDT ACNU (96.48%) and PDT LPDH (98.58%) also indicated a synergistic or additive effect. The survival fraction and synthetic rate of DNA, RNA, and protein of glioma 9L tumor cells in vitro after single treatment of PD