Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) and multiple pulmonary epithelioid hemangioendothelioma (PEH): a case report.

We report a case of a 76-year-old female with multiple lung nodules (Fig. 1 Rx). Pathologic evaluation of the lower left video-assisted thoracoscopic surgery (VATS) lobectomy VATS-lobectomy showed four nodules that were described as pulmonary epithelioid hemangio-endothelioma (PEH); the immunohistochemical stains showed that the neoplastic cells expressed CD31, a variable expression for factor VIII and a low expression of CD34. In the remaining parenchyma of the lobe, multiple nests of neuroendocrine cells were observed with immunohistochemical confirmation, and the diagnosis was diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). To our knowledge, the association between PEH and DIPNECH has never been described in the literature.

Changes in interhemispheric inhibition following successful epilepsy surgery: a TMS study.

Epileptic foci can influence cortical excitability, brain perfusion and metabolism not only directly in the focus or perifocally, but also in remote areas. Effects of successful epilepsy surgery on cortical networks and changes in excitability have rarely been addressed. We report a study on changes in interhemispheric inhibition following successful surgical removal of an epileptic focus. Eighteen patients (11 females, 7 males, mean age 34.2 years) were enrolled in this transcranial magnetic stimulation (TMS) study. All patients were seizure free after surgery and had identical antiepileptic medication pre- and postsurgically. Investigations were performed before and at least 3 months after surgery. Motor thresholds (MT) and motor evoked potentials (MEPs) of interhemispheric paired pulse paradigms were investigated on both hemispheres. Resection of the epileptic focus resulted in a significant change in interhemispheric inhibition (IHI). The ability of the non-focal hemisphere to inhibit the motor cortex (M1) of the focal hemisphere significantly increased (p=0.02) and normalized to the level of the other hemisphere. In summary, this TMS study suggests that an epileptic focus can modulate interhemispheric inhibitory interactions between the motor cortices. A decreased susceptibility of M1 of the focal hemisphere or alterations in the non-focal hemispheric inhibitory output may be underlying mechanisms. These findings may contribute to a better understanding of widespread functional impairments in focal epilepsy.

[Gorlin-Goltz syndrome: manifestations in an elderly patient]. / Das Gorlin-Goltz-syndrom: Aspekte im Senium.

Gorlin-Goltz syndrome is a rare inherited genodermatosis with an autosomal dominant trait. We hereby present a case of a 69 year old patient with known Gorlin-Goltz syndrome to emphasize the peculiar syndrome manifestations in the elderly.

Survival following complete resection of multifocal T4 node-negative NSCLC: a retrospective study.

BACKGROUND: Multifocal NSCLC in the same lobe are staged as T4. This study was designed to assess the impact of multifocal NSCLC in the same lobe on survival in completely resected node-negative patients to determine whether the T4 (stage III B) designation is valid. METHOD: We reviewed our database from October 1987 through 2004 to identify completely resected patients with N0 multifocal (T4) NSCLC. Patients with multifocal pure bronchiolo-alveolar carcinoma were excluded. Thirty-two patients had multifocal NSCLC in the same lobe and were node-negative. RESULTS: Five-year survival rate was 42.4 % for the whole group with a median survival of 48 months. When tumors were staged independently of the satellite nodule/s, patients in stage I A had a 5-year survival rate of 55 % while those in stage I B had a rate of 22 %. CONCLUSION: Patients with N0 multifocal intralobar NSCLC should be upstaged but not to stage IIIB. They should undergo complete surgical resection whenever multiple nodules are detected preoperatively.

The use of flexible spiral drains after non-cardiac thoracic surgery. A clinical study.

OBJECTIVE: After an observational study on 50 patients determined the efficacy and safety of a small calibre (19F), flexible, fluted spiral drains with round cross-section after non-cardiac thoracic surgery we undertook a prospective study to compare these drains to standard chest drains also in terms of pain using a Visual Analog Score. METHODS: One hundred consecutive patients who had to undergo non-cardiac chest surgery either by thoracotomy or by VATS were randomly assigned to receive small calibre drains with round cross-section (group A) or the standard chest drains (group B) to drain the pleural space. Drains were connected to a unitized chest drainage system. Pain was assessed using a Visual Analog Scale (VAS) 0-100. RESULTS: The amount of fluid evacuated daily in patients who received the spiral drains was as much as 1150 ml, that of patients who received standard drains was as much as 950 ml. In no case did spiral drains have to be replaced with standard tubes. In group A first drain was removed after a mean of 3.4 days and the second after a mean of 5.9 days; in group B after a mean of 4.1 and 6.1 days, respectively. Patients were discharged after a mean of 8.5 days in group A (SD 4.04) and 8.1 days in group B (SD 4.76). There were no drains-related complications in both groups. The drains-related pain for the patient was significantly less for patients with spiral drains compared to standard drains at rest, during cough induced by respiratory therapists and at the time of removal. CONCLUSIONS: Spiral drains proved to be at least as safe and effective as conventional tubes after lung surgery; they allowed for evacuation of large amounts of blood/fluid as well as air, and were associated with minimal discomfort.

[Levetiracetam in combined therapy for focal epilepsy: experience with 80 patients]. / Levetiracetam in der Kombinationsbehandlung fokaler Epilepsien. Erfahrungen bei 80 Patienten.

BACKGROUND: Levetiracetam was released in 2000 as an antiepileptic drug for add-on treatment of focal epilepsies. Its efficacy and tolerability were investigated in this retrospective study. METHODS: The effects of add-on treatment with levetiracetam on seizure frequency and side effects were analyzed retrospectively in 80 consecutive patients with focal epilepsy. RESULTS: With a mean follow-up of 12.3 months, 18.8% of patients treated with levetiracetam became seizure-free, and additional 15.0% and 3.8% had reductions in seizure frequency of 75% and 50%, respectively. Increasing the dosage to more than 3,500 mg/day did not improve efficacy but could induce a paradoxical increase in seizure frequency and psychic side effects. Levetiracetam was efficacious against all seizure types independently of focus localization. There was no evidence for the development of tolerance with longer periods of treatment. The most common adverse effects were somnolence and aggressiveness; tolerability did not decrease with rapid titration. CONCLUSIONS: Levetiracetam is a potent and generally well tolerable new antiepileptic drug which is also efficacious in patients with difficult-to-treat focal epilepsies.

Gene expression of the hematopoietic cell phosphatase in juvenile myelomonocytic leukemia.

We analyzed the relative expression of Hematopoietic cell phosphatase (HCP) in mononuclear cells (MNC) of peripheral blood (PB), bone marrow (BM) and spleen of patients with juvenile myelomonocytic leukemia (JMML) and normal donors. Two regions of HCP with alternative exon skipping of exon 6 or exon 12 are described. There was no difference in the expression of the amplified HCP cDNA regions in MNC of JMML patients compared to normal donors. The two forms of exon skipping were present in unstimulated MNC of JMML patients or normal donors. In contrast, phytohemagglutinin (PHA) stimulated MNC of normal donors, Epstein-Barr Virus (EBV) transformed B-cells of JMML patients, BFU-E and CFU-GM derived colonies of JMML patients, and the cell lines K562 and HEL did not or only barely express these two forms of exon skipping. These results may indicate that alternative HCP exon skipping may be associated with the proliferative state of the cell.

Studies on the standardization of mistletoe preparations.

The newly isolated phenylpropanoids syringin, syringenin-apiosylglucoside, eleutheroside E and the high molecular lectins and viscotoxins were selected for a standardization of mistletoe extracts and drug preparation. The phenylpropanoids found in all alcoholic and aqueous extracts were suitable for an HPLC fingerprint analysis, and for quantitative determination. The lectin content of the drug preparations was determined by single radial immunodiffusion. As shown by the isoelectric focussing method, Iscador and fermented mistletoe extracts contain only the mistletoe lectins ML II/III, whereas the proteins of the ML I complex are missing. For identification and quantitative determination of viscotoxins, an HPLC method was designed.