Brain activation in sedated children: auditory and visual functional MR imaging.

PURPOSE: To map developing areas of activation with functional magnetic resonance (MR) imaging in sedated children by using passive auditory and visual tasks. MATERIALS AND METHODS: Forty children between 2 months and 9 years old were examined and grouped according to age. Children were selected from patients referred to undergo brain MR imaging. Patients received pentobarbital (3.0-7.0 mg per kilogram of body weight) or chloral hydrate (50-75 mg/kg). The functional MR imaging study was performed at the end of the examination. Paradigms consisted of flashing lights at 8 Hz displayed on special goggles and a prerecorded mother's voice presented through headphones. Activation maps were obtained from a paired t test with a P value of.0005 (uncorrected). RESULTS: The visual stimulus produced statistically significant negative values in the rostral aspect of the primary visual area (28 [90%] of 31 patients). The auditory paradigm activated either temporal or frontal areas in 26 (68%) of 31 patients. There was more frontal activation in the older children. CONCLUSION: Visual and auditory cortices can be activated in children who have been sedated. Visual responses show negative values in the rostral visual cortex, independent of age. Auditory activation is seen in temporal and frontal lobes.

Unusual immunophenotype of a soft tissue sarcoma in a European polecat (Mustela putorius).

The most commonly reported tumors in ferrets are carcinomas, followed by round cell tumors. Soft tissue sarcomas are reported and characterized much less frequently. Because domesticated ferrets (Mustela putorius furo) are direct descendants of European polecats (Mustela putorius), the types and prevalence of tumors are expected to be similar in the two species. Presented here is a case report of unusual immunohistochemical staining characteristics of an abdominal wall leiomyosarcoma in a close relative of domestic ferrets, the European polecat. Sections of tissue were preserved in 10% buffered formalin, embedded in paraffin, and sectioned at 5 mm. Routine staining with hematoxylin and eosin and several immunohistochemical tests were performed to identify the tumor tissue of origin. Although the tumor did not stain with antibody to desmin, further staining for smooth muscle actin was consistent with a smooth muscle origin. To the authors' knowledge, this report is the first description of a leiomyosarcoma in the European polecat. This report emphasizes the importance of using additional secondary markers to accurately diagnose anaplastic tumors.

Potentiation of metastasis by cell surface sialomucin complex (rat MUC4), a multifunctional anti-adhesive glycoprotein.

Sialomucin complex (SMC), a rat homologue of the human mucin MUC4, is a large membrane-bound mucin complex, originally isolated from highly metastatic ascites 13762 mammary adenocarcinoma cells. When overexpressed, SMC exerts potent anti-adhesive effects, which sterically disrupt molecular interactions for cell-cell and cell-ECM adhesions. SMC similarly suppresses anti-tumor immunity by inhibition of interactions between cytotoxic lymphocytes and target tumor cells. Previously, recombinant cDNAs for SMC were transfected and inducibly expressed in A375 human melanoma cells using a tetracycline-responsive expression system. In the current studies, we investigated the role of MUC4/SMC in tumor metastasis by regulating SMC expression of tumor transplants in vivo. Intravenous injection of SMC-overexpressing cells resulted in substantially greater lung metastasis than injection of SMC-repressed cells. Injection of SMC-overexpressing cells followed by in vivo downregulation of SMC did not lower the frequency of lung metastasis. Growth of the micrometastatic lesions was the same for all 3 cases in short-term (3-week) assays. Further, subcutaneous injection of A375 cells followed by in vivo induction of SMC overexpression within the solid tumor resulted in spontaneous distant metastasis. These studies suggest that SMC potentiates metastasis by contributing to the establishment of metastatic foci. These studies directly demonstrate for the first time that tumor metastasis can be modulated by the regulation of MUC4/SMC expression.

Hematologic, plasma protein, and biochemical profiles of brown pelicans (Pelecanus occidentalis).

OBJECTIVE: To establish hematologic and biochemical reference values for the brown pelican (Pelecanus occidentalis). ANIMALS: 31 captive, healthy, but permanently disabled pelicans and 35 wild-caught, healthy pelicans from a rehabilitation facility on the east coast of Florida. PROCEDURES: Samples of venous blood were collected from each pelican, and hematologic, plasma biochemical, and electrophoretic protein analyses were performed. Student t-tests were used to compare blood values between captive versus wild-caught, adult male versus adult female, and adult versus juvenile pelicans. RESULTS: Hematologic and electrophoretic values were similar between male and female, adult and juvenile, and captive and wild-caught pelicans. Significant sex differences existed for plasma calcium and triglyceride concentrations. Plasma concentrations of calcium, cholesterol, and CO2 content differed between captive and wild-caught adults. No significant differences were found between wild-caught adult and juvenile pelicans. CONCLUSIONS AND CLINICAL RELEVANCE: Our plasma biochemical results are similar to those of other brown pelicans and confamilial species. Additional studies on seabirds are encouraged, as age, sex, reproductive status, feeding habits, and captivity are important variables for health assessment in this and other aquatic species.

Imaging the brachial plexus and peripheral nerves in infants and children.

Imaging of the brachial plexus and peripheral nerves is challenging in the pediatric patient. Magnetic resonance imaging is the modality of choice as it is not invasive and demonstrates proximal and distal lesions. This may be used to detect nerve root avulsions, nerve ruptures, pseudo-meningoceles, brachial plexus scarring, post-traumatic neuromas, brachial plexus edema, spinal cord damage, abnormalities of the shoulder joint, trauma, neoplasms, and infection. Imaging allows diagnosis and careful preoperative evaluation of children suffering from brachial plexus injuries and peripheral nerve disorders.

Zinc responsive dermatopathy in goats: two field cases.

Two adult female goats presented with symmetrical alopecia, rough hair coats, weight loss, and generalized unthriftiness. In light of the history and clinical signs, we suspected a mineral deficiency or endocrine imbalance. These animals were being fed a diet of alfalfa, a legume high in calcium, which can block zinc uptake. Serum zinc levels were low, and skin biopsies supported the diagnosis of zinc deficiency. Therefore, these findings suggest that the main factor blocking zinc absorption was increased dietary calcium.

Medium-sized business employees speak out about smoking.

UNLABELLED: A health promotion study, funded by a state health department to meet objectives 3.4 and 3.11 of Healthy People 2000, was designed to: (1) identify tobacco use; (2) assess employees' beliefs on one's health and family member's health; and (3) assess the type of smoking policies favored. Using the Health Belief Model, it was hypothesized that there were differences in the health beliefs of tobacco users, former users, and never users. A 34-item questionnaire was administered to 1090 employees with a return rate of 603 (55%). RESULTS: tobacco users perceived weight control and reduction of tension as benefits; they accepted warning label as hazardous but reported smokeless not as harmful; they perceived heart disease and cancer as related to tobacco use; and 62% had tried to quit smoking. Former and never users wanted "total ban policies" while, tobacco users wanted "designated areas" for smoking. All perceived their smoking and environmental tobacco smoke hazardous to their health and the health of family.

Molecular analysis of the 18S rRNA gene of Cryptosporidium serpentis in a wild-caught corn snake (Elaphe guttata guttata) and a five-species restriction fragment length polymorphism- based assay that can additionally discern C. parvum from C. wrairi.

An adult wild-caught corn snake (Elaphe guttata guttata) was presented for humane euthanasia and necropsy because of severe cryptosporidiosis. The animal was lethargic and >5% dehydrated but in good flesh. Gastric lavage was performed prior to euthanasia. Histopathologic findings included gastric mucosal hypertrophy and a hemorrhagic erosive gastritis. Numerous 5- to 7-microm-diameter round extracellular organisms were associated with the mucosal hypertrophy. A PCR, acid-fast stains, Giemsa stains, and an enzyme immunoassay were all positive for Cryptosporidium spp. PCR and restriction fragment length polymorphism (RFLP) analysis on gastric lavage and gastric mucosal specimens, and subsequent sequencing of the 18S rRNA gene, enabled a distinct molecular characterization of the infecting organism as Cryptosporidium serpentis. Until recently, studies on snake Cryptosporidium have relied on host specificity and gross and histopathologic observations to identify the infecting species. A multiple alignment of our sequence against recently published sequences of the 18S rRNA gene of C. serpentis (GenBank accession no. AF093499, AF093500, and AF093501 [L. Xiao et al., unpublished data, 1998]) revealed 100% homology with the C. serpentis (Snake) sequence (AF093499) previously described by Xiao et al. An RFLP method to differentiate the five presently sequenced strains of Cryptosporidium at this locus was developed. This assay, which uses SpeI and SspI, complements a previously reported assay by additionally distinguishing the bovine strain of Cryptosporidium from Cryptosporidium wrairi.

Cerebral aneurysmal arteriopathy in childhood AIDS.

OBJECTIVE: To identify cerebral aneurysmal arteriopathy in children with longstanding AIDS. BACKGROUND: Five cases are described from the authors' experience, and eight additional cases are reviewed from the literature. Details are presented in regard to the clinical picture as well as brain imaging with cerebral angiography and magnetic resonance angiography in some cases. Autopsy information is available in four cases, including one of the authors' patients. RESULTS: Seven patients acquired HIV infection perinatally, five patients were infected by blood transfusions, and one patient had both risk factors. In the four postmortem patients, the vascular pathology was similar, showing ectasia and aneurysmal dilatation confined to the large arteries of the circle of Willis. Medial fibrosis and loss of muscularis with destruction of the internal elastic lamina and intimal hyperplasia was common. The latency period following infection varied from 2 to 11 years. Once a diagnosis of aneurysmal arteriopathy was made, the patients deteriorated rapidly, with death occurring in less than 6 months. CONCLUSIONS: The development of cerebral aneurysmal arteriopathy in childhood AIDS tends to occur after a prolonged delay and is usually followed by death in a short period of time. The etiology for the vasculitis is unknown. Varicella zoster virus may be the etiology in some of the cases because of its potential to cause this pathology and the striking unilateral arterial involvement found in Case 5. HIV vasculitis is also a possibility, as suggested by the detection of HIV protein or genomic material in two of the four autopsy cases.

Epilepsy surgery in the first three years of life.

PURPOSE: Partial seizures in early postnatal life may be catastrophic and associated with poor long-term outcome. Epilepsy surgery can alleviate partial seizures in older children and adults, but there is little experience with surgical therapy in infancy apart from hemispheric epilepsy syndromes. METHODS: We analyzed the results of cortical resection to treat medically refractory partial epilepsy in 31 children (16 boys, 15 girls) aged <3 years (mean, 18.3 months). Subjects were included only if seizure relief was the primary indication for surgery. RESULTS: Follow-up of at least 1 year (mean, 4.6 years) in 26 patients revealed that 16 were seizure-free, 4 had >90% seizure reduction, and 6 had <90% reduction. There was no significant difference in seizure outcome between hemispherectomy/multilobar resections and lobar resections or temporal versus extratemporal resection. Seizure outcome was independent of the amount of cortex removed in nonlesional patients. Only the presence of a discrete lesion on preoperative neuroimaging correlated with a favorable outcome. Family perceptions of accelerated development in seizure-free patients were not confirmed on developmental assessment. CONCLUSIONS: We conclude that cortical resection often benefits very young children with catastrophic partial seizures, but does not guarantee enhanced neurological development. The location and extent of the excised cortex may not be critical as long as the entire epileptogenic region and lesion are removed.

Diffuse cerebral vasospasm with ischemia after resection of a cerebellopontine angle primitive neuroectodermal tumor in a child.

This case report describes a 15-month-old female who developed diffuse cerebral vasospasm after resection of a cerebellopontine angle primitive neuroectodermal tumor. The patient developed an acute dense left hemiparesis 16 days postoperatively with partial right ptosis. Initial magnetic resonance imaging and diffusion study were unremarkable, though a magnetic resonance angiography 1 day later demonstrated severe intracranial vasospasm of both carotid and vertebral arteries. The vasospasm was confirmed with cerebral angiography. The patient progressed to bihemispheric infarcts with laminar necrosis despite combination therapy with anticoagulation, pharmacological hypertension, hypervolemia, and nimodipine. The clinical course, radiographic, and pathological findings are presented.

Prostate cancer progression, metastasis, and gene expression in transgenic mice.

We previously reported that a transgenic mouse line containing the fetal globin promoter linked to the SV40 T antigen (T Ag) viral oncogene (Ggamma/T-15) resulted in prostate tumors. In this study, we further explored tumor origin, frequency, invasiveness, androgen sensitivity, and gene expression pattern. T Ag was detected in adult but not fetal and neonatal prostates, suggesting a role for androgens in tumor progression. However, castration shortly after prostate morphogenesis did not prevent tumor development, suggesting an androgen-independent phenotype. Tumors originated within ventral or dorsal prostate lobes and involved intraepithelial neoplasia, rapid growth in the pelvic region, and metastasis to lymph nodes and distant sites. In addition, the primary cancers could be propagated in nude mice or nontransgenic mice. Seventy-five percent of hemizygous and 100% of homozygous transgenic males developed prostate tumors, suggesting a T Ag dosage effect. Biochemical characterization of advanced tumors revealed markers of both neuroendocrine and epithelial phenotypes; markers of terminal differentiation are lost early in tumorigenesis. Tumor suppressor genes (p53 and Rb), normally bound to T Ag, were up-regulated; bcl-2 proto-oncogene, which prevents apoptosis, was slightly up-regulated. Myc, a stimulus to cell cycle progression, was unchanged. We propose the Ggamma/T-15 transgenic line as a model of highly aggressive androgen-independent metastatic prostate carcinoma with features similar to end-stage prostate cancer in humans.