Video-assisted thoracoscopic surgery for intrathoracic extramedullary hematopoiesis.

Extramedullary hematopoiesis is a rare cause of an intrathoracic mass in individuals with hemolytic disorders. It can be clinically confused with other tumors of the mediastinum. While radiologic studies often demonstrate findings suggesting intrathoracic extramedullary hematopoiesis, histology is usually required for diagnostic purposes. Thoracotomy was the mainstay procedure for obtaining tissue diagnosis and resection. However, video-assisted thoracoscopy (VATS) is an amendable and less-invasive means of tumor removal. We report a case of a posterior mediastinal extramedullary hematopoietic mass in a forty-two year old male in which VATS was utilized for diagnosis and resection.

Large solitary fibrous tumor of the kidney: report of two cases and review of the literature.

Solitary fibrous tumors are spindle cell neoplasms frequently arising in the serosal surface as well as a variety of other sites. We report two cases of large solitary fibrous tumor arising in the kidney, clinically thought to be renal cell carcinoma, in 41- and 72-year-old men. Although large in size (13.0 and 14.0 cm in greatest dimension, respectively), both lesions were well circumscribed and composed of a mixture of spindle cells and dense collagenous bands with no areas of necrosis or cystic changes noted macroscopically or microscopically. Immunohistochemical studies revealed reactivity for vimentin, CD34, collagen IV, and bcl-2 protein in both cases, with no staining for keratin, S-100 protein, or muscle markers, confirming the diagnosis of solitary fibrous tumor of the kidney. Solitary fibrous tumor of the kidney is rare but may present as a large mass that may be clinically confused with carcinoma or sarcoma.

Elevated picture completion scores: a possible indicator of hypervigilance in maltreated preschoolers.

OBJECTIVE: The Picture Completion subtest of the Wechsler Preschool and Primary Scales of Intelligence-Revised (WPPSI-R) measures visual alertness and the ability to differentiate essential from nonessential details. In children who are hypervigilant as a result of maltreatment, these skills may be over-functioning. It was hypothesized that the Picture Completion subtest scores of these children would be significantly elevated in comparison to their other nonverbal scores and their overall intellectual functioning. METHOD: Fourteen children from a therapeutic day treatment preschool program for maltreated children were administered the WPPSI-R. Standardized discrepancy scores between Picture Completion scores and Performance mean scores (PC-Performance Discrepancy) and the mean of all subscale scores (PC-Overall IQ Discrepancy) were formed and then analyzed. RESULTS: The abused preschoolers scored significantly lower than the population mean on four of the five WPPSI-R Performance subscales. Only on Picture Completion did they score significantly higher. Average PC-Performance Discrepancy and PC-Overall IQ Discrepancy scores were greater than one, indicating that the mean difference of children's Picture Completion score from either their Performance mean score or all of their mean scores was more than one standard deviation. CONCLUSION: Elevated Picture Completion score may serve as a marker for hypervigilance and/or PTSD in children with histories of maltreatment.

Neutron yields from 155 MeV/nucleon carbon and helium stopping in aluminum.

Neutron fluences have been measured from 155 MeV/nucleon 4He and 12C ions stopping in an Al target at laboratory angles between 10 and 160 deg. The resultant spectra were integrated over angle and energy above 10 MeV to produce total neutron yields. Comparison of the two systems shows that approximately two times as many neutrons are produced from 155 MeV/nucleon 4He stopping in Al and 155 MeV/nucleon 12C stopping in Al. Using an energy-dependent geometric cross-section formula to calculate the expected number of primary nuclear interactions shows that the 12C + Al system has, within uncertainties, the same number of neutrons per interaction (0.99 +/- 0.03) as does the 4He + Al system (1.02 +/- 0.04), despite the fact that 12C has three times as many neutrons as does 4He. Energy and angular distributions for both systems are also reported. No major differences can be seen between the two systems in those distributions, except for the overall magnitude. Where possible, the 4He + Al spectra are compared with previously measured spectra from 160 and 177.5 MeV/nucleon 4He interactions in a variety of stopping targets. The reported spectra are consistent with previously measured spectra. The data were acquired to provide data applicable to problems dealing with the determination of the radiation risk to humans engaged in long-term missions in space; however, the data are also of interest for issues related to the determination of the radiation environment in high-altitude flight, with shielding at high-energy heavy-ion accelerators and with doses delivered outside tumor sites treated with high-energy hadronic beams.

Chronic childhood illness and maternal mental health--why should we care?

This study evaluated which factors most influenced the impact of childhood asthma on the child's family. Seventy children/families seen at a tertiary-care hospital for asthma were evaluated. Stepwise multiple regression examined the effects of illness severity; family socioeconomic status (SES); family structure; social support; child's emotional characteristics; parent's health; family functioning; and maternal psychological distress on the Family Impact of Illness Scale. Analysis indicated that only the parent's Psychiatric Symptom Index significantly predicted impact scores. The most important predictors of how much impact a child's asthma has on the family are parental emotional distress and amount of social support.

Production of neutrons from interactions of GCR-like particles.

In order to help assess the risk to astronauts due to the long-term exposure to the natural radiation environment in space, an understanding of how the primary radiation field is changed when passing through shielding and tissue materials must be obtained. One important aspect of the change in the primary radiation field after passing through shielding materials is the production of secondary particles from the breakup of the primary. Neutrons are an important component of the secondary particle field due to their relatively high biological weighting factors, and due to their relative abundance, especially behind thick shielding scenarios. Because of the complexity of the problem, the estimation of the risk from exposure to the secondary neutron field must be handled using calculational techniques. However, those calculations will need an extensive set of neutron cross section and thicktarget neutron yield data in order to make an accurate assessment of the risk. In this paper we briefly survey the existing neutron-production data sets that are applicable to the space radiation transport problem, and we point out how neutron production from protons is different than neutron production from heavy ions. We also make comparisons of one the heavy-ion data sets with Boltzmann-Uehling-Uhlenbeck (BUU) calculations.

Ground-based simulations of cosmic ray heavy ion interactions in spacecraft and planetary habitat shielding materials.

This paper surveys some recent accelerator-based measurements of the nuclear fragmentation of high energy nuclei in shielding and tissue-equivalent materials. These data are needed to make accurate predictions of the radiation field produced at depth in spacecraft and planetary habitat shielding materials and in the human body by heavy charged particles in the galactic cosmic radiation. Projectile-target combinations include 1 GeV/nucleon 56Fe incident on aluminum and graphite and 600 MeV/nucleon 56Fe and 290 MeV/nucleon 12C on polyethylene. We present examples of the dependence of fragmentation on material type and thickness, of a comparison between data and a fragmentation model, and of multiple fragments produced along the beam axis.

Neutron yields from 435 MeV/nucleon Nb stopping in Nb and 272 MeV/nucleon Nb stopping in Nb and Al.

Neutron fluences were measured from 435 MeV/nucleon Nb ions stopping in a Nb target and 272 MeV/nucleon Nb ions stopping in targets of Nb and Al for neutrons above 20 MeV and at laboratory angles between 3 degrees and 80 degrees. The resultant spectra were integrated over angles to produce neutron energy distributions and over energy to produce neutron angular distributions. The total neutron yields for each system were obtained by integrating over the angular distributions. The angular distributions from all three systems are peaked forward, and the energy distributions from all three systems show an appreciable yield of neutrons with velocities greater than the beam velocity. Comparison of the total neutron yields from the two Nb + Nb systems suggests that the average neutron multiplicity decreases with decreasing projectile energy. Comparison of the total yields from the two 272 MeV/nucleon systems suggests that the total yields show the same dependence on projectile and target mass number as do total inclusive neutron cross sections. The data are compared with Boltzmann-Uehling-Uhlenbeck model calculations.

Microsurgical resection of incompletely obliterated intracranial arteriovenous malformations following stereotactic radiosurgery.

Radiosurgery is effective in obliterating small arteriovenous malformations (AVMs), but less successful in thrombosing larger AVMs. This study reviewed patients who underwent surgical resection of their large AVMs following failed radiosurgical obliteration. AVMs from 36 patients (aged 7 to 64 years, mean 29.9) were surgically resected 1 to 11 years after radiosurgery. Initial AVM volumes were 0.7 to 117 cm3 (mean 21.6 cm3), and radiosurgical doses ranged from 4.6 to 45 Gray equivalent (GyE) (mean 21.1 GyE). Thirty AVMs (83%) were located in eloquent tissue. Venous drainage was deep (14), superficial (13), or both (9). Spetzler grades were II (2), III (12), IV (18), and V (4). Nine patients suffered rehemorrhage after radiosurgery but prior to surgery, while three patients developed radiation necrosis. Twenty-seven patients underwent endovascular embolization prior to surgery. During microsurgical resection, the AVMs were found to be significantly less vascular and more easily resected, compared to AVMs in patients who had not received radiosurgery. Histology showed endothelial proliferation with hyaline and mineralization in vessel walls. Partial or complete thrombosis of some AVM vessels, and evidence of vessel and brain necrosis were noted in many cases. Clinical outcome was excellent or good in 34 cases, with two patients dying of rebleeding from residual AVM. Five patients were neurologically worse following microsurgical resection. Final outcome was largely related to the pretreatment grade. Radiosurgery several years prior to surgical resection appears useful in treating unusually large and complex AVMs.

Heavy fragment production cross sections from 1.05 GeV/nucleon 56Fe in C, Al, Cu, Pb, and CH2 targets.

We have obtained charge-changing cross sections and partial cross sections for fragmentation of 1.05 GeV/nucleon Fe projectiles incident on H, C, Al, Cu, and Pb nuclei. The energy region covered by this experiment is critical for an understanding of galactic cosmic ray propagation and space radiation biophysics. Surviving primary beam particles and fragments with charges from 12 to 25 produced within a forward cone of half-angle 61 mrad were detected using a silicon detector telescope to identify their charge and the cross sections were calculated after correction of the measured yields for finite target thickness effects. The cross sections are compared to model calculations and to previous measurements. Cross sections for the production of fragments with even-numbered nuclear charges are seen to be enhanced in almost all cases.