Somatostatin receptor scintigraphy in central nervous system tumors: role of blood-brain barrier permeability.

UNLABELLED: Somatostatin receptors are expressed in meningiomas and low-grade gliomas, raising the hope that scintigraphy with 111In-DTPA-D-Phe1-octreotide might be helpful in the in vivo localization, differential diagnosis and postoperative/postradiotherapy brain tumor follow-up. METHODS: Indium-111-DTPA-D-Phe1-octreotide scintigraphy and brain scintigraphy using 99mTc-DTPA as a nonspecific tracer for blood-brain barrier integrity were simultaneously performed in 60 patients with CNS tumors using dual-isotope acquisition mode SPECT. For 23 patients, the scintigraphic findings were also compared with in vitro somatostatin receptor autoradiography of surgical biopsy specimens. RESULTS: In meningiomas (located outside the blood-brain barrier), the somatostatin receptor scan showed all tumors and scintigraphic signal intensity correlating with in vitro SSR density positive in all meningiomas. Less contrast was seen on 99mTc-DTPA scans. In all tumors inside the blood-brain barrier, the 111In-DTPA-D-Phe1-octreotide scan visualized the tumors with a disrupted blood-brain barrier, as seen by 99mTc-DTPA scintigraphy. Discrepancies, however, were observed between somatostatin receptor scintigraphy and in vitro receptor autoradiography. CONCLUSION: Combined somatostatin receptor and 99mTc-DTPA scintigraphy may be helpful for noninvasive differentiation between meningiomas and other CNS tumors. False-negative scans were observed as a result of shielding by the intact blood-brain barrier. Interpretation of negative and positive somatostatin receptor scans in CNS tumors must therefore be done with caution.

The expression of beta-catenin in non-small-cell lung cancer: a clinicopathological study.

AIMS: To investigate the expression of beta-catenin in non-small-cell lung cancer (NSCLC) and its clinical significance. METHODS: 101 patients were surgically treated for NSCLC by lobectomy or pneumectomy with systematic lymph node dissection. Follow up was available in all patients, ranging from 24 to 110 months. Immunostaining of tissue sections from primary tumours and (when present) their lymph node metastases was performed and evaluated using a monoclonal antibody against beta-catenin. Correlations were investigated between beta-catenin immunostaining in primary tumours and E-cadherin immunostaining (data available from a previous study), lymph node stage, and survival. RESULTS: There were significant correlations between scores for beta-catenin immunostaining and E-cadherin immunostaining in primary tumours (p = 0.007), and between the beta-catenin immunostaining score in primary tumours and in their lymph node metastases (p = 0.006). An inverse correlation was found between the beta-catenin immunostaining score in primary tumours and lymph node stage N0, N1, or N2 (p = 0.03). According to the Kaplan-Meier survival estimate, the level of beta-catenin expression in primary tumours was a statistically significant prognostic factor (p = 0.01). CONCLUSIONS: Reduced beta-catenin expression in surgically treated NSCLC is clearly associated with lymph node metastasis and an infavourable prognosis. The existence of a functional relation between E-cadherin and beta-catenin is supported by the results of this clinicopathological study.

[18 q deletion in mother and daughter (author's transl)]. / 18q-deletion bei mutter und Tochter

Transmission of 18 q deletion from a mother to her daughter is described in this report. By means of diverse banding techniques the same deletion was proven in both cases. Partial deletion on the long arm of chromosome 18 produces typical malformations and clinical characteristics which are compatible with life. In case of propagation it can be transmitted as a dominant characteristic.

[The incidence of caries in juvenile diabetics (author's transl)]. / Zum Kariesbefall jugendlicher Diabetiker.

The present state of knowledge regarding the aetiology of caries implicates the interrelationship between low-molecular carbohydrates and the bacterial flora as an essential factor in the potential development of caries. Persons with hereditary fructose intolerance and patients with diabetes mellitus are of special interest in studying these interrelations. The DMF/S index was calculated and a regression analysis carried out in 101 diabetic children and juveniles aged 4 to 18. The incidence of dentine caries was significantly lower in children with onset of diabetes preceding the appearance of the second dentition than in children with manifest diabetes of up to 3 years' duration. The DMF/S index was high in individual patients in spite of the prescribed dietary treatment.

[The status of managing the type I diabetic patient in Austria. Organization]. / Stand der Betreuung der Typ-I-Diabetiker in Osterreich*. Organisation.

During the Annual Meeting of the Austrian Diabetes Association various diabetic centres presented their success and failure rates with respect to metabolic control and prevention of late complications in diabetic patients on a country-wide basis. The analysis revealed that only 30% of all type I diabetic patients are adequately controlled. Intensive education in diabetes self-management, capable of leading to optimal metabolic control in up to 50% of the instructed patients, is however available only to a small minority of the diabetic patients to date. Despite the enormous improvement which has been achieved in the management of pregnant diabetic women, intensive specialized care is often commenced far too late. In rural areas, in particular, even conventional therapy is not fully implemented and late complications are, thus, inevitable.

Chronic bronchopleural fistula in conservatively-treated calcified fibrothorax.

We describe two cases of a bronchopleural fistula developing in a calcified fibrothorax several decades after the initial pleurisy. In a follow-up lasting many years, the fistulae are persistent, with only minor symptoms. We suggest that this benign course without serious illness is due to the fact that the calcified shell effectively seals off the infection, and that a conservative approach is likely to be successful.

[Indications for an increase in lung disease caused by Mycobacterium kansasii in the former Limburg mining area?]. / Aanwijzingen voor toename van longziekte door Mycobacterium kansasii in de voormalige Limburgse mijnstreek?

OBJECTIVE: To establish the occurrence of lung disease caused by Mycobacterium kansasii in order to determine whether the incidence has increased since 1991. DESIGN: Descriptive and retrospective. SETTING: The former coal-mining region (Limburg) of the Netherlands. METHOD: The occurrence of lung disease caused by M. kansasii and other non tuberculous mycobacteria (NTM) in the Netherlands and in the former coal-mining region in particular, was inferred from reports of tuberculosis of the national and local Public Health Authorities and of the Regional Public Health Laboratory. RESULTS: Between 1991 and 1993 in the former coal-mining region of the Netherlands 43 cases of tuberculosis were reported, of which 12 afterwards proved to be caused by M. kansasii, i.e. more than were diagnosed in the ten preceding years. An epidemiological relationship between these patients could be neither established nor disproved. CONCLUSION: The incidence of NTM diseases may be increasing with falling prevalence rates of tuberculosis infection. As lung disease caused by M. kansasii is not transmissible from man to man and its treatment is different from that of lung tuberculosis, it is essential to be able to differentiate between these diagnoses quickly by using rapid modern microbiological identification methods, and to determine the epidemiological links.

[Defective organification of iodine in an infant demonstrated with 123J and gamma camera (author's transl)]. / Verifizierung der Jodisationsstörung im Kleinkindesalter mit Jod-123.

A defective organification of iodine is demonstrated in a two year old male infant. The availability and a relatively simple radiation detector and storage system (gamma camera and 1600 word memory) gives a reasonable low radiation dose, allows correction for extrathyroid neck activity and obviates problems of collimation.

Quality assessment of diabetes care according to the recommendations of the St. Vincent Declaration: a population-based study in a rural area of Austria.

Using a mobile ambulance the quality of diabetes care was evaluated, according to the recommendations of the St. Vincent Declaration, in 95% of all known diabetic patients (n = 395) in a geographically defined rural area of Austria with 7871 inhabitants. Fourteen of the 395 patients had Type 1 (insulin-dependent) diabetes with age at onset of diabetes below 30 years. Of the 375 patients examined (women 61%, age 66 +/- 13 years, median diabetes duration 6 years) 16% were treated with insulin and 47% with oral agents; HbA1c levels were 7.3 +/- 1.7%. Prevalence of known hypertension was 54%; 68% of these patients had their blood pressure uncontrolled (systolic greater than or equal to 160 and/or diastolic greater than or equal to 95 mmHg); a further 15% of patients with previously unknown hypertension had blood pressure values of greater than or equal to 160 and/or greater than or equal to 95 mmHg. Urinary albumin concentrations of greater than 200 mg/l were found in 15% of patients, 2% had a serum creatinine level of greater than 177 mumol/l, no patient had renal replacement therapy. Six patients (1.5%) were blind. Screening for retinopathy identified six patients (out of 317 in whom the retina could be evaluated) for whom consultation with an ophthalmologist as soon as possible was recommended. Of the total patient group (n = 395) 20 patients (5%) had foot complications (amputations and/or ulcers): 14 patients had a total of 21 lower limb amputations (eight above knee, six below knee, seven below ankle); eight of these 14 patients lived in a nursing home; 11 patients had a total of 13 foot ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

[Age of onset of diabetes mellitus in relation to caries]. / La durée du diabète et la carie.

The DMF-Index of 101 children was established, regression analyses were made. It was found: -- that the D3-4MF/S was notably diminished in relation to patients with diabetes lasting a maximum of three years -- that the DMF/S of separately examined children was not reduced in spite of the diet. This may be interpreted as a sign of poor collaboration of the patient during therapy.

[The course of caries and frequency of dental restorations in low sugar diet]. / Kariesverlauf und Versorgungsrate bei zuckerarmer Diät.

The influence of a restricted low molecular carbohydrate diet was tested in 101 children and juveniles with diabetes mellitus. Due to the influence of this diet deep carious lesions develop more slowly. Children in whom the diabetes manifested itself at an early age had a lower index of filling and a higher index of defect. The degree of dental care was altogether alarmingly low.

[DMF/S study of children with different duration of diabetes (author's transl)]. / DMF/S-Studie an Kindern mit unterschiedlicher Diabetesdauer.

The objective of this study was to determine the DMF/S indices of 101 children, make regression analyses, and compare the regression coefficients of subjects, in whom diabetes mellitus became manifest before the beginning of secondary dentition, with the regession coefficients of patients with a duration of diabetes as long as three years. It has been found that in the case of manifestation of diabetes before the commencement of secondary dentition the D3-4 MF/S index was significantly lower compared to subjects with a duration of diabetes up to a maximum of three years and the DMF/S index of individual subjects was anything but low despite a specific diet.--From our present knowledge of the pathogenesis of caries it is possible to conclude that a high incidence of caries in the case of early manifestation of diabetes is due primarily to a lack of therapeutic cooperation of the patient.

[The caudal regression syndrome (author's transl)]. / Das kaudale Regressionssyndrom.

Caudal regression syndrome in a male newborn with total aplasia of the vertebral column below L I is reported. A family history of malformations of the vertebral column and diabetes as atiologic factors are discussed.

Lipoma of the external thoracic wall.

We report the case history of an external thoracic wall lipoma, which was noticed incidentally on a chest roentgenogram because of its calcification. A probable diagnosis was made by computer tomography. Because of the increase in size of the tumour it was removed surgically, but no evidence of malignant degeneration was found.

[Clinico-pharmacological case (2). Bradycardia and ventricular tachycardia of the torsades de pointes type as a side effect of vasopressin: 3 case reports]. / Der klinisch-pharmakologische Fall (2).Bradykardie und ventrikuläre Tachykardia vom Typ Torsade de pointes als Nebenwirkung von Vasopressin: drei Fallberichte.

We present three patients with ornipressin-induced bradycardia, one of which developed also ventricular tachycardia of the torsade de pointes type. All three patients were treated with this vasopressin derivative because of bleeding esophageal varices due to portal hypertension in liver cirrhosis. Bradycardia ceased after discontinuing ornipressin therapy. One patient was treated successfully with atropine, one with isoprenalin and magnesium (he had to be defibrillated); the third patient recovered after cessation of ornipressin administration. Bradycardia is a known but rarely reported side effect of vasopressin and its derivatives. Animal studies suggest that this effect is due to its cardiodepressive action and also to a vagus-mediated reflex following vasopressin-induced increase in blood pressure. When injected directly into the ventricles of the brain, vesopressin leads to a decrease of the heart rate without affecting blood pressure; however, it remains unclear whether this mechanism is responsible for bradycardia after intravenous administration. Careful monitoring is essential during the treatment with vasopressin and its derivatives.

Influence of long-term amelioration of anemia and blood pressure control on left ventricular hypertrophy in hemodialyzed patients.

The course of left ventricular hypertrophy was investigated in anemic hemodialysis patients treated with recombinant human erythropoietin (r-huEPO). 12 patients, aged 60.8 +/- 9.9 years (mean +/- SD) were treated for 18.8 +/- 2.7 months. Left ventricular size was estimated by echocardiography performed before treatment and at least 12 months after relieving anemia. Patients had signs of left ventricular and/or asymmetric septal hypertrophy when compared with a nonanemic and normotensive control group matched for sex and age. At baseline, hemoglobin (Hb) was 8.6 +/- 0.7 g/dl; interventricular septum thickness (IVST) was 1.75 +/- 0.34 cm, left ventricular posterior wall thickness (LVPWT) 1.32 +/- 0.19 cm, left ventricular muscle mass index (LVMI) 222.7 +/- 41 g/m2 and blood pressure (BP) 146.4 +/- 10/81.6 +/- 6 mm Hg. Hb rose to 11.4 +/- 1.2 g/dl (p less than 0.001); IVST and LVMI decreased to 1.42 +/- 0.35 cm (p less than 0.02) and 155.4 +/- 25.1 g/m2 (p less than 0.001); LVPWT and BP remained unchanged (1.30 +/- 0.26 cm and 146.8 +/- 16.9/81.2 +/- 7.8 mm Hg) at the end of the study. During the observation period, two groups of 5 and 7 patients differed from each other. The group of 5 patients had higher BP values (158.9 +/- 9.8/86.5 +/- 5.3 vs. 140.0 +/- 9.5/79.2 +/- 6.8 mm Hg, p less than 0.01), and the period with Hb values above 10 g/dl was shorter (14.5 +/- 2.4 vs. 17.8 +/- 2.4 months, p less than 0.05). These 5 patients failed to show a significant decrease in IVST and LVMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Reduced E-cadherin expression is associated with increased lymph node metastasis and unfavorable prognosis in non-small cell lung cancer.

E-cadherin is a calcium-dependent, epithelial cell adhesion molecule whose reduced expression has been associated with tumor dedifferentiation and increased lymph node metastasis in clinical studies involving several carcinomas. In this study, 111 patients who had previously undergone complete resection and systematic mediastinal lymph node dissection for non-small cell lung cancer (NSCLC) were studied retrospectively. In the primary tumor, as well as in the lymph node metastases, E-cadherin expression was detected by immunohistochemistry using a monoclonal antibody (HECD-1; Takara, Otsu, Japan). There was a significant inverse correlation between E-cadherin expression and lymph node stage (Pearson correlation coefficient -0.52, p = 0.0001) as well as tumor differentiation (Pearson correlation coefficient -0.27, p = 0.005). Moreover, Kaplan and Meier survival estimates showed a significant correlation between E-cadherin expression and patient survival in log rank testing (p = 0.006). In the patient group with the highest proportion of E-cadherin positive tumor cells, 60% of the patients were still estimated to be alive at 36 mo, versus 32% of the patients in the group classified as showing negative E-cadherin expression. Our findings provide clinical evidence that reduced E-cadherin expression is associated with tumor dedifferentiation, increased lymphogenous metastasis and poor survival. It seems therefore that E-cadherin expression might be an important prognostic factor in NSCLC.