Calcifying pseudoneoplasm of the neuraxis: A case report and review of the literature.

Calcifying pseudoneoplasms of the neuroaxis (CAPNON) are rare, slow-growing, fibro-osseous lesions that can occur throughout the entire neuroaxis with few reported cases. We describe a case of craniocervical CAPNON that was treated by our unit and review the available literature. CAPNON are rare benign lesions occurring throughout the neuroaxis. Although rare, these lesions should be considered in cases of histopathological and radiology features of calcified lesions in both brain and spine. Despite a paucity of reports complete safe surgical resection should remain the goal to obtain the best clinical outcomes.

Plasmacytoma of the mesentery.

Extramedullary plasmacytoma represents 3%-5% of all plasma cell neoplasms. Plasmacytomas of the mesentery are extremely rare. We report the case of a 56-year-old man who presented with an abdominal mass and was diagnosed to have plasmacytoma of the mesentery. A literature review was also conducted on publications pertaining to solitary mesenteric plasmacytomas. These patients present late by which time the abdominal mass has reached a significant size. Radiation as a modality for local control has a limited role in treating mesenteric plasmacytomas. Surgery is the preferred modality for local control. Patients must be kept on a regular follow-up as there is a risk of transformation to multiple myeloma.

Composite lymphomas: Experience from a tertiary cancer center in Kerala, South India.

OBJECTIVES: Composite tumors are defined as tumors in which there are two different intermixed histologic types. Our objective was to study the clinical and pathologic features of five cases of composite lymphoma. MATERIALS AND METHODS: Our study included five patients of composite lymphoma diagnosed over a period of 5 years. Clinical presentation, hematological parameters including peripheral smear, bone marrow aspirate, and histopathological examination of lymph node including immunohistochemistry (IHC) were studied. Treatment and follow-up details were also noted. RESULTS: All the five cases were in the adult age group ranging from 44 to 72 years. All the cases were composite follicular lymphoma (FL) and mixed cellularity classical Hodgkin lymphoma (CHL). Diagnosis in all cases was suspected on morphology by identification of distinct neoplastic follicles in FL and classic Reed-Sternberg cells in CHL and confirmed by IHC. CONCLUSION: Although rare, composite lymphomas should be kept in mind. Careful histopathological examination of lymph node with identification of distinct morphological features along with IHC helps to arrive at the definitive diagnosis.

Incubation of conditioned fear in the conditioned suppression model in rats: role of food-restriction conditions, length of conditioned stimulus, and generality to conditioned freezing.

We recently adapted the conditioned suppression of operant responding method to study fear incubation. We found that food-restricted rats show low fear 2 days after extended (10 d; 100 30-s tone-shock pairings) fear training and high fear after 1-2 months. Here, we studied a potential mechanism of fear incubation: extended food-restriction stress. We also studied whether fear incubation is observed after fear training with a prolonged-duration (6-min) tone conditioned stimulus (CS), and whether conditioned freezing incubates after extended training in rats with or without a concurrent operant task. Conditioned fear was assessed 2 days and 1 month after training. In the conditioned suppression method, fear incubation was reliably observed in rats under moderate food-restriction conditions (18-20 g food/day) that allowed for weight gain, and after extended (10 d), but not limited (1 d), fear training with the 6-min CS. Incubation of conditioned freezing was observed after extended fear training in rats lever-pressing for food and, to a lesser degree, in rats not performing an operant task. Results indicate that prolonged hunger-related stress does not account for fear incubation in the conditioned suppression method, and that fear incubation occurs to a longer-duration (6-min) fear CS. Extended training also leads to robust fear incubation of conditioned freezing in rats performing an operant task and weaker fear incubation in rats not performing an operant task.

Effect of pharmacological manipulations of neuropeptide Y and corticotropin-releasing factor neurotransmission on incubation of conditioned fear.

We recently developed a procedure to study fear incubation in which rats given 100 tone-shock pairings over 10 days show low fear 2 days after conditioned fear training and high fear after 30 or 60 days. Here, we studied the role of the stress-related peptides, neuropeptide Y (NPY) and corticotropin-releasing factor (CRF), in fear incubation. We gave rats either 10 or 100 30-s tone-0.5-s footshock pairings over 1 day (short training) or 10 days (long training) and then assessed tone-cue-induced conditioned suppression of lever responding 2 days after short training or 2 days and 1 month after long training. Prior to testing, we injected NPY (5-10 microg, i.c.v.), the NPY Y1 receptor antagonist BIBO3304 (20-40 microg, i.c.v.), the NPY Y2 receptor antagonist BIIE0246 (2.5-5 mg/kg s.c.), the non-selective CRF receptor antagonist D-Phe CRF(12-41) (10 microg, i.c.v.), or the CRF1 receptor antagonist MTIP (10-20 mg/kg s.c.). Conditioned suppression after long training was higher after 1 month than after 2 days (fear incubation); conditioned suppression was robustly expressed 2 days after short training (non-incubated fear). Both incubated and non-incubated fear responses were attenuated by NPY. In contrast, D-Phe CRF(12-41), MTIP, BIBO3304, or BIIE0246 had no effect on conditioned fear at the different time points. Results confirm previous work on the potent effect of exogenous NPY administration on conditioned fear, but the negative results with BIBO3304 and BIIE0246 question whether endogenous NPY contributes to incubated (or non-incubated) fear. Results also suggest that CRF receptors are not involved in cue-induced fear in the conditioned suppression procedure.

Differential effects of the hypocretin 1 receptor antagonist SB 334867 on high-fat food self-administration and reinstatement of food seeking in rats.

BACKGROUND AND PURPOSE: Many studies have demonstrated a role of hypocretin 1 (orexin 1) receptors in home-cage food consumption in rodents. However, the role of these receptors in operant food self-administration or relapse to food seeking in animal models is unknown. EXPERIMENTAL APPROACH: In Experiment 1, we trained food-restricted rats (16-20 g per day) to lever press for high-fat (35%) pellets (3-6 h per day, every other day). We then tested the effect of the hypocretin 1 receptor antagonist SB 334867 (10, 20 mg kg(-1), i.p) on pellet self-administration. In Experiment 2, we trained rats to self-administer the food pellets, and following extinction of the food-reinforced responding, we tested the effect of hypocretin 1 (3 and 6 mug, i.c.v) on reinstatement of food-seeking and the effect of SB 334867 on this reinstatement. In Experiment 3, we tested the effect of SB 334867 on reinstatement induced by non-contingent pellet exposure (pellet-priming) or the pharmacological stressor yohimbine (2 mg kg(-1), i.p). KEY RESULTS: SB 334867 attenuated high-fat pellet self-administration. In contrast, SB 334867 had no effect on reinstatement of lever presses induced by hypocretin 1, pellet-priming or yohimbine. CONCLUSIONS AND IMPLICATIONS: These data indicate that during dieting, hypocretin 1 receptors contribute to operant high-fat pellet self-administration, but not to relapse to food seeking induced by acute re-exposure to the food itself or by the induction of a stress-like state.

Role of food type in yohimbine- and pellet-priming-induced reinstatement of food seeking.

We have recently adapted a reinstatement model, commonly used to study relapse to drugs of abuse, to study the role of stress and anxiety in relapse to palatable food seeking [Ghitza UE, Gray SM, Epstein DH, Rice KC, Shaham Y. The anxiogenic drug yohimbine reinstates palatable food seeking in a rat relapse model: a role of CRF(1) receptors. Neuropsychopharmacology [in press]]. We found that the anxiogenic drug yohimbine, as well as pellet-priming, reinstate food seeking in food restricted rats previously trained to lever press for palatable food pellets (25% fat, 48% carbohydrate). Here, we studied the generality of the effect of yohimbine and pellet priming on reinstatement of food seeking by using three distinct pellet types: non-sucrose carbohydrate (NSC) (5.5% fat, 60% carbohydrate, 4.5% fiber), fiber (0% fat, 0% carbohydrate, 91% fiber) and sucrose (0% fat, 91% carbohydrate, 4% fiber). Rats were placed on a restricted diet (75-80% of daily standard food) and for 9-12 intermittent training days (9 h/day, every other day) lever-pressed for the food pellets under a fixed ratio-1 (20-s timeout) reinforcement schedule. Subsequently, the rats were given 9-10 daily extinction sessions during which lever-presses were not reinforced, and were then injected with yohimbine (0, 0.5, 1.0, 2.0 mg/kg, i.p.) or given a single food pellet to induce reinstatement of food seeking. Yohimbine reinstated food seeking previously reinforced by NSC and sucrose pellets, but had a minimal effect on food seeking in rats previously trained to lever press for fiber pellets. Pellet priming produced a greater degree of reinstatement of lever pressing in rats previously trained on NSC pellets than in rats trained on fiber or sucrose pellets. Results suggest that the magnitude of the effect of yohimbine and pellet priming on reinstatement of food seeking depends in part on the composition of the food pellets used during training.

Effect of a serotonin depleting regimen of 3,4-methylenedioxymethamphetamine (MDMA) on the subsequent stimulation of acetylcholine release in the rat prefrontal cortex.

The amphetamine analog 3,4-methylenedioxymethamphetamine (MDMA) is considered to be selectively neurotoxic to serotonergic nerve terminals. Although the long term effects of MDMA on serotonin (5-HT) terminals have been well studied, other potential neurochemical consequences associated with MDMA-induced 5-HT depletion have been less well investigated. In view of the cognitive impairments in human MDMA abusers and the role of acetylcholine (ACh) in learning and memory, it was of interest to determine the influence of a 5-HT depleting regimen of MDMA on subsequent stimulation of ACh release in the prefrontal cortex (PFC). Male rats received vehicle or MDMA (10 mg/kg, i.p. every 2 h for four injections) and underwent in vivo microdialysis 7 days later to assess the subsequent drug- (e.g., MDMA, 5-HT1A agonist) or stress- (e.g., tail pinch, presence of an intruder rat) induced stimulation of ACh release. The increase in the extracellular concentration of ACh in the PFC produced by MDMA (10 mg/kg, i.p.) was significantly less in rats previously exposed to the neurotoxic regimen of MDMA than that in control animals. In contrast, there was no difference in the magnitude of the stimulation of cortical ACh release elicited by the 5-HT1A agonist, 8-hydroxy-2-(di-n-propyl-amino)tetralin (8-OH-DPAT, 0.3mg/kg, s.c.), tail pinch (30 min) or the presence of an intruder rat (40 min) between control animals and animals previously exposed to a neurotoxic regimen of MDMA. These results suggest that although MDMA-induced 5-HT depletion diminishes subsequent MDMA-induced ACh release, there is little impact on cortical ACh release elicited by the stress of pain or the novelty of an environmental intruder.

Left hemidiaphragmatic mobility: assessment with ultrasonographic measurement of the craniocaudal displacement of the splenic hilum and the inferior pole of the spleen.

OBJECTIVE: The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm. METHODS: Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.5-MHz convex transducer in a left intercostal position under a longitudinal orientation. Statistical analyses were performed with linear regression, a paired Student t test, and Bland-Altman analyses. RESULTS: The correlation between the craniocaudal splenic hilum displacement and radiographic measurements was found to be linear: hemidiaphragmatic mobility = 17.795 + 0.429 x splenic hilum displacement (SE for the regression coefficient = 0 .12; P = .0012), although the values obtained with both methods were statistically different (P < .05). The same results could be observed with the use of the inferior pole of the spleen: hemidiaphragmatic mobility = 9.5596 + 0.5455 x inferior polo displacement (SE for the regression coefficient = 0 .11; P < .0001). The mean difference between the values obtained by ultrasonography and by radiography was statistically significant (16.7 +/- 16.1 mm; P < .05 [hilum]; 18.9 +/- 14.2 mm; P < .05 [inferior pole]). CONCLUSIONS: These results allow us to conclude that ultrasonography can be used as an alternative method for left hemidiaphragm mobility evaluation compared with radiography.

Right hemidiaphragmatic mobility: assessment with US measurement of craniocaudal displacement of left branches of portal vein.

PURPOSE: To evaluate the correlation and agreement between ultrasonographic (US) measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein and radiographic measurement of right hemidiaphragmatic mobility. MATERIALS AND METHODS: Fifty-one patients with indications for abdominal angiography or percutaneous cholangiography prospectively underwent radiographic evaluation of right hemidiaphragmatic mobility and B-mode US measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein. US was performed by using a 3.5-MHz convex transducer in a right subcostal position with a longitudinal orientation. Statistical analyses were performed by using linear regression, paired Student t test, and Bland-Altman analyses. RESULTS: The correlation between the US and radiographic measurements was found to be linear: hemidiaphragmatic mobility = (-1.562 + 1.032) x portal vein branch displacement (r = 0.651, P <.001). The mean craniocaudal displacement of the intrahepatic branches of the portal vein measured at US was 35.2 mm +/- 10.7 (SD). The mean right hemidiaphragmatic mobility measured at radiography was 34.8 mm +/- 17.0. The mean difference between the two measurements was not statistically significant (0.4 mm +/- 12.9, P =.807). CONCLUSION: US measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein can be used for indirect assessment of right hemidiaphragmatic mobility.

Poorly differentiated carcinoma of the lung presenting with Lambert--Eaton myasthenic syndrome.

Lambert-Eaton myasthenic syndrome commonly seen in small-cell lung cancer represents an autoimmune reaction against antigens coexpressed by tumor and neurons. It is rarely seen with other histologic subtypes. Symptoms antedate the appearance of the neoplasm by weeks to years. Therapeutic options range from immunosuppression, plasmapheresis, pharmacologic facilitation of neuromuscular transmission, and definitive therapy of the primary tumor. This case report describes the rare association of Lambert-Eaton myasthenic syndrome with non-small-cell lung cancer.

Primary small cell anaplastic carcinoma of the breast diagnosed by fine needle aspiration cytology: a case report.

BACKGROUND: Small cell anaplastic carcinoma most commonly presents as a lesion in the central portion of the lung but occasionally is found in peripheral locations. Only seven cases originating in the breast have been described. To our knowledge, the preoperative diagnosis of this entity by fine needle aspiration has not been previously reported in the cytologic literature. CASE: A 67-year-old female presented with a 4 x 3-cm, rapidly growing mass in the left breast. On fine needle aspiration (FNA) the tumor was soft to the needle and yielded a highly cellular aspirate. CONCLUSION: In this case the morphologic interpretation of FNA, combined with the immunocytochemical demonstration of neuron-specific enolase in tumor cells, was extremely helpful in establishing the nature of the breast tumor.

Spontaneous carotid-cavernous fistula and multiple arterial dissections in type IV Ehlers-Danlos syndrome. Case report.

A 43-year-old woman without phenotypic expression of Ehlers-Danlos syndrome developed a spontaneous unilateral carotid-cavernous fistula (CCF). Attempts at balloon occlusion of the CCF were unsuccessful, and caused multiple arterial dissections and lacerations eventually leading to massive retroperitoneal hemorrhage and death. The CCF was demonstrated during postmortem studies. In addition, the patient had independent dissections of the internal carotid artery at the site of the fistula and an intracavernous aneurysm of the contralateral internal carotid artery. Despite widespread dissections, the major arteries showed only mild histological abnormalities. Morphometric analysis of collagen from the aorta revealed an increase in large-sized fibers, consistent with deficiency of Type III collagen.

The glucose tolerance of the West African dwarf goats.

Glucose tolerance tests conducted on 4 adult goats and 3 kids, injecting glucose intravenously (0.5 g/kg body weight), showed that the former required 180 min and the latter 45 min after injection, to restore blood glucose to normal. For the adult goats, the turnover rate (K) was 0.38 +/- 0.03/hr, turnover time (TT) 2.64 +/- 0.18 hr and half-time (T 1/2) 110.24 +/- 7.73 min for glucose clearance while for the kids, these were 1.59 +/- 0.12/hr, 0.64 +/- 0.04 hr and 26.05 +/- 4.36 min respectively. The higher glucose clearance in the kids than in the adults may be attributed to a more efficient insulin response and to greater glucose utilization than in the former. The dwarf goats appear to differ substantially from the cows in their homeostatic responses to induced hyperglycemia.

Complementary use of computerized tomography and technetium scanning in the diagnosis of accessory spleen.

A patient with a previous splenectomy presented with acute gastrointestinal bleeding. He was found to have a benign gastric ulcer, esophagogastric varices, and a mass indenting the gastric fundus. Abdominal computerized tomography and technetium liver-spleen scanning established the diagnosis of an accessory spleen as cause for the mass effect. This diagnostic approach obviated the need for arteriography and exploratory laparotomy.

Ketamine sequelae. Evaluation of the ability of various premedicants to attenuate its psychic actions.

The ability of a number of drugs to abolish the emergence delirium and unpleasant dreams which follow anaesthesia induced with 2 mg/kg ketamine was studied. These included three benzodiazepines, droperidol and 'neurolept' combinations and four commonly-used premedicants. When given intravenously 10 min before induction of anaesthesia flunitrazepam and lorazepam gave best results. In a subsequent study, these two benzodiazepines and diazepam were given intravenously 30-40 min before induction of anaesthesia. There was no doubt that 4 mg lorazepam gave the greatest protection and is worthy of further study in this respect.

Studies of drugs given before anaesthesia XXVI: lorazepam.

Lorazepam has been studied as preanaesthetic medication given by mouth, i.m. and i.v. Sediation and side-effects and the incidence of anterograde amnesia in patients having a standard operation under methohexitone-nitrous oxide-oxygen anaesthesia were assessed. In a preliminary study of three i.m. (2-, 4- and 8-mg) and six oral (1-,2-,2.5-,4-,5- and 8-mg) doses, the optimum dose was found to be 4 mg for patients with an average weight of 60 kg. This dose was studied in detail when given by all three routes and compared with the commercially available 2.5- and 5-mg tablets. Even when given i.v., there was a delay of 30-40 min in the onset of maximum sedative effect and drowsiness persisted for at least 4 h. Although the onset of action by i.m. injection was slightly faster than when the drug was given by mouth this advantage was more than offset by the high frequencies of pain at the site of injection and restlessness which persisted for 20-40 min. Oral lorazepam in doses of 2.5-5.0 mg was a reliable, effective sedative which could be recommended for routine preanaesthetic medication, provided rapid recovery was not essential. Its soporific effect was accompanied by an appreciable incidence of anterograde amnesia.

The influence of three antacids on the absorption and clinical action of oral diazepam.

Diazepam 10 mg given orally alone or with one of the three antacids (aluminium hydroxide 40 ml, magnesium trislicate 30 ml, sodium cirate 30 ml) was given in a single dose at random to 200 women undergoing minor gynaecological procedures. The concomitant use of aluminium hydroxide or sodium citrate hastened the onset of the soporific effect of diazepam marginally, while magnesium trisilicate tended to delay it. The estimation of plasma diazepam concentrations over 90 min in a similar series of 67 patients showed that the absorption of diazepam was increased significantly by the use of aluminium hydroxide, but there were no striking differences in the four groups. The clinical implications of these findings are discussed.