Detection of pro-opiomelanocortin mRNA in human and rat caudal medulla by RT-PCR.

Pro-opiomelanocortin (POMC) mRNA has been localized in the NTS of the rat, but not in the human or other species. Here, we report that RT-PCR amplification of human caudal medulla RNA generated a distinct band on agarose gels corresponding in size and sequence to the predicted 742-bp POMC PCR product. The 742-bp signal was undetectable following amplification of cortex, amygdala or caudate nucleus RNA. An homologous, 678-bp band was amplified from rat caudal medulla and, unexpectedly, from other brain regions. Competitive RT-PCR demonstrated that POMC cDNA from rat cortex, striatum and cerebellum was 17%, 22% and 45% of caudal medulla levels. These data indicate that the POMC gene is expressed in human caudal medulla and suggest that small amounts of POMC mRNA are present in regions other than the hypothalamus and NTS of rat brain.

A convenient derivatization method for gas chromatography/mass spectrometric determination of phenmetrazine in urine using 2,2,2-trichloroethyl chloroformate.

Phenmetrazine is a central nervous system stimulant currently used as an anorectic agent. The drug is abused and is reported to cause death from overdose. We describe a new derivatization method for phenmetrazine using 2,2,2-trichloroethyl chloroformate. Quantitation of urinary phenmetrazine can be easily achieved by using N-propylamphetamine as an internal standard. The phenmetrazine 2,2,2-trichloroethyl carbamate showed a molecular ion isotope cluster at m/z 351, 353, 355, and 357 (isotope effect of three chlorine atoms in the derivatized molecule) and other peaks at m/z 247, 245, 204, 114, and 70 in the electron ionization mass spectrometry, thus aiding in unambiguous identification. The underivatized phenmetrazine showed a relatively weaker molecular ion at m/z 177 and a base peak at m/z 71. The N-propylamphetamine 2,2,2-trichloroethyl carbamate (internal standard) showed a very weak molecular ion at m/z 351 and a base peak at m/z 260. Another strong characteristic peak at m/z 91 was also observed. The retention time of derivatized phenmetrazine (9.5 min) was substantially longer than the retention time of the underivatized molecule (2.5 min). Moreover, underivatized phenmetrazine showed poor peak shape (substantial tailing) while derivatized phenmetrazine had excellent chromatographic property. The within-run and between-run precisions of the assay were 1.9% and 3.2% at a urinary phenmetrazine concentration of 20 micrograms/mL. The assay was linear for urinary phenmetrazine concentration of 1 microgram/mL to 100 micrograms/mL with a detection limit of 0.5 microgram/mL.

MR of spinal cord ganglioglioma.

PURPOSE: Our purpose was to describe the MR imaging features in a series of spinal intramedullary gangliogliomas and to compare these findings with the MR features of intramedullary astrocytomas and ependymomas. METHODS: A retrospective analysis was performed of 76 MR examinations in 27 patients with histologically proved spinal ganglioglioma; these were then compared with imaging findings in a representative sample of histologically proved spinal cord astrocytomas and ependymomas. RESULTS: Statistically significant observations regarding spinal gangliogliomas included young age of the patients (mean, 12 years), long tumor length, presence of tumoral cyst, presence of bone erosion and scoliosis, absence of edema, presence of mixed signal intensity on T1-weighted images, and presence of patchy enhancement and cord surface enhancement. A trend (not statistically significant) was noted for holocord involvement and lack of magnetic susceptibility. CONCLUSION: Spinal ganglioglioma can be strongly suspected if MR images reflect the above criteria; however, the ultimate diagnosis still depends on radical resection and appropriate histopathologic investigation.

Apolipoprotein E genotypes in Parkinson's disease with and without dementia.

The apolipoprotein E gene (Apo E) type 4 allele is a genetic risk factor influencing the development and age of onset of Alzheimer's disease. Because Parkinson's disease shares many characteristics of Alzheimer's disease, we studied the frequencies of Apo E genotypes in a cohort of 52 Parkinson's disease patients with dementia and 61 patients without dementia. Dementia was determined per National Institute of Neurological and Communicative Disorders and Stroke criteria and Mattis Dementia Rating Scale (DRS) < 126. Normal cognition was defined as DRS > 132. Apo E genotype and allele frequencies did not differ between demented and nondemented parkinsonian patients. Neither group's genotype and allele frequencies differed from that of a nondemented population of 78 controls. We conclude that the Apo E epsilon 4 allele influences neither the development of Parkinson's disease nor the dementia associated with Parkinson's disease.

Neurosarcoidosis with unusual MRI findings.

This 53-year-old white male presented with a 4-month-history of weakness and pain. Despite an initial partial response to steroid therapy, his neurologic deterioration progressed culminating in paraparesis, paresthesias, urinary incontinence, altered mentation and a 20 lb weight loss. A gadolinium-enhanced MRI study showed a pattern suggestive of perivascular involvement. A subsequent cerebral biopsy was diagnostic for neurosarcoidosis.

Practitioner-provider joint ventures, the OIG, and the IRS.

Increased forays by hospitals and physicians into joint ventures make both parties subject to a complex network of laws and regulations and to scrutiny by many Federal agencies. Institutional healthcare providers should be aware of the legal pitfalls and exercise extreme caution when creating such arrangements. This is the second of a two-part examination of issues relative to taxes and Medicare and Medicaid fraud and abuse regulations. (Part I was published in the October 1992 issue of HFM.)

The impact of fraud and abuse regulations.

Increased forays by hospitals and physicians into joint ventures make both parties subject to a complex network of laws and regulations and to scrutiny by many Federal agencies. In this article, the law of fraud and abuse under the Federal Medicare and Medicaid statutes is discussed.

Incidental detection of a microcystic adenoma of the pancreas.

Cystic neoplasms of the pancreas are uncommon. The two major types of cystic pancreatic neoplasms are microcystic (serous) cystadenoma and mucinous cystic lesions (mucinous cystadenoma and mucinous cystadenocarcinoma). The two types differ substantially in the long-term mortality. Symptoms and signs do not distinguish between the two types, and small lesions are often asymptomatic. The neoplasms may be discovered during imaging procedures for unrelated complaints. Computerized tomography may suggest the diagnosis of microcystic adenoma or mucinous cystic neoplasm when the features are typical, but the final diagnosis must be established by surgical biopsy. Characteristic gross findings, light microscopic findings, and immunohistochemical staining patterns distinguish between the two types. When preliminary open biopsy confirms microcystic adenoma, extensive unnecessary surgery can be avoided.

Legal review: AIDS patient records--legal issues of access and disclosure.

All 50 states require AIDS cases to be reported to the department of health. Many jurisdictions require HIV and ARC reporting, as well. Many states have also enacted confidentiality provisions that prohibit health care providers from releasing HIV-related information without the patient's consent, although exceptions to the statutes authorize disclosure without consent to other health providers, spouses, and other persons under certain conditions set forth in the legislation. In addition, the patient may obtain access to his or her own records and may authorize release to third parties. Providers who violate the provisions are subject to liability. The patient usually has a private cause of action for damages and costs; in addition, the state may impose fines and jail terms for more egregious violations. Finally, courts may authorize disclosure of confidential HIV information in certain situations. In the absence of a statutory provision governing court-ordered disclosures, courts will balance the patient's privacy interest against the plaintiff's need to know and the public interest involved. Several states have enacted statutes that modify this traditional balancing approach, although it is unclear whether these statutes provide additional protection for health care providers and patients seeking to prevent disclosure of information. Health record practitioners should keep abreast of legislative and regulatory developments in their states that affect use and disclosure of AIDS patient records. Careful discussion with the health institutions' legal counsel of any situation not covered clearly by applicable statue or regulation is strongly recommended.

Magnetic resonance imaging and computed tomography of an intraventricular craniopharyngioma.

The computed tomography (CT) and magnetic resonance imaging (MRI) appearances of an intraventricular craniopharyngioma are discussed. The unusual CT appearance of our case is compared to the previous 13 cases in the CT literature. The MRI scan represents the only known description of an intraventricular craniopharyngioma in the current literature. The characteristics of our case are compared to the MRI appearance of suprasellar craniopharyngiomas.

Streaming hypointensity in hemorrhagic glioblastoma multiforme. An illustrative case.

The computed tomography, the magnetic resonance and the angiographic features of a patient with the unusual findings of multicentric intraparenchymal, subependymal and intraventricular hemorrhage in association with glioblastoma multiforme are presented. The utility of MR in demonstrating an irregular, streaming pattern of hypointensity within the lesion (and thereby suggesting an underlying neoplasm) is briefly discussed.

Intramedullary melanotic schwannoma of the cervicomedullary junction.

We report a case of a patient with an intramedullary tumor of the cervicomedullary junction. At operation, the tumor was noted to be highly pigmented, and pathological study demonstrated that the tumor was a melanotic schwannoma. Both intramedullary schwannomas and melanotic schwannomas in any location in the body are exceedingly rare. This is the first reported case of an intramedullary melanotic schwannoma of the central nervous system. The possible origin of this tumor is discussed.