Late peritoneal metastasis in a patient with osteosarcoma

Nutrient transport across the mammalian small intestine is regulated by several factors, including intrinsic and extrinsic neural pathways, paracrine modulators, circulating hormones and luminal agents. Because beta-adrenoceptors seem to regulate gastrointestinal functions such as bicarbonate and acid secretion, intestinal motility and gastrointestinal mucosal blood flow, we have investigated the effects of different beta-adrenergic agonists on nutrient absorption by the rat jejunum in-vitro. When intestinal everted sacs were used the beta2-agonist salbutamol had no effect either on galactose uptake by the tissue or mucosal-to-serosal flux whereas mixed beta1- and beta2-agonists (isoproterenol and orciprenaline) and beta3-agonists (BRL 35135, Trecadrine, ICI 198157 and ZD 7114) inhibited galactose uptake and transfer of D-galactose from the mucosal-to-serosal media across the intestinal wall (although the inhibiting effects of isoproterenol and Trecadrine were not statistically significant). In intestinal everted rings both Trecadrine and BRL 35135 clearly reduced galactose uptake, the effect being a result of inhibition of the phlorizin-sensitive component. Total uptake of phenylalanine by the intestinal rings was also reduced by those beta3-adrenergic agonists. These results suggest that beta1- and beta3-adrenergic receptors could be involved in the regulation of intestinal active transport of sugars and amino acids.     

Acquired neuromyotonia in a patient with spinal epidural abscess

We report a case of acquired neuromyotonia in a patient with Staphylococcus aureus septicemia and a spinal epidural abscess. Autoantibodies to voltage-gated potassium channels, which are associated with acquired neuromyotonia, were present during the patient's acute illness but became undetectable on clinical recovery. The spinal epidural abscess may have triggered the production of these specific autoantibodies, resulting in clinically and electromyographically detectable neuromyotonia.     

Muscle metastasis in a patient with epidermoid carcinoma of the lung

Diagnosis of vertically acquired human immunodeficiency virus (HIV) infection is often difficult because of transplacentally acquired maternal antibodies. The polymerase chain reaction (PCR) test is commercially available and has high sensitivity and specificity. To evaluate the usefulness of PCR testing in the early diagnosis of perinatally acquired HIV infection, we reviewed records of 122 children having follow-up in the Northeast Florida Pediatric AIDS Program. Seventy-two children were excluded for various reasons. Of the remaining 50 children, 37 had PCR testing. In 5 children, the initial PCR test was done at > 18 months of age. Results of PCR testing were positive in 8 of 13 (62%) at birth, 12 of 18 (67%) by 1 month of age, 18 of 23 (78%) by 2 months of age, and 20 of 24 (83%) by 3 months of age. In 24 of 27 (85%), results were positive by the time the children reached 4 months of age. Our data suggest that the PCR test is a useful tool for early diagnosis of vertically transmitted HIV infection.     

Sequences and techniques in spinal MR imaging

The optimal protocol in spinal MR imaging is not evident. Sagittal T2 weighted FSE, sagittal T1 weighted SE and axial T2 weighted FSE sequences are widely accepted for imaging patients with sciatica and/or lumbar pain. Because of the limited amount of CSF compared to the lumbar spine, the choice of sequences is much more complex in the study of the cervical spine. Sagittal T2 FSE, sagittal T1 SE and axial 2D GE images are suggested in routine cervical spine imaging. To assess the bone marrow, a STIR sequence can be added to this protocol on both lumbar and cervical spine examinations. The 2D GE produces an acceptable image quality to differentiate between the disc and bony protrusions. The use of FLAIR for imaging spinal cord lesions remains controversial in the literature.     

Multifocal varicella-zoster virus leukoencephalitis in a patient with AIDS: MR findings

We describe a patient with AIDS who presented with an acute encephalitis caused by infection with varicella-zoster virus. The hemorrhagic, necrotizing encephalitis had an unusual MR appearance, with innumerable discrete, small, targetlike lesions in the right cerebral hemisphere, which were coalescent in the posterior temporal, parietal, and occipital regions. Of the several known disease patterns of varicella-zoster viral infection in the CNS, this histopathologic pattern of multifocal leukoencephalitis is rare. It is important to recognize, as effective antiviral drug treatments are available.     

MR of spinal cord ganglioglioma

PURPOSE: Our purpose was to describe the MR imaging features in a series of spinal intramedullary gangliogliomas and to compare these findings with the MR features of intramedullary astrocytomas and ependymomas. METHODS: A retrospective analysis was performed of 76 MR examinations in 27 patients with histologically proved spinal ganglioglioma; these were then compared with imaging findings in a representative sample of histologically proved spinal cord astrocytomas and ependymomas. RESULTS: Statistically significant observations regarding spinal gangliogliomas included young age of the patients (mean, 12 years), long tumor length, presence of tumoral cyst, presence of bone erosion and scoliosis, absence of edema, presence of mixed signal intensity on T1-weighted images, and presence of patchy enhancement and cord surface enhancement. A trend (not statistically significant) was noted for holocord involvement and lack of magnetic susceptibility. CONCLUSION: Spinal ganglioglioma can be strongly suspected if MR images reflect the above criteria; however, the ultimate diagnosis still depends on radical resection and appropriate histopathologic investigation.     

Pulmonary epidermoid carcinoma in a 22-year-old patient with multiple cutaneous metastasis]

The authors present one clinical case of lung epidermoid carcinoma with several concurrent features which are uncommon in relation to this type of neoplasia. Consequently, the age of the patient (22), the lack of known risk factors, the histologic type (little differentiated squamous) and an aggressive biologic behaviour of the tumour, preceded of multiple cutaneous metastasis, are circumstances that make this clinical case exceptional. The more significative aspects present at lung carcinoma included in this age group respect to others are analyzed.     

Pre-and post-mortem MR imaging of unsuspected multiple sclerosis in a patient with Alzheimer's disease

A patient with the clinical diagnosis of Alzheimer's disease is presented in whom pre-mortem T2-weighted MRI revealed a periventricular white matter lesion. Postmortem T2 weighted MRIs of the formalin fixed brain revealed the same white matter lesion. Microscopically, classical Alzheimer changes were found and, unsuspectedly, the histopathological correlate of the white matter lesion proved to be an old, inactive, MS plaque. A similar lesion was discovered in the cervical myelum. These findings illustrate that T2-weighted post-mortem MRIs are highly comparable to pre-mortem images and that MRI is sensitive in detecting clinically silent white matter lesions. The histopathology of such lesions may also include MS plaques.     

Symptomatic hypocalcemia in a patient with latent hypoparathyroidism and breast carcinoma with bone metastasis following administration of pamidronate

Pamidronate is an effective drug used not only in patients with tumor-associated hypercalcemia, but also in normocalcemic patients with metastatic bone disease to relieve pains. We describe a 39-year-old normocalcemic patient with subclinical hypoparathyroidism and bone metastasis due to breast carcinoma. Following parenteral administration of 60 mg pamidronate, the corrected serum level of calcium decreased from 2.12 mmol/l (=8.9 mg/dl) to 1.42 mmol/l (5.7 mg/dl), accompanied with carpal pedal spasm. The present case indicates that the hypocalcemia due to latent hypoparathyroidism was compensated by extensive osteolysis due to bone metastasis, and that overt hypocalcemia may develop after intravenous administration of pamidronate in such a patient.     

Cauda equina syndrome after spinal anaesthesia in a patient with severe vascular disease

The effect of pendent side-chain length and crosslinking agent concentration in methyl methacrylate/dimethylaminoethyl methacrylate as a polybasic/hydrophobic pH-sensitive hydrogel was studied. Increasing both side-chain length and crosslinking agent concentration decreased the sharpness of response to pH and water-uptake capacity of the polymer. A case-II water transport mechanism and a nonlinear swelling kinetic was observed for the homologues of this hydrogel.     

Giant somatosensory evoked potentials in a patient with the anterior spinal artery syndrome

We studied a previously healthy 25-year-old woman with the anterior spinal artery syndrome, a rare thoracocervical myelopathy with multiple potential etiologies. Quantitative and clinical sensory examination showed dissociated loss of pin-prick and temperature discrimination below the level of the lesion, with normal light touch, vibratory, and position sense. Magnetic resonance imaging was consistent with cervical spinal cord infarction. Median SEPs showed normal Erb's potential with absent spinal N13- and normal scalp N20- latency. Tibial SEPs showed normal lumbosacral responses and normal scalp P30- latency. Both median and tibial nerve stimulation produced cortical responses of unusually large amplitude (median 38 microV, tibial 17 microV). We hypothesize that large SEP amplitudes in this patient resulted from loss of anterolateral inhibitory influences on the dorsal column-medial lemniscal system.     

Longitudinal involvement of the spinal cord in a patient with lupus related transverse myelitis

Arachidonic acid is suggested to play a role in the expression of long-term potentiation (LTP), a synaptic analog of memory and learning. However, it is unknown whether this free fatty acid is actually released during LTP or not. To address this question, we assayed arachidonic acid with an HPLC system using 9-anthryldiazomethane (ADAM) as a fluorescent probe. High frequency stimulation (tetanic stimulation) to a hippocampal slice from the guinea pig brain caused a huge increase in the release of glutamate from presynaptic terminals and in turn, a gradual increase in the release of arachidonic acid. A similar increase in the release of arachidonic acid was induced by application of glutamate and the increase was inhibited by either the selective AMPA/kainate receptor antagonist, DNQX, or to a lesser extent by the selective NMDA receptor antagonist, APV. These findings suggest that arachidonic acid is produced by activation of ionotropic glutamate receptors involving expression of LTP. Arachidonic acid exerted a long-lasting facilitatory action on synaptic transmission in the CA1 region of rat hippocampal slices and the facilitation occluded the tetanic LTP. Arachidonic acid, thus, appears to be a significant factor for the expression of LTP.     

MR arthrography of the shoulder joint in a postoperative patient sample

Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff.     

Magnetic resonance imaging of a mediastinal ependymoma

Ependymomas typically occur in the brain and spinal cord, and represent 5% and 16% of primary intracranial and spinal cord tumors respectively. Ependymomas arising outside the central nervous systems are uncommon and when they do occur are usually seen in the sacrococcygeal region. Other reported sites include the pelvis, spinal nerve roots, and lung. An extraspinal mediastinal ependymoma is a rare occurrence, with only two previously reported cases to our knowledge. In both instances, the lesion arose in the posterior mediastinum, and were imaged with either chest radiographs alone or chest radiographs and computed tomography. In our case, plain radiography was followed by magnetic resonance imaging. This report documents the clinical, pathological, and magnetic resonance imaging findings in a case of a posterior mediastinal ependymoma. Primary mediastinal ependymomas are rare lesions that may be considered in the differential diagnosis of a posterior mediastinal mass.     

Axial loading of the spine during CT and MR in patients with suspected lumbar spinal stenosis

PURPOSE: To evaluate the effect of compressive axial loading in imaging of the lumbar spine in patients with clinically suspected spinal stenosis. MATERIAL AND METHODS: A total of 84 patients were examined, 50 with CT (after intrathecal contrast administration) and 34 with MR. First the dural sac cross-sectional area (CSA) was determined with the patient in the supine psoas relaxed position (PRP). Then the CSA was determined during supine axial compression in slight extension (ACE), obtained with a specially designed loading device. A measurement error study was performed. RESULTS: A minimum difference in CSA of 15 mm2 between PRP and ACE was found to be significant. In 40/50 (80%) of CT-examined patients and in 26/34 (76%) of MR-examined patients a significant difference in CSA was found. In 25/84 (30%) of the patients there was a significant difference at more than one level. CONCLUSION: For an adequate evaluation of the CSA, CT or MR studies should be performed with axial loading in patients who have symptoms of lumbar spinal stenosis.     

Clinical, neurodiagnostic, and MR findings in children with spinal and brain stem multiple sclerosis

PURPOSE: To describe the clinical, neurodiagnostic, and MR findings in seven children with brain stem and spinal multiple sclerosis. METHODS: Spinal or brain stem multiple sclerosis was diagnosed in seven children between 1986 and 1992. All patients had neurologic and MR examinations as well as neurodiagnostic testing, including spinal fluid analysis and brain stem and auditory evoked potentials. RESULTS: Three children had clinical findings and masslike lesions in the brain stem (two) or spinal cord (one) suggestive of neoplasm, which prompted biopsy (two) or radiation therapy (one). Five of six patients with spinal involvement had cord swelling with increased signal on T2-weighted images over at least three cord segments, and two children had essentially holocord involvement. Three children had normal cranial MR at presentation. CONCLUSIONS: Multiple sclerosis involvement of the brain stem and spinal cord may be associated with extensive swelling and MR signal changes suggestive of neoplasm without typical cerebral white matter abnormalities. Serial clinical and neuroimaging examinations may be necessary to make a definitive diagnosis of multiple sclerosis in children.