Adenocarcinoma of the rectum in childhood following chemotherapy and radiotherapy for a rhabdomyosarcoma--a case report.

We report a case of rectal adenocarcinoma in a 9-year-old boy, which took the form of a second malignant neoplasm following treatment for an early childhood malignancy. The abdominal complaints were for a long time interpreted as an infectious disease. At the time of diagnosis of the rectal carcinoma, the tumor had already progressed to the stage of metastatic disease. Therapy consisted of deep anterior rectal resection and regional arterial chemotherapy for liver metastases. The child died 18 months after the diagnosis of rectal carcinoma. As survival for childhood tumors improves, rare second malignant neoplasms will become increasingly common in children and adolescents. This phenomenon emphasizes the need for continued clinical surveillance of patients who have been treated with chemotherapy or irradiation for childhood tumors. The increased risk of second malignant neoplasms and an early onset of adult-type tumors has to be considered.

[Supratentorial primitive neuroectodermal tumor: a single center experience and comparison with the literature]. / Supratentorieller primitiver neuroektodermaler Tumor: Erfahrungen in einem Zentrum im Vergleich zur Literatur.

Supratentorial primitive neuroectodermal tumors (stPNETs) are malignant tumors. We saw within three years six children with stPNETs. In four of the six children radical resection could be achieved. All had craniospinal irradiation and chemotherapy according to the HIT-91 protocol. The two children with incomplete resection died due to tumor progression after 7 and 10 months. Two of the 4 children with complete tumor resection had local relapses 8 months after diagnosis and died after 14 and 18 months. One child had a diffuse meningeal relapse 12 months after diagnosis. Despite (high-dose) systemic chemotherapy and intraventricular mafosfamide, he died 21 months after diagnosis due to tumor although remission could be achieved. Only one child is still in remission 86 months after diagnosis.

Associations between self-reported dental status and diet.

The purpose of this study was to develop a battery of dental, nutritional and psychological health survey measures and to use this survey instrument to explore links between age, tooth loss and dietary risk. The survey was undertaken in a dental school and hospital. Forty-nine consecutive patients (age range 25-74 years) participated in this pilot study and completed the health survey instrument. A quarter of the patients reported changing dietary habits due to dental problems, 56% reported difficulty in chewing as a result of problems with their teeth or dentures, and 36% reported having to interrupt meals due to dental difficulties. Tooth number was associated with MNA scores (0.35, P=0.03, Pearson's correlation coefficient) and reported number of foods eaten (0.33, P=0.04, Pearson's correlation coefficient) from the questionnaire checklist. Lower MNA scores were associated with age (F=6.54; d.f.=1, 46; P<0.01) indicating that older adults were more at risk of poor nutritional status. Overall health was not rated as an important factor influencing food choice, and only 14% of the sample felt that they had nutritional problems. Poor diet and impaired food choice was associated with declining numbers of teeth and increasing age. Older adults may require dietary advice to increase awareness of the importance of a healthy diet.

Diving seals: are they a model for coping with oxidative stress?

The diving lifestyle of seals depends upon cardiovascular adjustments that result in frequent vasoconstriction of numerous organs. With the first post-dive breath, reperfusion allows for eliminating accumulated carbon dioxide (CO(2)) and reloading oxygen (O(2)) stores. Reintroduction of oxygenated blood raises the potential for production of reactive oxygen species (ROS) and the possibility that they may overwhelm the antioxidant defenses. This study addresses the question of possible adaptive responses that allow ringed seal (Phoca hispida) tissues to tolerate repeated cycles of ischemia and reperfusion, and thus protect them from oxidative insult. We obtained samples of ringed seal heart, muscle and kidney through the cooperation of native subsistence hunters at Barrow, Alaska. Samples were subjected to oxidative stress by addition of xanthine oxidase. Production of superoxide radical (O(2)(.-)), lipid peroxidation (as determined by the presence of thiobarbituric acid reactive substances, TBARS) and antioxidant capacity (AOX) were quantified by spectrophotometric analysis. Similarly treated pig tissues were anticipated to be more susceptible to oxidative stress. Contrary to expectations, pig tissues revealed less O(2)(.-) and TBARS compared with ringed seal tissues. These results show that ringed seal muscle, heart and kidney can be induced in vitro to generate ROS, and suggest that the living seal's protective defenses may depend upon O(2)(.-) production, similar to the protective effect of experimental preconditioning, or on enhanced intermediate scavenging, as evidenced by the larger AOX found in ringed seal tissues.

Interactions between texture and trigeminal stimulus in a liquid food system: effects on elderly consumers preferences.

Changes to the chemical senses of taste and smell that accompany ageing are widely believed to influence food preferences and consumption in the elderly. The possibility that interactions between the residual senses of texture and trigeminal perception can compensate for specific losses was explored using a complex liquid food system, soup. A consumer panel of twenty-four young people (20-35, mean age 27.7 +/- 3.95 years) and twenty-four elderly people (>65 years, mean age 73.6 +/- 5.78 years) were used for preference tests. Eight soups were prepared using a standardised recipe, with four variations in texture and two levels of trigeminal stimulus. The consumer panel preferences were measured using a nine point hedonic scale. The hedonic data was corrected for a scaling effect, and principle components analysis was completed on the normalised data of the two age cohorts. The preference decision of both age groups was in the direction of the lower level of trigeminal stimulation. Overall the older panel was less discriminating than the younger panel. However the older panel made an attempt to grade the different textures while the younger panel seemed to ignore the textural attribute in their preference decision. The older panel's preference decreased as the thickness of the soups increased across trigeminal levels. These results suggest that perhaps a judicious selection of a certain texture or mouthfeel combined with a preferred level of trigeminal irritation could boost elderly food enjoyment. Finally, a postal questionnaire was circulated to gain an insight in to the consumer's background and thus partially explain the motivation for their preferences.

A pulsating auroral X-ray hot spot on Jupiter.

Jupiter's X-ray aurora has been thought to be excited by energetic sulphur and oxygen ions precipitating from the inner magnetosphere into the planet's polar regions. Here we report high-spatial-resolution observations that demonstrate that most of Jupiter's northern auroral X-rays come from a 'hot spot' located significantly poleward of the latitudes connected to the inner magnetosphere. The hot spot seems to be fixed in magnetic latitude and longitude and occurs in a region where anomalous infrared and ultraviolet emissions have also been observed. We infer from the data that the particles that excite the aurora originate in the outer magnetosphere. The hot spot X-rays pulsate with an approximately 45-min period, a period similar to that reported for high-latitude radio and energetic electron bursts observed by near-Jupiter spacecraft. These results invalidate the idea that jovian auroral X-ray emissions are mainly excited by steady precipitation of energetic heavy ions from the inner magnetosphere. Instead, the X-rays seem to result from currently unexplained processes in the outer magnetosphere that produce highly localized and highly variable emissions over an extremely wide range of wavelengths.

Odor threshold, recognition, discrimination and identification in centenarians.

The main purpose of this study was to learn the use of select measures that are relevant to olfactory discrimination, identification and recognition and to ascertain the appropriateness of extant methods and procedures for adaptation for use with the oldest-old. A second purpose of this study was to attempt initial examination of the relationship of different memorial systems in the oldest old through an atypical sensory modality. Twenty-one centenarians (mean=105.1 years) were tested on odor thresholds for phenethyl alcohol (PEA) and menthol, recognition and discrimination of lexically challenging odors, and identification of common odors. Chronological age was not found to be a significant predictor of abilities for any of the tasks. Thresholds for PEA and menthol were found to be better than anticipated levels and were associated with odor recognition and certainty of response. Mini Mental State Examination scores were not found to be associated with olfactory measures, contrary to expectations. Findings suggest much of the previous research into olfactorial abilities of older adults may have failed to account for the influence of illness, trauma, dementia and pathologies typically associated with age. In light of their performance on the tasks, the relative good health and cognitive status of the participants strengthens the idea that olfaction is an appropriate addition to diagnostic tests of Alzheimer's and other diseases.

Muscle capillary supply in harbor seals.

The purpose of this study was to examine muscle capillary supply in harbor seals. Locomotory and nonlocomotory muscles of four harbor seals (mass = 17.5-41 kg) were glutaraldehyde-perfusion fixed and samples processed for electron microscopy and analyzed by morphometry. Capillary-to-fiber number and surface ratios were 0.81 +/- 0.05 and 0.16 +/- 0.01, respectively. Capillary length and surface area per volume of muscle fiber were 1,495 +/- 83 mm/mm(3) and 22.4 +/- 1.6 mm(2)/mm(3), respectively. In the locomotory muscles, we measured capillary length and surface area per volume mitochondria (20.1 +/- 1.7 km/ml and 2,531 +/- 440 cm(2)/ml). All these values are 1.5-3 times lower than in muscles with similar or lower volume densities of mitochondria in dogs of comparable size. Compared with terrestrial mammals, the skeletal muscles of harbor seals do not match their increased aerobic enzyme capacities and mitochondrial volume densities with greater muscle capillary supply. They have a smaller capillary-to-fiber interface and capillary supply per fiber mitochondrial volume than terrestrial mammals of comparable size.

Environment and medication use influence olfactory abilities of older adults.

BACKGROUND: Age-associated changes in eating behavior and nutritional status are often caused by changes in olfactory perception. OBJECTIVE: This study determined the relative contribution of medication use and environmental risk to age-associated change in olfaction. DESIGN: Fifty participants aged 50-96 (M = 70.4) in two groups (environmentally at-risk and low-risk) were administered a set of four olfactory tasks, WAIS Vocabulary, MMSE, and demographic questionnaires. Environmental risk was defined as having worked in places where exposure to caustic fumes (e.g., formaldehyde, toluene, etc.) was common and long-term. Olfactory tasks included detection thresholds for phenethyl alcohol (PEA; assesses olfactory function) and menthol (assesses olfactory and trigeminal function); odor recognition in a forced-choice paradigm; odor difference discrimination; and odor identification with supplied names. RESULTS: The high-risk group had significantly higher thresholds for PEA, and significant within-group variability for menthol. Medication usage and cognitive status were significantly associated with odor recognition. Only medication was strongly associated with the odor discrimination task. Medication usage, environmental risk, and age in order were found to be the greatest risk factors for odor identification. CONCLUSION: These results highlight the need to carefully consider environmental and pharmacological effects in age-associated sensory tasks.

The Irving-Scholander legacy in polar physiology.

The pioneer arctic and cold environment studies of Laurence Irving and Per Scholander, undertaken during the middle decades of the 20th century, have had a wide ranging and major influence on the direction and character of experimental research on polar species. Their investigations included comparative studies of metabolism, insulation, and acclimatization of mammals and birds in arctic Alaska and the tropics. Freezing, supercooling, and antifreeze research included fishes, insects, and plants. They examined the special problems of cooling in appendages of mammals and birds and the potential for acclimatization of these structures by repeated cold exposure. Studies of cold exposure in human populations considered possible adaptive reactions. Their research on diving mammals opened a vast new area for studies with attention to asphyxial tolerance and temperature regulation. A lesser-known accomplishment was an innovative approach to recovery of ancient atmospheric gases from polar ice fields, an approach that was stimulated by original investigations of frozen insect larvae and gas permeability through ice.

Laparoscopic partial adrenalectomy for bilateral pheochromocytomas in a boy with von Hippel-Lindau disease.

OBJECTIVES: In adults, increasing numbers of adrenalectomies for pheochromocytomas are performed laparoscopically. We report for the first time laparoscopic bilateral subtotal adrenalectomy for pheochromocytomas in an 8-year-old boy with von Hippel-Lindau disease. METHODS: In July 1998, an 8-year-old boy with von Hippel-Lindau disease underwent laparoscopic adrenal-sparing surgery for bilateral pheochromocytomas. The boy presented with severe hypertension and two pheochromocytomas on both sides. RESULTS: The child could be solely treated with laparoscopic adrenal-sparing surgery. The procedure was completed as planned. There were absolutely no intraoperative or postoperative complications. Postoperatively, catecholamine levels and hypertension went back to normal. At follow-up no residual tumor could be detected and no steroid replacement therapy was necessary. CONCLUSIONS: In experienced hands, laparoscopic adrenal-sparing surgery for pheochromocytomas is feasible and safe. Moreover, this minimal invasive approach represents an exceptional improvement in life quality, especially in children with von Hippel-Lindau disease since surgery will probably be necessary again and again in their future life.

Ethical and policy considerations for centenarians--the oldest old.

PURPOSE: To illustrate the incongruence of ethical standards and fiscal and policy constraints on quality care for the oldest old. As the fastest growing demographic segment in the United States, care needs of the oldest old are a special challenge to the health care system. DESIGN: Narrative analysis of interviews with centenarians who used nursing home services. The sample was three participants of the Georgia Centenarian Study who had been community dwelling and cognitively intact at the onset of participation (between 1988 and 1997). Interviews were conducted in nursing homes or after discharge. METHODS: Case histories were constructed from interviews in 1997 to improve understanding of quality of care. FINDINGS: Less-than-optimal care was provided for these elders, and little consideration was given to their input to care decisions and prospects for medical improvement. Appropriate consideration was not given to providing least-restrictive environments, appropriate restraint use, and options for community care. CONCLUSIONS: Six policy reforms are suggested for meeting the needs of the oldest-old before and after institutionalization. These include: integration of resident involvement in care decisions; development of alternate models of care; greater input from nurses concerning nursing care of special populations; more effective family and community involvement in the caring of elderly populations; increased research to promote function and independence; and increased education of personnel and nursing students to allow for more accurate assessment of cognitive and physical status.

Preserved adrenocortical function after laparoscopic bilateral adrenal sparing surgery for hereditary pheochromocytoma.

BACKGROUND: Familial pheochromocytoma, increasingly diagnosed in asymptomatic subjects with inherited syndromes such as multiple endocrine neoplasia type 2 and Von Hippel-Lindau disease, is frequently bilateral and multifocal, but very rarely malignant. Therefore, bilateral adrenalectomy and subsequent lifelong steroid replacement, with its attendant side effects, is not desirable. Minimally invasive adrenal sparing surgery by means of laparoscopy was explored for the treatment of bilateral pheochromocytoma. We report on the cure rate and adrenocortical function in a series of patients treated accordingly. PATIENTS AND METHODS: Four patients (three male, one female, ages 9-60 yr) with hereditary bilateral adrenal pheochromocytoma were treated by laparoscopic surgery in an organ sparing fashion. Postoperatively, all patients were reevaluated for complete tumor removal and for adrenocortical function. RESULTS: Two to 24 months after surgery, all patients were normotensive, had normal sodium potassium, glucose, aldosterone, renin, and cortisol serum concentrations, 24-h excretion of norepinephrine, epinephrine, and vanillylmandelic acid. Abdominal magnetic resonance imaging (n = 3) and computed tomographic scan (n = 1) disclosed no remnant or relapsing tumor tissue. ACTH stimulation testing resulted in normal cortisol responses. CONCLUSION: By adrenal sparing laparoscopic surgery not only bilateral pheochromocytoma can be successfully removed, but also adrenocortical function preserved. This may become the treatment of choice for familial pheochromocytoma.

Consumer preference optimization of scallopini made from boneless, skinless chicken thighs.

Scallopini is a general name derived from scallopine, an Italian preparation of veal, which describes thinly pounded cuts of meat which are either used as a cutlet or rolled around other foods and cooked. Concept development was accomplished through use of focus groups, consumer ranking studies, and mailed surveys. The objective of this study was to assess consumer acceptability of chicken scallopini at various thicknesses (4, 8 and 12 mm) and concentrations (0, 1, and 2%) of added sodium tripolyphosphate (STPP). A 3 x 3 factorial design with three replications was adopted for use in this study. To assess consumer acceptability of packaged products, 53 participants were presented with three packages of the raw scallopini packaged on white styrofoam trays and overwrapped with film. Because STPP produces no visual change in the product at the levels used, only product thickness was varied. The mean price suggested by panelists from the sensory evaluation was $1.28/lb. The average price per pound suggested for the raw, packaged product was $1.62. For the attributes of overall acceptability, tenderness, juiciness, flavor, size, and texture, the mean ratings were high, indicating an acceptable product in any of the nine treatments. Sensory attributes were affected by STPP concentration but not by scallopini thickness. As STPP concentration increased, hedonic ratings for tenderness, texture, juiciness, flavor, overall acceptability, and purchase likehood increased. Purchase likelihood was rated highest for scallopini containing 2% STPP. Purchase likelihood was verified through use of a simulated supermarket simulation test.

Diving seals, ischemia-reperfusion and oxygen radicals.

The cardiovascular adaptations of seals that contribute to their ability to tolerate long periods of diving asphyxial hypoxia result in episodic regional ischemia during diving and abrupt reperfusion upon termination of the dive. These conditions might be expected to result in production of oxygen-derived free radicals and other forms of highly reactive oxygen species. Seal organs vary during dives with respect to the degree and persistence of ischemia. Myocardial perfusion is reduced and intermittent; kidney circulation is vigorously vasoconstricted. Heart and kidney tissues from ringed seals (Phoca hispida) and domestic pigs (Sus scrofa) were compared in reactions to experimental ischemia. Resulting production of hypoxanthine, indicative of ATP degradation, was higher in pig than in seal tissues. Activity of superoxide dismutase (SOD), an oxygen radical scavenger, was higher in seal heart. We suggest that these results indicate enhanced protective cellular mechanisms in seals against the potential hazard of highly reactive oxygen forms. SOD activity was unexpectedly higher in pig kidney.

Heterogeneous cholinergic reactions of ringed seal coronary arteries.

Coronary blood flow of some seal species is unusual in that it is highly variable in both non-diving and diving conditions and shows intermittent fluctuations, especially during dives when it frequently ceases for brief periods. We sought regulatory mechanisms governing these reactions by studying isometric tension recordings of isolated left circumflex (LC) and left anterior descending (LAD) coronary arteries of ringed seals, Phoca hispida, during reactions to a variety of agents for stimulating or blocking autonomic responses of the vascular smooth muscle. Micromolar acetylcholine (ACh) produced constriction of the small diameter segments of the LAD, but relaxation of the LC and larger segments of LAD. Both constrictions and dilations were prevented by atropine. Small vessel constriction by ACh was prevented by micromolar indomethacin and by a thromboxane receptor antagonist. Large vessel ACh dilations were prevented or reduced by rubbing off the endothelium and by the L-arginine analog, L-NG-nitro-arginine, an inhibitor of nitric oxide synthesis. We conclude that cholinergic, muscarinic, dilation of ringed seal large coronary arteries is mediated by endothelial-derived relaxing factor (EDRF), whereas ACh constriction of small arteries is mediated by a prostaglandin.

Consumer acceptance of stir-fry and kabobs from dark chicken meat and their packaging.

In a study of marketing opportunities for fresh, dark, chicken meat, focus group participants (n = 34) provided qualitative information concerning potential products and packaging concepts. Results of the focus groups indicated that the participants were willing to purchase new, convenient poultry products made from dark chicken meat. Specific dark meat products the participants were willing to by included boneless, skinless thighs, kabob cubes, and stir-fry strips. Consumers desired clear packaging for the products but did not want the packaging to be microwaveable or ovenproof. Acceptance of chicken kabob chunks and stir-fry strips of varying piece sizes (2.54, 3.81, and 5.08 cm) and seasoning concentrations (1.6, 2.1, and 2.6%) was evaluated by consumers (n = 83) using a nine-point hedonic scale. The most preferred products were a 5.08 cm (2 in) kabob with 2.6% seasoning and a stir-fry strip with 2.6% seasoning. A simulated supermarket setting test was conducted to verify findings from a mailed survey (n = 115) and actual purchase behavior by consumers (n = 121). A calculated desirability index indicated a ranked preference to be: breasts > kabobs > stir-fry > boneless, skinless thighs > bone-in, skin-on thighs.

Determination of acceptability of flavored oat bran frankfurters by older adults.

The US population is aging rapidly and, within the next 25 years, 20-25% will be over age 60. This creates a vast new market for age-specific products and increases the responsibility of food scientists and nutritionists to provide appropriate foods for older adults. Many older individuals are energy deficient and need to be encouraged to consume more food in order to maintain body weight and health, but need to decrease the calories from fat in their diets. Many of these older individuals are not inclined to eat foods that they enjoy for fear that these foods may be detrimental to their health (de Castro, 1993), or they have lost their gustational abilities to the degree that these foods are no longer enjoyable. This research looks at a possible solution to both problems by replacing fat in a favorite food of older adults and adjusting the flavor levels of this product. Frankfurters were made from mechanically deboned poultry meat in which standard commercial formulation was compared to three flavoring treatments using oat bran as a fat replacer (6% oat bran, 30% H2O). Mixed spices (traditional saucisson) were added to two of these treatments in standard and double proportions. Participants were 71 individuals over the age of 65 in varying levels of health from four regional care facilities. Seven gram, three-digit-coded samples were evaluated at 60 degrees C, and scored on a nine-point hedonic scale. A significant (alpha = 0.0004) preference was shown for the double-spiced frank. No differences by sex or race were found. Research concluded that addition of flavoring aids in the increased acceptability of products by older adults.