Fluorescence detection of pleural malignancies using 5-aminolaevulinic acid

STUDY OBJECTIVE: Although the use of video-assisted thoracoscopy has improved the diagnostic accuracy in patients presenting with pleural diseases, not all biopsies performed are conclusive and staging of the disease is not always optimal. Fluorescence diagnosis (FD) with 5-aminolaevulinic acid (5-ALA) has been used in the diagnostic workup for various malignancies. The impact of 5-ALA-mediated FD on diagnosis and staging during video-assisted thoracoscopy was examined. DESIGN: Prospective, single-center study. SETTING: National cancer center. PATIENTS: Twenty-six patients with nonconclusive pleural effusions who were scheduled for video-assisted thoracoscopy. INTERVENTION: Eligible patients were administered 1,500 to 2,500 mg po of 5-ALA before video-assisted thoracoscopy. After conventional inspection with white light, fluorescence inspection of the pleural cavity was performed (D-LIGHT Auto Fluorescent System; Karl Storz; Tuttlingen, Germany). Biopsy specimens of both normal and abnormal sites, as determined from white light and FD inspection, were obtained for histologic examination. RESULTS: One patient was ineligible, and two patients were not evaluable because of equipment failure. One postoperative death occurred due to preexisting myocardial disease. In another patient, an empyema developed; in another patient, a postoperative infection of the lung developed. Other toxicities were minimal. A definitive diagnosis was obtained in 24 of 25 cases, with malignant mesothelioma in 15 cases, other malignancies in 5 cases, one infection, and three benign diseases. Upstaging occurred in four patients (unsuspected tumor deposits) due to FD examination. In 23 patients, a total of 111 biopsy specimens could be analyzed. When correct findings of white light and FD were compared, FD had an additional value in 21 of 111 biopsies, compared to white light with 16 of 111 biopsies. CONCLUSIONS: FD using 5-ALA in the pleural cavity is feasible with limited side effects when used in addition to white light inspection. It improved visualization of abnormal lesions and led to upstaging in 4 of 15 mesothelioma patients.     

Severe cutaneous reactions to sulfadoxine-pyrimethamine and trimethoprim-sulfamethoxazole in Blantyre District, Malawi

We estimated the frequency of clinically diagnosed Stevens-Johnson syndrome and toxic epidermal necrolysis associated with sulfadoxine-pyrimethamine (SP) and trimethoprim-sulfamethoxazole (CTX) in Blantyre District, Malawi. Cases were detected by passive surveillance at 22 health centers from March 2001 through September 2002. Denominators were estimated from the Malawi national census for Blantyre District and the frequency of SP and CTX use reported in five household surveys. Crude rates of adverse reactions were estimated to be 1.2 per 100,000 exposures for SP and 1.5 per 100,000 exposures for CTX. Rates were higher in adults (1.7 cases per 100,000 SP exposures and 2.6 cases per 100,000 CTX exposures) and in persons positive for human immunodeficiency virus (4.9 cases per 100,000 SP exposures and 8.4 cases per 100,000 CTX exposures). Infrequent treatment doses with SP are associated with a low risk of an adverse cutaneous reaction, and SP can be recommended for treatment of malaria in areas where P. falciparum is susceptible.     

Transcranial magnetic stimulation of the visual cortex induces somatotopically organized qualia in blind subjects

After loss of a particular sensory channel, the deprived cortex can be activated by inputs from other sensory modalities. It is not known whether activation of the rewired cortex evokes subjective experiences characteristic of that cortex or consistent with the rerouted sensory information. In a previous study, blind subjects were trained to perform visual tasks with a tongue display unit, a sensory substitution device that translates visual displays into electrotactile tongue stimulation. This cross-modal sensory stimulation activated their visual cortices. We now extend this finding by using transcranial magnetic stimulation to examine the perceptual correlates of training-induced plastic responses. We find that blind subjects proficient with the use of the tongue display unit report somatopically organized tactile sensations that are referred to the tongue when transcranial magnetic stimulation is applied over the occipital cortex. No such sensations were evoked in trained, blindfolded, seeing control subjects who performed the sensory substitution task equally well. These data show that the perceptual correlate of activity in a given cortical area reflects the characteristics of its novel sensory input source.     

Neocortical neurogenesis in humans is restricted to development

Stem cells generate neurons in discrete regions in the postnatal mammalian brain. However, the extent of neurogenesis in the adult human brain has been difficult to establish. We have taken advantage of the integration of (14)C, generated by nuclear bomb tests during the Cold War, in DNA to establish the age of neurons in the major areas of the human cerebral neocortex. Together with the analysis of the neocortex from patients who received BrdU, which integrates in the DNA of dividing cells, our results demonstrate that, whereas nonneuronal cells turn over, neurons in the human cerebral neocortex are not generated in adulthood at detectable levels but are generated perinatally.     

Dicentric (17;20)(p11.2;q11.2): an uncommon cytogenetic abnormality in myeloid malignancies

We report on two patients with myeloid disorders and complex karyotypes including a dicentric chromosome, dic(17;20)(p11.2;q11.2), resulting in the loss of most of 17p and 20q. The presence of the centromeres of chromosomes 17 and 20 in the dic(17;20), as well as the loss of TP53, were confirmed by fluorescence in situ hybridization. Deletions of 17p and 20q are recurrent abnormalities in hematologic disorders, particularly myelodysplastic syndrome and acute myeloid leukemia). However, a dic(17;20) is an uncommon finding. According to the few reports in the literature, dic(17;20) is associated with an unfavorable prognosis. The key mechanism might be the loss of TP53 as well as other tumor suppressor genes in 20q that may have a critical role in tumor genesis.     

Prevalence of major depressive disorder in the general population of South Korea

INTRODUCTION: Previous epidemiological studies have reported a high prevalence of major depressive disorder (MDD) in North America and Western Europe. However, little information exists on MDD in Asian countries. This study investigates the prevalence of MDD and its characteristics in the general population of South Korea. METHODS: A representative sample of the South Korean general population composed of 3719 non-institutionalized individuals aged 15 years or older was interviewed by telephone using the Sleep-EVAL system. The participation rate was 91.4%. The interviews covered sociodemographic characteristics, health care utilization, physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) psychiatric disorders. RESULTS: A depressive mood, i.e., feeling sad, downcast, having the blues or having lost interest in things formerly pleasant was reported by 20.9% of the sample without significant difference between men and women and among age groups. DSM-IV MDD was found in 3.6% (95% CI: 3.0-4.2%) of the sample. The prevalence of MDD was comparable among age groups. Shift workers were more likely to have MDD than daytime workers. Factor significantly associated with MDD were: being a woman, being a light or heavy smoker, perceiving one's health as being average or poor, doing physical activities at least three times per week in the evening, having a BMI below 18.5 kg/m2 and perceiving one's life as being moderately or highly stressful. CONCLUSIONS: Prevalence of MDD in Korea is higher than what it was previously estimated to be two decades ago. The number of individuals seeking help for depression was very low, and only a small number of MDD subjects received appropriate treatment for their condition.