Ependymomas of childhood. II. Electron-microscopic study

Electron-microscopic study of various histological types of ependymoma has shown three basic types of cells. One type of cells has features typical of normal ependymal cells, the second type consists of cells resembling normal or reactive astrocytes, and the third type of cells is undifferentiated. The three types of cells are present in various proportions in every tumor. Generally speaking, the astrocyte-like cells are more frequently encountered than the ependymol cells. The undifferentiated cells are seen, in small numbers, in all forms of ependymoma but they are the dominant cell type in the ependymoblastomas.     

Macular hole opercula. Ultrastructural features and clinicopathological correlation

OBJECTIVE: To investigate the ultrastructural features of idiopathic full-thickness macular hole (FTMH) opercula excised during vitrectomy and to correlate them with the outcome of surgery. METHODS: Opercula were collected from eyes undergoing vitrectomy for stage 3 FTMH using noncrushing, cupped foreign body forceps. Following immediate fixation, specimens were processed for transmission electron microscopy. The ultrastructural features were correlated with the clinical data recorded for each patient before and after surgery. RESULTS: Eighteen specimens were studied. Native vitreous collagen was identified on the surface of all 18, while fragments of internal limiting membrane were present in 11 (61%). Eleven (61%) were found to contain only glia, comprising fibrous astrocytes and Müller cells in variable proportions. The remaining 7 (39%) were found to contain, in addition to glia, neurites and synaptic complexes, of which some were typical of cone photoreceptors. The initial surgical closure rate was significantly better in eyes in which only glia were present (9/11 [82%]), compared with those with neurites (1/7 [14%]) (P = .01). Once closure had been achieved with reoperation, the median final visual acuity was 20/60 in both groups (P = .26), although the likelihood of achieving an acuity of 20/40 or better was greater in the former (50%) than the latter group (17%). CONCLUSIONS: Two distinct types of opercula occur in association with stage 3 FTMH--those containing only glia (pseudo-opercula), which are probably associated with a foveal dehiscence and little or no loss of foveal tissue, and those containing both glia and a significant number of avulsed foveal cones (true opercula), which arise from a full-thickness foveal tear. Although the loss of foveal tissue in true opercula would seem to explain the worse initial anatomical and more modest visual results in some eyes, significant visual improvement may still be achieved after successful closure. The presence of neurites in true opercula suggests that, in at least some cases, direct traction on the foveal retina leads to macular hole formation.     

Sacral chordoma in early childhood: clinicopathological and immunohistochemical study

Two cases of sacral chordoma in a 7-year, 9-month-old boy and a 3-year, 4-month-old boy are presented. In addition to the typical histology of conventional chordoma, both tumors showed the less differentiated sarcomatoid appearance of atypical chordoma in the major portion. Immunohistochemically, in both cases neoplastic cells in areas of conventional as well as atypical chordoma were positive for keratins (CAM 5.2, AE1 and AE3), epithelial membrane antigen, vimentin, S-100 protein, carcinoembryonic antigen, and glial fibrillary acidic protein. Both patients underwent resection of the tumor and chemotherapy. In comparison with conventional chordomas in adults, however, these two tumors showed more aggressive clinical course and were less amenable to therapeutic control. The older boy died of multiple metastasis 1 year after initial diagnosis. At the last follow-up, 15 months after initial diagnosis, the younger boy was alive, but with recurrent and metastatic disease of the left parasacral area and chest wall. Our studies of these two cases and the reported cases suggest that sacral chordoma in children has distinctive clinicopathologic features denoting a highly aggressive tumor and that it should be treated as such.     

Tumors of the eye and its adnexa in childhood. I. General]

The authors present a review of contemporary findings of investigations of minimal residual disease in patients with acute leukaemia. They present brief information on different monitoring techniques and on their practical application. Attention is paid above all to multiparameter flow cytometry as this method is used in their laboratory work.     

Considering the role of the amygdala in psychotic illness: a clinicopathological correlation

Today a "just" health policy is balanced between the problem of the allocation of scarce resources and the priority setting of services, care and cures. Despite technologies and molecular medicine, with their tendency to reach absolute prediction of disease or absence of disease and to cure with predicted efficacy, a large portion of the public refuse the results of experimental procedures and prefer to place trust in so-called alternative medicine or in drugs which are not in the official guide-lines following the principles of evidence-based medicine according to DL Sackett. Juridical problems arise between the rights of free choice of cure and social dimension of Governmental care programs, which include the maximum of benefits (i.e. effective therapies) for a pre-fixed total budget. An explicit rationing only on budgetary bases without rationalisation of medical procedures reduces the rights to care of citizens-patients. Thus, an explicit rationing-rationalisation seems to be the only procedure compatible with the interest of patients in a social security system allocating "scarce" resources.     

Frequent loss of p16 expression and its correlation with clinicopathological parameters in pancreatic carcinoma

Expression of the p16 gene product in human primary pancreatic carcinoma (PC) was investigated in paraffin-embedded tissue using a monoclonal antibody against p16 protein, clone G175-405, by means of immunohistochemistry, and the correlation of results with various clinicopathological parameters was evaluated. All six cases of normal pancreas and all but 1 of 20 cases of chronic pancreatitis expressed p16 protein, whereas 37.5% (3 of 8) of cystadenomas and 41. 9% (26 of 62) of PCs lost p16 expression. There was a significant difference between chronic pancreatitis and PC for frequency of the loss of p16 expression (P < 0.01). Moreover, loss of p16 expression in pancreatic malignancy was significantly associated with histological grade (G1 versus G2 and G3, P < 0.01) but not with sex, age, clinical stage, tumor location, or resectability. The survival period was shorter and metastasis is more likely in those cases that did not show p16 expression than those that did.     

The experience of "forgetting" childhood abuse: A national survey of psychologists.

A national sample of psychologists were asked whether they had been abused as children and, if so, whether they had ever forgotten some or all of the abuse. Almost a quarter of the sample (23.9%) reported childhood abuse, and of those, approximately 40% reported a period of forgetting some or all of the abuse. The major findings were that (1) both sexual and nonsexual abuse were subject to periods of forgetting; (2) the most frequently reported factor related to recall was being in therapy; (3) approximately one half of those who reported forgetting also reported corroboration of the abuse; and (4) reported forgetting was not related to gender or age of the respondent but was related to severity of the abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-sectional studies of personality in a national sample: I. Development and validation of survey measures.

Developed and validated 3 personality scales that were included in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study conducted by J. Cornoni-Huntley et al (1983). Items to measure neuroticism were selected rationally from a general well-being schedule developed by A. J. Dupuy (1978) and items to measure extraversion and openness to experience were selected by multiple regression from a personality inventory developed by the present authors (see record 1984-00201-001). In a sample of 654 20–96 yr old men and women from the Augmented Baltimore Longitudinal Study of Aging, all 3 short scales showed clear evidence of convergent and discriminant validity against full scales in self-reports, and against peer and spouse ratings. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memories of childhood sexual abuse: a survey of young adults

OBJECTIVE: To explore the prevalence of, characteristics of, and factors associated with forgetting of childhood sexual abuse memories in a large non-clinical sample (N = 1712). METHOD: Using an anonymous survey, we asked respondents about (a) the nature and severity of their childhood abuse; (b) the continuity of their abuse memories; and (c) their experiences with others suggesting to them that they might have been abused. RESULTS: A substantial minority of victims in our sample reported having temporarily forgotten their childhood sexual abuse. Forgetting was largely unassociated with victim or abuse characteristics. Compared to individuals who always remembered their abuse, however, individuals who temporarily forgot were more likely to report that someone had suggested to them that they might have experienced abuse. Those who received such suggestions were particularly likely to suspect that they may have experienced childhood sexual abuse that they do not yet remember. CONCLUSION: Forgetting may be less common than implied by earlier estimates from clinical samples, yet it is not uncommon. Also, a sizable minority of the population is wondering whether they have experienced unremembered abuse, and these suspicions are linked to having encountered suggestions from others. We discuss the implications of these findings for understanding the phenomenon sometimes labeled repression.     

Radiation myelopathy: a clinicopathological study with special reference to correlation between MRI findings and neuropathology

We describe magnetic resonance imaging (MRI) and neuropathological findings in a patient with chronic progressive radiation myelopathy (CPRM). An 81-year-old man with esophageal cancer underwent radiotherapy. Four years later he developed a progressive neurological deficit below the irradiated level of the spinal cord. Neurological examination revealed spastic paraplegia. MRI findings showed an area of high signal intensity on T2-weighted images of the thoracic spinal cord. On the basis of clinical and MRI findings, we diagnosed his condition as CPRM. MRI performed thirteen months after onset of neurological signs revealed mild atrophy of the spinal cord detected on T1-weighted images and an area of high signal intensity within the spinal cord detected on T2-weighted images. Neuropathological examination revealed findings consistent with radiation myelopathy. We speculate that the area of high signal intensity within the spinal cord detected on T2-weighted images might be a result of proliferation of small vessels, which was discovered upon autopsy.     

K-ras gene point mutations in human endometrial carcinomas: correlation with clinicopathological features and patients' outcome

In order to evaluate the role of K-ras gene point mutations in the progression of endometrial carcinoma, we applied the polymerase chain reaction/restriction-fragment-length polymorphism technique to 57 tumours surgically removed from women of Polish origin. We assessed the relationship between K-ras gene activation and clinicopathological features as well as patients' outcome. Mutational activation in codon 12 of the K-ras gene was detected in 8 out of 57 (14%) endometrial carcinomas, while in codon 13 of the K-ras gene no point mutations were noted. A correlation between the histological type of the tumour and codon 12 K-ras gene mutation was noted (P < 0.05; Fisher exact test). K-ras gene mutation was not related to the patients' age, surgical stage, histological grade or to the depth of myometrial invasion. A trend towards a poorer prognosis was noted during the follow-up of patients whose tumours had shown K-ras codon 12 point mutations, but the difference was not significant (P = 0.06; log-rank test). Our data indicate that point mutations in codon 12 of the K-ras gene are a rare event in human endometrial carcinomas. The lack of correlation between K-ras point mutations and clinicopathological features (except histological type) supports the hypothesis of a random activation of the K-ras gene in human neoplastic endometrium.     

Remembering childhood sexual abuse: A national survey of psychologists' clinical practices, beliefs, and personal experiences.

A national survey of 1,000 psychologists, to which 223 responded, assessed professionals' clinical practices and beliefs about the treatment of adult survivors of childhood sexual abuse (CSA), personal CSA history, and the phenomenon of clients remembering CSA in therapy. Results indicated that over 25% of therapists reported using guided imagery, dream interpretation, bibliotherapy regarding sexual abuse, referral to sexual abuse survivors' group, and free association of childhood memories as memory retrieval techniques with clients who had no specific memory of CSA. However, the majority of therapists reported that they had not seen any cases of adult clients entering therapy with no memory of CSA and subsequently recalling abuse in the course of therapy. A personal history of CSA was not associated with most clinical practices related to treating sexual abuse survivors. The implications for training and establishing scientific standards of psychological practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiological study of primary intracranial tumors in childhood. A population-based survey in Kumamoto Prefecture, Japan

Between 1989 and 1995, we diagnosed primary intracranial neoplasms in 79 children younger than 15 years. All of them belonged to a well-defined population residing in Kumamoto Prefecture, Japan. Of the tumors, 64 (81.0%) were confirmed microscopically. The age-adjusted annual incidence rate was 34.3 cases per million child population. There was a marked difference in the incidence rate between boys (47.1) and girls (22.05). The age-specific annual incidence per million was 24.3 cases for the 0- to 4-year age group, 46.7 for the 4- to 9-year age group and 30.8 for the 10- to 14-year age group. The highest incidence rate was seen in 5- to 14-year-old boys (53.5), the lowest in 10- to 14-year-old girls (7.1). The most common tumors were astrocytomas (41.8%), with an incidence of 14.52 per million, followed by germ cell tumors (15.1%), with an incidence of 6.24 per million, craniopharyngiomas (15.1%), incidence 5.25 per million, ependymomas (6.3%), incidence 2.19 per million, and medulloblastomas (6.2%), incidence 2.19 per million. The distribution of tumor types varied with patient age at the time of diagnosis. Although no germ cell tumors were encountered in the 0- to 4-year age group, in the 10- to 14-year age group, they comprised about one third of all tumors. In contrast, white craniopharyngiomas were rare in the 10- to 14-year age group, they made up more than 22% in the 0- to 4-year age group. In this survey of Japanese children, we found a higher incidence of primary intracranial tumors, especially germ cell tumors and craniopharyngiomas, and a lower incidence of medulloblastomas compared to the incidence reported for Western countries.     

Association of childhood rhabdomyosarcoma with neurofibromatosis type I and birth defects

Rhabdomyosarcoma (RMS) is an uncommon malignant soft tissue sarcoma whose cause is largely unknown. Reported risk factors include genetic alterations (e.g., p53 mutations, a defective gene at 11p15.5, or specific chromosomal translocation of t(2:13)), and parents' use of drugs around the time of conception. We present results from a national, case-control study of 249 RMS cases (170 males and 79 females) and 302 controls (196 males and 106 females). The cases, aged 0-20 years at diagnosis, were identified via the Intergroup RMS Study-III during 1982-1988. Controls were selected by random digit telephone dialing. As a supplement to the original study, information on genetic diseases and birth defects (BD) was collected from the subjects' parents by telephone interview. Fifty-six (22.5%) cases and 55 (18.2%) controls were reported to have genetic diseases or BD (odds ratio [OR] = 1.30,95% confidence interval [CI] = 0.85-2.02, P = .21). The case group had a significantly higher frequency of neurofibromatosis type I (NF1) than did the control group, i.e., five cases (2.0%) had NF1 vs. zero controls (P = .02). The case group also had a higher frequency of major BDs than did the control group (6.0% vs. 2.6%, OR = 2.36, 95% CI = 0.92-6.52, P = .05). However, this excess was only observed in males (7.6% vs. 2.6%, OR = 3.16, 95% CI = 1.02-10.41, P = .02). Among the 15 cases having both RMS and major BDs, six (40.0%) had both conditions in the same regional anatomic site: Two (13.3%) had both in the extremities, two (13.3%) in the genitourinary system, and two in the head and neck. These findings suggest that common genetic mechanisms or in utero exposures may be involved in the development of many childhood tumors and congenital abnormalities.     

Adult survivors of childhood sexual abuse. Do I have them in my practice?

The long term sequelae of childhood sexual abuse include many symptoms commonly encountered in general practice settings. Guidelines to empathic history taking, comprehensive assessment, and an overview of management are presented, together with a contextual background.