Temporal bone giant cell tumour: report of a second primary giant cell tumour of the temporal bone and infratemporal fossa.

OBJECTIVE: To report a second primary giant cell tumour (GCT) of the temporal bone and infratemporal fossa. METHODOLOGY: Medical records were analyzed in the context of the available literature. RESULTS: A 30 year-old male developed a temporal bone GCT with infratemporal fossa extension 12 years after undergoing successful surgical treatment of a GCT of the femur. These tumours were histologically distinct, suggesting the development of a second primary GCT rather than metastatic disease. This case differs from prior reported cases by surgical approach. Complete removal was achieved but required resection of the zygomatic arch and dissection of all upper facial nerve branches. The patient is disease free after 3 years with acceptable functional and cosmetic results. CONCLUSION: Complete resection of GCTs of the temporal bone and infratemporal fossa is advocated. Surgical techniques that allow for visualization of the facial nerve and increase surgical access can enhance overall clinical success.

Egr3 stimulation of GABRA4 promoter activity as a mechanism for seizure-induced up-regulation of GABA(A) receptor alpha4 subunit expression.

GABA is the major inhibitory transmitter at CNS synapses. Changes in subunit composition of the pentameric GABA(A) receptor, including increased levels of alpha4 subunit in dentate granule cells and associated functional alterations such as increased zinc blockade of GABA currents, are hypothesized to be critical components of epileptogenesis. Here, we report that the minimal promoter of the human alpha4 subunit gene (GABRA4p), when used to drive reporter gene expression from adeno-associated viral vectors, controls condition-specific up-regulation in response to status epilepticus, defining a transcriptional mechanism for seizure-induced changes in levels of alpha4 subunit containing GABA(A) receptors. Transfection studies in primary hippocampal neurons show that inducible early growth response factor 3 (Egr3) up-regulates GABRA4p activity as well as the levels of endogenous alpha4 subunits. Given that Egr3 knockout mice display approximately 50% less GABRA4 mRNAs in the hippocampus and that increases in alpha4 and Egr3 mRNAs in response to pilocarpine-induced status epilepticus are accompanied by increased binding of Egr3 to GABRA4 in dentate granule cells, our findings support a role for Egr3 as a major regulator of GABRA4 in developing neurons and in epilepsy.

Relations of imagery, creativity, and socioeconomic status with performance on a stock-market E-trading game.

The purpose of the present investigation was to examine how measures of imagery, creativity, and socioeconomic status relate to performance in a stock-market trading game. The 368 participants were students enrolled in an administration studies curriculum. A multiple regression analysis showed imaging scores to be a predictor of stock-trading performance as were creativity and socioeconomic status to a lesser extent. High imagers and high scorers on creativity and socioeconomic status made several times more profit with their portfolios. Results are discussed in terms of imagery having multiple repercussions on learning, e.g., memory and problem-solving. It is concluded that scores on imagery, creativity, and socioeconomic status, being weakly correlated, are interdependent and likely associated with personality traits shaped within a stimulating home or social environment.

Apoptosis in cavitation of middle ear space.

Mesenchyme cells surround early ossicles in the developing middle ear, then are replaced by space that is created by what has been described as an expansion of the pharyngeal pouch. Cell death has not been considered important in cavitation of chick middle ear (Jaskoll and Maderson [1978] Anat. Rec., 190:177-200), but an uncharacterized form of cell death has been reported to play a major role in cavitation of mouse middle ear (Jaskoll [1977] PhD thesis, CUNY). We investigated whether this uncharacterized cell death is the non-random form known as apoptosis. We examined the middle ear cavitation process using an in situ immunomarker for apoptosis. CBy RF mice during prenatal days 15-20 and postnatal days 1-3 and chick embryos representing HH stages 33-38 were investigated. Apoptotic cells were marked in mouse postnatal day 1. No indication of apoptosis was present in other prenatal and postnatal days of development included in this study, although morphology showed that cavitation proceeds over several perinatal days in the mouse. Apoptosis was not marked in the chick middle ear. Previously observed cell death in murine middle ear is the non-random form of cell death known as apoptosis. Cell death has not been reported in avian middle ear, and lack of apoptotic marker supports those observations. The limited occurrence of apoptosis in mice and apparent absence of apoptosis in chicks suggest that several mechanisms contribute to cavitation of vertebrate middle ear space.

Who should treat pyloric stenosis: the general or specialist pediatric surgeon?

Recent reports suggest that children under 3 years of age are best operated on by a specialist pediatric surgeon. In the United Kingdom, hypertrophic pyloric stenosis traditionally has been treated by adult general surgeons. Should this change? In 1991, a retrospective review of 10 years' experience with pyloric stenosis, managed by general surgeons in a large district general hospital, was published. In 1969, an accredited pediatric surgeon, who largely took over the management of pyloric stenosis, was appointed to the staff. His results with 70 children over a 5-year period (series 2) were reviewed retrospectively and compared with the previously published general surgical series of 170 children (series 1). There was no significant difference in the gender, age, or weight distribution between the two series. There was a marked difference in the rates of wound infection (15.5% in series 1; 2.8% in series 2; P < .05), wound dehiscence (6.7% in series 1; 0% in series 2; P < .05), and breach of the duodenal mucosa (12.8% in series 1; 0% in series 2; P < .01). The lower morbidity rate resulted in a shorter hospital stay, with emotional and financial savings. This supports the recommendation that children with this condition should be managed by a pediatric surgeon.

Prediction of acute renal failure after birth asphyxia.

Twenty-one babies of 34-41 weeks' gestational age with birth asphyxia (5 minute Apgar score less than or equal to 5 or umbilical artery pH less than or equal to 7.2) were studied during the first two days of life to find out whether the urinary excretion of tubular markers of renal function is of value in the early diagnosis of acute renal failure. Urinary retinol binding protein, myoglobin, and N-acetyl-beta-D-glucosaminidase (NAG), expressed as a ratio with urinary creatinine, were measured and excretion profiles repeated at 3-6 days in 15 infants and at 7-14 days in 11 infants. Plasma creatinine concentration, creatinine clearance, plasma myoglobin concentration, and fractional sodium excretion were measured where possible in asphyxiated infants. Control data were obtained from 50 healthy infants: 28 gave urine samples alone, 17 urine and blood, and five blood alone. Normal urinary values were derived from 17, 25, and three infants, respectively, for the three time periods. The number of control samples was limited for ethical reasons. Four asphyxiated infants had acute renal failure (group 1), four had tubular dysfunction without glomerular disturbance (group 2) and 13 had normal renal function (group 3). Group 1 were clearly identified by greatly increased urinary retinol binding protein (greater than 27,000 micrograms/mmol creatinine) and myoglobin (greater than 1500 micrograms/mmol creatinine) excretion measured in the first two days of life. In control infants the range of excretion of retinol binding protein within the same time period was 3 to 967 micrograms/mmol creatinine and urinary myoglobin was undetectable. Excretion of NAG failed to discriminate between groups 1 and 2. Acute renal failure occurred only in infants who had heavy myoglobinaemia. Tubular dysfunction in group 2 was transient and not accompanied by plasma electrolyte disturbances. We conclude that measurement of urinary excretion of retinol binding protein or myoglobin after birth is helpful in the early diagnosis of acute renal failure.

Postmicturition residual bladder volumes in healthy babies.

Thirty eight assessments of postmicturition residual volume were undertaken in 34 babies of various gestational and postnatal ages using abdominal ultrasonography. Twenty one (54%) babies had no detectable residual bladder volume. In all cases manual expression of the bladder failed to eliminate the residual volume. The formula widely used in the estimation of fetal bladder size and urine output is not applicable in the newborn infant.