Intratumoral methotrexate kinetics in a patient with intracranial anaplastic ependymoma.

Little is known about intratumoral anticancer drug concentration in childhood brain tumors. We were able to measure methotrexate (MTX) tumor concentrations directly in a cystic anaplastic ependymoma. Cyst fluid was obtained by puncture of a subgaleal Rickham reservoir connected to a catheter in the tumor cyst. MTX concentrations were determined by fluorescence polarization immunoassay and compared to serum concentrations. Maximum MTX concentrations in tumor and CSF were found at the end of MTX infusion. Twenty-four hour after MTX infusion the mean tumor concentration was significantly higher than in the serum indicating MTX retention and accumulation in the tumor cyst. An AUC(tumor)/AUC(serum) ratio of 1.95 was obtained. In response to the applied multiagent chemotherapy the clinical condition of our patient improved and the tumor showed partial response on MRI. Cystic ependymomas might benefit from high dose MTX especially because of drug retention in the tumor cyst.

MRI-monitoring for muscle flaps in osteitis cavities.

Filling osteitis cavities with local muscle flaps has proved to be a useful method for treating this disease. However, there will often be some uncertainty about remaining voids and about the viability of the flap once it is inside the cavity. As shown by selected cases, MRI-monitoring is capable of reassuring us by showing us how the cavity has been filled with muscle and, by use of contrast-medium, proving the perfusion of the flap. Problems which might arise, for instance by incorporated metal, are also demonstrated. On the whole, we recommend the use of MRI-monitoring after applying muscle flaps into osteitis cavities, at least in problematic cases.

[A case of osteopoikilosis combined with dermal changes and compression syndromes of peripheral nerves]. / Ein Fall von Osteopoikilie kombiniert mit dermalen Veränderungen und Kompressionssyndromen peripherer Nerven.

In the case of combination of osteopoikilosis with dermal alterations we wanted to know if the hereby discussed general mesenchymal lesions are the cause of the additional entrapment syndromes of peripheral nerves present in our case. For this purpose we recorded the pressure at the distal median and ulnar nerves within and out of the entrapment location. The results of the pressure recording of not point to a primary nerve lesion by a elevated pressure susceptibility or a pressure elevation at the peripheral nerve out of a defined entrapment location e.g. by an increase of connective tissue. Because of a hypertrophic scar formation in this case it should be paid attention to the wound healing of all patients with osteopoikilosis. The histologically verified nevoid mesenchymal alterations of the connective tissue found in this case, are to be delineated from the disseminated lenticular dermatofibrosis of the Buschke-Ollendorff syndrome.