Increased blood flow in human brain tumor after administration of angiotensin II: Demonstration by pet

To evaluate the changes of regional cerebral blood flow (CBF) in artificial hypertensive state, we investigated vascular responses to changes of arterial carbon dioxide tension (PCO2) and blood pressure by means of positron emission tomography (PET). The subjects were eight brain tumors which were histologically proven. We calculated CBF changes in hypercapnic and hypocapnic state, and then using those results, CBF changes in hypertensive state were corrected. Every patient represented a selective increase of tumor blood flow in hypertensive state induced by angiotensin II, demonstrating a loss of autoregulation in tumor. Our results suggested the possibility of enhancement of chemotherapy for brain tumors.     

Spinal cord ependymoma: a positron emission tomographic study with (11C-methyl)-L-methionine

An intramedullary spinal cord ependymoma was studied by positron emission tomography (PET) using (¹¹C-methyl)-L-methionine (¹¹C-Met). MRI showed a homogeneously enhancing tumour at C6-T2 with cysts at its rostral and caudal ends. Sagittal PET images demonstrated high¹¹C-Met uptake in the solid portion of the tumour, particularly ventrally at C7-T2, where viable tumour cells proliferated in association with abundant perforating vessels. Met-PET would appear useful for delineating the viable protion of intramedullary ependymomas.     

Primary oligodendroglioma of the lateral ventricle with computed tomographic and positron emission tomographic evaluations

Two cases of primary intraventricular oligodendrogliomas are presented. Total excisions of well-demarcated large tumors in the lateral ventricle were successfully performed in young women by means of a frontal transventricular approach. An evaluation by computed tomography and positron emission tomography was attempted to obtain definite diagnosis of not only the location of the tumor but also the histologic grade of malignancy.     

Family carers for older relatives: sources of satisfaction and related factors in Finland

This study focuses on sources of satisfaction among family carers for older relatives and related factors in Finland. It is part of a major international project concerned with the coping of family carers in four countries. The results reported here are based on questionnaire data collected among 290 family carers from three Finnish towns. The questionnaire included the Carer's Assessment of Satisfaction Index (CASI) developed by Nolan and Grant (1992). The data were processed using SPSS statistical software. The results suggest that carers derived most satisfaction from seeing they could help their relative feel more comfortable, making them feel needed and wanted. Among factors relating to interpersonal dynamics, carers felt that this is one way in which they can show their love for the person they cared for. The family carer's as well as the dependent person's gender, the family carer's age, care burden and general life satisfaction were associated with sources of satisfaction. The results are compared with earlier findings on family carers' sources of satisfaction in Sweden and the UK. Implications for policy and practice are considered.     

Etiology and bronchofiberscopic treatment of pulmonary atelectasis in patients with severe motor and intellectual disabilities

Atelectasis is a common respiratory complication in patients with severe motor and intellectual disabilities. We encountered 3 patients with irreversible atelectasis due to delayed therapy, emphasizing the necessity of performing flexible bronchofiberscopy. A total of 21 patients with atelectasis were studied to assess the etiology and efficacy of bronchofiberscopy. The underlying condition was bronchitis/pneumonia in 19 cases, tracheal hemorrhage in 1, and lung cancer in 1. Most of the patients had predisposing factors, such as a bedridden status in 90% and a weak or absent cough reflex in 81%. It was statistically suggested that atelectasis is likely to occur on the side contralateral to thoracic scoliosis. Among the 18 patients who underwent bronchofiberscopy within 2 weeks after the diagnosis of atelectasis, 16 (89%) showed recanalization and resultant improvement of respiratory failure. Bronchofiberscopy is useful for treating atelectasis in patients with severe motor and intellectual disabilities.     

Usefulness of flexible bronchoscopy for aspiration of foods into the tracheobronchial trees in 2 patients with severe motor and intellectual disabilities

Two patients with severe motor and intellectual disabilities who suffered from acute asphyxia and respiratory failure due to aspiration of foods into the tracheobronchial trees were reported. Numerous food particles were found in the tracheobronchial trees of both the patients. One patient showed recurrent atelectasis at various sites. After oral intubation, flexible bronchoscopy could successfully remove food particles from the tracheobronchial trees in both the patients without any complications. A rigid bronchoscope is usually recommended for removal of foreign bodies from the airways in children. However, it is difficult to use in patients with severe motor and intellectual disabilities, because their airway may show deformation or the aspirated foods may enter the peripheral bronchi. Our cases suggest that flexible bronchoscopy can be useful for removing foreign bodies from the tracheobronchial trees in neurologically handicapped patients for whom rigid bronchoscopy can not be applied.     

Electron microscopic study of metastatic hemangiopericytic meningioma

Electron microscopic observations in a case of metastatic hemangiopericytic meningioma was presented. Cell origin of this tumor was discussed in detail from the point of the leiomyoblastic differentiation. The patient was a 49-year-old woman who was operated four times in the past for the cerebellar tentorial and the left parasagittal tumors. Six years after the first operation, metastatic lesions were found in the rib, the liver, the cervical vertebra and the sternum. Specimens were prepared from the intracranial and the rib tumors. On light microscopy the tumor cells with large nuclei and scant cytoplasm were proliferated around an endothelial-lined capillaries constituting obstructive or distended lumens. Mitoses and focal necrosis also existed. On electron microscopy the tumor cells were ovoid or ellipsoidal and had large irregular-shaped nuclei with conspicuous nucleoli. Knob-ended cytoplasmic processes occupying among tumor cells formed interdigitation. Microorganellae such as rough endoplasmic reticulum, Golgi apparatus, and mitochondriae were well developed. Glycogen granules were abundant. Some cells had a large number of 5-7nm microfilaments. Occasionally these filaments condensed into the dense body-like structure parallel to the cell surface. Pinocytic vesicles were not observed. Vascular channels varied in shape. The capillaries were lined by an endothelial cell. The endothelium had pinocytic vesicles under the plasmalemma and intracytoplasmic processes projecting into the vascular lumen. The neoplasmic cells and capillaries were surrounded by the basement membrane-like substance which consisted of amorphous and fibrous components.(ABSTRACT TRUNCATED AT 250 WORDS)     

Development of resistance to antitumor chloroethylnitrosoureas in vitro in brain tumor cells.

Rat brain tumor cell lines (9L, C6-1, C6-2), human brain tumor cells (T98G), and HeLa S3 cells were studied to assess their acquired resistance to the chloroethylnitrosoureas (CENUs), 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) and methyl-6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-alpha-D-glucopyr anosid e (MCNU), after 10 repeated exposures of a panel of different drug concentrations. Assay end-point was colony-forming ability after 24-h drug exposure. Intrinsic resistance was tested at the 10% survival dose (SD10) and C6-1, T98G, and HeLa S3 cell lines were 3 to 16 times more resistant to ACNU than 9L and C6-2 cell lines. After repeated exposures to ACNU, 9L and C6-2 cells acquired 2- and 5-fold resistance to ACNU respectively, whereas C6-1 and T98G cells retained a resistance almost equivalent to the respective parent cells. HeLa S3 cells also acquired resistance to ACNU, as evidenced by a 3.5-fold increase. The SD10 of the cells to MCNU ranged from 4.3 microM (C6-2 cells) to 151.7 microM (T98G cells). After long-term exposure to MCNU, all five cell lines became significantly resistant compared to their respective parent cells. The easily obtained acquired resistance to CENUs suggests a clinical disadvantage of continual and repeated adjuvant monochemotherapy with these agents.     

Positron emission tomography (PET) study in patients with meningiomas

Regional hemocirculation and metabolism were evaluated in five patients with meningiomas using positron emission tomography (PET). Histological diagnoses were: two cases of meningotheliomatous type, one hemangiopericytic type, one fibroblastic type, and one transitional type. Regional cerebral blood flow (rCBF), blood volume (rCBV), oxygen extraction fraction (rOEF), and metabolic rates of oxygen (rCMRO2) and glucose (rCMRG1) were measured with 15O2, C15O. 15O2, and 18F-fluorodeoxyglucose tracers. For the quantitative analysis, regions of interest were delineated on tumors, the peritumoral region, and the contralateral gray matter in comparison with age-corresponding 5 malignant gliomas and 5 normal volunteers. Tumor hemocirculatory parameters (rCBF: 57.2 +/- 22.6 ml/100 ml/min, rCBV: 7.95 +/- 3.27 ml/100 ml, mean + SD, n = 5) were markedly higher than those of the contralateral gray matter (p less than 0.05 by a Student-t test). The high values were consistent with angiographic findings of tumor staining and with abundant tumor vessels demonstrated by pathological examination. rCMRO2 was 2.15 +/- 0.80 ml/100 ml/min, which were comparable to those of the contralateral gray matter. Tumor rCMRG1 showed 4.76 +/- 2.37 mg/100 ml/min; the values of two cases were similar to the respective gray matter. The raised metabolic rate (rCMRO2/rCMRG1) therefore suggests rather aerobic glycolysis as compared with gliomas. Low rOEF (0.26 +/- 0.16) reveals an excessive blood flow beyond oxygen demand of the tumor. In the peritumoral regions, rCBF and metabolism fell slightly but rOEF reached a level similar to the contralateral gray matter, possibly due to hemocirculatory stasis caused by intracranial hypertension; in contrast, an unmatched reduction of rCBF and rCMRO2 implies tumor cells infiltration in gliomas.(ABSTRACT TRUNCATED AT 250 WORDS)