Intramedullary abscess of the spinal cord in children: a case report and review of the literature

A case report of an intramedullary spinal cord abscess in a 13-month-old boy and a review of relevant existing pediatric literature is presented. Thirty-eight cases of pediatric intramedullary spinal cord abscess are analyzed for presenting signs and symptoms, microbiology of isolated organisms, surgical intervention, antibiotic administration and outcome. The most significant variable on outcome is timely surgical intervention, followed by appropriate antibiotic administration.     

Transplacental and other routes of cancer transmission between individuals

Cancer in pregnancy is not rare, and the possibility of transmission of malignancy from mother to child, while infrequent, represents a clinical challenge for the primary pediatric hematologist-oncologist. The authors summarize all reported cases of vertically transmitted cancer and review other reported cases of person-to-person transfer of malignancy. As these cases represent a unique physiologic model of tumor transplantation, the biology of cancer transmission is discussed and provisional guidelines are given for the screening of infants born to women with cancer.     

Risk of lymph node metastases in patients with ovarian cancer

AIM: The aim of this study was the assessment of incidence of the lymph node spread in patients with ovarian cancer. Additionally, some of clinical and histopathology factors, as well as patients age were analyzed in relation with lymph nodes metastases. MATERIAL AND METHOD: Based on 112 operations performed in patients with ovarian cancer FIGO stage I-IV, analysis of pelvic and paraaortic lymph node metastasis was carried out. In this group only in 70 patients paraaortic lymph nodes were removed. The rest of patients underwent pelvic lymphadenectomy only because of poor general condition or very intensive cytoreductive surgery. Statistical analysis was provided using unvaried regression test and Pearson test. RESULTS: In early stages of ovarian cancer (I and II) the percent of patients with involved lymph nodes was 17.4 and in advanced stages 37.9. Strong correlation between involvement of pelvic and paraaortic lymph nodes was seen. The most frequent localization of lymph node metastases was the site around intercrossing of left renal vein and aorta. It should be stressed that in 8 cases isolated paraaortic metastases were seen. Risk factors of lymph node metastases were clinical stage, tumor grade and age of patients. Clear cell carcinoma and mixed carcinoma had also prognostic significance. CONCLUSION: This analysis proved that incidence of lymph node metastases was high even in early stage, and therefore lymphadenectomy should be an integral part of standard surgical procedures in patients with ovarian cancer.     

The stereospecificity of flobufen metabolism in isolated guinea pig hepatocytes

Background

Extracellular nucleotides play an important role in the regulation of vascular tone and may be involved in cerebral vasospasm after subarachnoidal haemorrhage. This study was designed to characterise the contractile P2 receptors in endothelium-denuded human cerebral and omental arteries. The isometric tension of isolated vessel segments was recorded in vitro. P2 receptor mRNA expression was examined by RT-PCR.

Results

In human cerebral arteries, the selective P2Y₆ receptor agonist, UDPβS was the most potent of all the agonists tested (pEC₅₀ = 6.8 ± 0.7). The agonist potency; UDPβS > αβ-MeATP > UTPγS > ATPγS > ADPβS = 0, indicated the presence of contractile P2X₁ P2Y₂, P2Y₄ and P2Y₆, but not P2Y₁ receptors, in human cerebral arteries. In human omental arteries, UDPβS was inactive. The agonist potency; αβ-MeATP > ATPγS = UTPγS > ADPβS = UDPβS = 0, indicated the presence of contractile P2X₁, and P2Y₂ receptors, but not P2Y₁ or P2Y₆ receptors, in human omental arteries. RT-PCR analysis of endothelium-denuded human cerebral and omental arteries demonstrated P2X₁, P2Y₁, P2Y₂ and P2Y₆ receptor mRNA expression. There were no bands for the P2Y₄ receptor mRNA in the omental arteries, while barely detectable in the cerebral arteries.

Conclusions

P2Y₆ receptors play a prominent role in mediating contraction of human cerebral arteries. Conversely, no such effect can be observed in human omental arteries and previous results confirm the absence of P2Y₆ receptors in human coronary arteries. The P2Y₆ receptor might be a suitable target for the treatment of cerebral vasospasm.     

An evaluation of rapid point-of-collection oral fluid drug-testing devices

New technology is currently being marketed to rapidly test oral fluids for drugs of abuse at the point of collection (POC). There are no nationally accepted standards or cutoff concentrations for detecting drugs in oral fluids and for most analytes there are significant differences in cutoff concentrations across devices. Four devices were evaluated (OralLab), RapiScan, Drugwipe, and SalivaScreen) for their ability to meet manufacturers claims, and proposed federal standards for criminal justice and workplace programs. Human oral fluid fortified with known quantities of drug [drug(s) or metabolite(s)] was used to test these devices. Overall, the performance of these rapid POC oral fluid drug-testing devices was quite variable. Some devices performed well for the analysis of some drug classes but poorly for others. In general, most devices performed well for the detection of methamphetamine and opiates, but all performed poorly for the detection of cannabinoids. The ability to accurately and reliably detect cocaine and amphetamine was dependent on the individual device.     

Prominent Tc-99m MIBI skeletal uptake in renal osteodystrophy: a possible role for whole-body scanning

Renal osteodystrophy is a process whereby renal failure causes profound bone disease. Effects on bone include osteosclerosis, osteomalacia, osteoporosis, pathologic fractures, aseptic necrosis of the hips, and bone pain. The authors present a case of renal osteodystrophy with intense Tc-99m 2-methoxy isobutyl isonitrile (MIBI) radiotracer uptake in the mandible and propose that Tc-99m MIBI may have a potential role in diagnosing renal osteodystrophy.     

Potential antitumor effects of statins (Review)

Statins, which have been introduced to the clinic for the treatment of hypercholesterolemia, are competitive inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the major rate-limiting enzyme that controls the conversion of HMG-CoA to mevalonic acid (MA). MA is the precursor in the biosynthesis of isoprenoid compounds including cholesterol, dolichol and ubiquinone. Furthermore, mevalonate-derived prenyl groups enable precise cellular localization and function of many proteins such as Ras and Rho proteins. Therefore, besides lowering cholesterol level, statins exert pleiotropic effects on many essential cellular functions including cell proliferation, differentiation, and survival but also participate in the regulation of cell shape and motility. Statins have been shown to inhibit proliferation and to induce apoptosis in a variety of tumor cells. They have also been found to display antitumor effects against melanoma, mammary carcinoma, pancreatic adenocarcinoma, fibrosarcoma, glioma, neuroblastoma, and lymphoma in animal tumor models resulting in retardation of tumor growth, and/or inhibition of the metastatic process. In preclinical studies statins have also been demonstrated to potentiate the antitumor effects of some cytokines and chemotherapeutics. The molecular mechanisms underlying antitumor activity of statins have not been fully elucidated but interference with the function of Ras and Rho family GTPases, inhibition of the activity of certain cyclin-dependent kinases (CDK), and activation of CDK inhibitors, all seem to participate in this activity. The results of several clinical studies of statins in cancer patients including phase I, phase I/II, and phase II trials have been published. Although evaluation of the therapeutic efficacy is not the purpose of early clinical trials and all conclusions might be premature at this stage, some preliminary conclusions have already been drawn. The results of these studies do not show any significant therapeutic effects of statins in cancer patients. However, the results of one of these studies suggest that statins could effectively strengthen the therapeutic activity of some chemotherapeutics. This observation seems to agree with the results of preclinical studies. However, as toxic side effects of statins have been particularly evident in their combination with some other drugs great caution should be advised while planning clinical trials based on combination therapy including statins in cancer patients.     

Pentoxifylline inhibits leukocyte infiltration and splenocyte cytotoxicity against murine colon adenocarcinoma

Pentoxifylline (PTX), a methylxanthine derivative, is commonly used in patients suffering from peripheral vascular diseases. Besides its well-known hemorheological properties PTX has been found to decrease the secretion of some inflammatory cytokines such as TNF, IL-12 and IFN-gamma. PTX also suppresses lymphocyte cytotoxicity, affecting mainly the perforin-dependent pathway. We investigated the influence of PTX on the splenocyte cytotoxicity and leukocyte infiltration in a murine colon adenocarcinoma model. We observed that PTX decreased the cytotoxic activity of isolated splenocytes against C-26 cells and reduced the inflammatory cell infiltration in the peritumoral tissue. Thus, our results strongly suggest the necessity of further studies concerning the safety of PTX use, especially in elderly patients or patients with already diagnosed cancer.     

Current status of sentinel lymph node mapping and biopsy: facts and controversies

Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. Morton first described the application of lymphatic mapping for melanoma only a decade ago, and this technique is now accepted as the standard of care. The application for lymphatic mapping and sentinel lymph node biopsy in breast cancer remains approximately 5 years behind its utilization in melanoma. This technique has the potential to be utilized in all solid tumors. The rapid assent of this technique in clinical practice is the result of multiple factors, including accuracy, decreased morbidity, and supplying the pathologist with only a few nodes to allow a more focused and sensitive pathologic evaluation. Despite the success and acceptance of lymphatic mapping, many controversies remain. We have attempted to clearly highlight these controversies in this review.