Intracranial peripheral primitive neuroectodermal tumors of the cavernous sinus: a diagnostic peculiarity

Peripheral primitive neuroectodermal tumors (pPNETs) are aggressive, poorly differentiated neoplasms that occur in children and young adults. These tumors are associated with a peak incidence in the second decade and a slight male preponderance. Recently, Ewing sarcoma and pPNET tumors have been proven to carry identical translocations, the most common being t(11;22)(q24;q12). Intracranial Ewing sarcoma/pPNETs have rarely been described in the literature. We studied a case of intracranial pPNET arising in the right cavernous sinus of a 46-year-old man. On imaging, the tumor had both sellar and suprasellar components and was centered within the right parasellar region. Histologically, the tumor was composed of intermediate to large cells with round to oval hyperchromatic nuclei with distinct nucleoli. The cells contained a moderate amount of slightly basophilic cytoplasm. The tumor was markedly fibrotic and had collagen bands surrounding both individual and groups of cells. A large immunohistochemical panel was positive only for CD99 and vimentin. Fluorescence in situ hybridization did not show translocations associated with Ewing sarcoma/pPNET. However, a small percentage of these tumors can be negative for this translocation. In these cases, histology and immunohistochemical techniques in the absence of an alternative diagnosis are the only tools available to establish the diagnosis.     

Comparison of abilities of recombinant interleukin-1α and -β and noninflammatory IL-1β fragment 163–171 to upregulate C3b receptors (CR1) on human neutrophils and to enhance their phagocytic capacity

Both recombinant IL-1 and - caused an upregulation of C3b receptors (CR1) on human neutrophils and caused a receptor-mediated enhancement of phagocytosis of C3b·IgG-coated microspheres by these leukocytes. The and forms of the recombinant cytokine were of comparable potency regarding CR1 upregulation, although both generally had less than 25% of the potency of FMLP in this respect. Recombinant IL-1 was slightly more potent than the form of the cytokine regarding phagocytosis of opsonized microspheres and, again, both forms were less potent than FMLP in causing an enhancement of phagocytosis by neutrophils. The synthetic noninflammatory immunostimulatory nonapeptide corresponding to residues 163–171 of IL-1 was completely inert with respect to upregulation of CR1 on neutrophils and the enhancement of phagocytosis by these cells. Thus this domain in the intact IL-1 molecule apparently is not involved in CR1 upregulation and the ensuing enhancement in phagocytosis by neutrophils, although it is apparently important in the immunostimulatory activity regarding the proliferation of lymphocytes.     

A multimedia database system for thermal ablation therapy of brain tumors

A prototype multimedia medical database is described for supporting thermal ablation therapy of brain tumors. Its design is motivated by the major need to manage and access multimedia information on the progress and reaction of tumors to various therapy protocols. The database links images to patient data in a way that permits the user to view and query medical information using alphanumeric, temporal, and feature-based predicates. Visualization programs permit the user to view or annotate the query results in various ways. These results support the wide variety of data types and presentation methods required by neuroradiologists to manage thermal ablation therapy data. The database satisfactorily meets the requirements defined by thermal ablation therapy. A similar approach is being undertaken for supporting different therapies of other types of tumors, thus showing the generality of our approach.     

Lactoferrin gene expression is estrogen responsive in human and rhesus monkey endometrium.

We have previously shown that the estrogen responsiveness of the human lactoferrin gene in a transient transfection system is mediated through an imperfect estrogen response element (ERE) and a steroidogenic factor 1 binding element (SFRE) 26 bp upstream from ERE. Reporter constructs containing SFRE and ERE respond to estrogen stimulation in a dose-dependent manner, whereas mutations at either one of the response elements severely impaired the estrogen responsiveness. In this study, we demonstrated that estrogen receptor (ERalpha) binds to the human lactoferrin gene ERE and forms two complexes in an electrophoresis mobility shift assay (EMSA). These complexes could be supershifted by an antibody to ERalpha. We also showed that in normal cycling women, lactoferrin gene expression in the endometrium increases during the proliferative phase and diminishes during the luteal phase. This in-vivo study thus supported the finding from transient transfection experiments that the human lactoferrin gene expression is elevated in an environment with a high level of estrogen. The estrogen effect on lactoferrin gene expression in the rhesus monkey endometrium was studied by Western blotting and immunohistochemistry. The immunohistochemistry results showed that immunoreactive lactoferrin protein was not detectable in the untreated ovariectomized monkey endometrium, was elevated by estrogen treatment, and was suppressed by sequential, combined estrogen plus progesterone treatment. In conclusion, this study has shown that lactoferrin gene expression is responsive to estrogen in primate endometrium.     

Immunological recovery after measles

Twenty-two children with measles were studied at the stage of the rash and 6 weeks later, and results compared with matched controls. The total lymphocyte count and lymphocyte subpopulations with T- and B-cell markers and those with absence of both markers (null cells) were significantly below control levels in the acute phase. At 6 weeks the B-cell and null-cell counts were still significantly diminished. The function of T cells assessed by 14C uptake of phytohaemagglutinin-stimulated lymphocytes and the delayed skin hypersensitivity reaction to dinitrochlorobenzene was impaired during the acute stage, and this persisted for 6 weeks. Over the 6 weeks of study there was a small but significant rise in serum IgG, IgM and complement factors.     

Effect of EMG Biofeedback and Progressive Muscle Relaxation Training on Awareness of Frontalis Muscle Tension

Awareness of muscle tension, as estimated by a modification of the Kinsman et al. (1975) procedure for determining probability of correct estimation (P(c)) of absolute differences in muscle tension between adjacent trials, was examined before and after volunteer subjects underwent 4 sessions of either: 1) EMG biofeedback (BF) training, 2) progressive muscle relaxation (PMR) training, or 3) a placebo-control (MC) procedure which involved listening to music as an alleged guide for relaxation. The subjects were 30 females (mean age = 28.3 yrs) responding to an offering of experimental treatment for anxiety and tension. Measurements of frontalis muscle tension (EMG) and P(c) were made before and after training. The results showed that EMG was significantly reduced by BF and PMR training but not by the MC procedure. Increases in P(c) after training were significantly greater for BF than for PMR or MC training. There were no group differences for subjective report of tension. Correlations between pre- to post-training EMG and P(c) change scores were significant only for the BF group and the combined group of BF and PMR subjects. These results suggest that: 1) both BF and PMR training were effective in producing frontalis EMG reductions, 2) the following relationship may exist among training groups in terms of relative influence upon awareness of tension—BF training > PMR training > MC training, and 3) awareness of tension appears to be related to the ability to reduce EMG although the exact nature of this relationship remains unclear.     

Endogenous component chemotactic assay (ECCA)

We have developed a chemotactic assay in which migrated cells are quantitated by measuring levels of an endogenous cellular component. The endogenous component chemotactic assay (ECCA) employs standard double-membrane, blind-well methodologies but is unique in that leukocyte migration is quantitated by measuring lactic dehydrogenase (LDH) activity endogenous to cells that have migrated. This approach avoids the tedium of microscopic counting as well as the problems associated with cell-labeling techniques. Using the ECCA technique we have shown: (1) that N-formylmethionyl-leucyl-phenylalanine (fMLP) is both chemokinetic and chemotactic for human polymorphonuclear neutrophils (PMNs); (2) that both incubation time and starting PMN density affect the proportion of cells that migrate; (3) that approximately 30% of the available PMNs eventually migrate; and (4) that PMN "fall off" from membranes, readily detectable by this assay, is affected by starting PMN density, incubation period, and nature of the attractant. The technique as presented can detect migration when a starting cell density as low as 7 x 10(4) PMNs/well is employed and can be made more sensitive by increasing the period over which LDH is allowed to act. Considerable potential exists to further apply the ECCA concept to the study of the migration of subpopulations of cells in mixtures by assaying for distinguishing endogenous cellular markers.     

Aggressive resection of metastatic disease in selected patients with malignant gastrinoma.

Fifteen patients with Zollinger-Ellison syndrome followed at the National Institutes of Health with extensive metastatic disease had an actuarial 5-year survival of 20%. Therefore, in 1982 a prospective study to examine the effect and feasibility of removing all gross tumor in selected patients with extensive metastatic disease was instituted. Five patients with extensive metastatic gastrinoma confined to the abdomen in whom imaging studies suggested the possibility of complete surgical resection were entered into this study and underwent attempted complete surgical resection and chemotherapy with streptozotocin, doxorubicin, and 5-fluorouracil. Median follow-up was 24 months. Surgical resection of all gastrinoma was possible in 4/5 patients attempted. In one patient in whom all gross disease could not be resected, the residual tumor progressed and the patient died 19 months after operation. All four patients with all disease resected appeared to benefit since all of them had a significant reduction in antisecretory medications and are enjoying normal activity and work. Three patients have had no detectable tumor on follow-up, and two of these patients are clinically and biochemically "cured" with normal fasting gastrin levels and negative provocative gastrin tests at 14 and 32 months. Therefore, aggressive resection of metastatic disease in selected patients with malignant gastrinoma is recommended.     

Dilemma of black community hospitals

This feature of Urban Health covers a wide range of topics related to metropolitan hospitals, both public and private. This month's column discusses a hospital setting with which relatively few practicing physicians are well acquainted--the Black community hospital. More than 500 such hospitals were established in years following the Civil War, but their numbers have dwindled steadily in recent decades to the point where today only a handful survive. A recasting of missions and a thrust into the middle class population are among strategies needed to halt the demise of these institutions, says the author.     

Home parenteral nutrition: a hospital-based program with commercial logistic support

Since home parenteral nutrition was introduced in the 1970's, a number of medical centers have formed successful home parenteral nutrition programs which have reduced expenses to the patient and third party payers by 50 to 73% over in hospital costs. However, the cost of maintaining these programs for training and follow-up has largely been absorbed by the hospital as a nonreimbursable teaching expense. To offset the costs of our growing program in these times of budget "caps," we have established an agreement between our hospital and commercial home care company which provides for patient instruction and follow-up by the hospital parenteral and enteral nutrition team and logistic support by the home care company. We used the average cost of our first five patients to establish a fee schedule which the commercial company agreed to pay the hospital parenteral and enteral nutrition team for its services. This agreement reduces the number of nurses and pharmacists that the commercial company would otherwise have to hire for teaching and follow-up of home care patients, and supports the concept of regional care in medical centers where parenteral and enteral nutrition teams maintain quality control, continuity of care, and efficient teaching programs for patients requiring home parenteral nutrition.