Cutaneous squamous cell carcinoma in two pediatric lung transplant patients on prolonged voriconazole treatment

Oral voriconazole is commonly used for treatment and prophylaxis of invasive fungal disease post‐LTx. Development of cutaneous SCC has been described in adult LTx recipients, although it is extremely rare in children. We describe two Caucasian children who developed cutaneous SCC beyond three yr post‐LTx. Both developed severe photosensitivity, actinic keratosis and required curative surgical excision of the cutaneous SCC lesions. Neither patient developed metastatic lesions nor had allograft dysfunction as a result of the SCC or the change in medical treatments. The effect of voriconazole on the development of malignant skin lesions is discussed and a recommendation on dermatologic surveillance, preventive measures against phototoxicity and early treatment of SCC are provided.     

Effect of matrigel on the tumorigenicity of human breast and ovarian carcinoma cell lines

The effect of Matrigel, a solubilised tissue basement membrane extract, has been investigated on the tumorigenicity of 3 breast (MCF-7, T47D and MDA.MB.231) and 5 ovarian [PEO1, PEO1 cDDPr, PEO4, PEO14 and OV(hyg)CAR3] carcinoma cell lines. In the absence of Matrigel, the PEO14 and MDA.MB.231 cell lines produced take rates of 30% and 50%, respectively, while the other cell lines either did not develop or only occasionally developed as tumours. With Matrigel, 100% take rates were achieved for 7 of the 8 cell lines (MCF-7, T47D, MDA.MB.231, PEO1, PEO1 cDDPr, PEO4 and PEO14); in the remaining cell line [OV(hyg)CAR3] 2/6 (33%) tumours grew. Xenografts established with Matrigel could be transferred into recipient animals and grown in the absence of Matrigel, suggesting that Matrigel is necessary only for initial establishment of tumours. Furthermore, cells which had been re-established from a T47D xenograft and then inoculated into mice without Matrigel showed a take rate greater than that of the original cell line but less than that of the xenograft. In conclusion, Matrigel has proven to be extremely useful in establishing a variety of cell lines as xenografts. © 1996 Wiley-Liss, Inc.     

Insight in Alzheimer's disease

Increasing interest in insight and anosognosia in neuropsychiatric illness has been accompanied by growing academic study of such awareness phenomena in Alzheimer's disease. This article reviews the current status of knowledge of this topic and makes the case that insight and anosognosia are concepts with direct clinical relevance to Alzheimer's disease. The associated symptomatology, and implications for patient management, are emphasized. Such relevance should form the basis for future research.     

The vcop scale: A measure of overprotection in parents of physically vulnerable children

A scale is developed for measuring the overprotecting vs. optimal developmental stimulation tendencies for parents of physically “vulnerable” children. A series of items were administered to parents whose parenting techniques had been rated as either highly overprotective or as optimal by a group of MDs and other professionals. Correlations were estimated between each of the items and parental tendencies as rated by professionals. Twenty-eight items were selected that provided maximum prediction of overprotection. The resulting R² was extraordinarily high (.94). Coefficient alpha and test-retest coefficients were acceptable. It is hoped that release of the new instrument (VCOPS) at this time will allow others to join in determining the clinical and experimental validity of this scale.     

Inherited RORB pathogenic variants: Overlap of photosensitive genetic generalized and occipital lobe epilepsy

Variants in RORB have been reported in eight individuals with epilepsy, with phenotypes ranging from eyelid myoclonia with absence epilepsy to developmental and epileptic encephalopathies. We identified novel RORB variants in 11 affected individuals from four families. One was from whole genome sequencing and three were from RORB screening of three epilepsy cohorts: developmental and epileptic encephalopathies (n = 1021), overlap of generalized and occipital epilepsy (n = 84), and photosensitivity (n = 123). Following interviews and review of medical records, individuals' seizure and epilepsy syndromes were classified. Three novel missense variants and one exon 3 deletion were predicted to be pathogenic by in silico tools, not found in population databases, and located in key evolutionary conserved domains. Median age at seizure onset was 3.5 years (0.5-10 years). Generalized, predominantly absence and myoclonic, and occipital seizures were seen in all families, often within the same individual (6/11). All individuals with epilepsy were photosensitive, and seven of 11 had cognitive abnormalities. Electroencephalograms showed generalized spike and wave and/or polyspike and wave. Here we show a striking RORB phenotype of overlap of photosensitive generalized and occipital epilepsy in both individuals and families. This is the first report of a gene associated with this overlap of epilepsy syndromes.     

Physical therapy in the emergency department: A new opportunity for collaborative care

Emergency department-initiated physical therapy (ED PT) is an emerging resource in the United States, with the number of ED PT programs in the United States growing rapidly over the last decade. In this collaborative model of care, physical therapists are consulted by the treating ED physician to assist in the evaluation and treatment of a number of movement and functional disorders, such as low back pain, peripheral vertigo, and various gait disturbances. Patients receiving ED PT benefit from the physical therapist's expertise in musculoskeletal and vestibular conditions and from the individualized attention provided in a typical bedside evaluation and treatment session, which includes education on expected symptom trajectory, recommendations for activity modulation, and facilitated outpatient follow-up. Early data suggest that both physicians and patients view ED PT services favorably, and that ED PT is associated with improvement of several important clinical and operational outcomes. Hospital systems interested in building their own ED PT program may benefit from the key steps outlined in this review, as well as a summary of the typical clinical volumes and practice patterns encountered at existing programs around the country.