Caring for children and adolescents with cancer: the intrathecal chemotherapy phase

This study aims to explore the experiences of children and adolescents with cancer during the intrathecal chemotherapy phase, by means of a qualitative approach. Empirical data were collected on the basis of semi-structured interviews. Study participants were eleven children/adolescents who received intrathecal chemotherapy, between 07 and 16 years old, from both genders, attended at a hospital school in the interior of S?o Paulo State, Brazil. Results converged towards the following issues: intrathecal routine; fear, pain and relief fantasies and strategies. This study gave access to important information with a view to caring for children/adolescents during the intrathecal chemotherapy phase, which is considered as one of the most stressing situations. With respect to nursing implications, we identified the vital nature of information for children/adolescents with cancer since this makes it possible to minimize uncertainties and negative feelings and makes them collaborate and participate in treatment.     

Bilateral anterior thalamic nucleus lesions and high-frequency stimulation are protective against pilocarpine-induced seizures and status epilepticus

OBJECTIVE: The thalamus is thought to play an important role in secondary generalization of seizures. The aim of the present study was to investigate the influence of anterior thalamic nucleus lesions and high-frequency stimulation in the pilocarpine model of secondarily generalized seizures in rats. METHODS: Adult Wistar rats underwent unilateral (n = 7) or bilateral anterior nucleus thalamotomies (n = 10), or unilateral (n = 4) or bilateral (n = 9) anterior thalamic nucleus stimulation through implanted electrodes. Control animals (n = 9) received bilateral implants but no stimulation. Seven days after these procedures, animals were provided pilocarpine (320 mg/kg intraperitoneally) to induce seizures and status epilepticus (SE). Electrographic recordings from hippocampal and cortical electrodes were evaluated, and ictal behavior was assessed. RESULTS: In the control group, 67% of the animals developed SE 15.3 +/- 8.8 minutes after pilocarpine administration. Neither unilateral anterior nucleus lesions nor stimulation significantly reduced the propensity or latency for developing seizures and SE. Bilateral thalamic stimulation did not prevent SE (observed in 56% of the animals), but it significantly prolonged the latency to its development (48.4 +/- 17.7 min, P = 0.02). Strikingly, no animal with bilateral anterior nucleus thalamotomies developed seizures or SE with pilocarpine. CONCLUSION: Bilateral anterior thalamic nuclear complex stimulation and thalamotomies were protective against SE induced by pilocarpine.     

Shock overview

Despite improved understanding of the pathophysiology of shock and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the shock state is well established and the body's compensatory mechanisms have started to fail. Although the causes of shock are varied, the basic abnormality in all varieties is tissue and cellular dysoxia. In this overview we discuss the definition, classification and pathogenesis of shock in light of the recent advances in our understanding of its mechanisms. The epidemiology, diagnosis, and management of the various types of shock are also briefly discussed.     

Influence of pupillary diameter, ciliary muscle tone, and ambient light on nerve fiber layer measurements with scanning laser polarimetry

PURPOSE: To evaluate the influence of the pupillary diameter, ciliary muscle tone, and room light on nerve fiber layer measurements with the scanning laser polarimeter (GDx). METHODS: One randomly selected eye of ten normal volunteers was examined with the GDx in a two-day protocol under eight testing conditions (pilocarpine 1%, phenylephrine 10%, tropicamide 1%, or no drops with room lights on or off). The twelve parameters, obtained by the GDx, were compared under the eight testing conditions, using two way ANOVA for repeated measurements and Tukey HSD post hoc test. RESULTS: Ten of the twelve parameters were statistically significantly different (P < 0.05) when measured under the three medication or no medication conditions, controlling for the ambient light status. There were no significant differences when measured with the light on or off, controlling for use of drops. CONCLUSIONS: Nerve fiber layer measurements with the GDx were influenced by drugs affecting pupillary diameter, but not by the status of room light or ciliary muscle tone.     

Non-functioning pituitary adenomas: clinical features and immunohistochemistry

Clinically non-functioning pituitary adenomas do not produce clinical signs of hormonal hypersecretion. Therefore, signs and symptoms will depend on the mass effect of these adenomas over the central nervous system. Their etiopathogeny is complex and their development is probably influenced by several factors, such as hypothalamic hormones (GHRH), growth factors (FGF), proliferation factors (PCNA, and KI-67), protein P53 and the proto-oncogene c-erb-B2. OBJECTIVE: 1) Determining the clinical features of a population of 117 patients treated for clinically non-functioning pituitary adenoma (age, sex, tumor size, number of surgical procedures, development of hormonal deficiency and hyperprolactinemia). 2) Identifying, after the patients had been clinically characterized, those with clinically non-functioning adenomas with positive immunohistochemistry for hypophyseal hormones (PRL, LH, FSH, GH, TSH and ACTH). 3) Determining if the immunohistochemistry of this population was positive for the cellular proliferation factor Ki-67, protein P53 and protein C-erb-B2 and establishing a correlation with tumor size and tumor invasiveness. This will help in the evaluation of the prognostic value of these proliferation factors. 4) Confronting the results of immunohistochemistry using a standard block with the results of immunohistochemistry using a tissue micro-array. METHOD: Study of the clinical features of 117 patients with clinically non-functioning pituitary adenoma (age, sex, tumor size, number of surgical procedures, development of hormonal deficiency and hyperprolactinemia). Immunohistochemical study (H&E) of 39 patients for hypophyseal hormones, protein P53, protein C-erb-B2, Ki-67 to establish their correlation to tumor growth. The next step was a tissue micro-array of the 39 previously studied cases, using immunohistochemistry for hypophyseal hormones, protein P 53, protein C-erb-B2, Ki-67 to establish their correlation to tumor growth. RESULTS: There was no statistically significant difference between males and females with regards to age, tumor size and number of surgical procedures (p=0.279, p=813, p=139 respectively). There is a statistically significant correlation between the size of the tumor, the number of surgical procedures and hormonal deficiency (p=0.032, p=0.223 respectively). There was no statistically significant correlation between a positive immunohistochemistry for protein P53, protein C-erb-B2, Ki-67 and tumor size (r=0.182, p=0.396; r=-0.181, p=0.397; r=0.272, p=0.199, respectively). The tissue micro-array also did not demonstrate a correlation between positive immunohistochemistry for Ki-67 and C-erb-B2 and tumor size, but it showed a statistically significant correlation between a positive immunohistochemistry for p53 and tumor size (r=-0.696; p=001). CONCLUSION: The biological behavior of the clinically non-functioning adenoma is similar for both sexes. The larger the tumor the greater the number of surgical procedures needed. Hormonal deficiency also becomes more significant as the size of the tumor increases. This paper suggests that a positive immunohistochemistry for p53 is negatively correlated to tumor size, thus demonstrating that it has a predictor value. However, a positive immunohistochemistry for Ki-67 and protein C-erb-B2 does not seem to be a prognostic factor for clinically non-functioning pituitary adenomas, as is the case with other neoplasias.     

Multiple meningiomas within the spinal canal: case report with 23 tumors

In most series of neoplasms of the spinal canal, spinal cord and its leptomeninges, the incidence of meningioma group comprises approximately 25%. The incidence of multiple meningiomas is small when compared with the frequency of its single occurrence. In the majority of cases, their multiplicity is intracranial and spinal. Multiple meningiomas confined exclusively to the spinal canal are extremely rare. We report on a 33 years-old man, with 23 tumors located in the spinal thoracic region.     

Cloning and expression analysis of retinoic acid receptors in the zebra finch brain

The vitamin A derivative retinoic acid is produced postembryonically in discrete portions of the songbird brain, including some of the nuclei involved in song production and song learning, and its synthesis is required for the normal maturation of song behavior. To identify the brain targets for retinoic acid action, we cloned the zebra finch homologs of the alpha, beta, and gamma classes of retinoic acid receptors (RARs). In situ hybridization analysis revealed that the mRNAs for all three RARs are expressed at different levels in several brain areas, with a broader distribution than the mRNA for retinaldehyde-specific aldehyde dehydrogenase (zRalDH), a retinoic acid-synthesizing enzyme. Detectable RAR expression was found in all nuclei of the song control system, with the most marked expression occurring within the striatal song nucleus area X. These observations are consistent with a persistent action of retinoic acid in the postembryonic and adult songbird brain and provide further evidence for an involvement of retinoic acid signaling in the control of learned vocal behavior in a songbird species. They also suggest that the striatum is a major target of retinoic acid in songbirds.     

Interferon alpha-2B and liver resection to treat multifocal hepatic epithelioid hemangioendothelioma: a relevant approach to avoid liver transplantation

BACKGROUND: Hepatic epithelioid hemangioendothelioma is a rare malignant tumor of vascular origin with frequent multifocal appearance. Liver resection may cause tumor spread. Liver transplantation has been indicated for unresectable nodules. We hypothesized that adjuvant interferon treatment is effective to prevent metastasis after liver resection. We report a case of multifocal hepatic epithelioid hemangioendothelioma successfully treated with interferon pulse therapy and bilobar hepatic resection. METHODOLOGY: CT scan and magnetic resonance imaging diagnosed three nodules in the liver (segments IV, VI and VII). Histopathology and specific immunostaining of a percutaneous nodule biopsy confirmed the diagnosis of hepatic epithelioid hemangioendothelioma. The treatment protocol included daily interferon alpha 2b 9 weeks before and 1 week after resection of liver segments IV, VI and VII. RESULTS: The postoperative outcome was complicated by a self-limited biliary fistula. The patient remains tumor free at 3 years after liver resection and currently enjoys excellent health. CONCLUSION: Interferon pulse therapy and hepatic resection was a good option to treat multifocal bilobar hepatic epithelioid hemangioendothelioma; it may prevent metastasis dissemination.