Neck neoplasms: MR imaging. Part II. Posttreatment evaluation

Thirty-three patients who had undergone prior surgery and/or radiation therapy for malignant neoplasms of the neck were studied with magnetic resonance (MR) imaging. Twenty-seven of these patients were also evaluated with computed tomography (CT). Ten patients were healthy posttreatment volunteers, and 23 had documented tumor recurrence. MR images better demonstrated normal muscular landmarks, especially in patients with obliterated fat planes. Areas of posttreatment fibrosis or scarring were low in signal intensity with all MR pulse sequences. However, in three patients, high signal intensity from postradiation edema of the supraglottic area mimicked neoplasm. In patients with recurrent tumor, MR imaging was superior to CT in defining the relationship of tumor and muscle and in demonstrating vascular anatomy when no intravenous contrast material was given during the CT examination. In two patients tumor and fibrosis were separated on MR images because of signal intensity differences. CT scans, however, showed adjacent bone and cartilage anatomy better. Our data indicate that an MR examination may be helpful in patients in whom CT is indeterminate either because of anatomical distortion or suboptimal demonstration of vascular anatomy.     

Azoospermia in testicular sarcoidosis is an indication for corticosteroid therapy

OBJECTIVE: To report improvement of azoospermia and hypogonadism after high-dose corticosteroid therapy in a patient with testicular sarcoidosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old man with testicular sarcoidosis and azoospermia. INTERVENTION(S): High-dose corticosteroid therapy was commenced in an attempt to improve sperm count and restore gonadal function. MAIN OUTCOME MEASURE(S): Analysis of sperm count, T, and gonadotropin response to steroid therapy. RESULT(S): FSH and LH concentrations decreased and T levels increased in parallel with control of disease activity with steroid therapy. Repeat semen analysis demonstrated a significant increase in sperm count, allowing sperm banking to take place. CONCLUSION(S): High-dose corticosteroid therapy may be indicated in testicular sarcoidosis, not only for control of systemic disease activity but also for recovery of gonadal function and spermatogenesis.     

ARE EXTANT LUNGFISH NEOTENIC?2

1. The thyroid axis in developing lungfish is being explored to ascertain whether it shows similar deficiencies to those characteristic of neoteny in urodele amphibians. 2. At hatching, the pituitary of Neoceratodus forsteri comprises a lumen surrounded by a single layer of epithelial cells lying immediately below the hypothalamus, but unconnected to it. Over the first year of development, the number of pituitary cells increases and several cell types, including thyrotropes, can be recognized immunocytochemically, but the pituitary remains unconnected to the hypothalamus. 3. By treating the lungfish with thyroid inhibitor, no increase in thyroid uptake of iodine, indicative of induced pituitary thyroid-stimulating hormone (TSH) activity, could be demonstrated; neither was there any response to exogenous human TSH. In the liver, thyroid hormone receptors were found to be primarily of the a type. 4. Taken together, these findings suggest that up to 1 year of age, lungfish development is equivalent to amphibian premeta-morphosis, which is consistent with neoteny but cannot be taken as evidence for neoteny unless confirmed at later stages of lungfish life history, which are yet to be studied.