Magnetoencephalography and normal pressure hydrocephalus: A case report.

A 82-year-old male experiencing headaches, dementia, urinary incontinence and gait instability was diagnosed with normal pressure hydrocephalus (NPH) and underwent a resting state magnetoencephalography (MEG) examination. MEG data were recorded in a magnetically shielded room with a whole-head 122 channel biomagnetometer. Following MEG, a ventriculoperitoneal (VP) shunt was placed in his head and greatly improved his symptomatology. Spontaneous MEG recordings revealed lower magnetic fields at frontal and frontotemporal regions compared to central and posterior regions. This finding correlated well with the significant ventricular distention, and specifically the enlargement of the frontal horns of the lateral ventricles, observed in presurgical CT. The regional pattern of MEG signal decrease in NPH seems to be quite different from that encountered in brain atrophy. In the latter case, a more generalized distribution of low magnetic fields is observed, possibly reflecting the high sensitivity of MEG to activity originating in sulci. Acquired data suggest that MEG may be able to differentiate between NPH and brain atrophy. Furthermore, MEG could potentially constitute a non-invasive, non-imaging tool, useful in the selection of patients with NPH to undergo shunt surgery. The findings of this study warrant further research in patient groups before firm conclusions can be drawn.

A comparative immunohistochemical investigation of the consequences of chorioamnionitis on the developing human fetal spleen.

INTRODUCTION: The objective of this study was to determine the effects of chorioamnionitis on the extracellular matrix (ECM) structural glycoproteins of the developing human fetal spleen, and their influence on the haematopoiesis and spleen immune system compared to controls. MATERIALS AND METHODS: After elective induced pregnancy termination due to chorioamnionitis or voluntary abortion, paraffin-embedded specimens from the spleen and respective fetal membranes of 90 fetuses were investigated by immunohistochemistry for presence of ECM structural glycoproteins, haematopoietic, and lymphoid cells. Conventional histological examination of the relative fetal membranes was performed. RESULTS: The present results showed no quantitative variations in the expression of the ECM glycoproteins and haematopoietic lineages of the fetal spleen parenchyma at the end of first trimester (in both groups). At the second and third trimesters, acute chorioamnionitis showed a decreased number of the aforementioned proteins, with an increase of granulopoiesis and CD34 progenitor/stem haematopoietic cells. The immune system of the spleen during the third trimester demonstrated a decrease of both B and T lymphocytes, in comparison with controls. CONCLUSIONS: These results suggest that toxins and cytokines generated during chorioamnionitis, seem to influence ECM structural glycoproteins synthesis and release in fetal splenic parenchyma by reducing them, and probably cause further disorders of haematopoiesis and lymphopoiesis.

Biomagnetic activity and non linear analysis in obstetrics and gynecology in a Greek population.

This article reports the application of non-linear analysis to biomagnetic signals recorded from fetal growth restriction, fetal brain activity, ovarian lesions, breast lesions, umbilical arteries, uterine myomas, and uterine arteries in a Greek population. The results were correlated with clinical findings. The biomagnetic measurements and the application of non-linear analysis are promising procedures in Obstetrics and Gynecology.

MEG localization of spike sources in human patients with brain tumors.

The purpose of this study was to use magnetoencephalography (MEG) to identify epileptic zones in patients with brain tumors before undergoing tumor surgery. The MEG data were recorded with a 122-channel biomagnetometer. Equivalent current dipoles (ECD) were calculated for epileptic spikes on MEG recordings according to the single dipole model. Eight patients (five males and three females) within the age range (43-73 years; mean ± SD = 55.12 ± 9.77) were examined by MEG before neurosurgery operation. Four patients had meningioma grade I, three had glioblastoma grade IV and one had astrocytoma grade II. All the patients showed ECD at their MEG's before surgical operation except a female one with meningioma who showed no ECD. Tumors observed in the frontal areas show posteriorly located ECD. We conclude that the MEG is a valuable clinical tool for the localization of epileptic foci in patients with brain tumors before surgical tumor operation.

Biomagnetic activity in prostate cancer and BPH.

OBJECTIVE: The aim of this study was to investigate the role of biomagnetic activity measurements in detecting prostate malignancies, in differentiating cancerous from benign prostate lesions and in generally improving our understanding of prostate cancer biology. METHODS: Magnetic recordings were obtained from 47 patients with palpable prostate lesions. Twenty-four had prostate carcinoma and 23 benign prostatic hyperplasia (BPH). RESULTS: The magnetic field recorded in the 2-7 Hz frequency range was of high amplitude in most (95%) malignant lesions 248 +/- 82 Ft/Hz) and of low amplitude in most (95%) benign ones (166 +/-31 Ft/Hz). These findings displayed significant difference (p = 0.0021). CONCLUSIONS: Prostate cancer emits higher biomagnetic activity than BPH. This finding confirms the higher angiogenic activity of prostate cancer. The use of this method is safe and seems promising.

Meg evaluation of epileptic activity in the time and frequency domain.

We investigated the localization of current sources in the time and frequency domain from spontaneous MEG data recorded from nine epileptic patients (six females; three males) randomly selected, who had a mean age of 41 years old (range of 17-78 years old), with different types of epilepsy. The MEG data were recorded in a magnetically shielded room with a whole-head 122 channel biomagnetometer. For each MEG spike, we calculated the single Equivalent Current Dipole (ECD) sources at the initial spike peaks with a spherical model. MRI and EEG findings were available in patients' records. Prominent low frequencies can be seen in the majority of channels. For each patient there was an increase of the frequency range after the ECD in comparison with the frequency range before the ECD, in the whole study group due to epileptic discharge which is statistically significant (p=0.02). There was also a statistical significant difference in the increase of the frequency range in four patients with pathologic MRI (p=0.05), in five patients with normal MRI (p=0.02), in five patients with a high incidence of seizures (p=0.04) and in four patients with onset<10 years (p=0.04). The MEG analysis of neuromagnetic data gives information about the modification of the frequency range in the epileptic brains.

Evaluation of an intracranial arachnoid cyst with MEG after magnetic stimulation.

A 34-year-old male diagnosed of an intracranial arachnoid cyst arising in the left-sided temporal-parietal area, by computed tomography (CT), underwent evaluation by means of MEG. Biomagnetic waveform recordings were obtained from the target area and the Fourier analysis of these measurements was carried out. External magnetic stimulation in the order of pico Tesla was applied with proper field characteristics (intensity: 1-7.5 pT, frequency: 8-13 Hz), which were obtained prior to the application and the emitted MEG activity was recorded again. The cortical area adjacent to the borders of the arachnoid cyst emitted biomagnetic waveforms with high values. The application of magnetic stimulation resulted in a rapid attenuation of the high MEG activity in the target area. MEG may provide useful information in the diagnostic evaluation of arachnoid cyst patients and could be a supplement to other imaging modalities.

Magnetic field profiles in normal human breast during the menstrual cycle.

OBJECTIVE: To investigate the subtle magnetic fields produced by living normal breast tissue during the menstrual cycle. METHODS: The magnetic activity of the breast was recorded in four young women, 26-28 years old; two had regular and two irregular menstrual cycles. The recordings were accomplished with a biomagnetometer and covered two complete menstrual cycles. The results were correlated with estrogen and progesterone levels on days 7, 14 and 21 of the menstrual cycle. RESULTS: The magnetic breast recordings in the two young women with the regular cycling endometrium showed a biphasic magnetic curve, apparently corresponding to the proliferative and secretory phase of the menstrual cycle. By contrast, the two young women with irregular menstrual cycles showed a monophasic magnetic curve. CONCLUSION: It is suggested that a biphasic, but not a monophasic, pattern of magnetic activity in the breast is indicative of an ovulatory endometrial cycle.

Biomagnetism in gynaecologic oncology. Our experience in Greece.

Our experience in the application of biomagnetism in gynaecologic oncology is presented. We provide a brief description of our research work in the investigation of biomagnetic activity in benign and malignant ovarian and breast diseases, and an evaluation of uterine myomas, providing a new approach of biomagnetism as a non invasive imaging modality for assessing gynaecologic tumours.

Correlation of immunohistochemically detected HER-2/neu (c-erbB-2) with histological stage and perineural invasion in pancreatic cancer.

BACKGROUND/AIMS: HER-2/neu (c-erbB-2) oncoprotein is a transmembrane glycoprotein and may function as a growth factor being involved in the regulation of cell growth and cell transformation. c-erbB-2 was correlated with established outcome factors in pancreatic cancer. METHODOLOGY: We performed an analysis of 100 patients with pancreatic cancer using an immunoperoxidase technique on formalin-fixed, paraffin-embedded tissue samples in order to determine HER-2/neu oncoprotein expression along with stage and perineural involvement. RESULTS: HER-2/neu oncoprotein was expressed in the tumors of 21 patients (21%). CONCLUSIONS: Histologic stage, and perineural invasion did not correlate with HER-2/neu oncoprotein.

Does neoplastic gastrin expression remodel the embryonal pattern of the protein? A study in human pancreas.

BACKGROUND/AIMS: To determine the immunoreactivity of gastrin during the development of the human fetal pancreas and ductal pancreatic adenocarcinoma, given that, gastrin positive cells were demonstrated either into its embryonic anlage or into pancreatic cancer. METHODOLOGY: Tissue sections from 15 pancreatic fetal specimens, and an equal number of ductal adenocarcinoma specimens, were assessed using immunohistochemical methods for gastrin. RESULTS: The density of positive cells in the primitive exocrine ductal walls and outgrowing buds was significantly higher than the relevant density in the neoplastic pancreatic tissue of mixed (ductal endocrine) and pure ductal type (p1=0.017, p2<0.0001, p3<0.0001 and p4=0.019, respectively). The above values were estimated from 20-22 weeks of gestation. There was no significant difference in the density of positive cells in the islet cell epithelium from 25-30 weeks, and the neoplastic tissue of mixed (p5=0.24) and pure ductal type (p6=0.55). CONCLUSIONS: The immunostaining for gastrin identifies a subgroup of pancreatic ductal adenocarcinomas with a neuroendocrine component (initially considered as pure ductal tumors), and mixed ductal-endocrine tumors. This pattern of expression in neoplasms recapitulates the normal pattern during the embryonal development of the organ, and may be important for the development of new therapeutic approaches with eventual clinical utility.

Induction of hepatic hematopoiesis with tenascin-C expression during the second trimester of development.

OBJECTIVE: To determine the role of tenascin-C in fetal hepatic hematopoietic proliferation and differentiation in different stages of development. STUDY DESIGN: We examined and compared the immunohistochemical expression of tenascin-C in the hepatic stromal portal fields in the first, second, and third trimester of gestation respectively, in relation to the appearance of CD34 progenitor hematopoietic, stromal progenitor and vascular endothelial positive cells. RESULTS: Our results demonstrated a quantitative difference in the second trimester of gestation concerning the expression of tenascin-C in the connective tissue stroma of the hepatic portal fields over the equivalent expression of the protein in the first (P<0.0001, t-test) and third trimester (P<0.0001, t-test). Similar changes in the above period were found concerning the expression of CD34 over the first (P<0.0001, t-test) and third trimesters (P<0.0001, t-test), suggesting a direct involvement of tenascin-C in the sustaining of hematopoietic activity. CONCLUSIONS: Our data provide evidence that an ECM glycoprotein component, tenascin-C, plays a relevant role in hematopoiesis through interaction between stromal cells and hematopoietic progenitor cells.

Prognostic significance of HLA-DR antigen in serous ovarian tumors.

The antigens encoded by the major histocompability complex (HLA-DR) are cell glycoproteins that play a fundamental role in the regulation of the immune response. The prognosis of ovarian cancer is dependent on the histological type and on the clinical stage at diagnosis. Our study reports the value of HLA-DR antigen as a prognostic marker of ovarian serous adenocarcinoma. We studied 31 cases of serous ovarian cystadenoma, 12 cases of serous ovarian borderline cystadenoma, and 39 cases of well-differentiated cystadenocarcinoma for HLA-DR monoclonal antigen. We also studied the T helper marker (CD4) in the tumor stroma of the relevant cases, given that it is now known that the dependence of immune responsiveness on the class II antigens reflects the central role of these molecules in presenting antigen to T helper cells. HLA-DR was expressed in 20 of 31 cystadenomas (64.5%), 4 of 12 borderline tumors (33.3%), and in 10 of 39 invasive carcinomas (25.6%). CD4 was expressed in 9 of 31 cystadenomas (29%), 5 of 12 borderline tumors (42%), and in 26 of 39 invasive carcinomas (67%). There was a statistically significant difference for the two examined antigens in cystadenomas ( p<0.001) and invasive carcinomas ( p<0.001), whereas there was no statistical difference in borderline tumors ( p<0.5). The results showed decreased expression of HLA-DR and increased expression of CD4 as the lesion progressed to malignancy. The aberrant expression of HLA-DR by epithelial cells of cystadenomas, of borderline tumors, and of invasive adenocarcinomas agrees with the hypothesis of the adenoma/adenocarcinoma sequence. The immune attraction mechanism by low HLADR signaling seems to be of minor importance in the malignant and metastatic potential of serous ovarian tumors.

Presence of a bone marrow stromal cell line with myoid differentiation in reactive plasmacytosis and plasma cell myeloma.

The presence of myoid cells (MCs) - stromal cells with myogenic differentiation - in human bone marrow (BM) has been observed during hematopoiesis in embryonic life, whereas during adult life, it is strictly related to various pathologic conditions. The aim of this study was to examine the presence, distribution and quantitation of cells in the stroma of the BM expressing alpha-smooth muscle actin (alpha-SMA) in reactive BM plasmacytosis and plasma cell myeloma. For this reason, a series of 10 trephine BM biopsies from patients with plasma cell myeloma and 10 specimens from healthy controls with reactive plasmacytosis were examined for the presence of stromal cells with myoid differentiation, using a monoclonal antibody recognizing alpha-SMA. Our results suggest that the incidence of MCs and subsequent fibrosis rises in plasma cell myeloma and in a lesser degree in the BM stroma of individuals with reactive plasmacytosis.

Imprint cytology for rapid evaluation of lung and mediastinal lesions.

BACKGROUND: Frozen-section biopsy (FSB) of pulmonary and mediastinal tumors is commonly used in the evaluation of diagnostic tissue in thoracic surgery. However, FSB can be labor intensive for the pathology department and time-consuming while the patient is anaesthetised. Imprint cytology is more rapid than the FSB procedure (average, 1 min versus 10 min per tissue sample) and allows more extensive sampling of the specimen. METHODS: In this preliminary study we compared the diagnostic accuracy of imprint cytology and permanent sections on lung and mediastinal lesions from 38 patients. RESULTS: There were no false-positive results and 2 false-negative results. The sensitivity was 99.13%, the specificity was 100% and the positive predictive value was 100%, as no false-positive results were observed. These results match favorably with those in other studies comparing the diagnostic accuracy of imprinting cytology with that of FSB and with reported accuracy rates of the FSB method. CONCLUSION: Our findings confirm the usefulness of this procedure as an adjunt or alternative for FSB in the pathologic evaluation of lung and mediastinal space-occupying lesions.

Pre- and postsurgical biomagnetic activity in malt-type gastric lesions. A case report.

PURPOSE: To evaluate the biomagnetic activity of a low-grade mucosa-associated lymphoid tissue (MALT-) type gastric lymphoma, and to determine if this procedure could be an adjunct to endoscopic ultrasonography (EUS) in the assessment of the disease pre- and postsurgically. MATERIAL AND METHODS: A 47-year-old female with a 2-year clinical history of a low-grade MALT-type gastric lymphoma associated with Helicobacter pylori was examined. The disease showed no histologic remission after eradication of the H. pylori infection and subsequent treatment with chemotherapy and the patient was classified as stage II EA. A decision for surgical resection was made. Biomagnetic waveform recordings were made in the target area before and after surgery and the Fourier analysis of these recordings was performed. RESULTS: The gastric lymphoma biomagnetic waveforms showed high amplitudes (1.8 pT) before and low amplitudes (0.6 pT) after resection. The corresponding Fourier analysis demonstrated that the maximum spectral power of the presurgical measurement was elevated (mean 235 +/- 847 pT2/Hz) compared with that obtained postsurgically (mean 725 +/- 89 pT2/Hz). The difference was of statistical significance ( p < 0.0001, t-test). CONCLUSION: Biomagnetic monitoring of gastric lymphoma, which is an entirely new diagnostic modality, could be a supplement to EUS for assessing remission or persistence of disease with medical treatment during follow up.

Detection of chromosome 1p deletion using FISH on meningioma touch imprints suggest a region outside chromosome 22 as important in tumor recurrence.

BACKGROUND: Atypical and anaplastic meningiomas tend to recur and to invade adjacent brain, bone, and skin. They can also metastasize to extracranial organs such as the lung, liver, or bone causing death. The classic genetic abnormality is loss in chromosome 22. Recent reports have indicated that allelic deletion of chromosome 1p is associated with malignant progression of meningiomas. METHODS: Cytogenetic analysis of 4 meningiomas was performed using double target fluorescent in situ hybridization and focusing on chromosomes 1 and 22. The meningioma series included 4 patients whose tumors were histologically benign. RESULTS: One patient's tumor had recurred. FISH was performed on 500 nuclei/tumors. All our cases showed a loss of chromosome 22q while only 1 meningioma showed an additional loss of chromosome 1p, and this was the recurred one. CONCLUSIONS: The results of this study support the existence of tumor suppressor gene(s) on 1p associated with recurrence in meningiomas and suggest that status of chromosome 1p by FISH may assist physicians in predicting prognosis of patients affected by this tumor. However more in-vestigation is needed in this direction, as our re-sults refer to a small number of subjects studied.

Differential diagnosis of prostate lesions with the use of biomagnetic measurements and non-linear analysis.

The purpose of this study was to investigate the biomagnetic activity emitted from the prostate gland and to differentiate cancerous from benign prostate lesions with the use of biomagnetic measurement and non-linear analysis. Magnetic recordings were obtained from 47 patients with palpable prostate lesions. Histology revealed 24 prostate cancer patients and 23 benign prostate hyperplasia (BPH) patients. The superconducting quantum interference device (SQUID) biomagnetometer was used to measure the prostate's magnetic field by placing the SQUID detector 3 mm above the symphysis pubis. The magnetic field recorded in the 2-7 Hz frequency range was of high amplitude in most malignant lesions whereas all benign cases were of low amplitude. According to our results, the sensitivity, specificity, positive predictive value and negative predictive value were 83.33%, 100%, 100% and 85.18%, respectively. By applying the Grassberger-Procaccia algorithm to the magnetoprostatogram time series in malignant and benign prostate lesions we found clear saturation in malignant prostate lesions with m>7 whereas in the benign lesions there was not clear saturation. Prostate cancer emits higher biomagnetic activity than the BPH. This confirms a higher angiogenic activity in prostate cancer than the BPH lesions. Furthermore, the saturation value in the estimation of the correlation dimension of the attractor for the cancer lesions confirms the lower complexity of the system in comparison to the BPH, which is characterized by higher complexity.

Prognostic significance of HLA-DR antigen in dysplasia, carcinoma in situ and invasive carcinoma of the gallbladder.

OBJECTIVE: Prognosis of gallbladder carcinoma is poor. The two most important factors having the greatest effect on survival are pathologic stage of disease and histologic grade of the tumour. Our study points towards the value of HLA-DR antigen in the prognosis of gallbladder carcinoma. DESIGN: Thirty one cases of dysplasia of the gallbladder, 12 cases of carcinoma in situ, and 39 cases of invasive carcinoma for the detection of HLA-DR monoclonal antigen were studied. T helper (TH) marker (CD4) in the tumour stroma of the relevant cases was also studied, given that it is now known that the dependence of immune responsiveness on the class II antigens reflects the central role of these molecules in presenting antigen to TH cells. SETTING: Pathology Departments of Drama General Hospital and Ippokration Hospital of Salonica in twelve years period (1990-2002). RESULTS: HLA-DR was expressed in 20 of 31 dysplasias (64.5%), four of 12 in situ (33.3%), and in 10 of 39 invasive carcinomas (25.6%). CD4 was expressed in nine of 31, dysplasias (29%), five of 12 in situ (42%), and in 26 of 39 invasive carcincomas (67%). CONCLUSIONS: The results showed decreased expression of HLA-DR and increased expression of CD4 as the lesion progressed to malignancy. The aberrant expression of HLA-DR by epithelial cells of dysplasias, of carcinomas in situ and of invasive carcinomas agrees with the hypothesis of the dysplasia-carcinoma in situ sequence as the usual route for the development of invasive carcinoma. The immune attract mechanism by low HLA-DR signalling seems to be of minor importance in the malignant and metastatic potential of the gallbladder, epithelial tumours.

Renal extramedullary hematopoietic tumor diagnosed by fine needle aspiration: a case report.

UNLABELLED: We report a case of a 58 year-old-male with a history of sickle cell anemia, who presented with a left kidney mass. Guided fine needle aspiration of the mass revealed extramedullary hematopoiesis and enabled avoiding an unnecessary surgical procedure. INTRODUCTION: Extramedullary hematopoiesis (EMH) generally occurs in patients with deficient bone marrow hematopoiesis secondary to either peripheral red cell destruction or marrow replacement. EMH is most commonly seen in the liver and spleen as a diffuse lesion. Rarely EMH presents as a solitary mass, posing a diagnostic dilemma. In asymptomatic patients without obvious evidence of hemato-pathology, the differential diagnosis is even more complex. Despite several reports describing the radiographic findings in EMH, fewer promote the use of fine needle aspiration (FNA) in making this diagnosis.