[Primary meningioma of the optical nerve sheet in infancy as initial presentation of neurofibromatosis type 2]. / Primäres Meningeom des Nervus opticus im Säuglingsalter als Erstmanifestation einer Neurofibromatose Typ 2.

Intraorbital meningiomas are rare tumors, making up less than 4% of all intraorbital tumors. Intraorbital meningiomas of childhood are curiosities with only few documented cases. We present the case of an 8­month-old male infant, presenting with strabismus and nystagmus. Magnetic resonance imaging showed a long segment thickening of the optical nerve and an intraocular tumor. The tumor was suspicious for retinal dysplasia and enucleation of the eye was performed to exclude malignancy. Histological examination revealed a meningothelial meningioma (WHO grade I), extending along the optical nerve and into the eye accompanied by retinal dysplasia and epiretinal membranes. Meningiomas of childhood, retinal dysplasia, and epiretinal membranes are regularly associated with neurofibromatosis type 2. Subsequent genetic analysis led to the final diagnosis. This case documents a very unusual early beginning of a neurofibromatosis type 2.

[Intraocular metastases]. / Intraokulare Metastasen.

Metastatic cancer represents the most common form of intraocular malignancy. Due to its abundant vascular supply the choroid is the most common ocular site for intraocular metastatic disease (approximately 90%). Less than 10% of intraocular metastases are located in the iris and/or ciliary body, whereas the retina and vitreous are rarely affected. Most intraocular metastases are carcinomas; the majority of metastases originate from breast cancer in females and lung cancer in males. However, virtually every primary malignancy has been described to metastasize to intraocular structures. In this review we address the pathology and clinical features of intraocular metastases, noninvasive and invasive diagnostic procedures, as well as the pathological work-up of cytological and histological specimens obtained either by fine needle aspiration biopsy or special biopsy forceps.

[Retinoblastoma and retinocytoma (retinoma)]. / Retinoblastom und Retinozytom (Retinom).

Retinoblastomas are extremely rare withabout half of the cases being hereditary eye neoplasms in young children. They show highly proliferative, CRX-positive undifferentiated tumour cells (occasionally forming rosettes). Staging is performed according to the pTNM classification and the International Retinoblastoma Staging System (IRSS). The diagnostic basis for systemic administration of chemotherapy and/or radiation is postlaminar optic nerve invasion, massive choroidal tumour infiltration, scleral invasion or even extraocular invasion. In cases that are difficult to diagnose, immunohistochemical stains (CRX and Ki67) may be very helpful. Retinocytomas (retinomas) completely lack undifferentiated tumour cell areas, show an exclusive photoreceptor differentiation and an exceptionally low Ki67 index.

[Intraocular Tumors other than Retinoblastoma in Children]. / Intraokulare Raumforderungen im Kindesalter ohne Retinoblastom.

The diagnosis of an intraocular mass in children can be challenging as invasive procedures are not allowed, in particular if a retinoblastoma may be present. In eyes with a unilateral tumour mass and loss of function enucleation with subsequent histopathological processing might be the only option to establish a diagnosis and to exclude a malignant tumour. The present paper deals with intraocular tumours other than retinoblastoma in children, with a special focus on the correlation of modern imaging techniques and histopathological findings.

[Transretinal Biopsy of Intraocular Lymphoma]. / Transretinale Biopsie beim intraokularen Lymphom.

BACKGROUND: Intraocular lymphoma is in most cases a diagnostic challenge. Gold standard is a diagnostic vitrectomy. Vitreous biopsy and transretinal biopsies are therefore employed. METHODS: A retrospective analysis was undertaken of all cases of cytological or histological proven intraocular lymphoma between 2002 and the beginning of 2015 in our clinic. RESULTS: The diagnosis of intraocular lymphoma could be established in 16 cases by cytological or histological analysis. Six patients had previously been treated with steroids in the assumption of uveitis. Five of 16 patients had a systemic or CNS lymphoma in their history. The diagnosis of intraocular lymphoma could be made on the basis of a vitreous biopsy in only in 3 cases. In 7 cases an additional vitrectomy with transretinal biopsy was needed. In 1 case a transretinal biopsy was performed initially and in 1 case a re-transretinal biopsy was needed to establish the diagnosis. Two patients underwent iris biopsy to diagnose a secondary metastatic intraocular lymphoma. One amaurotic eye was diagnosed with intraocular lymphoma after enucleation. DISCUSSION: Due to the high relevance for the diagnosis intraocular lymphoma, when a vitreous biopsy was non-informative, a transretinal biopsy should always be considered in cases of retinal or subretinal involvement.

Effects of tail docking on behavior of confined feedlot cattle.

Tail tip injuries occur in some feedlot cattle housed in slatted-floor facilities typically found in the midwestern United States. The practice of tail docking cattle on entry into these feedlot facilities was initiated to prevent tail injuries. Tail docking is a welfare concern from the standpoint that an important method of fly avoidance is removed and the tail docking procedure is painful and often excludes local anesthesia or extended analgesia. The primary objective of this study was to describe the behavioral responses of feedlot cattle following tail docking. Thirty-six heifers were randomly assigned to 1 of 2 treatment groups: docked (DK) or control (CN). All calves received an epidural following surgical preparation of the sacrococcygeal area and postoperative intravenous flunixin meglumine. A portion of the tail of DK calves was removed using pruning shears. An elastrator band was placed near the tail tip for hemostasis and tail tips were sprayed with fly spray. IceQube accelerometers collected step counts, motion index, lying time, lying bouts, and lying bout duration during d -4 through 13. Direct observations of cattle behavior were performed on d 0, 1, and 2. Step counts of DK calves were increased (P < 0.05) on d 0, 2, 3, 4, 6, 9, 10, and 13, and motion index of DK calves was also increased (P < 0.05) on d 0, 3, 4, 9, 10, 11, and 13. Docked cattle performed rear foot stomp behavior more (P < 0.001) than CN on d 0, 1, and 2. Forty-eight hours after tail docking, DK calves had increased lying bouts per hour (1.7 vs. 0.9 on d 0; P < 0.001; 1.1 vs. 0.8 on d 1; P < 0.01) but reduced lying bout durations (12.6 vs. 47.1 min on d 0; P < 0.001; 22.6 vs. 44.7 min on d 1; P < 0.001). On d 0, DK calves twitched tails more (P < 0.05) and ruminated less (P < 0.001). Despite provision of perioperative and postoperative analgesia, we identified altered behavior in DK cattle that may reflect a compromised welfare state for tail-docked feedlot cattle. We recommend that alternative strategies to reduce tail tip injury be explored.

Effects of tail docking on health and performance of beef cattle in confined, slatted-floor feedlots.

Tail docking of feedlot cattle is a management practice used in some confined, slatted-floor feedlots of the midwestern United States. Justification for tail docking in these management systems is to reduce tail injuries and their sequelae and improve performance, but limited evidence exists to support these claims. The primary objective of this study was to determine the effect of tail docking on performance, carcass traits, and health parameters after tail docking in feedlot cattle raised in slatted-floor feedlots. Three separate trials were performed. Trial 1 consisted of 140 Angus-cross (370-kg) yearling steers that spent 144 to 160 days on feed (DOF). Trial 2 consisted of 137 Angus-cross (255-kg) weaned steers that spent 232 DOF. Trial 3 consisted of 102 Holstein steers (370 kg) that spent 185 to 232 DOF. Cattle were randomly assigned to 1 of 2 treatment groups: docked (DK) or control (CN). All steers received an epidural following surgical preparation of the sacrococcygeal area and postoperative intravenous flunixin meglumine. Approximately two-thirds of the tail of DK calves was removed and an elastrator band was placed near the tail tip for hemostasis. Performance parameters collected included daily gain, final weight, feed intake, and feed efficiency. Carcass data included HCW, subcutaneous fat thickness, LM area, KPH percent, marbling, USDA yield grade, and USDA quality grade. Morbidity, mortality, incidence of lameness, and incidence of tail lesions were recorded. Across all 3 trials, there was no significant effect (P < 0.05) of treatment on performance parameters, carcass traits, or health parameters. In all 3 trials, tail tip injuries occurred in 60 to 76% of undocked (CN) calves, developed while living in the slatted-floor environment, compared to 100% of DK calves, whose injuries were a result of the tail docking procedure. We were unable to identify a performance or significant health advantage to tail docking. However, tail tip injuries still occur in cattle raised in slatted-floor facilities. Because of the animal welfare issues associated with tail docking and tail injuries, we recommend pursuing alternative solutions to reducing the incidence of tail tip injury in feedlot cattle housed in confined slatted-floor facilities.

[Value of transretinal tumor biopsy as diagnostic and predictive instrument]. / Stellenwert der transretinalen Tumorbiopsie als diagnostisches und prädiktives Instrument.

Transretinal biopsy of intraocular tumors plays a decisive role as a diagnostic tool in ocular oncology. A biopsy is indicated to confirm a clinical diagnosis before treatment and allows identification of high risk melanomas of the uvea with a high potential of metastasis by molecular genetic evaluation of the specimen. This review will focus on the various biopsy techniques and indications for this method.

[Heterotopic gastric mucosa of the rectum. Case report with literature review]. / Rektale Magenschleimhautheterotopie. Ein Fallbericht in Zusammenschau mit der Literatur.

Heterotopic gastric mucosa is a rare finding in the rectum. Apart from two other hypotheses, a misdifferentiation of entodermal stem cells is the most widely accepted aetiopathogenetic assumption today. Due to acid secretion, the lesions predominantly manifest with hematochezia. Therapeutic options include medicinal therapy and particularly (endoscopic) removal. From the pathologist's point of view a careful evaluation is required also in terms of basically possible dysplastic or malignant changes.

[TTF-1 (8G7G3/1) positive colon adenocarcinoma: diagnostic implications]. / TTF-1- (Klon 8G7G3/1) positives Kolonkarzinom: Diagnostische Implikationen.

Immunohistochemical evaluation of primary and secondary (adeno-) carcinomas of the lung often includes utilisation of two different clones (8G7G3/1 or SPT24) of TTF-1 (thyroid transcription factor 1) antibodies. In a subgroup of adenocarcinomas with a primary site other than the lung a positive reaction of clone SPT24 and also of clone 8G7G3/1 is described. We report on a patient with TTF-1 (clone 8G7G3/1) positive adenocarcinoma of the colon with metastases to the eye and lung and discuss TTF-1 based diagnostic considerations.

[Impressive picture of a melanosis coli after chronic anthraquinone laxative use--is there an increased risk for colorectal cancer?].

We report the case of a 74-year-old female with an extreme picture of melanosis coli of the whole colon after chronic use of anthraquinone laxatives for the treatment of constipation over many decades. Endoscopic work-up revealed an impressive deep black pigmentation of the whole colon mucosa which could be verified by histopathology as a widespread lipofuscin granulation. In addition, various adenomas but no colorectal carcinoma could be detected. The term melanosis coli describes a brown or black pigmentation of the colonic mucosa. Induction of melanosis coli by anthraquinone laxatives and their derivatives can be regarded as verified. The question if melanosis coli predisposes for colorectal neoplasia is discussed controversially. Based on the current literature, an association of melanosis coli between colorectal adenomas, but not colorectal carcinomas, is under discussion but the mechanisms to effect the development of colorectal neoplasia are not completely understood. Considering our case and the current scientific backround, we conclude that due to pharmaceutical side effects of anthraquinone derivatives such as electrolytic shift and water loss in addition to the risk of developing melanosis coli, anthraquinone laxatives should not be used for long-term therapy of constipation.

Anthracyline-reduced sequential combination chemotherapy for younger patients with good-prognosis aggressive B-cell non-Hodgkin's lymphoma.

INTRODUCTION: Anthracyline-based chemotherapy is the treatment of choice for patients with aggressive B-cell non-Hodgkin's lymphoma (NHL). However, anthracyclines have been associated with long-term cardiac toxicity. METHODS: We conducted a study using a sequential combination chemotherapy with a reduced cumulative dose of anthracyclines in younger patients with good-prognosis aggressive NHL. Chemotherapy consisted of one cycle of vincristine, ifosfamide, etoposide, and dexamethasone, followed by three cycles of epirubicin, cyclophosphamide, vincristine, and dexamethasone, and a fifth cycle containing carboplatin, etoposide, and dexamethasone. 86 patients were treated, 65 without and 21 with additional rituximab. Consolidating involved-field irradiation was applied in patients with stage I/II, bulky disease, or localized residual lymphoma. RESULTS: Complete and partial remissions were achieved in 67 and 27% of patients, respectively, and the 3-year event-free and overall survival estimates were 75 and 87%. The survival estimates were substantially better in patients who received rituximab. Main toxicity was grade 3/4 leukocytopenia in 89% patients with neutropenic fever in 30%. Two patients died of septic shock. CONCLUSION: The treatment appears to be effective in this group of patients. The hematological toxicities, particularly after the first and fifth cycle, require the use of G-CSF and/or a dose reduction in selected patients.

Social contexts in adolescent smoking: does school policy matter?

According to an ecological perspective in psychology and in line with social cognitive theory, smoking behaviour is determined by different social contexts (for example, peers, family and school) providing adolescents with important role models. This paper investigates the effects of personal characteristics as well as family, peer and school context variables on youth smoking behaviour. We hypothesize that school smoking policy variables predict adolescents' smoking in addition to other context variables. Data were obtained from a self-report survey administered to 3364 students in 40 secondary schools in Bavaria, Germany. For both younger (10-15 years) and older (16-21 years) students, strong associations were found between smoking behaviour and (i) smoking best friends and friends in general, (ii) other substance use and (iii) school performance. In the younger age group, the non-existence of smoking bans for students was associated with an increased risk of being smoker. For the older students, a positive association was found between the presence of smoking teachers on school grounds and smoking behaviour. Results are discussed considering methodological aspects and public health concerns.

[Fever and nonspecific pulmonary lesions--a rare differential diagnosis]. / Fieber und unklare pulmonale Infiltrate--eine seltene Differenzialdiagnose.

HISTORY AND ADMISSION FINDINGS: A 70-year-old woman presented with rapidly increasing weakness, night sweats, progressive dyspnea and daily fever up to 39 C. 30 years before early stage breast cancer had successfully been treated by resection. INVESTIGATIONS: Blood tests revealed moderate normocytic anemia and a considerable elevation of the serum level of lactate dehydrogenase (LDH). The differential blood count was normal. Chest radiography showed interstitial infiltrates. Computed tomography revealed reticular shadows and ground-glass opacities which on histological examination were attributed to intravascular lymphoma (IVL) of B cell lineage. TREATMENT AND COURSE: Treatment with eight cycles of the R-CHOP 14 regimen (rituximab, cyclophophamide, doxorubicine, vincristine, prednisone; interval: 14 days) resulted in complete remission with rapid resolution of constitutional symptoms. 7 months later the IVL relapsed, again with fever and an elevation of the LDH level. Bone marrow biopsy revealed intravascular infiltration by lymphoma cells. Salvage treatment with six courses of a methotrexate-containing protocol led to a second complete remission. CONCLUSION: Nonspecific constitutional symptoms, a large variety of potential clinical presentations and the infrequency of the disease render the ante mortem diagnosis of an intravascular lymphoma difficult. Treatment follows the same principles as in nodal aggressive non-Hodgkin's lymphomas.

[Proportion of smokers, stages of preparedness to change and utilisation of a smoking cessation intervention in mother-child rehabilitation]. / Anteil von Raucherinnen, Stadien der Veränderungsbereitschaft und Inanspruchnahme von Tabakentwöhnung in der Mutter-Kind-Rehabilitation.

BACKGROUND: Smoking mothers put their own health as well as that of their children at risk. Mother-child inpatient rehabilitation centres can be a suitable setting for reaching this target group and providing support for smoking cessation. AIM: The aim of the study is to describe for the first time the smoking prevalence and motivation to change of patients in German mother-child inpatient rehabilitation centres and to investigate the actual utilisation of an offered smoking cessation programme. METHOD: In a cross-sectional field study with a consecutive sample from 22 mother-child inpatient rehabilitation centres (N=4329 mothers) smoking prevalence, stage of preparedness to change according to the transtheoretical model and consideration to seek help for cessation were assessed via a questionnaire. In addition, the number of smokers who can be reached by the offer of a quit-smoking programme was assessed by means of reports of the course instructors. RESULTS: 29.2% of patients in mother-child rehabilitation are smokers. Compared to the female general population, a higher proportion of the women were in an advanced stage of preparedness to change (19.4% are in preparation) and the majority of smokers are willing to seek help to quit smoking. 37.6% of smoking mothers participated in the offered smoking cessation intervention. CONCLUSION: There is a high proportion of smokers and a high readiness to change in German mother-child rehabilitation centres. The actual participation rate in an offered smoking cessation programme is quite remarkable, but nevertheless has to be enhanced further. One possible approach is measures to enhance smoking mothers' motivation to quit.

Dualism of mixed chimerism between hematopoiesis and stroma in chronic idiopathic myelofibrosis after allogeneic stem cell transplantation.

Scant knowledge exists concerning lineage-restricted mixed chimerism (mCh) after allogeneic peripheral blood stem cell transplantation (PSCT) in patients with chronic idiopathic myelofibrosis (CIMF). Following a sex-mismatched PSCT, a combined immunopheno- and genotyping by fluorescence in-situ hybridization (FISH) was performed on sequential bone marrow (BM) biopsies at standardized intervals. Results were compared with PCR analysis of corresponding peripheral blood samples in five patients. According to FISH, pretransplant specimens revealed a gender congruence of more than 99%, while in the first three months the total BM exhibited a persistent fraction of host cells (30% to 40%) with a tendency to decline after about one year. It is noteworthy that the majority of endothelial cells maintained a recipient origin, whereas CD34+ progenitors and especially CD61+ megakaryocytes exhibited only very few host-derived cells. In keeping with the prevalence of donor cells in the hematopoietic compartment, PCR analysis of peripheral blood cells displayed a non-significant degree of mCh. In conclusion, according to FISH and PCR analysis, successful PSCT in CIMF results in an almost complete chimeric (donor-derived) state of the hematopoietic cell population. The non-transplantable stromal compartment includes the vascular endothelium with a predominance of recipient cells. The minimal mCh of this population implies probably a donor-derived origin (endothelial progenitor cells).

Ifosfamide, etoposide, cytarabine, and dexamethasone as salvage treatment followed by high-dose cyclophosphamide, melphalan, and etoposide with autologous peripheral blood stem cell transplantation for relapsed or refractory lymphomas.

High-dose chemotherapy (HD-CT) with autologous stem cell transplantation is considered to be the treatment of choice for relapsed high-grade non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) patients, but the optimal treatment has not yet been defined. We evaluated a salvage treatment regimen consisting of conventional cycles with ifosfamide, etoposide, cytarabine, and dexamethasone (IVAD) followed by two cycles of HD-CT consisting of cyclophosphamide, melphalan, and etoposide (CMV) with autologous stem cell support in patients with relapsed or refractory NHL (n = 59) and HL (n = 16). Response to IVAD was complete remission (CR) in 16 patients (21%), partial remission (PR) in 39 patients (52%), stable disease (SD) in 18 patients (24%), and progressive disease (PD) in two patients (2.7%). Of 70 patients treated with HD-CT, 41 patients (59%) showed a CR, 20 patients a PR (29%), eight patients a SD (11%), and one patient a PD (1.4%). The 5-yr overall survival for the entire group of patients was 29%, and for patients with NHL and HL 25%, and 38%, respectively. The respective event-free survival probabilities at 5 yr were 22%, 16%, and 31%. Seven treatment-related deaths due to septicemia (three), cardiac arrhythmia (one), pneumonia (one), pneumonitis (one), and toxic epidermal necrolysis (one) were observed. In multivariate analysis, an International Prognostic Index of > or = 2 and resistant disease to first-line chemotherapy were poor independent prognostic factors for the subgroup of patients with NHL. In conclusion, these results indicate that IVAD/CMV is feasible as a salvage therapy for lymphoma patients. This treatment is currently evaluated with the addition of rituximab.

[Smoking cessation during treatment of alcohol dependence in drug and alcohol rehabilitation centres--a review]. / Tabakentwöhnung bei Personen mit einer Alkoholabhängigkeit im Setting der Suchtrehabilitation--Ein Uberblick.

PURPOSE: Review of the international literature on smoking cessation with smokers having a concurrent alcohol abuse disorder. The three aims are: 1. discussion of the pros and cons of concurrent smoking cessation and treatment of alcohol use disorder, 2. smoking cessation strategies and 3. description of national and international studies evaluating smoking cessation interventions with patients who are at the same time treated for their alcohol abuse disorder. METHOD: The results are collected on the basis of an extensive literature research in PsychInfo, Science Direct and Medicine. RESULTS: Considering the pros and cons, it can be concluded that smoking cessation should be offered to this subgroup of high risk smokers. The open question is which kind of interventions are effective. Intervention strategies should consist of a multi-level approach including structural as well as person-specific components. Evaluation studies show that a 12% abstinence rate at one year follow-up can be achieved in case of an intensive intervention in combination with a restrictive tobacco policy. Alcohol abstinence is not jeopardised by a concurrent smoking cessation, when smoking cessation is voluntary. CONCLUSIONS: On the basis of empiric research the common arguments against smoking cessation within the subgroup of alcohol-addicted smokers cannot be maintained on the basis of empiric research. Rehabilitation centres treating substance abuse disorders provide an excellent setting for the treatment of nicotine dependence. Interventions should include structural as well as subgroup-specific components.

Dynamics of bone marrow changes in patients with chronic idiopathic myelofibrosis following allogeneic stem cell transplantation.

Scant knowledge exists about the dynamics of fibro-osteosclerotic bone marrow (BM) lesions and regeneration of hematopoiesis following allogeneic peripheral stem cell transplantation (SCT) in chronic idiopathic myelofibrosis. Therefore, an immunohistochemical and morphometric study was performed on BM biopsies in 20 patients before and at standardized intervals (days 30 through 384) following SCT. In responding patients, a total regression of the pretransplant increased fibrosis was completed in the posttransplant period after about six months, while the extent of osteosclerosis did not change significantly during observation time. The quantity of CD61+ megakaryocytes including precursors was strikingly variable after SCT and, by using planimetric methods, atypical microforms exhibiting a dysplastic aspect could be demonstrated. These anomalies may be responsible for posttransplant thrombocytopenia. CD34+ progenitor cells were increased before transplantation, however, their number declined rapidly to normal values in responding patients. Nucleated erythroid precursors revealed a decreased amount before and after SCT accounting for anemia. Large clusters of this cell lineage indicated an initial hematopoietic reconstitution comparable with the expansion of the neutrophil granulopoiesis. Proliferative activity and apoptosis showed an increase until one year after SCT that implied a still regenerating hematopoiesis in keeping with an enhanced cell turnover.