Non-Hodgkin lymphoma of the central skull base: MR manifestations

OBJECTIVE: The aim of this study was to demonstrate the MR characteristics of non-Hodgkin lymphoma of the skull base to help in the differential diagnosis of this neoplasm from other conditions. MATERIALS AND METHODS: MR of five patients, 7-64 years old, with pathologically proved lymphomas of the skull base were reviewed. Three cases had primary skull base lesions involving the sphenoid bone and the cavernous sinus. One case with a nasal cavity lesion involving the skull base and one with a relapsing skull base lesion of previously treated tonsillar lymphoma were included. RESULTS: The lesions had signal intensities that were similar to that of gray matter of brain on both T1- and T2-weighted imaging. Bilateral cavernous sinuses were involved with encasement of internal carotid arteries in every case. Postcontrast MR showed homogeneous enhancement of the tumor with dural infiltration along the planum sphenoidale, clivus, or tentorium. The clivus was destroyed or replaced by tumors in adult cases but in two children the clivus was preserved with intact sphenooccipital synchondrosis. In one case the tumor extended to the extracranial portion through the jugular foramen. CONCLUSION: The MR findings of a permeative lesion of the skull base, invasion of the cavernous sinus without arterial narrowing, infiltration along the dural surface, and an iso- or hypointensity with brain on T2-weighted imaging should suggest lymphoma.     

Information systems and uncertainty: a conspiracy of misplaced confidence

Abstract. Information technology is becoming an increasingly important factor in contemporary management. Information systems are being set up in business explicitly to accommodate the new opportunities of this technology, and these are having a lasting effect on managerial practice. The full implications of this technology-driven development have not been appreciated by organizations, which in absorbing technological systems, are tolerating a great drain on their resources.
The efficacy of computers is predicated on the acceptance of some very specific perspectives. A growing discontent and disappointment with their limited achievements is our reason for advocating a different point of view. We will discuss how a shift in perspective, particularly in respect to the perception of uncertainty, will affect thinking and practice in the field of management support systems. We will render our view of the application of computerized decision support systems (DSS), and especially, we will focus on the beliefs and assumptions that have shaped this technology thus far. To this end we will discuss the concept of uncertainty, by juxtaposing current thinking and practice with our understanding of the context of its application. Finally, we will place our understanding of uncertainty in a managerial context and explain the implications this would have for strategists.     

Contractor Prebid Planning Principles

Planning is an essential function of project management. Yet, many small- and medium-sized contractors do a relatively poor job of operational planning. Better prebid plans will reduce costs, shorten schedules, and improve labor productivity. Unfortunately, the published literature offers little guidance for smaller contractors on what constitutes effective planning. Most papers describe planning as a macrolevel process for owners. Most emphasize scope definition for industrial projects. This paper describes a microlevel planning process for contractors. It consists of eight steps which are: (1) assess contract risks; (2) develop a preliminary execution plan; (3) develop site layout plans; (4) identify the sequences that are essential-to-success; (5) develop detailed operational plans; (6) develop proactive strategies to assure construction input into design; (7) revise the preliminary plan; and (8) communicate and enforce the plan. The entire process is illustrated with a case study project and is fully illustrated with figures which show how to integrate the work of multiple contractors, keep key resources (crews or equipment) fully engaged with no downtime, provide time buffers so the work of follow on crews can be efficiently done, expedite the schedule using multiple work stations and concurrent work, ways to communicate the work plan to the superintendent and foremen, and how to assess the feasibility of various work methods. The steps are easy to understand and implement. They will yield immediate positive results.     

Denial of illness in stroke

BACKGROUND: The effects of stroke on classically nondominant hemisphere functions have received less attention than those on the dominant hemisphere, but visuospatial neglect and denial of illness both produce significant morbidity. SUMMARY OF COMMENT: The early literature on denial of illness is discussed and the etiological theories are examined. These are explanations based on deficits of higher mental function, impaired sensory input (especially proprioceptive), an abnormal representation of body image, psychodynamic defense mechanisms, and/or premorbid personality factors. CONCLUSIONS: Denial of illness is an important consequence of stroke. No explanation thus far proposed is entirely satisfactory. The consequences on rehabilitation and strategies for therapy have not been adequately investigated.     

High-dose busulfan, melphalan, thiotepa and peripheral blood stem cell infusion for the treatment of metastatic breast cancer

The purpose of this study was to determine the outcome of patients with metastatic breast cancer treated with high-dose busulfan (Bu), melphalan (Mel) and thiotepa (TT) followed by peripheral blood stem cell (PBSC) infusion. Fifty-one patients with chemotherapy refractory (n = 32) or responsive (n = 19) metastatic breast cancer received Bu (12 mg/kg), Mel (100 mg/m2) and TT (500 mg/m2) followed by PBSC collected after chemotherapy and growth factor (n = 43) or growth factor alone (n = 8). The 100 day treatment-related mortality was 8% including one death from cytomegalovirus pneumonia, one from aspiration pneumonia and two from regimen-related toxicity (RRT). Seven of 28 refractory (25%) and 5/7 (71%) responsive patients with evaluable disease achieved a complete response of all measurable disease or all soft tissue disease with at least improvement in bone lesions (PR*). Fifteen of 51 patients (29%) are alive and progression-free a median of 423 days (range 353-934) after treatment, 5/32 (16%) with refractory disease and 10/19 (53%) with responsive disease. The probabilities of progression-free survival (PFS) at 1.5 years for the patients with refractory (n = 32) and responsive (n = 19) disease were 0.24 and 0.53, respectively. These preliminary data suggest that high-dose Bu/Mel/TT has significant activity in patients with advanced breast cancer and may be superior to some previously published regimens.     

Imaging of follicular dendritic cell tumours of the liver

Follicular dendritic cell tumour of the liver is a recently recognized entity. To date, only two cases have been described, both in the pathology literature. Histologically, it resembles an inflammatory pseudotumour and immunohistochemical and ultrastructural studies are required for its diagnosis. The ultrasound, computed tomography and angiographic features of two cases of follicular dendritic cell tumour of the liver are described in detail. One of the patients had multiple recurrences of this tumour. The imaging features are very similar to those of hepatocellular carcinoma. As follicular dendritic cell tumour is considered to be of low-grade malignant potential, in contrast to the dismal prognosis for hepatocellular carcinoma, it is important to be able to accurately distinguish between the two types of tumour prior to initiating definitive therapy.     

Face recognition: combining cognitive psychology and imageengineering

Many cognitive tasks that are easy for humans to perform are proving difficult to emulate in computer systems. Combining the disciplines of psychology and engineering may offer a solution to some of these problems. A connectionist or neural network model of face recognition by humans which incorporates aspects of a model proposed by cognitive psychologists is presented. A comparative set of experiments has been performed using this simulation and human subjects for familiar face recognition. By employing the same stimuli for both humans and the computer model, it is possible to advance not only our understanding of human cognition but also to develop improved automated systems for face recognition     

Knowledge conceptualization tool

Knowledge acquisition is one of the most important and problematic aspects of developing knowledge-based systems. Many automated tools have been introduced in the past, however, manual techniques are still heavily used. Interviewing is one of the most commonly used manual techniques for a knowledge acquisition process, and few automated support tools exist to help knowledge engineers enhance their performance. The paper presents a knowledge conceptualization tool (KCT) in which the knowledge engineer can effectively retrieve, structure, and formalize knowledge components, so that the resulting knowledge base is accurate and complete. The KCT uses information retrieval technique to facilitate conceptualization, which is one of the human intensive activities of knowledge acquisition. Two information retrieval techniques employing best-match strategies are used: vector space model and probabilistic ranking principle model. A prototype of the KCT was implemented to demonstrate the concept. The results from KCT are compared with the outputs from a manual knowledge acquisition process in terms of amount of information retrieved and the process time spent. An analysis of the results shows that the process time to retrieve knowledge components (e.g., facts, rules, protocols, and uncertainty) of KCT is about half that of the manual process, and the number of knowledge components retrieved from knowledge acquisition activities is four times more than that retrieved through a manual process     

Monocyte diapedesis through an in vitro vessel wall construct: inhibition with monoclonal antibodies to thrombospondin

Human peripheral blood monocytes were examined for migration across an endothelial cell monolayer in an in vitro vessel wall construct. Few monocytes invaded in the absence of a chemotactic gradient, despite significant adhesion to the endothelial monolayer. However, the addition of zymosan-activated human plasma to the lower compartment, to create a chemotactic gradient across the vessel wall, resulted in significantly enhanced monocyte migration. Pretreatment of the monocytes with monoclonal antibodies to thrombospondin (TSP) dramatically inhibited monocyte diapedesis into the vessel wall. The same treatment inhibited monocyte adhesion to endothelial cells in two-dimensional monolayer cultures as well as in vessel wall constructs (no chemotactic gradient). Of interest, however, the monoclonal antibodies had no inhibitory effect on monocyte migration into collagen gels devoid of endothelial cells in response to the same chemotactic gradient, suggesting the importance of TSP in monocyte-endothelial cell interactions. Monoclonal antibodies to fibronectin and normal mouse immunoglobulin G did not inhibit migration in this model of a vessel wall. Furthermore, monoclonal antibodies to TSP showed no inhibition of human peripheral blood neutrophil migration. Previous studies have shown that monocytes synthesize TSP and express this moiety on their surface. The present data suggest that monocytes may utilize TSP to interact with endothelial cells lining the vessel wall during diapedesis.     

Supervisory system for cascaded semiconductor laser amplifier repeaters

A technique for locating a transmission path failure in an inline cascade of semiconductor laser amplifier repeaters to within one fibre span is demonstrated. If a fault occurs, the loss of signal is detected in the following repeaters and a locally generated tone modulates the spontaneous emission of the repeater, signalling the fault to the system terminals.<>