Intratemporal vascular tumors: detection with CT and MR imaging

The diagnostic contributions of computed tomography (CT) and magnetic resonance (MR) imaging were compared in 12 patients with benign intratemporal vascular tumors (hemangioma or vascular malformation). The tumors included six in the internal acoustic canal and six in the geniculate ganglion region. Clinical and histologic correlations were made. Two of the six patients with tumors in the internal acoustic canal underwent CT, and both required gas cisternography to show the tumor. Five patients in that group underwent MR imaging, and all five studies showed the tumor. All six patients with geniculate ganglion tumors underwent CT. Results in one study were questionable, and five showed the tumor. Five patients in this group underwent MR imaging, but the MR findings were positive in only two cases. MR imaging should therefore be performed before CT in the evaluation of facial nerve dysfunction, as it demonstrated all tumors in the internal acoustic canal and some in the geniculate ganglion region. If MR findings are negative, CT should then be performed to rule out a possible geniculate ganglion lesion.     

The effect of elevated glucose levels on myo-inositol metabolism in cultured bovine aortic endothelial cells

Bovine aorta endothelial cells were used to determine the effect of high ambient glucose concentrations on myo-inositol metabolism. Culturing the cells for a minimum of 1 week in elevated glucose concentrations caused an increase in the intracellular sorbitol content and a decrease in myo-inositol levels. The accumulation of myo-inositol from the medium and incorporation into phospholipids was reduced 25% to 50% in cells grown in the presence of 30 to 50 mmol/L glucose. This effect was not observed following a short-term exposure of the cells to elevated glucose levels. Kinetic analysis of high-affinity myo-inositol uptake showed that the K'm was significantly increased in cells grown in 30 mmol/L glucose compared to those cultured in 5.6 mmol/L glucose. This would suggest that exposing endothelial cells to high ambient glucose levels for a minimum of 1 week leads to a competitive type of inhibition of high-affinity myo-inositol uptake. The changes in myo-inositol metabolism and content and sorbitol levels mediated by glucose exposure were blocked by addition of the aldose reductase inhibitor, sorbinil, to the media, suggesting that these changes are caused by the accumulation of sorbitol by the cells. Exposure of bovine aorta endothelial cells to high ambient levels of glucose leads to accumulation of sorbitol in the cells, which is responsible for alterations in myo-inositol metabolism. These changes could result in alteration of endothelial cell membrane function and contribute to the pathology of diabetes mellitus.     

Cervical lesions of branchial origin

A brief review of the developmental background of the lateral cervical sinuses, fistulas, cysts and auricles has been presented. In all likelihood they are of branchial cleft origin. Surgical excision is the recommended treatment as shown in the cases described.     

Consistent stress profiles in mothers of children with autism

The present study extends the area of research on stress in parents of autistic children. In this study we used the Questionnaire on Resources and Stress (Holroyd, 1987) to compare the stress profiles across mothers (a) who lived in different cultural and geographic environments; (b) who had children of different ages; and (c) who had children with different functioning levels. Results showed a characteristic profile that was highly consistent across each of these subgroups. Major differences from the normative data occurred on scales measuring stress associated with dependency and management, cognitive impairment, limits on family opportunity, and life-span care. Results suggest the importance of developing treatment programs aimed at reducing stress in specific areas in families with autistic children.Orchard Mental Health CenterThis research was supported by U.S. Department of Education, NIDRR Cooperative Agreement No. G0087C0234 (Koegel and Dunlap), by U.S. Public Health Service Research Grants MH28210 (Koegel) and MH39434 (Schreibman) from the National Institute of Mental Health, by Grant No. G008530082 from the U.S. Department of Education, Handicapped Children's Early Education Program (Dunlap), and by Fogarty Senior International Fellowship 1 FOB TWO 1374-01 (Schreibman) from the Fogarty International Center of the National Institutes of Health. The authors acknowledge the contributions of Prof. Dr. med. Hedwig Amorosa, and Dorle Staniczek, Soz. Pad. of the Max Planck Institute for Psychiatry, Munich, West Germany, and express particular appreciation to Prof. Dr. med. D. Ploog, Director of the Institute.     

Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.     

Keratoameloblastoma: a tumor sui generis or a chimera?

The term keratoameloblastoma has been used to describe a histologically heterogeneous group of ameloblastoma variants which have in common the formation of keratin by the ameloblastomatous epithelium. The English language literature contains reports of only 12 cases of keratoameloblastoma, of which 4 cases exhibited a papilliferous component. We report a unique tumor that we believe falls within the broad histopathologic spectrum of keratoameloblastoma. We review the key clinical and histopathologic features of the previously reported cases of keratoameloblastoma and present an additional case that presented as an expansile, radiolucent lesion with internal opacification between the roots of teeth in the left anterior maxillary alveolar ridge of a 45-year-old white male. There is wide variation in the histopathologic appearance of cases reported under the appellation keratoameloblastoma. Our case exhibited a histopathologic feature shared by only 2 of the previously reported cases, notably islands and anastomosing cords of epithelium forming lamellated, pacinian-like stacks of parakeratin that extruded into the collagenous tumor stroma without eliciting a foreign body response. Due to the small number of reported cases, we are unable to accurately assess whether the biologic behavior of keratoameloblastoma differs from other histologic types of ameloblastoma.     

What some patients can eat during migraine attacks: therapeutic and conceptual implications

Although nausea and vomiting are diagnostic migraine symptoms, most patients can take tablets by mouth and a few say they can eat some food. This study was conducted to determine the proportion who could eat or drink, what was consumable and with what effect. One-hundred-and-nine migraineurs were asked what they could eat or drink at the beginning or height of their attacks; 59 could not take any food by mouth, but 50 could eat during the headache phase of their migraine attacks. Four ate normally, 5 took smaller amounts of their normal dietary intake, and 3 took lighter meals. Dry, carbohydrate foods were consumable by the remaining 38: a few had specific cravings, most stated the precise variety which, when eaten, reduced nausea, headache, other symptoms or length of attacks. Patients should therefore be encouraged to eat what they can tolerate, with their tablets taken as early as possible after the onset of attacks. Simultaneous nausea, tolerance or even craving for specific foods occur in other conditions, particularly high altitude headaches which share other features of migraine attacks. The observations in this paper support the notion that migraine is a central neuronal metabolic disturbance.     

An animal model of human-type memory loss based on aging, lesion, forebrain ischemia, and drug studies with the rat

The goals of this research were to develop a within-subject test of spatial working memory and performance for the rat in a T-maze, based on a delayed alternation, or "win-shift" foraging strategy. Using this model, specific aims were to compare the effects of: (1) age, (2) basal forebrain, medial septal, and amygdala lesions, (3) four vessel occlusion (4-VO), forebrain ischemia, and (4) physostigmine, scopolamine, arecoline, piracetam, and clonidine on memory and performance of young middle-aged, and old rats. Aging significantly impaired working memory and performance of Long-Evans rats. Memory of septal and basal forebrain, but not of amygdala lesioned rats was significantly impaired without effects on performance. Transient, 4-VO forebrain ischemia produced significant memory impairment, without effects on performance, and highly selective CA1 cell loss in the hippocampus. Physostigmine enhanced working memory in middle-aged and old rats. Scopolamine impaired memory in young, middle-aged, and old rats. Physostigmine reversed the scopolamine impairments of working memory. Arecoline enhanced memory in old rats without effects on performance. Piracetam and clonidine had no direct effects on memory, but piracetam increased and clonidine decreased speed of performance. From the aging, lesion, ischemia, and drug studies it was concluded that there was a convergence of evidence from 4 different approaches for a critical role for the hippocampus, particularly the CA1 fields, in spatial working memory.