MRI in seven cases of Rathke's cleft cyst in infants and children

Seven MRI observations of presumed Rathke's cleft cysts in infants and children are reported. Age ranged between 6 months and 13 years. Size of the cysts ranged between 4 and 20 mm. While 3 small cysts were detected incidentally, 4 were large enough to cause symptoms secondary to compression of the pituitary gland and suprasellar components. The MRI appearance of the Rathke's cleft cysts varied according to their nature. MRI provides a major contribution to the diagnosis of these lesions; nevertheless, it often remains difficult to differentiate complex Rathke's cleft cysts from cystic craniopharyngiomas. The difficulties related to this differentiation are discussed.Presented at the 29th Congress of the European Society of Pediatric Radiology, 27 April to 1 May 1992, Budapest, Hungary and selected for publication by an International Group of the ESPR     

Unilateral cerebellar hypoplasia

A case of unilateral cerebellar hypoplasia is presented. This was an incidental finding in a patient with no evidence of neuromuscular or metabolic disease and no past history of trauma, anoxia, or perinatal difficulties. Computed tomographic scans showed posterior fossa asymmetry with underlying unilateral cerebellar hemisphere hypoplasia. In addition, there was overlying skull table thickening and excess petrous pneumatization on the affected side.     

Effect of desipramine and pargyline on brain gamma-aminobutyric acid

In mice, intraperitoneal administration of desipramine (12·5–100 mg/kg) or pargyline (25–200 mg/kg) reliably elevated the brain concentration of gamma-aminobutyric acid in a dose-dependent manner. In addition, both drugs caused hypothermia and a prolongation of sodium barbital induced narcosis. None of those effects of desipramine, but not of pargyline, were seen when the treated animals were placed in high ambient temperature to prevent drug-induced hypothermia.     

Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging

The clinical and histologic status of cervical lymph nodes has been correlated with the results of treatment in 1,069 consecutive patients who underwent radical neck dissection as part of the initial treatment of a primary epidermoid carcinoma arising in either the oral cavity or oropharynx.The influence on “cure” rates of size, number, location, and fixation of involved nodes, correlated with the specific site of origin within the oral cavity, was evaluated in determinate patients with proved nodal metastasis. As the extent of lymph node involvement increased from solitary to multiple ipsilateral and to bilateral enlarged nodes, cure rates dropped progressively. Survival was not invariably decreased in those whose involved nodes were large or considered fixed, and there was considerable variance among examiners when size and fixation were evaluated. These data suggest that the N system of staging presently advocated might be improved. Rather than designating contralateral or bilateral node involvement as N₂, this category might be reserved for those with multiple ipsilateral cervical node metastases. Those with contralateral and bilateral as well as so-called fixed metastases might better be relegated to the N₃ category. The results of treatment were uniformly poor in the latter group of patients, provided the term “fixed” indicated immobility of involved lymph nodes and not merely the presumption that tumor had extended beyond the capsule of the node.     

Comparison of membrane proteins of Burkitt's lymphoma and EBV-transformed B lymphoblast cell lines and of Con A-activated T lymphocytes and T lymphoblast cell lines.

The aim of this study was to examine the heterogeneity of membrane proteins of several B and T lymphoblast cell lines and activated normal T lymphocytes using SDS gel electrophoresis of [³⁵S]methionine metabolically labeled cells. In part, we hoped to test the hypothesis that human lymphocytic malignancies are “frozen” representatives of various stages in the differentiation paths of normal lymphoid cells. The membrane protein patterns of Burkitt's lymphoma cell lines were very similar to each other and to those of EBV-transformed B lymphoblastoid cell lines from healthy persons. The American Burkitt's lymphoma cell line Ramos lacked p29, 34 (HLA-DR) antigen, as was confirmed with immunoprecipitation studies of this complex and of p44, 12 (HLA-A, and -B antigens and β₂-microglobulin) from each of the cell lines. Heterogeneity in the electrophoretic mobility of HLA-DR antigen was apparent, reflecting size or charge variations. Small degrees of membrane protein heterogeneity among the T lymphoblast cultured cell lines was also evident. Proteins of mol. wt 90,000, 75,000, 18,000 and 16,000 were more heavily labeled on some cell lines than on others. This heterogeneity is consistent with the hypothesis that these tumors might be derived from cells of varying maturational stages or from different subsets of T lymphocytes. In contrast to the T lymphoblast lines, Con A-activated T lymphocytes on each successive day of stimulation expressed dramatically different membrane proteins. Proteins of mol. wt 30,000 and 36,000 were found on day 2 cells; mol. wt 55,000 proteins were dominant on days 1, 2 and 3; a group of proteins of mol. wt about 120,000 was present on cells surviving a lytic process on day 4. Although many proteins were shared between Con A blasts and cultured T cell lines, the absence from the cultured lines of proteins which were dominantly synthesized by mitogen-activated lymphoblasts was consistent with the view that long-term cultured lymphoblasts represent a more primitive, undifferentiated, immature T-cell population, while the changes seen with Con A activation represent metabolically controlled changes consequent to activation of one or more subsets of mature T cells. While many proteins were shared among membrane proteins of T lymphoid tumors and mitogen-activated, normal T lymphocytes, the differences were so striking that simple parallelisms between these lymphoid tumors and activated sets of normal lymphocytes could not be proposed.     

Microsurgical results with large vestibular schwannomas with preservation of facial and cochlear nerve function as the primary aim

Summary Objective. To evaluate our microsurgical results in dealing with vestibular schwannomas (VS) greater than or equal to 30 mm when preservation of cranial nerve function was considered more important than total tumour removal.Methods. Sixteen consecutive cases were operated on by the same neurosurgeon according to a prospective protocol using intraoperative neuro-monitoring (IONM) based on electromyographic and brain stem auditory evoked potential recordings. Facial nerve function was evaluated on the House-Brackmann Scale and cochlear nerve function on the Gardner-Robertson Scale. Someone not involved in the clinical management of our patients collected all data.Results. Fifteen patients showed facial nerve (FN) function of House-Brackmann grade (HBG) I or II at one year postoperatively and one kept the HBG IV she had preoperatively. Two patients of four maintained a cochlear nerve function of Gardner-Robertson grade (GRG) II. The tumour excision rates were: total, 68.7%; near total, 6.3%; subtotal, 18.7%, and partial, 6.3%. The average follow-up was 55 months (1–106). Three patients underwent radiotherapy later with growth stabilisation and no additional morbidity.Conclusion. When dealing with VS greater than or equal to 30 mm, microsurgery guided by IONM, with a rate of total or near-total tumour excision of about 75%, can retain socially acceptable facial nerve function (HBG I or II) in all cases and serviceable hearing (GRG I or II) in two cases out of four. Maintaining serviceable cranial nerve function should take precedence over total tumour excision.     

Remitting/relapsing idiopathic hypertrophic spinal pachymeningitidis: comprehensive imaging work-up and MR monitoring

We present the initial MR and PET work-up in a diabetic 31-year-old female patient presenting with spinal cord compression because of abnormal meningeal tissue and highlight the close correlation between the clinical course and the monitoring of the lesions on MR images. The combination of non-specific inflammatory signs at histopathological examination and of the negative results of a comprehensive bacteriological and serological testing led to the diagnosis of idiopathic hypertrophic spinal pachymeningitidis. The abnormal tissue showed mild glucose uptake at whole-body FDG-PET examination. Repeated MR follow-up examinations during corticoid treatment only demonstrated partial shrinkage of the abnormal tissue. Symptomatic relapse and re-increase in lesion size on MR images occurred concomitantly after an 11-month symptom-free remitting interval under tapering corticoid treatment.