Parotid masses: MR imaging

Over a 2-year period 20 patients who presented with masses in the parotid gland were evaluated with magnetic resonance (MR) imaging. T1-weighted images were obtained on a high-resolution, thin-section MR imaging system. When "cystic-appearing" lesions were found, T2-weighted images were obtained in order to better characterize the tumor. As in other areas of the body, MR images of parotid tumors are not usually histologically specific. MR findings may be distinctive in rare cases and define the internal architecture of complex parotid masses. Although poor tumor margination was a clue to malignancy, this was not a consistent finding. The real advantage of MR imaging in evaluating parotid masses was its ability to accurately reveal the extraparotid or intraparotid location of a tumor and demonstrate the relationship of the tumor to the facial nerve. Small and medium-sized mass lesions could be seen as superficial or deep to the facial nerve. Larger masses producing some distortion of the normal course of the nerve made identification of the nerve more difficult, if not impossible. In malignant tumors with gross invasion of the facial canal, MR images can show the extent of nerve involvement.     

Alteration of the aflatoxin cyclopentenone ring to a delta-lactone reduces intercalation with DNA and decreases formation of guanine N7 adducts by aflatoxin epoxides

The regio- and stereospecificity exhibited by reaction of aflatoxin B1 8,9-epoxide with DNA as well as the efficiency of reaction are remarkable and suggests that a specific orientation of bound epoxide facilitates formation of the transition state leading to guanine N7 adducts. We have compared aflatoxins B1 and B2 with aflatoxins G1 and G2 as to their binding with calf thymus DNA, d(ATGCAT)2, d(GCATGC)2, and plasmid pBR322. Aflatoxins B1 and B2 contain a cyclopentenone ring fused to the lactone ring of the coumarin. They have similar DNA association constants and intercalate with B-DNA, as demonstrated by NMR analysis of association with d(ATGCAT)2 and d(GCATGC)2, alteration of pBR322 electrophoretic mobility, and flow dichroism using linearly oriented calf thymus DNA. The less planar delta-lactone ring of aflatoxins G1 and G2 reduces DNA binding affinity by approximately 1 order of magnitude. Nevertheless, binding studies with d(ATGCAT)2 and d(GCATGC)2 suggest that aflatoxins G1 and G2 also bind B-DNA by intercalation. To establish the existence of a relationship between the association of these aflatoxins with DNA and adduct formation induced by aflatoxin epoxides, we compared the yield of guanine N7 adduct from aflatoxin B1 8,9-epoxide and from aflatoxin G1 9,10-epoxide at three concentrations of calf thymus DNA. As DNA concentration is decreased, two observations are made: (1) the number of adducts formed by either aflatoxin B1 8,9-epoxide or aflatoxin G1 9,10-epoxide is reduced with a concomitant increase in formation of the respective dihydrodiols, and (2) the ratio of adducts formed by aflatoxin G1 9,10-epoxide to those formed by an equivalent concentration of aflatoxin B1 8,9-epoxide decreases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Study of Pigtail Catheters for Tube Thoracostomy

Background

To study the efficacy and complications of percutaneous small bore pigtail catheters for tube thoracostomy.

Methods

50 cases of pleural effusion requiring drainage were enrolled in the study. Pigtail catheters of the size 9 to 12 F were used.

Results

The procedure was successful in 46/50 (92%) cases. Fibrinolytic therapy and pleurodesis was successful through these tubes. Complications included blockade in 4 (8%), small pneumothorax in 10 (20%) and chest pain at tube thoracostomy site requiring analgesics in 30 (60%).

Conclusion

Small bore pigtail catheters are safe, comfortable, cost effective and have few complications especially in loculated pleural effusions.Key Words: Pigtail catheter, Tube thoracostomy     

Detection of fetal central nervous system anomalies: a practical level of effort for a routine sonogram

To evaluate the efficacy of examining the lateral ventricular atrium, cisterna magna, and cavum septi pellucidi as a means of ascertaining that the development of the fetal central nervous system (CNS) is normal, a retrospective evaluation of the sonograms of 112 fetuses (15-39 weeks gestational age) with sonographically diagnosed CNS anomalies was performed. Malformations included in the study were diverse. The lateral ventricular atrium was enlarged (greater than 10 mm) in 99 (88%) fetuses. Of the remaining 13 fetuses, seven had an abnormal-sized cisterna magna (less than 2 mm or greater than 11 mm). These two measurements alone could be used to identify the presence of a CNS abnormality in 95%. Three of the six remaining fetuses exhibited gross abnormalities easily seen on the standard axial images obtained for biparietal diameter measurement. Although the cavum septi pellucidi was absent in a number of cases, its absence did not enhance sensitivity in the cohort examined. Prospective examination of 130 consecutive normal fetuses (15-40 weeks gestational age) was also performed. When specifically sought, the ventricular atrium was identifiable and measurable 99% of the time; the cisterna magna, 90% of the time; and the cavum septi pellucidi, 95% of the time. Because major CNS anomalies are uncommon and these measurements afford high sensitivity, an extremely low probability (0.005%) of abnormal brain or spinal cord development can be predicted if a normal-sized lateral ventricular atrium and cisterna magna are present. These results should not be construed as a license to underexamine fetuses for malformations. Rather, these measurements should serve as simple positive steps to assist in a difficult task.     

Social, emotional, and behavioral functioning of children with cancer

OBJECTIVE: It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates. STUDY DESIGN: Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling. RESULTS: Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different. CONCLUSIONS: Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.     

Corpus callosum and subcallosal-periventricular lesions in multiple sclerosis: detection with MR

Examination with magnetic resonance imaging of 40 patients with confirmed diagnoses of multiple sclerosis showed that corpus callosum involvement is common. Thirty percent of the patients had focal callosal lesions similar to those described in the pathology literature. Long, inner callosal-subcallosal lesions were found in 55% of patients. These lesions had signal characteristics similar to those of noncallosal periventricular lesions. Diffuse moderate to severe atrophy of the corpus callosum was noted in 40% of patients, with one exception concurrent with inner callosal lesions. The nature of the inner callosal lesions is not known, since these lesions are not typically described in the literature. These lesions may represent demyelination or increased water content and may be the precursor to atrophy that progresses from the ependymal surface toward the outer fibers of the corpus callosum.     

Immunizations and pregnancy: An update for pharmacists

ObjectiveTo review the safety of immunizations in pregnancy.Data sourcesPubMed search using the termsvaccine, immunizations, andpregnancy, as well as current national guidelines.Data synthesisImmunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles–mumps–rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus–diphtheria–acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances.ConclusionPharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.