Fatal pulmonary arterial occlusive vascular disease following chemotherapy in a 9-month-old infant

Fatal pulmonary hypertension developed in an infant during the 7-month period in which he received, via a central venous catheter, combination chemotherapy for stage IV neuroblastoma as well as intermittent parenteral feeding. In a lung biopsy and at autopsy, small pulmonary arteries showed diffuse medial hypertrophy and peripheral muscularization, very extensive concentric intimal fibrosis, and focal eccentric fibrosis evolving from organizing thrombi. Pulmonary veins were normal. Hypothetically, chemotherapeutic drug therapy (possibly potentiated either by the parenteral nutrition or simply by the vehicular fluids causing volume loading of the pulmonary circulation) could cause occlusive pulmonary arterial disease by several mechanisms, but the association has not been described previously, although use of such drugs has been reported with pulmonary veno-occlusive disease.     

In situ polymerase chain reaction and its applications to the study of endocrine diseases

Conclusion In situ PCR is a new and exciting technology that is already providing a mechanism to gain insights into disease pathogenesis. As with other emerging technologies, its true strengths and weaknesses are becoming clearer with time.In situ PCR encompasses several different techniques, not all of which are equally applicable to different starting materials. It appears to be most effective for low-copy DNA or RNA detection in single-cell preparations after controlled fixation and pretreatment. However, the exact quantification of results still remains somewhat problematic. Directin situ PCR yields significantly less specific results than indirectin situ PCR and is— with currently used protocols—not applicable in tissue sections. Protocols need to be improved significantly to render them applicable to routinely processed specimens. Clinical application of this technology in routine laboratories must await resolution of its current limitations. Its impact in endocrine pathology will be most marked where conventional ISH fails owing to low sensitivity. It is also reasonable to believe that other methods, such as the self-sustained sequence replication (3SR) [14] or refined ISH procedures, may soon become suitable for studies on archival materials.     

Cancer care for people with dementia: Literature overview and recommendations for practice and research

As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.     

Dentofacial features of a family with Crouzon syndrome. Case reports

Crouzon syndrome is an autosomal dominant condition characterized by craniosynostosis with associated dentofacial anomalies. This paper describes the variable clinical features in affected individuals over two generations of a family with particular reference to the dentofacial deformities and discussion of management strategies.     

Bilateral fracture of the mandible in chronic lymphocytic leukaemia. Case report

The development of osteolytic bone lesions in patients with chronic lymphocytic leukaemia (CLL) is extremely rare and has not been reported to involve the mandible. A case of bilateral pathologic fracture of the mandible extensively involved with multiple bony deposits of CLL is reported.     

Propofol Prevents Peroxide-induced Inhibition of Glutamate Transport in Cultured Astrocytes

Background: Glutamate transporters located in the plasma membrane of cerebral astrocytes take up excitatory neurotransmitters from the synaptic cleft. In diseases characterized by oxidative stress, the extracellular glutamate concentration increases and contributes to neuronal death. The authors wanted to determine whether propofol defends brain cells against oxidant-induced changes in their transport of glutamate.

Methods: Primary cultures of rat cerebral astrocytes were exposed to tert-butyl hydroperoxide (1 mM) to serve as an in vitro model of oxidative stress. Astrocytes were incubated with propofol for 2 h and tert-butyl hydroperoxide was added for the final hour. Alternatively, astrocytes were incubated with tert-butyl hydroperoxide for 30 min and then with propofol for another 30 min. Control cells received drug vehicle rather than propofol. The rate of uptake of glutamate, the efflux of the nonmetabolizable analog D-aspartate, and the intracellular concentration of the endogenous antioxidant glutathione were measured.

Results: Tert-butyl hydroperoxide decreased the glutathione concentration and inhibited glutamate uptake but had a negligible effect on D-aspartate efflux. At clinically relevant concentrations, propofol did not affect the glutathione concentration but did prevent the effect of tert-butyl hydroperoxide on glutamate transport. Furthermore, the addition of propofol after tert-butyl hydroperoxide reversed the inhibition of glutamate uptake.