Calcitonin therapy in central giant cell granuloma of the jaw: a randomized double-blind placebo-controlled study.

The successful therapeutic use of calcitonin in patients with a central giant cell granuloma has been shown in several case reports. In a prospective, randomized, double-blinded, placebo-controlled clinical trial, 14 patients with a histologically confirmed central giant cell granuloma and normal calcium and parathyroid hormone serum levels were studied over 2 years. Patients were treated with intranasally administered salmon calcitonin (200 IU/day) or a placebo once a day. The placebo-controlled period was 3 months, after which all patients were treated with calcitonin for 1 year. Treatment response was assessed at the end of the placebo-controlled study phase (3 months), at the end of therapy (15 months' timepoint with patients being on calcitonin treatment for either 12 or 15 months) and at 6 months' follow-up. The chi(2)-test was used to compare the proportion of patients with a tumour reduction >/=10% of the pretreatment measurement between the 2 populations at the 3 timepoints: no differences were observed between the placebo group and the calcitonin group. At the 6-month follow-up timepoint, tumour volume had decreased by >/=10% in a total of 7 patients with a 37.9% (95% CI 31.3-44.5%) mean volume reduction in this subgroup. Complete remission was not observed.

[Balance disorder and subacute hydrocephalus due to haemorrhage in a cerebral cavernous malformation]. / Evenwichtsstoornis en subacute hydrocefalus door bloeding in een cerebrale caverneuze malformatie.

A 58-year-old man presented with a balance disorder, followed by progressive memory disturbance, urinary incontinence and vomiting. MRI of the brain revealed multiple cavernous malformations, with recent haemorrhage from one of them, in the brainstem, causing a hydrocephalus. After treatment for the hydrocephalus, the symptoms resolved quickly. Cerebral cavernomas may cause epileptic seizures, haemorrhaging and progressive neurological deficits. Diagnosis is on the basis of the typical MRI pattern of a hyperintense core, surrounded by a hypointense rim of old blood. Treatment consists of surgery if the lesion is easily accessible and can be completely removed. Other options are gamma-knife surgery, stereotactic radiotherapy and conservative treatment.

Interobserver variability and accuracy of computed tomographic assessment of nodal status in lung cancer.

To assess the interobserver variability of computed tomography in determining nodal status in non-small cell lung carcinoma, four experienced radiologists reviewed the computed tomographic scans of 147 patients. Interobserver variability was calculated using the kappa statistic. In addition, the accuracy of CT assessment of the nodal status by the four observers was measured by comparing their findings with thorough mediastinal exploration at both mediastinoscopy (n = 35) and thoracotomy (n = 112). Interobserver variability was large between the four radiologists regarding nodal status on a per-patient basis (kappa = 0.38). Sensitivity of computed tomography for the observers on a per-patient basis ranged from 40% to 69% with a 1.0-cm criterion and from 28% to 56% with a 1.5-cm criterion. From the large interobserver variability and the low sensitivities in this study it can be concluded that a negative result of computed tomography regarding mediastinal lymph nodes does not eliminate the need for mediastinoscopy or exploration of the mediastinum at the time of operation in patients with non-small cell lung cancer.

Computed tomographic staging of esophageal carcinoma: a study on interobserver variation and correlation with pathological findings.

Despite numerous reports on the efficacy of CT in the staging of esophageal carcinoma, no data are available on the reproducibility of the procedure. Three experienced radiologists independently reviewed the CT scans of 35 patients retrospectively. Calculation of interobserver variation was performed using the kappa statistic. The CT findings of each observer were subsequently correlated with the surgical and pathological findings of 17 patients. There was a large interobserver variation concerning involvement of the aorta, pulmonary vessels, vertebral column, stomach and lymph nodes, ranging from poor to excellent agreement. Agreement between observers on extension of the disease to the tracheobronchial tree, pericardium and liver was good or excellent. Agreement between the CT findings of all observers and the surgical findings for invasive growth was poor. CT pathological correlation of the three observers showed sensitivities ranging from 50 to 57%, specificities ranging from 50 to 60% and accuracies ranging from 46 to 71%. It can be concluded from this study that patients with positive CT findings for involvement of the tracheobronchial tree, the pericardium and the liver should be considered unresectable for cure. Negative findings, however, should be interpreted with caution, because involvement of other structures may still be present. Despite optimistic reports on the efficacy of CT in the pretherapy staging of esophageal neoplasms, this modality has its limitations.