Intracranial plasmocytoma manifesting multiple myeloma: apropos of a case]

Neurological complications of myeloma are multiple and various. Cranial and intracranial locations have been rarely reported. They can be classified into three clinical groups: (1) cranial nerve palsies secondary to single or multiple lesions in the base of the skull, (2) intraorbital tumors, (3) intracranial tumors, either cranial myeloma extending intracranially or pure intracranial tumor (dural and/or cerebral). In our case, macroscopic and microscopic examination of the brain showed dural and cerebral involvement, confirmed by immunohistochemical studies. The radiological features are discussed (CT scan, MRI, angiography). To our knowledge, a single report of intracranial plasmacytoma documented by MRI has been reported in the literature.     

Induction of IL-15 by TCR/CD3 aggregation depends on IFN-gamma and protects against apoptosis of immature thymocytes in vivo

TCR/CD3 aggregation by injection of anti-CD3 Ab produces T cell activation, release of cytokines such as IFN-gamma, and apoptosis in the cortical region of the thymus. We show that anti-CD3 Ab induces IL-15 mRNA in spleens of wild-type but not IFN-gamma receptor-knock-out (IFN-gammaR KO) mice. The loss of IL-15 mRNA induction in IFN-gammaR KO mice was associated with increased thymocyte apoptosis. Pretreatment of wild-type mice with neutralizing anti-IL-15 Ab increased the anti-CD3-triggered thymocyte apoptosis, thus mimicking the sensitive phenotype of IFN-gammaR KO mice. Inversely, anti-CD3-induced apoptosis in IFN-gammaR KO mice was suppressed by administration of recombinant IL-15. In IFN-gammaR KO mice and in wild-type mice that were treated with anti-IL-15, augmented apoptosis affected mainly CD4+CD8+ immature thymocytes. IL-15 as well as IL-15Ralpha mRNA expression in thymocytes was not increased by anti-CD3. These data demonstrate that systemic IL-15 exerts anti-apoptotic activity on immature T cells and establish a regulatory mechanism whereby TCR/CD3 engagement induces IL-15 expression via an IFN-gamma-dependent pathway. The self-amplifying nature of this IFN-gamma/IL-15 connection may constitute a regulatory pathway in central tolerance to self.     

Juxtabulbar neurinoma of the spinal accessory nerve]

A 27-year-old woman presented with right spinal accessory juxtabulbar schwannoma, associated with hydrocephalus. The only specific clinical symptom was long-standing weakness of the right trapezius. C.T. scan evoked a cerebellar tumor, whilst the jugular foramen appeared normal. Vertebral angiography was not decisive. M.R.I. suggested an extra-axial tumor. Post-operative evolution was entirely favourable. Schwannomas of the 9th, 10th and 11th cranial nerves are generally located at the level of the jugular foramen but can also be observed along the extracranial path of these nerves. An intracranial paramedial, or so-called "intracisternal" localization is rare and is best diagnosed by magnetic resonance imaging.     

Treatment of patients with advanced non-small cell lung cancer

In advanced non-small cell lung cancer (NSCLC), an objective response to chemotherapy is of limited value and the impact of chemotherapy on survival is modest. Therefore, endpoints evaluating the patients’ subjective benefit such as symptom control (SC), quality of life (QOL) or clinical benefit (CB) have recently been implemented into clinical trials, mostly as secondary endpoints. Chemotherapy offers SC, not only in patients with an objective response, but also in a proportion of patients with disease stabilization. For this purpose, three to four cycles of platinum-based chemotherapy are recommended. Interpretation of QOL objectives is limited by several methodologic problems. Studies comparing best supportive care alone with either older platinum-based combinations or single-agent chemotherapy with a new cytotoxic drug usually indicate improved survival and improvement of some component(s) of QOL in the active treatment arm. However, results from studies comparing different chemotherapies are less definitive. Trials comparing single-agent therapy with a new drug with new combinations mostly report no difference in QOL. In addition, most trials comparing new platinum-based combinations with older ones, and trials comparing new platinum-based regimens fail to show any differences in QOL. As a whole, it is far from clear whether combination therapy is superior to modern single-agent therapy, when the patient’s benefit is the primary endpoint. Non-platinum-based doublets, compared with platinum-based doublets, may lead to slightly inferior survival, are not always less toxic, and have not been proven to provide better QOL outcomes. The CB response, originally reported in pancreatic cancer, measures more than SC, but not full QOL. Encouraging experience with this tool was reported in advanced NSCLC. Randomized studies designed to look at some form of patient benefit as a primary endpoint should be a priority in advanced NSCLC.     

Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes

We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0–18?years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77?%) and had at least one parent of Belgian origin (78?%). Nearly all patients (≥95?%) underwent determination of HbA_1c and BMI. Screening for retinopathy (55?%) and microalbuminuria (73?%) was less frequent, but rates increased with age and diabetes duration. Median HbA_1c was 61?mmol/mol (7.7?%) [interquartile range 54–68?mmol/mol (7.1–8.4?%)] and increased with age and insulin dose. HbA_1c was higher among patients on insulin pump therapy. Median HbA_1c significantly differed between centres [from 56?mmol/mol (7.3?%) to 66?mmol/mol (8.2?%)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA_1c and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. Conclusion: Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA_1c remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge.     

Influence of cisplatin-use,age, performance status and duration of chemotherapy on symptom control in advanced non-small cell lung cancer: detailed symptom analysis of a randomised study comparing cisplatin-vindesine to gemcitabine

BACKGROUND: We previously reported that treatment of patients with symptomatic advanced non-small cell lung cancer with single agent Gemcitabine (GEM) resulted in a superior clinical-benefit response rate (RR) compared to cisplatin-based combination chemotherapy. We now report the detailed individual symptom control analysis, and the influence of cisplatin-use, age, performance status (PS) and duration of treatment. PATIENTS AND METHODS: Patients received either GEM (1000 mg/m(2), days 1, 8 and 15) or cisplatin (100 mg/m(2), day 1) plus Vindesine (3 mg/m(2), days 1 and 15) (PV), both every 4 weeks. Scores of 9 symptoms were listed weekly by the patient on visual analogue scales. Improvement of a symptom was defined as 2 consecutive cycles of improvement over baseline. RESULTS: Baseline symptoms in the 169 patients were well balanced between the 2 arms (84 GEM, 85 PV). Both patients with objective response and disease stabilisation had clearly better symptom control than those with disease progression. Symptom control in both arms was similar for 'disease-specific' symptoms such as cough, dyspnea, pain or haemoptysis. Compared to PV, a significantly larger number of GEM-patients had better scores for 'constitutional' items such as anorexia (P=0.007), ability to carry on with daily activities (P=0.04) and overall impression of quality-of-life (P=0.008). Symptom control was very similar in younger (<65 years) versus older (>/=65 years) patients, and only slightly better in those with a Karnofsky PS >/=80% compared to those <80%. Most of the symptom improvement occurred in the first 3 cycles, with some further symptom improvement in the following cycles in the GEM-arm only. CONCLUSIONS: Both GEM and PV yield a symptom control rate much higher than expected by the objective tumour RR. GEM is equally effective in controlling 'disease-specific' symptoms, but superior in controlling 'constitutional' symptoms. Most of the symptom control was achieved during the first 3 cycles of treatment, with some further improvement thereafter in the GEM-arm only.     

Spin-echo MR imaging of intracranial hemorrhage

Summary This retrospective study was performed to describe the appearance of intracranial hemorrhagic lesions on magnetic resonance (MR) imaging at 0.35 tesla using the spin-echo technique, and define the present clinical role of MRI in this particular pathology. Forty-eight examinations of forty-three patients with forty-seven intracranial hemorrhagic lesions (39 true hematomas and 8 hemorrhagic lesions mixed with other tissues) were reviewed for this study. Comparative CT studies were available for all the patients. In our limited experience with acute hematomas (less than 3 days old), low or isointense signal was seen with a short TR (0.5 s), but a relative increase in signal intensity was observed with a long TR (2.0 s). This appearance of acute hematoma was not specific. Chronic hematomas (more than 3 days old) were imaged as foci of bright signal intensity on both short and long TR. This pattern was characteristic of chronic hematoma. With a short TR (0.5 s), two hemorrhagic lesions (5 and 7 days old) were displayed as an isointense signal surrounded by a rim of high intensity signal. This peripheral zone most likely represented liquefaction at the clot's periphery and the initial formation of methemoglobin. T1 and T2 relaxation times were found to be very long for acute hematomas (first two days). T1 values of chronic hematomas (more than 3 days old) were compaaatively short and in the same range as T1 of white matter. T2 values of chronic hematomas decreased also but remained very long.