MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes.

BACKGROUND AND PURPOSE: The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes. MATERIALS AND METHODS: This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients. RESULTS: All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 × 10-3mm2/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 × 10-3mm2/s, P < .001, and 0.73 ± 0.10 × 10-3mm2/s, P < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve (P < .001 to P = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion (P < .001 to P = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral. CONCLUSIONS: The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.

Optimal Fat Suppression in Head and Neck MRI: Comparison of Multipoint Dixon with 2 Different Fat-Suppression Techniques, Spectral Presaturation and Inversion Recovery, and STIR.

BACKGROUND AND PURPOSE: Uniform complete fat suppression is essential for identification and characterization of most head and pathology. Our aim was to compare the multipoint Dixon turbo spin-echo fat-suppression technique with 2 different fat-suppression techniques, including a hybrid spectral presaturation with inversion recovery technique and an inversion recovery STIR technique, in head and neck fat-suppression MR imaging. MATERIALS AND METHODS: Head and neck MR imaging datasets of 72 consecutive patients were retrospectively reviewed. All patients were divided into 2 groups based on the type of fat-suppression techniques used (group A: STIR and spectral presaturation with inversion recovery gadolinium-T1WI; group B: multipoint Dixon T2 TSE and multipoint Dixon gadolinium-T1WI TSE). Objective and subjective image quality and scan acquisition times were assessed and compared between multipoint Dixon T2 TSE versus STIR and multipoint Dixon gadolinium-T1WI TSE versus spectral presaturation with inversion recovery gadolinium-T1WI using the Mann-Whitney U test. RESULTS: A total of 64 patients were enrolled in the study (group A, n = 33 and group B, n = 31). Signal intensity ratios were significantly higher for multipoint Dixon T2 and gadolinium-T1WI techniques compared with STIR (P < .001) and spectral presaturation with inversion recovery gadolinium-T1WI (P < .001), respectively. Two independent blinded readers revealed that multipoint Dixon T2 and gadolinium-T1WI techniques had significantly higher overall image quality (P = .022 and P < .001) and fat-suppression grades (P < .013 and P < .001 across 3 different regions) than STIR and spectral presaturation with inversion recovery gadolinium-T1WI, respectively. The scan acquisition time was relatively short for the multipoint Dixon technique (2 minutes versus 4 minutes 56 seconds for the T2-weighted sequence and 2 minutes versus 3 minutes for the gadolinium-T1WI sequence). CONCLUSIONS: The multipoint Dixon technique offers better image quality and uniform fat suppression at a shorter scan time compared with STIR and spectral presaturation with inversion recovery gadolinium-T1WI techniques.

Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy.

BACKGROUND AND PURPOSE: Esthesioneuroblastoma is a neuroectodermal tumor that commonly arises in the nasal cavity olfactory recess and, when isolated to the intranasal cavity, can be indistinguishable from benign processes. Because lesional aggressiveness requires a more invasive operation for resection than polypectomy, patients with isolated intranasal lesions were studied to define distinguishing CT characteristics. MATERIALS AND METHODS: Patients with intranasal esthesioneuroblastoma and controls without esthesioneuroblastoma with olfactory recess involvement were identified by using a report search tool. Studies demonstrating skull base invasion and/or intracranial extension were excluded. The imaging spectrum of these lesions was reviewed on both CT and MR imaging, and CT findings were compared with those of controls without esthesioneuroblastoma. Two blinded readers assessed subjects with esthesioneuroblastomas and controls without esthesioneuroblastoma and, using only CT criteria, rated their level of suspicion for esthesioneuroblastoma in each case. RESULTS: Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma. CONCLUSIONS: Esthesioneuroblastoma can present as a well-marginated intranasal lesion that unilaterally widens the olfactory recess. CT patterns can help predict esthesioneuroblastoma, potentially preventing multiple operations by instigating the correct initial operative management.

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision.

BACKGROUND AND PURPOSE: Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure threshold-lowering medications before myelography and to assess the reported incidence of postmyelographic seizures. MATERIALS AND METHODS: An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmyelographic seizures experienced in the past 5 years, the presence of an institutional policy for discontinuing seizure threshold-lowering medications, and the type of myelographic contrast used. We compared the postmyelographic seizure frequency in the responses. RESULTS: Of 700 survey responses, 57% reported that they do not discontinue seizure threshold-lowering medications before myelography. Most (97%) indicated never having a patient experience a seizure following myelography. The number of postmyelographic seizures between those who discontinue seizure threshold-lowering medications and those who do not was not statistically significant (OR = 2.13; 95% CI, 0.91-4.98; P = .08). Most (95%) reported using nonionic hypo-osmolar agents. CONCLUSIONS: Survey results revealed widely variable practices for patient myelography preparation and postprocedural monitoring. We found no difference in reported seizures between those who discontinued seizure threshold-lowering medications and those who did not. In light of our findings, we propose that discontinuing reportedly seizure threshold-lowering medications is not warranted with the current nonionic water-soluble contrast agents and may be potentially harmful in some instances. This work supports revision of existing recommendations to withhold such medications before myelography.

In vivo manganese MR imaging of calcium influx in spontaneous rat pituitary adenoma.

BACKGROUND AND PURPOSE: Rapid uptake of the calcium analog manganese (Mn2+) into spontaneous pituitary adenoma during MR imaging of aged rats generated the hypothesis that neuroendocrine tumors may have a corresponding increase in calcium influx required to trigger hormonal release. A goal of this study was to investigate the potential for clinical evaluation of pituitary adenoma by MR imaging combined with administration of Mn2+ (Mn-MR imaging). MATERIALS AND METHODS: Mn-MR imaging was used to characterize the dynamic calcium influx in normal aged rat pituitary gland as well as spontaneous pituitary adenoma. To confirm the validity of Mn2+ as a calcium analog, we inhibited Mn2+ uptake into the olfactory bulb and pituitary gland of normal rats by using the calcium channel blocker verapamil. Rats with adenomas received fluorodeoxyglucose-positron-emission tomography (FDG-PET) scanning for characterization of tumor metabolism. Mn2+ influx was characterized in cultured pituitary adenoma cells. RESULTS: Volume of interest analysis of the normal aged pituitary gland versus adenoma indicated faster and increased calcium influx in adenoma at 1, 3, 11, and 48 hours. Mn2+ uptake into the olfactory bulb and pituitary gland of normal rats was inhibited by calcium channel blockers and showed dose-dependent inhibition on dynamic MR imaging. FDG-PET indicated correlation between tumor energy metabolism and Mn2+ influx as well as tumor size. CONCLUSION: These results indicate that adenomas have increased activity-dependent calcium influx compared with normal aged pituitary glands, suggesting a potential for exploitation in the clinical work-up of pituitary and other neuroendocrine tumors by developing Mn-MR imaging for humans.

Stimulatory effects of 4-hydroxytamoxifen on proliferation of human endometrial adenocarcinoma cells (Ishikawa line).

The effects of trans-4-hydroxytamoxifen (OHTam) on proliferation of cells of the Ishikawa human endometrial adenocarcinoma line were studied under serum-free, phenol red-free conditions and compared to those of estradiol. The addition of OHTam (1 microM) to basal medium (BM), consisting of equal parts of Dulbecco's modified Eagle's medium and Ham's F-12 with additional glutamine and 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid, resulted in significant increases in cell numbers relative to controls. These effects were even greater than those obtained with estradiol (10 nM-1 microM) or 1% charcoal-treated fetal bovine serum (ctFBS). Addition of 1% ctFBS to BM containing 1 microM OHTam further increased cell numbers whereas addition of estradiol (10 nM) did not do so. The stimulation of growth was positively correlated with OHTam concentrations in the range of 10 nM to 1 microM. Dissociation of estradiol and OHTam proliferative effects was observed in a variant of Ishikawa cells in which estradiol did not increase proliferation while OHTam had a strong stimulatory effect. The growth-promoting effects of OHTam were also observed in BM containing 5% or 15% ctFBS. In contrast, in parallel experiments in which BM was replaced by minimal essential medium (Eagle's) with Earle's salts, OHTam (1 microM) did not stimulate proliferation under these conditions and acted as an antiestrogen, inhibiting the proliferative effects of estradiol. These results illustrate marked effects of medium composition on proliferation and antiestrogenic actions of OHTam. Alkaline phosphatase activity was strongly stimulated by estradiol (10 nM) but only very weakly affected by OHTam (1 microM); at these concentrations, OHTam inhibited the effect of estradiol, both in serum-free BM and in minimal essential medium plus 15% ctFBS, demonstrating dissociation in its actions on proliferation and on enzymatic activity. These findings suggest that OHTam may stimulate the proliferation of particular clones of endometrial cancer cells in human tumors. They also suggest that OHTam can exert effects not mediated by the estrogen receptor system, or form OHTam-estrogen receptor agonistic complexes unlike those resulting from estradiol-estrogen receptor interactions. Clearly, Ishikawa cells provide a useful model to investigate mechanisms of action of antiestrogens.

Proliferation and responsiveness to estrogen of human endometrial cancer cells under serum-free culture conditions.

Studies of hormonal growth regulation in cultured human endometrial cancer cells are limited by the requirement of exogenous growth factors, usually supplied by addition of serum. The present report provides evidence that estradiol can stimulate proliferation of endometrial cancer cells of the Ishikawa line in the absence of serum or added growth factors. Mitogenic effects of estrogen were demonstrated in two different experimental systems, in cells attached to the substratum of mammalian tissue culture dishes, and in cells forming colonies in soft agar under anchorage-independent conditions. Addition of estradiol to a mixture of serum-free, phenol red-free Dulbecco's minimal essential medium and Ham's F-12 medium, supplemented with L-glutamine and 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid [basal medium: (BM)] significantly increased the proliferation of cells attached to culture dishes. Dose-response experiments revealed maximal estradiol stimulation at 10 nM; significant responses were also observed at 1 nM and at 100 nM concentrations. The mitogenic effect of 10 nM estradiol was comparable to that of 1% charcoal-treated fetal bovine serum and the two effects were additive. The presence of estradiol in serum-free BM resulted in a shortening of the doubling time of exponentially proliferating cells from 38 to 29 h. From the labeling index, measured after exposure to a pulse of [3H]thymidine, and from the mitotic index, both determined in exponentially proliferating cells, the lengths of the S and M phases were calculated to be 11 and 1 h, respectively. From these data it was estimated that estradiol shortened the G1 phase by approximately 40%, from 22 to 13 h. Estradiol doubled the colony formation efficiency of cells plated in BM containing 0.3% agar in the absence of serum as well as in the presence of 1% charcoal-treated fetal bovine serum. The stimulation of colony formation by estradiol was influenced by medium components, since no effects were observed in minimal essential medium. The colony formation efficiency was positively related to the serum concentrations and remained significantly lower in minimal essential medium than in BM at comparable serum levels. The observed positive relationship between colony formation efficiency and cell densities at plating suggests a cooperative mitogenic effect, likely due to autocrine and paracrine action of secreted growth factors. These results define a model to evaluate hormonal growth regulation mediated by autocrine mitogens in human endometrial cancer cells in the absence of interfering exogenous growth factors.(ABSTRACT TRUNCATED AT 400 WORDS)

Transforming growth factor gene expression in human endometrial adenocarcinoma cells: regulation by progestins.

In an attempt to understand the antiproliferative effects of progestins in endometrial cancer, we have examined the effects of the potent progestin, medroxyprogesterone acetate (MPA), on the cell proliferation and the expression of transforming growth factor (TGF) alpha and beta genes in human endometrial adenocarcinoma cell lines. The two cell lines used were Ishikawa, var 1, and HEC-50. In addition, the effects of exogenous TGF-alpha and anti-epidermal growth factor (EGF) receptor monoclonal antibody on cell proliferation were determined. Incubation of both cell lines with MPA resulted in a time- and dose-dependent inhibition of cell proliferation. Half-maximal growth inhibition was observed at 0.6 nM. In Ishikawa cells, the relative abundance of TGF-alpha was significantly reduced by MPA. A significant decrease in TGF-alpha mRNA was apparent 6 h after exposure to MPA and a further decrease was seen 12-24 h after addition of the progestin. The concentration of TGF-alpha immunoreactivity in conditioned medium of MPA-treated cells was also significantly reduced compared to control cultures. MPA had no effect on TGF-alpha expression by HEC-50 cells. EGF mRNA was not detected by Northern blot analysis in either cell type. MPA had no significant effect on EGF receptor mRNA abundance but resulted in a small increase in EGF receptor number in Ishikawa cells. Anti-EGF receptor monoclonal antibody (0.6-6 nM) inhibited Ishikawa cell growth but had no effect on HEC-50 cell proliferation. Exogenous TGF-alpha stimulated proliferation of both cell lines, but Ishikawa cells were significantly more sensitive to exogenous TGF-alpha than HEC-50 cells. Furthermore, TGF-alpha could reverse the growth inhibitory effects of MPA on Ishikawa cells. A decrease in TGF-beta mRNA abundance was also observed in MPA-treated Ishikawa and HEC-50 cells. This effect was of small magnitude, variable, and only observed after prolonged exposure to MPA. These observations are consistent with the hypothesis that the antiproliferative effects of progestins on Ishikawa cells are mediated by decreased expression and autocrine action of TGF-alpha. Since similar growth inhibition is also seen in the HEC-50 cells in which progestins have no effect on TGF-alpha expression, additional mechanisms are likely to be involved in the antiproliferative effects of progestins in human endometrial cancer.

Dynamic Contrast-Enhanced MR Imaging in Head and Neck Cancer: Techniques and Clinical Applications.

In the past decade, dynamic contrast-enhanced MR imaging has had an increasing role in assessing the microvascular characteristics of various tumors, including head and neck cancer. Dynamic contrast-enhanced MR imaging allows noninvasive assessment of permeability and blood flow, both important features of tumor hypoxia, which is a marker for treatment resistance for head and neck cancer. Dynamic contrast-enhanced MR imaging has the potential to identify early locoregional recurrence, differentiate metastatic lymph nodes from normal nodes, and predict tumor response to treatment and treatment monitoring in patients with head and neck cancer. Quantitative analysis is in its early stage and standardization and refinement of technique are essential. In this article, we review the techniques of dynamic contrast-enhanced MR imaging data acquisition, analytic methods, current limitations, and clinical applications in head and neck cancer.

Do Radiologists Report the TNM Staging in Radiology Reports for Head and Neck Cancers? A National Survey Study.

BACKGROUND AND PURPOSE: CT and MR imaging are widely used for the staging of head and neck cancer. Currently, there are no data regarding whether the primary tumor, nodes, metastasis (TNM) staging is routinely incorporated into radiology reports. We conducted a national survey to determine whether radiologists routinely address staging, in particular regarding T (primary tumor) and N (nodal). MATERIALS AND METHODS: The survey was sent to 782 members of the American Society of Head and Neck Radiology. The survey asked whether they assign TN staging in reports. If they do assign TN staging, what are the reasons for doing so, and if not, what are the barriers or reasons for not including it in the radiology report? The method of measuring the size of the primary tumor and pathologic lymph nodes was also queried. RESULTS: A total of 229 responses were returned (29.3% response rate). Approximately half (49%; 95% confidence interval, 43.55-54.5%) of the responders thought that incorporating TN staging is important. However, only 24.5% (95% confidence interval, 19.8%-29.2%) stated that they routinely assigned TN staging in their radiology reports. The most common barriers were being afraid of being inaccurate (59%) and being unable to remember the staging classifications (58.2%); 76.9% indicated that they measure a primary tumor in 3D. CONCLUSIONS: Staging head and neck cancer based on imaging presents unique challenges. Nearly half of the responding radiologists think it is important to incorporate TN staging in radiology reports, though only a quarter of them routinely do so in practice.

Imaging evidence and recommendations for traumatic brain injury: advanced neuro- and neurovascular imaging techniques.

SUMMARY: Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge.

Impact of model-based iterative reconstruction on image quality of contrast-enhanced neck CT.

BACKGROUND AND PURPOSE: Improved image quality is clinically desired for contrast-enhanced CT of the neck. We compared 30% adaptive statistical iterative reconstruction and model-based iterative reconstruction algorithms for the assessment of image quality of contrast-enhanced CT of the neck. MATERIALS AND METHODS: Neck contrast-enhanced CT data from 64 consecutive patients were reconstructed retrospectively by using 30% adaptive statistical iterative reconstruction and model-based iterative reconstruction. Objective image quality was assessed by comparing SNR, contrast-to-noise ratio, and background noise at levels 1 (mandible) and 2 (superior mediastinum). Two independent blinded readers subjectively graded the image quality on a scale of 1-5, (grade 5 = excellent image quality without artifacts and grade 1 = nondiagnostic image quality with significant artifacts). The percentage of agreement and disagreement between the 2 readers was assessed. RESULTS: Compared with 30% adaptive statistical iterative reconstruction, model-based iterative reconstruction significantly improved the SNR and contrast-to-noise ratio at levels 1 and 2. Model-based iterative reconstruction also decreased background noise at level 1 (P = .016), though there was no difference at level 2 (P = .61). Model-based iterative reconstruction was scored higher than 30% adaptive statistical iterative reconstruction by both reviewers at the nasopharynx (P < .001) and oropharynx (P < .001) and for overall image quality (P < .001) and was scored lower at the vocal cords (P < .001) and sternoclavicular junction (P < .001), due to artifacts related to thyroid shielding that were specific for model-based iterative reconstruction. CONCLUSIONS: Model-based iterative reconstruction offers improved subjective and objective image quality as evidenced by a higher SNR and contrast-to-noise ratio and lower background noise within the same dataset for contrast-enhanced neck CT. Model-based iterative reconstruction has the potential to reduce the radiation dose while maintaining the image quality, with a minor downside being prominent artifacts related to thyroid shield use on model-based iterative reconstruction.

Isolation and analysis of the mouse genomic sequence encoding Cu(2+)-Zn2+ superoxide dismutase.

Cu(2+)-Zn2+ superoxide dismutase (SOD-1) is a ubiquitously synthesized eukaryotic enzyme with a variety of important roles in mammalian development and physiology. With the goal of better understanding the structure and regulation of this gene, we have cloned and analyzed the genomic structure of the mouse SOD-1 gene. The murine sequence has an intron:exon organization very similar to that of the human gene, though significant diversion was observed in the promoter and 3' regions. These differences account for the observation that only a single transcript for SOD-1 is seen in mouse cells, while two transcripts are derived from the human gene. The cloning of mouse SOD-1 should allow elucidation of the regulatory characteristics of this element, as well as new and informative genetic engineering experiments.

Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer.

PURPOSE: To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) "in-field," in which 95% or more of the recurrence volume (V(recur)) was within the 95% isodose; 2) "marginal," in which 20% to 95% of V(recur) was within the 95% isodose; or 3) "outside," in which less than 20% of V(recur) was within the 95% isodose. RESULTS: With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences (including one noninvasive recurrence) and 1 stomal recurrence were seen in 12 patients, for a 2-year actuarial local-regional control rate of 79% (95% confidence interval 68-90%). Ten patients (80%) relapsed in-field (in areas of previous gross tumor in nine patients), and two patients developed marginal recurrences in the side of the neck at highest risk (one in the high retropharyngeal nodes/base of skull and one in the submandibular nodes). Four regional recurrences extended superior to the jugulodigastric node, in the high jugular and retropharyngeal nodes near the base of skull of the side of the neck at highest risk. Three of these were in-field, in areas that had received the dose intended for subclinical disease. No recurrences were seen in the nodes superior to the jugulodigastric nodes in the side of the neck at less risk, where RT was partially spared. CONCLUSIONS: The majority of local-regional recurrences after conformal and segmental IMRT were "in-field," in areas judged to be at high risk at the time of RT planning, including the GTV, the operative bed, and the first echelon nodes. These findings motivate studies of dose escalation to the highest risk regions.

Effects of exercise training on home blood pressure values in older adults: a randomized controlled trial.

OBJECTIVE: To determine the effects of exercise training on the blood pressure (BP) values of older adults, using home blood pressure measurement. DESIGN: Randomized controlled trial. PARTICIPANTS: A total of thirty-nine free-living older adults (including 19 men) aged from 60-81 years with home systolic blood pressure > 120 mmHg and without significant cardiopulmonary-musculoskeletal disease, were randomly allocated to either 25 weeks of exercise training (exercise group) or to a control program (control group). MAIN OUTCOME MEASUREMENTS: Change in the 2-week averages of home systolic and diastolic blood pressure values measured with a validated automatic device before, during and after the intervention period. RESULTS: Compared with the control group, the exercise group showed a significant decrease in values for home systolic blood pressure (maximum between-group difference = 7.7 mmHg, P = 0.003) and home diastolic blood pressure (4.2 mmHg, P = 0.001). These changes were observed for both genders. CONCLUSIONS: Exercise training was effective for older adults in lowering home blood pressure values. This is the first trial to demonstrate the usefulness of home blood pressure measurement in examining the effect of exercise training on blood pressure values.

Prognostic factors for local control in nasopharyngeal cancer (NPC): analysis by multivariate proportional hazard models.

Despite the development of meticulous radiation therapy techniques, the local control of the nasopharyngeal cancer (NPC) remains unsatisfactory. We examined retrospectively the clinicopathologic factors which have impact upon local recurrence-free survival (LRFS) of the 67 patients with NPC who had been irradiated greater than or equal to 40 Gy with curative intent from 1975 through 1988. Three-year LRFS rate was 63%. T stage, histology, the presence of accompanying lymphocytic infiltration, and the properness of radiation therapy had influence upon LRFS with a statistical significance. Multivariate proportional hazard models showed that T stage and pathology retained significance. Radiation therapy properness emerged as a third factor when only the patients irradiated greater than or equal to 60 Gy were included in the analysis. From these results, three groups with low, moderate, and high risk of shortened LRFS could be separated. This risk classification could contribute to the stratification criteria of future study for the improvement of local control by new modalities.

Metastasis of adenocarcinoma of the lung to optic nerve sheath meningioma.

A 71-year-old woman developed chronic progressive visual loss in the right eye and computed tomographic scan showed enlargement of the intraorbital optic nerve consistent with optic nerve sheath meningioma. Over 12 years, the contralateral optic nerve was not clinically affected, and serial neuroradiologic imaging showed no evidence of intracranial tumor extension. Death occurred from metastatic adenocarcinoma of the lung 14 years after initial visual loss. Examination of the postmortem specimen of optic nerve and chiasm revealed extradural extension of meningioma with spread to the region of the optic chiasm and hypothalamus. A large focus of metastatic adenocarcinoma was present within the intraorbital portion of the meningioma. Carcinoma metastatic to intracranial meningioma is rare; to our knowledge, this is the first reported case in an optic nerve sheath meningioma. Neuroimaging may be inadequate to predict the value of tumor excision in preventing intracranial spread of optic nerve sheath meningioma.

Effects of transforming growth factors and regulation of their mRNA levels in two human endometrial adenocarcinoma cell lines.

The effects of the transforming growth factor-beta 1 (TGF-beta 1) and epidermal growth factor (EGF) on the growth of cells from 2 endometrial cancer lines, Ishikawa and HEC-50 were evaluated by measuring rates of DNA synthesis and changes in cell numbers during culture. EGF at 17 and 1.7 nM concentrations consistently enhanced HEC-50 cell proliferation. TGF-beta 1 inhibited Ishikawa cell proliferation but, unexpectedly for epithelium-derived cells, stimulated HEC-50 cell growth. This effect is of interest as it indicates that endometrial cells can acquire an altered responsiveness to a growth inhibitor during the process of malignant transformation. Northern blot analyses showed expression of TGF-alpha, TGF-beta 1 and EGF receptors mRNA in both cell lines. Neither estradiol (E2) nor 4-hydroxytamoxifen (OHTam) affected mRNA levels for either TGF-alpha or TGF-beta in HEC-50 cells, a line unresponsive to E2 for proliferation. In Ishikawa cells, previously shown to respond to both E2 and OHTam by increasing proliferation rates, E2 increased TGF-alpha mRNA and reduced TGF-beta mRNA levels. OHTam lowered the levels of both mRNA species, although the effect was greater on TGF-beta than TGF-alpha mRNA. These data are consistent with, but do not prove, the existence of a possible autocrine regulation by TGF-alpha and TGF-beta of human cancer cell proliferation, which might be under E2 influence in Ishikawa cells.

Rosai-Dorfman disease presenting with isolated bilateral orbital masses: report of two cases.

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is a rare benign idiopathic proliferative disease of phagocytic histiocytes. Approximately 80% of patients present with painless massive cervical lymphadenopathy. Isolated extranodal involvement is relatively uncommon. Two cases of Rosai-Dorfman disease are reported: one with isolated bilateral orbital involvement and one with marked cervical lymphadenopathy and multiple dural-based and intraventricular masses.