An atypical presentation of diffuse midline pontine glioma in a middle age patient: Case report.

INTRODUCTION: Diffuse midline glioma is a newly WHO defined entity (grade IV) (Louis et al., 2016) which includes diffuse intrinsic pontine glioma (DIPG) reported in pediatric population and, occasionally, in young adults. Here, we present a detailed description of an atypical case of diffuse midline glioma in a 53 years old woman. CASE REPORT: A caucasian woman aged 53 from Ukraine, was referred to another neurological department complaining of 3 months history of progressive postural instability and gait impairment with frequent falling. Magnetic resonance demonstrated two brainstem lesions, hyperintense in FLAIR with "patchy" peripheral enhancement, leptomeningeal and cranial nerves enhancement. CSF was normal. Due to positive antinuclear antibodies test (ANA 1:360), intravenous steroid treatment was administered and reported to initially improve the patient condition. However, the following weeks the lady worsened. Imaging features were unchanged. Because quantiferon test resulted positive, MRI-Spectroscopy showed an inflammatory pattern and MRI perfusion study and brain FDG-PET, were normal, tubercolar granulomatous hypothesis was initially favored. Antitubercular therapy with isoniazid, pyrazinamide, ethambutol and rifampicin was started without any clinical improvement. Hence, the biopsy was proposed. The procedure revealed a diffuse midline pontine glioma. Considering the advanced stage of the disease, radiotherapy was not indicated. Patient died after eight months from the onset of neurological disturbances. CONCLUSION: Our case shows that diffuse midline glioma is a CNS tumor not limited to young population but occurring also in middle aged patients with an insidious pattern. We therefore recommend to perform biopsy at very early stages in patients with atypical brainstem lesions.

Case report: severe hyponatremia after water intoxication: a potential cause of rhabdomyolysis.

A 28-year-old woman, treated for schizophrenia, developed severe hypotonic hyponatremia (serum Na: 109 mEq/L) after several days of compulsive water drinking. The patient was admitted in a coma and required intensive supportive therapy. Rhabdomyolysis quickly followed with high serum creatine phosphokinase levels and myoglobinuria. A high volume alkaline diuresis was initiated. Renal failure or compartment syndrome did not complicate the clinical picture. The mechanisms causing water intoxication and hyponatremia are discussed as are the possible pathogenetic explanations behind acute hyponatremia and rhabdomyolysis.

Vitiligo autoantibodies are effective against melanoma.

BACKGROUND: Vitiligo is a dermatologic disease characterized by local, dispersed, or diffuse white patches on the skin. The disease is defined as an autoimmune disorder because autoantibodies against membranal components of melanocytes are found in the patients' sera. The current study examined whether the autoantibodies reacting with the normal melanocytes could be a potent therapy against melanoma cells. METHODS: The three in vitro assays used to determine the antibody reactivities using a mouse melanoma cell line B-16-F10 and M-14 human melanoma cells as targets are as follows: enzyme-linked immunosorbent assay (ELISA), proliferation assay, and morphologic examination in the presence of antibodies purified from sera of patients with vitiligo. In the in vivo studies, experimental melanoma was intravenously induced in C57BL/6J mice, and the mice were treated by daily intraperitoneal injections with purified immunoglobulin G (IgG) fraction derived either from patients with vitiligo or from healthy subjects. RESULTS: The binding of IgG derived from patients with vitiligo was demonstrated by ELISA: Exposure of melanoma cells to the vitiligo autoantibodies was followed by inhibition of their proliferation capacity. In addition, morphologic alterations exemplified by detachment of the cells from their solid support associated with melanin release were observed in the B-16-F10 cells. Less metastatic foci developed in the lungs of the mice treated with the purified IgG fraction from the sera of patients with vitiligo compared with those treated with purified IgG fraction from healthy subjects. CONCLUSIONS: The results of this study point to the presence of anti-melanoma autoantibodies in the sera of patients with localized and diffuse vitiligo. These antibodies have a destructive effect on melanoma cells in vitro and in vivo.

Emotional and psychosocial adjustment of women to breast reconstruction and detection of subgroups at risk for psychological morbidity.

Thirty-four women who had undergone breast reconstruction after mastectomy for breast cancer were evaluated as to their emotional and psychosocial adjustment. Standardized psychological tests and a self-report questionnaire were used, along with the surgeon's evaluation of the aesthetic success of the reconstruction. Two psychodiagnostic tests were found to be of use in identifying maladjusted women who do not gain optimal benefit from the reconstruction: a questionnaire that evaluates the level of depression (Beck) and another that assesses the level of optimism (Cantrill). No correlation was observed between the surgeon's evaluation of the reconstruction's aesthetic success and the women's satisfaction. It was found that there are two groups of emotional-high-risk women: single women and women receiving adjuvant therapy. It is suggested that emotional-high-risk patients be given psychological support concerning the importance of the mastectomy and their reaction to breast reconstruction.

A team work model in a burn unit with the integration of a clinical psychologist.

This paper describes team work in a burn unit in Tel Hashomer Hospital, Israel, which is intended to answer the problems which arise during the period in hospital following burning injury. The model was constructed after observing the emotional reactions of patients, which disturbed not only their ability to cope efficiently, but also caused additional suffering to themselves, their families and the hospital staff. The main emphasis is on: (1) the recognition and treatment of both the physical and emotional requirements of the patient; (2) involvement of the family in the treatment; and (3) active cooperation between all those who have a professional interest in the patient's treatment, welfare and recovery. The coordinator and integrator of these elements is the clinical psychologist.

Mental function following scalp irradiation during childhood.

Between 1950 and 1960 about 20,000 israeli children were treated for tinea capitis by x-ray therapy as part of a large public health campaign to eradicate the disease. Dosimetric studies determined that these children were subjected to a mean brain dose of 130 rads. Almost 20 years later, possible radiation effects on the central nervous system were evaluated by comparing several measures of mental and brain function in approximately 11,000 of the irradiated children and in two nonirradiated, tinea-free comparison groups: (a) ethnic, sex- and age-matched individuals from the general population, and (b) siblings. While not all comparisons were statistically significant, there was a consistent trend for the irradiated subjects to exhibit signs of central nervous system inpairment more often than either comparison group. The irradiated children had lower examination scores on scholastic aptitude, intelligence quotient (IQ) and psychologic tests, completed fewer school grades, and had an increased risk for mental hospital admissions for certain disease categories. A slightly higher frequency of mental retardation was also suggested. These-long-lasting scholastic and mental health effects lead the authors to conclude that radiation to the immature brain may cause damage to the central nervous system.

Attitudes toward mental disease in a sample of Israeli urban residents.

A random sample of 463 residents of the Tel Aviv Metropolitan area in the 30 to 59 age group were interviewed in order to evaluate their attitude toward mental health. The image of mental disease among the respondents was vague and a general rejection of the ex-mental patient was observed. This is in contrast with findings of several similar studies conducted previously in the U.S.