Different clinical features of primary and secondary tumors in patients with multiple malignancies

Clinical features of the first and second primaries in patients with multiple malignancies have not been extensively studied. We compared patient and treatment characteristics of the primary malignancy in 48 consequent multiple primary cancer patients with those of the second primary in the same cohort. The second primaries comprised fewer breast cancers; 29.2% of primaries as opposed to 10.4% of second tumors were breast cancer (P = 0.049). In addition, primary tumors tended to be at a lower TNM stage than secondary tumors (P = 0.060). The median overall survival after the diagnosis of the first primary for the whole cohort was 22.3 years (95% CI, 2.0-42.5) and the median time to presentation of the second malignancy was 38 months after the diagnosis of the first primary (range, 0 to 384). Therefore, the prognosis of cancers in the multiple malignancy group appears to be good and they appear to have an indolent clinical behavior. Thus, we recommend a long screening time for secondary tumors after a curative treatment in patients with common cancers, taking into account the different occurrence patterns of second primaries with respect to first primaries.     

An unusual case of ruptured distal anterior cerebral artery aneurysm associated with brucellosis

Reports have noted aneurysmal dilatation of arteries in association with brucellosis, but involvement of intracranial vessels has not been documented to date. Sixty-one year old female patient who had been diagnosed with brucellosis 14 months earlier presented with symptoms of subarachnoid hemorrhage (SAH). Due to deterioration of the patient's clinical condition in spite of a two-drug antibiotic regimen, she was treated surgically and made a full recovery. It is important to identify this association promptly, as there are clinical implications for optimal management. The article also discusses the timing and duration of antibiotic therapy, indications for and considerations regarding surgery, and the use of other treatment modalities.     

Hippocampal volume in schizophrenia and its relationship with risperidone treatment: a stereological study

The purpose of this study was to assess the significance of the hippocampal volume differences and its relation with risperidone treatment in schizophrenia. In schizophrenic patients who were on risperidone treatment (n = 11) and in healthy volunteers (n = 11), volumes of the hippocampi were estimated using magnetic resonance images (MRIs). A detailed systematic series of coronal MRIs of the entire brain (3 mm thickness, T(1)-weighted, TR/TE 400/10 ms) was obtained for each subject. All estimations were done according to Cavalieri's method by a modified point-counting grid placed on surface areas of hippocampal slices. The mean right and left hippocampal volumes in schizophrenics and control subjects were 1059.4 and 1003.2 mm(3), and 1780.1 and 1589.1 mm(3), respectively. The corresponding coefficients of errors were 0.05 and 0.068, and 0.059 and 0.081, respectively. The volumes of left and right hemispheres were not significantly different in both schizophrenic patients and controls (p > 0.05). However, a statistically significant difference (p < 0.05) was found between hippocampal volumes of the schizophrenic patients and controls. In conclusion, the hippocampal volume of the schizophrenic patients is significantly smaller than of the healthy controls. The patients who responded well to risperidone treatment had significantly greater hippocampal volumes than the patients who did not respond properly. Thus, hippocampal volume may be a predictor of the treatment response of schizophrenics to risperidone.     

A simple method for reducing autotomy in rats after peripheral nerve lesions

Experiments using peripheral nerve lesions (crush or transection) in rats to study repair processes are hampered by the tendency for the animals to attack the limb in which the peripheral nerves are damaged (autotomy). In this paper we describe a simple method which significantly reduces the incidence of autotomy after peripheral nerve lesions. The method consists of painting the hind paws of operated rats with a commercially available non-toxic lotion, which is used to discourage nail-biting and thumb-sucking in humans. Although the method is not absolute, it was extremely beneficial in our experiments, since the number of animals that had to be taken out of the experiment due to severe autotomy was greatly reduced. We believe that this method may prove to be as beneficial to other investigators who are using experimental peripheral nerve lesions to study the regenerative aspects of the nervous system.     

Effect of carbon-11-acetate recirculation on estimates of myocardial oxygen consumption by PET

Mono- and biexponential fitting of myocardial 11C-acetate kinetics does not account for the effect of recirculating 11C activity following intravenous injection of the tracer. A tracer kinetic model comprising two and three compartments was developed to describe intravascular and myocardial 11C-acetate kinetics defined by PET. This model approach including a correction for 11C-metabolites in blood was validated by correlating the model parameter estimates with directly measured oxygen consumption (MVO2) in 11 closed-chest dog experiments over a wide range of cardiac work. The model parameter k2 closely correlated with oxygen consumption (r = 0.94). This approach was subsequently applied to human studies and k2-related to rate-pressure product (PRP). In comparison to conventional monoexponential fitting of 11C-acetate tissue kinetics, the model approach improved the correlation coefficients of scintigraphic MVO2 estimates and PRP values from 0.61 to 0.91. Thus, analysis of myocardial 11C-acetate and clearance kinetics with a tracer kinetic model corrects for recirculating 11C-activity and may provide more consistent estimates of myocardial oxygen consumption.     

Comparison of the intrapartum analysis of Doppler blood flow velocity waveform of the umbilical artery and fetal heart rate tracing for the prediction of perinatal outcome.

This study was performed to determine the value of umbilical artery Doppler flow velocity waveform (FVW) analysis and fetal heart rate (FHR) tracing in the course of labour for predicting poor perinatal outcome. The randomised, controlled and prospective study was carried out on 99 singleton term pregnant women in labour at the Zeynep Kamil Women and Children's Hospital, Istanbul. All patients were evaluated by both methods during the intrapartum period. Blood gases and pH of umbilical venous blood and 1 and 5 minute Apgar scores of the newborn infants were determined immediately after delivery. For the prediction of poor perinatal outcome, the sensitivity, specificity, negative predictive value and positive predictive value of FHR were 72.0%, 85.1%, 60.1% and 90.0%, respectively. FHR was pathological in all four cases with a neonatal death, whereas only two had pathological Doppler FVW. We conclude that FHR is a more sensitive method than umbilical artery Doppler FVW analysis (72.0% versus 36.0%) in the prediction of poor perinatal outcome during the intrapartum period. A combination of the two tests increases the specificity of the prediction of poor perinatal outcome from 89.2% and 85.1% to 94.9%. High negative predictive values of both tests should reassure the clinician when the test results are normal.     

Optimum distribution of diagnostic-specific technology

Recognizing that the suboptimal allocation of plant assets contribute to the inflationary pressures in the health industry, this paper employs the principles of goal programming to develop a model for distributing diagnostic-specific technology among potential recipients in a given geopraphic region. The model allocates diagnostic-specific equipment so as to ensure that (1) the provision of the related service satifies the health needs of the population at risk, (2) the capacity to provide the service in the region and in the hospital is optimal, (3) the service is provided at minimum cost, and (4) access to the equipment is satisfactory. An application and the practical implications of the model are also explored.     

Chiari Type I malformation presenting as glossopharyngeal neuralgia: case report

OBJECTIVE AND IMPORTANCE: Chiari Type I malformation is an important pathological state in which the brainstem is compressed by the cerebellar tonsil. We present a case of glossopharyngeal neuralgia caused by Chiari Type I malformation. CLINICAL PRESENTATION: A 50-year-old male patient was admitted with glossopharyngeal neuralgia. Magnetic resonance imaging studies revealed caudal displacement of the left cerebellar tonsil. INTERVENTION: Small occipital craniectomy and C1 laminectomy were performed. The left cerebellar tonsil was resected. CONCLUSION: This glossopharyngeal neuralgia was caused by compression of the lower cranial nerves and brainstem by the displaced left cerebellar tonsil. Decompression and pain relief were obtained with resection of the cerebellar tonsil. The patient was pain-free 30 weeks after the operation.