Exploratory Multisite MR Spectroscopic Imaging Shows White Matter Neuroaxonal Loss Associated with Complications of Type 1 Diabetes in Children.

BACKGROUND AND PURPOSE: Type 1 diabetes affects over 200,000 children in the United States and is associated with an increased risk of cognitive dysfunction. Prior single-site, single-voxel MRS case reports and studies have identified associations between reduced NAA/Cr, a marker of neuroaxonal loss, and type 1 diabetes. However, NAA/Cr differences among children with various disease complications or across different brain tissues remain unclear. To better understand this phenomenon and the role of MRS in characterizing it, we conducted a multisite pilot study. MATERIALS AND METHODS: In 25 children, 6-14 years of age, with type 1 diabetes across 3 sites, we acquired T1WI and axial 2D MRSI along with phantom studies to calibrate scanner effects. We quantified tissue-weighted NAA/Cr in WM and deep GM and modeled them against study covariates. RESULTS: We found that MRSI differentiated WM and deep GM by NAA/Cr on the individual level. On the population level, we found significant negative associations of WM NAA/Cr with chronic hyperglycemia quantified by hemoglobin A1c (P < .005) and a history of diabetic ketoacidosis at disease onset (P < .05). We found a statistical interaction (P < .05) between A1c and ketoacidosis, suggesting that neuroaxonal loss from ketoacidosis may outweigh that from poor glucose control. These associations were not present in deep GM. CONCLUSIONS: Our pilot study suggests that MRSI differentiates GM and WM by NAA/Cr in this population, disease complications may lead to neuroaxonal loss in WM in children, and deeper investigation is warranted to further untangle how diabetic ketoacidosis and chronic hyperglycemia affect brain health and cognition in type 1 diabetes.

An external reference for in vivo quantification of 1H spectroscopy.

We studied the validity of using an external signal reference for absolute quantification of brain metabolites. We chose cyclohexane as the signal standard. An expression of a perturbed magnetic field in diamagnetic cylindrical materials was first obtained by using a method of equivalent magnetic charges. Broadening of the spectrum in this perturbed magnetic field was then computed. We performed phantom studies. We measured the full width at half maximum (FWHM) of the cyclohexane and the signal ratio (SR) between water and cyclohexane in spheres of two different diameters, and in cylinders of various diameters and lengths. The observed FWHM and SR in the small cylinders had large variations in distribution, whereas those in the spheres and in the large cylinders had small variations. Specifically, in a cylinder with a diameter > 5 cm and with a length > 10 cm, the variation of the SR was < 1.0%. The diameter and the length of the cylinder preferably are large when a cylindrical material is adopted as an external signal standard.

Malignant lymphoma of the uterine cervix. Cytologic diagnosis of a case with immunocytochemical corroboration.

The cytologic findings in a case of primary malignant lymphoma of the uterine cervix initially suggested the presence of a malignant neoplasm. By the use of immunologic methods, the lymphoma cells were shown to possess the nature of B lymphocytes. The need for cytochemical study to make a definitive diagnosis of this rare condition is emphasized. The cytologic findings are compared with those of cytologically similar conditions in the cervix: reticulum-cell sarcoma, chloroma and endometrial stromal sarcoma.

Nuclear DNA content of trophoblastic tumors.

The nuclear DNA content of trophoblasts was measured in 25 cases of normal pregnancy, 46 cases with hydatidiform mole, ten cases with destructive mole and six cases of chorionepithelioma (choriocarcinoma). In normal pregnancy, DNA distribution in syncytiotrophoblasts and cytotrophoblasts showed a sharp peak at the diploid region, although a few cytotrophoblasts with increased DNA content were observed in the first trimester. In chorionepithelioma the DNA content of the trophoblastic cells showed extremely wide distribution without any special peak. In destructive mole, although a wide distribution was observed, the sharp peak was usually noted at the diploid range. Cases with hydatidiform mole were divided into two categories according to the DNA distribution patterns. Type I showed the patterns similar to the first trimester of normal pregnancy and type II resembled the patterns of destructive mole. In hydatidiform mole of type II, subsequent progress towards destructive mole was frequently encountered.

Adenocarcinoma of the uterine cervix metastatic from primary stomach cancer. Cytologic findings in six cases.

The cytologic features of six cases of stomach cancer metastatic to the uterine cervix are presented. Atypical cells were found in cytology samples from four patients. Fewer atypical cells, larger cellular and nuclear areas, more discrete vacuoles, increased frequencies of thickening of the nuclear membrane and more coarsely granular chromatin patterns were the characteristic cytologic findings of metastatic cervical adenocarcinoma as compared with primary endocervical adenocarcinoma.

Cytologic findings of ascites from patients with ovarian dysgerminoma.

The cytomorphologic observations of ascites from three patients with ovarian dysgerminomas are presented. As compared with those in adenocarcinoma, the cytologic findings in this rare malignant ovarian tumor showed more cells lying isolated or in sheetlike arrangements, fewer cells with discrete cytoplasmic vacuoles, less frequent thickening of the nuclear membrane and more frequent multinucleolation.

[Cisplatin, adriamycin and cyclophosphamide combination chemotherapy of epithelial ovarian cancer].

The chemotherapeutic effects of cisplatin + adriamycin + cyclophosphamide (PAC) on 50 epithelial ovarian cancers were compared with the effects of 5-fluorouracil + cyclophosphamide + mitomycin C (FAM) in 17 patients. The cumulative survival at 5 years was 61.1% in all patients, 62.5% in patients treated with PAC and 54.7% in patients treated with FAM. The 5-year survival rate was 100% in Stage I, 63.5% in Stage II, 40.1% in Stage III and 22.2% in Stage IV. Of 22 patients with Stage III and IV treated with PAC, 16 patients responded (8CRs + 8PRs). The median survival duration of the treated patients was 19 months. On the other hand, of 8 patients treated with FAM, only one patient responded (PR). The median survival duration was 7 months. These results indicated the effectiveness of PAC chemotherapy against advanced ovarian cancer. No severe toxicity was observed during treatment with PAC or FAM.

[Cryosurgery for dysplasia, carcinoma in situ, and microinvasive carcinoma of the uterine cervix (author's transl)].

One hundred and three patients with dysplasia, carcinoma in situ, or microinvasive carcinoma of the uterine cervix were treated with cryosurgery during 8 years from 1972 to 1978. Twenty-nine patients underwent several types of operations during 4-41 days (mean 18 days) after cryosurgery, and 74 patients were followed for 3-78 months (mean 3 years) after treatment. Seventy-six per cent of the patients who underwent an operation had residual lesions in their histologic materials. Seventy per cent of the patients who were followed, on the other hand, showed consecutively negative cytology and pathology after cryosurgery. It is necessary for the more effective management of CIN with cryosurgery to perform endocervical curettage in every case, to select small lesion for treatment, and to use more powerful method of cryocauterization.

[Histological grading of hydatidiform mole (author's transl)].

This study was performed to seek possibility of selecting the high risk group in the patients with hydatidiform mole at its delivery. The histologic specimens from 83 patients with hydatidiform mole were reviewed and classified by modified Hertig's grading. Lymphocyte count of peripheral blood was also studied as an immunological index. I. There were 36 Grade I cases, 16 Grade IIa, 23 Grade IIb, and 8 Grade III cases. Two subsequent destructive moles were found from the patients with Grade I, three from Grade IIb, and two from Grade III respectively. The incidence of developing subsequent destructive mole was 6% in Grade I, 8% in Grade II, and 25% in Grade III. II. There was no correlation between histological grading and patients age nor weeks in gestation. When the ratio of syncytiotrophoblast and cytotrophoblast was considered, most of Grade II or III cases were obtained from those in whom the cytotrophoblast prevailed over syncytiotrophoblast. III. The patients with lymphocyte less than 1500/mm3 in their peripheral blood were apt to take abnormal clinical course comparing to those with lymphocyte more than 1501/mm3. The more accurate prediction of clinical course was suggested by combination of histological grading and lymphocyte count.

[Quantification of brain metabolites by 1H spectroscopy using cyclohexane as an external reference].

We tested the reliability of quantifying brain metabolite concentrations by MR spectroscopy. We employed a PRESS sequence and used a cyclohexane sample as an external standard. The signal intensity ratios of water and cyclohexane were measured by changing the geometrical arrangement of the cyclohexane sample and water phantom with various loading factors of the coil. Choline (Cho) concentrations were calculated from the signal intensity ratios of Cho and water and compared with actual Cho concentrations (1.0 to 2.6 mmol/L). The brain metabolites Cho, creatine/phosphocreatine (Cr/PCr) and N-acetylaspartate (NAA) were evaluated in five normal volunteers and six patients with metastatic brain cancer before (0 Gy), after 20 Gy and after 40 Gy of whole brain radiotherapy. Variation in the ratio of spectrum intensity between water and cyclohexane was less than 1.5% for various geometrical arrangements and loading factors. The error in quantification of Cho concentrations in the phantom study was 0.05 +/- 0.10 mmol/L. The concentrations measured in the volunteers were: Cho 1.6 +/- 0.4 mmol/L, Cr/PCr 6.4 +/- 1.1 mmol/L and NAA 8.2 +/- 0.1 mmol/L. There was no significant difference (p > 0.05) in these concentrations between the control group and the patients before, during, or after radiotherapy.

Birth weight assessed by factor analysis.

To investigate the relevancy of birth weight, data on 300 term newborn infants were subjected to a reevaluation of 31 variables related to body measurements of both the mother and child and to the placenta. Factor analysis was introduced to analyze the data obtained. Each group was composed of multiple factor axes, of which factor structures were rather simple in Appropriate for Date (AFD) for approximating the practical images, compared to Heavy for Date (HFD) and Light for Date (LFD). In AFD, the birth weight was thought contributive by the limiting effect of the placenta, independently of the measurements of the mother. We found that the birth weight in itself seems to have a different meaning in each group, and it is difficult to readily categorize the findings on the table of equivalent parameters for labelling of the newborn.

Comparative study of combination chemotherapy of ovarian cancer: cyclophosphamide, adriamycin and cisplatin versus 5-fluorouracil, cyclophosphamide and mitomycin C.

CAP, a multiple-drug combination therapy using cyclophosphamide (750 mg/m2), adriamycin (20-30 mg/m2) and cisplatin (50-75 mg/m2), was applied to 69 cases of epithelial ovarian cancer. The results of this therapy were compared with those of FAM (involving 5-fluorouracil, cyclophosphamide and mitomycin C) in 47 cases of the same cancer, retrospectively. The 5-year survival rate was 61.6% for cases treated with CAP and 56.3% for cases treated with FAM. All 9 patients at stage Ia treated with CAP are free of disease, however, 3 patients out of 13 at stage Ia treated with FAM experienced a recurrence of the disease and died. In stage III and IV cases with detectable lesions, a response was observed in 61.3% (19/31) treated with CAP and in 10.5% (2/19) treated with FAM.

Teratoma of the neck in a newborn infant--a case report.

A case of teratoma of the neck in a newborn is presented. Teratoma of the neck is a rare lesion and is mostly found in the newborn, but in some cases in the fetus and stillborn infant. Although in this case prenatal diagnosis was possible via ultrasonography, the infant did not survive because of respiratory distress. Hence, urgent surgery is imperative in such cases.

Teratoma of the neck in a newborn infant - a case report.

A case of teratoma of the neck in a newborn baby is presented. Teratoma of the neck is a rare lesion and almost always found in the newborn, but also in the fetus and stillborn infant. Although the mass was found prenatally by ultrasonography in the present case, the patient could not be saved because of respiratory distress. Urgent surgical management is the only way to save life in this kind of neonate.