Advances in the care of children with brain tumors.

Recent advances in diagnostic imaging, neurosurgical techniques and oncologic therapies provide a more optimistic outlook for practitioners, children with brain tumors and their families. Newer imaging modalities such as magnetic resonance imaging and positron emission tomography improve accuracy of both initial diagnosis and follow-up evaluation for recurrence or metastasis. Recent advances in microsurgical technique allow for more complete tumor resection. Improving immunological and chemotherapeutic agents show future promise for tumor-specific treatment. Craniospinal irradiation techniques are changing in response to research into long-term effects of radiation on the developing nervous system and patterns of tumor recurrence and metastasis. Stereotactic radiation allows high-dose radiation to be given to focal areas minimizing radiation effects to surrounding normal structures. These changes impact the nursing care of children, requiring neuroscience nurses to be aware of current treatment modalities. Greater awareness of these changes ensures optimum patient care.

[Diagnostic value of arteriography in a case of splenomegaly of unknown origin (author's transl)]. / Apport de l'artériographie dans un cas de splénomégalie inexpliquée.

A 32 year-old patient was found to have a tender enlarged spleen with hardly any other signs apart from transient fever and moderate hepatomegaly. Coeliac arteriography was performed to eliminate the possibility of a splenic tumor. The splenic arteriography showed the presence of a great number of lacuna dispersed throughout the parenchyma and measuring 0,5 to 1 cm. Histopathological examination of samples of the spleen, removed by operation, and biopsies of the liver and lymphnodes confirmed the diagnosis of sarcoidosis of the liver, spleen and lymphnodes.

[Renal malacoplakia. A report of a case and discussion]. / La malakoplakie du rein. Etude d'un cas et discussion.

A woman of 40 years of age without any past history of urinary affections was discovered to have malacoplakia of one kidney, demonstrated by a mass in the right flank, fever, and a coliform urinary infection. No secretion from the affected side was observed on intravenous urography. Renal arteriography showed an inflammatory mass affecting mainly the lower half of the kidney. Histological examination of a nephrectomy specimen led to a diagnosis of a malacoplakia. The authors review the clinical, radiological, and pathological features of renal malacoplakia, which is an inflammatory condition of the renal parenchyma very similar to xantogranulomatous pyelonephritis. The pathogenesis is completely unknown, but the lesion probably arises from a disorder of macrophage function, and renal malacoplakia should be a differential diagnosis of inflammatory renal masses.

Plasma aldosterone concentrations related to 17alpha-hydroxyprogesterone in congenital adrenal hyperplasia.

Plasma aldosterone and 17alpha-hydroxyprogesterone (17-OHP) concentrations were measured in 35 patients with congenital adrenal hyperplasia resulting from 21-hydroxylase deficiency. Ten patients had never been treated and among them were 4 salt-losing infants. Both aldosterone and 17-OHP were high in the 6 untreated non salt-losers. The values ranged respectively from 110 to 376 pg/ml and from 150 to 292 ng/ml. Results were variable in the 4 salt-losers. Three out of 5 untreated non salt-losers who were submitted to a low sodium diet, responded by doubling their aldosterone levels. When plasma 17-OHP concentrations were less than 30 ng/ml, the mean aldosterone level in the treated non salt-losers (n=6) was 15.3 pg/ml +/- 4.3 (SE). This value was not different from the mean level found in the control children (n=7), 18.8 pg/ml +/- 3.2. In the treated salt-losers (n=9), the measured aldosterone levels were less than or equal to 10 pg/ml 7 times out of 9. When the treated patients exhibited plasma 17-OHP concentrations greater than 30 ng/ml, the salt-losers (n=11) were distinguished from the non salt-losers (n=8) in that they showed as significantly lower aldosterone mean level, 24.6 pg/ml +/- 4.3 against 69 pg/ml +/- 13.4 found in the non salt-losers. The salt-losers displayed no aldosterone increases to synthetic ACTH stimulation under treatment or at the withdrawal of treatment, while positive aldosterone responses were often observed in the non salt-losers. In the latter group, studied under different conditions (with and without therapy, on low sodium diet, after ACTH test) a significant correlation was found between aldosterone and 17-OHP levels expressed in log. values, (n=38, r=0.80, P less than 0.001). The relationship could also be established with the values obtained from all the salt-losers, but it was less significant, (n=35, r=0.46, P less than 0.02).