Marked antitumor activity of a new potent acronycine derivative in orthotopic models of human solid tumors

S 23906-1 is a novel acronycine derivative selected on the basis of its potency in vitro. We investigated the antitumor activity of S 23906-1 against several murine transplantable tumors (C38 colon carcinoma, P388 leukemia, B16 melanoma, and Lewis lung carcinoma) and in orthotopic models of human lung (NCI-H460 and A549), ovarian (IGROV1 and NIH:OVCAR-3), and colorectal cancers (HCT116 and HT-29). Against established C38 colon carcinoma, S 23906-1 administered twice i.v. from 1.56-6.25 mg/kg markedly inhibited tumor growth. Treatment at the optimal dose (6.25 mg/kg) induced tumor regression in all of the mice. Acronycine was 16-fold less potent and only moderately active at the maximum tolerated dose, 100 mg/kg. Against other murine tumors of the former National Cancer Institute panel, S 23906-1 was either only moderately active or totally inactive. When evaluated in human orthotopic models, S 23906-1 given p.o. or i.v. demonstrated a marked antitumor activity against human carcinomas. In the two human lung cancer models, S 23906-1 increased the survival of the animals in a dose-dependent manner and induced treated versus control values of 162% (NCI-H460) and 193% (A549). Vinorelbine was less active, with treated versus control values of 119% and 174%, respectively. A significant survival benefit was also observed against the two i.p. ovarian tumors in which S 23906-1 was as active as paclitaxel, inducing 80% long-term survivors in the NIH:OVCAR-3 model. Lastly, S 23906-1 inhibited the growth of primary HT-29 and HCT116 colon tumors grafted onto the cecum as efficiently as irinotecan and eradicated the formation of lymph node, hepatic, and pulmonary metastases in the aggressive HCT116 model. The novel spectrum of activity of S 23906-1 compared with existing anticancer agents warrants further preclinical investigation.

[French neurosurgery in the Bosnia-Herzegovina conflict]

Seven French neurosurgical missions, from June 1994 to December 1996, were sent successively to Bosnia-Herzegovina with the help of a non-governmental organisation Médecins du Monde. The aim of this article is to present the working conditions, make an overall evaluation of the missions and then to draw lessons and discuss the limits. The initial aim of these neurosurgical missions was: i) to provide human and logistic support to the Bosniac teams in the field; ii) to exchange knowledge and help in the training of local young neurosurgeons; iii) to be present as witnesses. The towns of Tuzla and Zenica in Eastern and Central Bosnia respectively were chosen as the missions bases. One hundred five neurosurgical operations were carried out in precarious conditions, particularly concerning anesthesia. The largest number of the operations (52%) concerned standard neurosurgical pathologies, without any direct link to the war but which had been put off or made difficult due to the war. Cranioplasties and peripheric nerve injuries were the main lesions directly related to the war situation which the French missions had to deal with. Actually, war neurosurgical pathologies were very often dealt with in emergency by Bosniac teams in the field hospitals near the front. Previously existing neurosurgical environment, in particular with access to a scanner is an absolute necessity to carry out a good quality neurosurgical mission. Precarious anesthesia and operating conditions require the surgical team to adapt to local conditions, but are not a contra-indication to such missions. Although help in the field can prove useful on occasions, training the resident teams is important. This can be done locally, but additional training in a neurosurgically developed country is fundamental. Missions such as these require relatively major funding (about 150 000 French francs for each of our missions) and suitable infrastructures. Prior to undertaking this type of mission, a neurosurgeon must evaluate local human and equipment needs.

Rational prescription of medicines--a study of indoor patients at a tertiary care hospital

BACKGROUND

A study was conducted at Ayub Teaching Hospital, Abbottabad, a tertiary hospital, to know whether drugs are prescribed rationally keeping in mind indications, interactions, contraindications, proper dosage and economy of the patient.

METHODS

The study was a descriptive case study. Records of 200 patients admitted in various units of the hospital were analysed by a panel of pharmacologists and conclusions drawn.

RESULTS

It was found that only 52% of patients receive prescriptions that were rationale in all aspects. Where as in rest of the patients the rationale could be challenged.

CONCLUSION

This study stresses the need for more concentrated and dedicated effort towards prescription of medicines.

Measurement of voice onset time in dysarthric patients: methodological considerations

Voice onset time (VOT) reflects the timing control between laryngeal and supralaryngeal adjustments. It has been studied both in normal speakers and patients with speech disorders, but very little information has been published on the feasibility of this measure in clinical practice. We examined 10 repeated utterances involving the voiceless stop consonants [p], [t] and [k] in 110 subjects (27 controls, 48 with spastic dysarthria and 35 with hypokinetic dysarthria). The mean rate of measurable VOT was 95% for normal speech, 80% for hypokinetic dysarthria and 84% for spastic dysarthria. The main obstacle to successful measurement was lack of the burst signifying the release of the plosive. The posterior stop [k] presented the greatest measurement difficulties for the dysarthric subjects, which is in accordance with previous perceptual reports on dysarthria.

The effect of metformin on glycemic control, serum lipids and lipoproteins in diet alone and sulfonylurea-treated type 2 diabetic patients with sub-optimal metabolic control

OBJECTIVE

To see if Metformin Monotherapy affects glycemic control, serum lipid or lipoprotein levels in the treatment of type 2 diabetes who were poorly controlled with diet alone or despite maximal doses of (sulfonylurea) oral glucose lowering agents.

DESIGN

A prospective, clinical intervention trial conducted between 1996-1997.

SETTING

Two out patient diabetic clinics of Karachi.

PATIENTS AND METHODS

A 12-week prospective clinical intervention trial. A total of 30 type 2 diabetic subjects were enrolled, of Whom 21 (12 men and 9 women) completed the study period. Their ages ranged between 35 and 70 years, (mean +/- SD 53.3 +/- 9.31) years, with a mean duration since diagnosis of diabetes was 4.5 +/- 2.3 years, body mass index (mean +/- SD) 26.8 +/- 3.53 kg/m2. They were previously treated with diet alone or had already been taking maximum doses of sulfonylurea monotherapy with suboptimal glycemic control, i.e., raised fasting blood glucose concentrations of 6-15 mmol/L or (108-270 mg/dL) on two occasions, with significant hyperglycemic symptoms. The patients were treated with metformin monotherapy with a follow up of 12 weeks. The initial dosage was 500 mg twice daily, and the dosage was increased to two or three tablets depending on the patient's metabolic changes. By comparing before and after 12 weeks therapy with metformin we assessed the importance of baseline parameters (glycemic control, serum lipid and lipoprotein concentrations, and measures of change in body weight and body mass index).

RESULTS

Metformin therapy significantly decreased fasting blood glucose levels in all patients [(mean +/- SD) 227.2 +/- 37.5 to 168.6 +/- 20.5 mg/dl, p < 0.001)]. Serum total cholesterol decreased marginally [(mean +/- SD) 200.3 +/- 18.7 to 181.4 +/- 19.4 mg/dl, p < 0.01)]. Serum total triglycerides concentration also decreased [(mean +/- SD) 195.9 +/- 31.9 to 174.2 +/- 26.6 mg/dl, P < 0.01)]. Low-density lipoproteins declined [(mean +/- SD) 123.5 +/- 16.9 to 105.5 +/- 19.1 mg/dl, P < 0.01)], and very-low density lipoprotein cholesterol also decreased [(mean +/- SD) 39.2 +/- 6.4 to 34.8 +/- to 5.3 mg/dl, P < 0.01)]. Whereas, high-density lipoprotein cholesterol tended to increase [(mean +/- SD) 37.7 +/- 5.1 to 39.5 +/- 4.9 mg/dl, P < 0.01)], while no significant changes occurred in body weight and body mass index.

CONCLUSION

Metformin treatment was effective, safe, and generally well tolerated.

[Surgical strategy in Cushing's disease]

Cushing's disease is almost always due to ACTH hypersecretion by a pituitary adenoma. Surgical excision is the only curative treatment. MRI together with ACTH assay in the inferior petrous sinus provides the diagnosis and localization in 80% of cases. Surgery should be wide in all cases, going beyond the limits of the adenoma visible on the MRI. Total or subtotal antihypophysectomy may be indicated if the imaging is negative and no lateralization can be determined from ACTH assays. In case of therapeutic failure, reoperation must be proposed early. A 5-year follow-up is required before the definitive results of surgery can be assessed. Cure is evaluated on the basis of postoperative cortisol levels (<3 - 5 g/dl). Initially, the rate of remission varies from 70 to 85%. Success after a second operation is to the order of 80 to 90%. The surgical risk for ACTH adenomas is higher than for other secreting adenomas (CSF fistulae, meningitis, thromboembolism, visual disorders), certainly due, in part to subtotal or total antihypophysectomy.

[Prolactinoma in man: clinical and histological characteristics]

Prolactinoma usually occurs a small intrasellar tumor in women or as a large tumor in men. To determine whether the predominance of macroprolactinomas in men is due to a delay in diagnosis as has been suggested, or whether there is a sex-related difference in growth rate we conducted a retrospective study in 45 men and 51 women with prolactinomas. Preoperative prolactin level (PRL) was 2,789 573 ng/ml and mean tumor size was 26 2 mm. Prolactin levels and tumor size were significantly higher in women (292 74 ng/ml and 10 1 mm; p<0.01). There was no correlation with age at diagnosis or duration of symptoms. Giant tumors were only observed in men (n=8). Frequency of resistance to bromocriptine (30% vs 5%, p<0.01) and invasive tumors (52% vs 27%, p<0.001) were significantly higher in men than in women. Likewise, proliferation rate was higher for the prolactinomas in men (Ki-67: 2.6 1.1% positive nuclei vs 0.4 0.2%; p=0.08; PCNA: 5.0 2.3% vs 3.7 1.1%). In conclusion, prolactinomas in men are more aggressive than in women. They grow rapidly, often invade the cavernous sinus and are resistant to bromocriptine; proliferation rates can be increased.

[MRI diagnosis of cavernous sinus invasion by pituitary adenomas]

Several MRI signs are helpful for the preoperative MRI diagnosis of cavernous sinus invasion by an adenoma. The first step is to analyse the percentage of encasement of the intracavernous ICA by the adenoma. If this percentage is greater than or equal to 66%, the cavernous sinus is invaded. If the percentage of encasement of intracavernous CA is less than 25%, the cavernous sinus is not invaded. If the percentage of encasement is between 25 and 66%, the analysis of the cavernous venous compartment, the drawing of intercarotid lines and the analysis of the shape and venous compartments of the cavernous sinus are necessary. The cavernous sinus invasion remains very likely if the carotid sulcus venous compartment is obliterated, or if the lateral intercarotid line is crossed. Conversely, if the median intercarotid line is uncrossed, the superior venous compartment is visible, the cavernous sinus is of normal size, or there is no bulging of its lateral dural wall, invasion of the cavernous sinus space can reliably be excluded.

Cavernous sinus invasion by pituitary adenoma: MR imaging

PURPOSE

To define magnetic resonance (MR) imaging criteria for the diagnosis of cavernous sinus invasion by pituitary adenoma.

MATERIALS AND METHODS

The MR images obtained in 106 patients (86 female, 20 male; age range, 16-71 years) were reviewed retrospectively by two physicians. The standard-of-reference criteria for invasion were the surgical findings. A chi(2) analysis was performed, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for nine groups of MR imaging signs were computed.

RESULTS

Invasion of the cavernous sinus was certain (PPV, 100%) if the percentage of encasement of the internal carotid artery (ICA) by tumor was 67% or greater. It was highly probable if the carotid sulcus venous compartment was not depicted (PPV, 95%) or the line joining the lateral wall of the intracavernous and supracavernous ICAs was passed by the tumor (PPV, 85%). It was definitely not invaded (NPV, 100%) if the percentage of encasement of the intracavernous ICA was lower than 25% or the line joining the medial wall of the intracavernous and supracavernous ICAs was not passed by the tumor.

CONCLUSION

The radiologic diagnosis of cavernous sinus invasion by pituitary adenoma remains difficult, but the above-mentioned criteria may be of assistance.

[Vascular cerebral thrombosis during pregnancy and post-partum]

Pregnancy and puerperium are associated with a number of cerebrovascular conditions that may result in stroke. Those include cerebral venous thrombosis and cerebral arteries occlusions. Comparing stroke rates during pregnancy with those of non-pregnant women showed only a marginal excess risk during pregnancy and puerperium. Strokes due to cerebral venous thrombosis represent 10-20 per 100 000 deliveries in western countries. The cause of intracranial venous thrombosis is usually unknown. However, better understanding of abnormalities in coagulation leading to intravascular clotting in the early puerperium is resulting in better understanding of this disease. Nevertheless, an etiological work up should be performed, particularly when the thrombosis occurs during pregnancy. Its clinical manifestations often include focal neurological signs, seizures and headache. Alterations in consciousness occur as intracranial pressure increases. Arterial occlusions account for about 60% to 80% of cerebral ischemic lesions. A probable cause of ischemic stroke is diagnosed on the basis of clinical, biological and radiological data. Eclampsia is the main cause of nonhemorrhagic stroke. A search for rare causes of stroke linked to pregnancy such as post-partum cardiomyopathy, paradoxical embolism, choriocarcinoma, cardiac and hematological disorders may be appropriate.

[Pituitary disorders in pregnancy]

During pregnancy there is a normal increase in the volume of the anterior pituitary as demonstrated by MRI and hormone secretions which increase (PRL) or decrease (FSH, LH). During pregnancy pituitary adenomas, especially prolactinomas, may evolve as in non-pregnant women (microadenomas) or differently (macroadenomas). In 35 % of cases macroprolactinomas worsen during pregnancy making their medico-surgical management mandatory prior to pregnancy. Inversely, pregnancy occurring in a subject with a microprolactinoma never induces severe local complications so such tumors may be managed surgically or medically. Surgery should be performed for acromegaly or Cushing's disease before or early in pregnancy. Subacute pituitary apoplexy (intratumoral hemorrhage) occurs in about 10 to 15 % of adenomas but, generally speaking, clinical symptoms remain mild in pregnant women. Lymphocytic hypophysitis occurs at the end of pregnancy, or during the post-partum period. The association of complete pan-hypopituitarism and hypersignal on MRI examination may mimic hypophyseal apoplexy and could lead to and inappropriate surgical procedure.

Neonatal cholestasis in Kashmiri children

Neonatal cholestasis is prolonged elevation of conjugated serum bilirubin (more than 20% of total bilirubin) beyond first 14 days of life. After extensive evaluation a diagnosis of either biliary atresia or neonatal hepatitis is made in 70-80% of cases. Neonatal hepatitis and biliary atresia form a pathophysiologic process directed at various levels of the hepatobiliary tract. Inflammation in the bile duct epithelium may result in the sclerosis and obliteration of the bile ducts and manifest as biliary atresia. Primary hepatocellular inflammation is more likely to result in neonatal hepatitis. Half of the cases of neonatal hepatitis resolve without sequelae, while most of the biliary atresia cases require surgical intervention for repair or, ultimately, liver transplant.

[Evaluation of motor speech function in the diagnosis of various forms of dysarthria]

Perceptual analysis is not sufficient enough to identify specific dysarthria types. In order to improve the discrimination between dysarthria types, we developed a standardized evaluation of different functions controlling speech motor performances. This was applied to 90 patients suffering from hypokinetic, spastic or ataxic dysarthria and 15 control subjects. A discriminate analysis showed that 71.4 p. 100 of the cases were correctly classified. This model was validated within a new group of 21 patients and showed that the less severe dysarthric parkinsonian patients were difficult to distinguish from control subjects. The discriminate analysis was then used for 20 patients with atypical parkinsonism. Seven patients with progressive supranuclear palsy were considered to have hypokinetic dysarthria. The 6 patients with multisystem atrophy and 7 with corticobasal degeneration were classified among the 3 dysarthric types. We suggest that motor speech evaluation may contribute to differential diagnosis within groups of patients suffering from atypical parkinsonism.

Histology and sensitivity to anticancer drugs of two human non-small cell lung carcinomas implanted in the pleural cavity of nude mice

We have established two metastatic models of human non-small cell lung carcinoma (NSCLC)-the NCI-H460 large-cell carcinoma and the A549 adenocarcinoma-by inoculating tumor cells into the pleural space of nude mice. The objectives of this work were as follows: (a) to study the histological characteristics and growth and dissemination patterns of these tumors in nude mice; (b) to assess their sensitivity to drugs that have demonstrated significant clinical therapeutic effect in the treatment of NSCLC; and (c) to investigate the antitumor activity of S 16020-2, a new olivacine derivative, currently in Phase II clinical evaluation. In each of the two models, all animals developed lung tumors, resulting in 100% mortality. Histopathological study showed that these two tumors spread locally to contiguous structures, including the mediastinal pleura and diaphragm, with histological characteristics consistent with the human pathology. Anticancer drugs used for the treatment of NSCLC, such as cisplatin, doxorubicin, vinblastine, and etoposide, enhanced the life span of treated mice in the two models and were more active in the NCI-H460 than in the A549 model. The increases of survival time as compared to control groups were from 60 (P < or = 0.05) to 83% (P < or = 0.01) and from 21 to 40% for NCI-H460 and A549, respectively. Vinorelbine, paclitaxel, and irinotecan showed similar activities in the two models and increased the survival of treated mice by between 38 and 79% (P < or = 0.001) and between 58 (P < or = 0.01) and 78% in the NCI-H460 and A549 models, respectively. However, none of these drugs was curative, reflecting the resistance of this disease to chemotherapy. S 16020-2 exhibited a remarkable antitumor activity, increasing the survival by 82% (P < or = 0.01) for NCI-H460 and by 126% (P < or = 0.001) for A549. This drug was among the most active compounds in these models, thereby indicating its potential for the chemotherapy of this disease.

[Hypophyseal surgical treatment of Cushing's disease in the child]

Cushing's disease in children is rare and not familar to pediatricians. We report here 7 cases concerning children between 8 and 16 years of age, treated by pituitary surgery with 1 to 9 year follow-up. A remission of hypercorticism was obtained in all cases. However, a pituitary deficiency requiring replacement opotherapy and/or a recurrence was observed in 5 out of 7 patients. From our experience and the review of literature (around 130 cases), Cushing's disease is more serious in children than in adult. We suggest therapeutic management with transsphenoidal surgery as the treatment of choice. Given the frequency of recurrence (13 à 54%) often late (9-12 years), we stress the need of regular and extended postoperative follow-up.

The effects of glibenclamide on serum lipids and lipoproteins in type II non-insulin dependent diabetes mellitus

OBJECTIVE

To examine the effects of glibenclamide treatment on plasma lipids and lipoprotein levels.

SETTINGS

Out patients of Type II diabetics from department of Baqai Diabetes and Endocrine Centre and two other diabetic clinics of Karachi.

METHODS

The effects of glibenclamide on blood glucose and various aspects of lipoproteins has been studied in 26 (14 male, 12 female) Type II Diapetes patients before and after 12 weeks of glibenclamide therapy. Treatment was initiated with 5 mg oral glibenclamide with diet control. The initial dosage of glibenclamide was 5 mg/day taken half an hour before meal; this was increased to 5 mg per week and was adjusted according to the patient's tolerance to the drug and their glycemic control.

RESULTS

The results demonstrated that fasting blood glucose declined from 221.53 + 7.84 to 165.02 + 5.12 mg/dl, (P < 0.001). There was a statistically significant increase in the plasma high-density lipoprotein cholesterol from 33.60 + 1.00 to 37.07 + 1.05 mg/dl, (P << 0.05). Total cholesterol, triglycerides, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol did not change significantly.

CONCLUSION

Improved glycaemic control in patients treated with glibenclamide with Type II Diabetes was achieved which lead to changes in lipoprotein metabolism. There was no evidence of changes in lipoproteins in directions associated with an increased risk for atherosclerosis.

[Tentorial meningioma. Surgical experience with 20 cases]

We report our experience and long-term results of twenty patients with tentorial meningiomas who underwent surgical removal between 1987 and 1996. Computed tomography, angiography and magnetic resonance imaging were used as diagnostic tools for planning the surgical procedure. The tumor site was posterolateral in 6 cases (30%), posteromedial in 4 cases (20%), in the tentorium itself in 4 cases (20%), anterolateral in 3 cases (15%), at the apex of tentorial incisura in 2 cases (10%) and at the free border of the tentorial notch in 1 case (5%). Neuroradiologically, 70% of the meningiomas ranged from 1 to 3 cm. Lateral and medial tumors with solely or mainly supratentorial development were approached from above. The approach from below was selected for meningiomas with subtentorial involvement only. In meningiomas with both supra and subtentorial growth, a supratentorial bone flap was combined with a suboccipital craniectomy using a retromastoid incision. Radical surgical removal (Simpson's grade I and II) was achieved in 80% of the cases. There was no mortality. The follow-up averaged 4 years and revealed that 65% of patients were able to return to their premorbid activity. Complications were mainly postoperative brain oedema, functional deficits, seizures and psychological disorders. Recurrence rate amounted at 6.25% in the group where the tumors were totally removed (16 cases). From this retrospective study, the statistically significant prediction of a good outcome was: duration of symptoms from onset to the operation inferior or equal to 1 year (p < 0.01), good preoperative neurological conditions (Karnofsky scale from 80 to 100) (p < 0.05) and tumor size inferior or equal to 3 cm (p < 0.002).

Radiation-induced optic neuropathy 4 years after radiation: report of a case followed up with MRI

We report a case of radiation-induced optic neuropathy in a 32-year-old man with Cushing's disease and a recurrent tumour of the left cavernous sinus. The patient experienced rapid, painless loss of vision 4 years after treatment without recurrence of tumour or other visual disorder. MRI showed enlargement and contrast enhancement of the optic chiasm. A year later the patient was almost blind and MRI showed atrophy and persistent contrast enhancement of the chiasm.

[Clinical assessment of dysarthria: presentation and validation of a method]

We adapted in French the Frenchay Dysarthria Assessment (FDA) developed by P. Enderby in 1983. This tool quantitatively evaluates the organs involved in speech and provides a measurement of intelligibility. Productions of normal subjects were analyzed. Reproductibility of data (correlation and interobserver concordance) was high in 18 dysarthric patients. A study performed in 100 dysarthric patients corresponding to 4 types of dysarthria (spastic, ataxic, hypokinetic and mixte) showed that dysarthria resulted from a global impairment of organs implied in speech, rather than one specific organ. The reduction in the intelligibility score was related to organ impairment.

[Surgical approaches to the corpus callosum]

There are no dedicated approaches to the corps callosum itself. The different approaches, subcallosal, supracallosal and posterior to the splenium are usually used to reach neighboring structures such as third ventricle or pericallosal arteries. MRI is the best guideline to reach a specific position in the corps callosum and must imperatively contribute to the choice of the type of approach. During the procedure, it is necessary to take great care to protect the vessels, arteries and veins especially, to avoid ischemic damage which is the main complication of these approaches.

Microanatomy of the hypophyseal fossa boundaries

OBJECT

The authors studied the heads of 17 adult cadavers and one fetus to clarify the anatomy of the sellar region, particularly the lateral boundaries of the hypophyseal fossa.

METHODS

Vascular injections and microdissection or histological techniques were used in this study. The roof of the cavernous sinuses and diaphragma sellae were part of a single horizontal dural layer that joined the two anterior petroclinoid folds. Laterally, the direction of this layer changed; it became the lateral wall of the cavernous sinus and joined the dura mater of the middle cerebral fossa. On the midline, this layer ballooned toward the sella through the diaphragmatic foramina, created a dural bag containing the hypophysis, and attached to the inferior aspect of the diaphragma sellae. As a consequence, no straight sagittal dural wall existed between the pituitary gland and cavernous sinus; the lateral border of the hypophyseal fossa was part of this anteroposterior and superoinferior convex bag. The authors stress the importance of the venous elements of the region and discuss the structure of the cavernous and coronary sinuses.

CONCLUSIONS

Invasion of the cavernous sinus makes surgery more risky and difficult and may necessitate modification of the surgical treatment plan. The preoperative diagnosis of cavernous sinus invasion is thus of great interest, but the possibility of normal lateral expansions of the pituitary gland must be kept in mind. A lateral expansion of this gland into the cavernous sinus was encountered in 29% of the specimens, and an adenoma that developed in such an expansion could easily mimic cavernous sinus invasion.

Primary spinal melanoma: case report

We report a case of primary melanoma of the thoracic spinal cord revealed by progressive bilateral lower extremity weakness associated with sensory loss and urinary dysfunction. The preoperative MRI revealed an intramedullary tumour from T7 to T9. Treatment was by complete surgical excision without radiotherapy. Histopathology and immuno-histochemical studies confirmed the diagnosis. The postoperative course was satisfactory with no sign of recurrence after 28 months of postsurgical follow-up. Primary spinal melanomas are rare intramedullary tumours that can be cured by appropriate surgical treatment.

[MRI diagnosis of sinus cavernous invasion by pituitary adenomas]

PURPOSE

To evaluate the preoperative MRI criteria of a sinus cavernous invasion by a pituitary adenoma.

MATERIAL AND METHODS

Study of 102 cavernous sinuses among 51 patients who had had a surgical cure of pituitary adenoma. Thirteen patients had a surgical invasion of the cavernous sinus.

RESULTS

A certain number of signs eliminated cavernous sinus invasion. The best means consisted in not crossing the intercarotid line (Sensitivity-Se = 100%, Specificity-Sp = 85% and Negative Predictive Value-NPV = 100%). The others means implied: not going past twelve o'clock on the internal carotid artery-ICA (NPV = 97.1%), symmetrical size of the cavernous sinus (NPV = 92.5%), non-convexity of the lateral wall (NPV = 90.2%), visualization of at least two venous groups of the laterosellar space (NPV = 90.2%) and finally, non-displacement of the ICA (NPV = 89.2%). The best criteria for diagnosis were passing by the intra and supracavernous ICA lateral tangent (Se = 84.6%, Sp = 95%) and the percentage of ICA encasement by the adenoma exceeding 25% (Se = 92.3%, Sp = 85%).

CONCLUSION

Except the total encasement of the intracavernous ICA, the cavernous sinus can be invaded when the lateral tangent of the supra and the intracavernous ICA is crossed, and also when the percentage of ICA encasement exceeds 25%.

Experimental antitumour activity of S 16020-2 in a panel of human tumours

The antitumour activity of S 16020-2, a new topoisomerase II inhibitor, was evaluated in comparison with doxorubicin against 13 human tumours, including colon (HT-29, Colo320DM), breast (MCF7, MDAMB-231), ovary (SK-OV-3, A2780, NIH:OVCAR-3), non-small cell lung (NCI-H460, A549, Calu-6, NCI-H125) and small-cell lung (NCI-H69, SCLC6) cancers. S 16020-2 was administered weekly intravenous within a dose range of 20-90 mg/kg for 3 weeks. Antitumour responses were obtained in all the tumour types tested except in the two colon cancers. S 16020-2 produced significant growth delays in nine tumour models and induced regressions of all A549 lung tumours. The antitumour activity of S 16020-2 was superior to that of doxorubicin against the NCI-H460, A549, NCI-H69, SCLC6 and NIH:OVCAR-3 xenografts. These results demonstrate the broad spectrum of antitumour activity of S 16020-2 in a large panel of in vivo experimental models and confirm its interest as a potential agent in the treatment of malignant disease.

Eriochrome Black T, structurally related to suramin, inhibits angiogenesis and tumor growth in vivo

The polyanionic species suramin is a potential anti-cancer agent of narrow therapeutic index. Among other pharmacological characteristics, suramin is an inhibitor of angiogenesis. We have targeted its angiostatic properties as part of a program to discover less toxic analogs. From screening a series of commercially available compounds, structurally related to suramin and containing a sulfonic acid substituted naphthylamine moiety, we discovered a new lead, Eriochrome Black T (EBT). EBT is a novel inhibitor of angiogenesis, more potent and less toxic than suramin in the chick chorioallantoic membrane assay. EBT was more active than suramin in inhibiting endothelial cell proliferation in primary culture and in inhibiting proliferation of three tumor cell lines, A431, L1210 and M5076 (IC50 10-100 microM). Cell cycle studies on the A431 line showed that both EBT and suramin caused an accumulation of cells in the S phase, EBT being 10-fold more potent. We suggest that this cell cycle perturbation is linked to inhibition of topoisomerase II catalytic activity. EBT was found to be a moderate but significant inhibitor of matrix metalloproteinases (10 microM range), more efficient than suramin. In a s.c. M5076 sarcoma model in mice, EBT had similar efficacy to suramin both by the i.p. or s.c. route and was moreover better tolerated. Combined pharmacological results show that EBT compared favorably with suramin in all assays, and that in ovo and in vivo, EBT is an analog of suramin with diminished toxicity.

Antitumor activity of S 16020-2 in two orthotopic models of lung cancer

S 16020-2, a new olivacine derivative selected on the basis of its cytotoxicity in vitro and antitumor activity in vivo, was evaluated against the human A549 and the murine Lewis lung tumor models implanted s.c. and i.v. Against Lewis lung carcinoma implanted s.c., S 16020-2 was found to be curative, with an activity and therapeutic index (Ti = 4) similar to that of cyclophosphamide. S 16020-2 administered weekly demonstrated a high therapeutic efficacy against A549 non-small cell lung carcinoma implanted s.c. in nude mice and induced tumor regression at 80 mg/kg. When A549 tumor cells were injected i.v. in SCID mice, experimental metastases rapidly developed and the progressive invasion of the lung tissue by tumor preceded the death of animals. In this model, S 16020-2 administered at 40 mg/kg i.v. following an early (days 8, 18 and 28) or delayed (days 20, 30 and 40) treatment schedule prolonged the survival of tumor-bearing mice with T/C values of 150 and 145%, respectively. Against the i.v. Lewis lung carcinoma, S 16020-2 was also highly active since when administered at 60 mg/kg on days 5, 9 and 13 it totally inhibited tumor growth and cured up to 89% of mice. When administered on days 11, 15 and 19 to animals with established tumors, S 16020-2 was still active but not curative. In the presented studies, S 16020-2 antitumor activity was superior to that of adriamycin and comparable or superior to cyclophosphamide (used as reference compounds). Our results demonstrate the efficacy of S 16020-2 against these highly aggressive and chemoresistant tumor models.

[Fetal growth in premature infants in Haute-Normandie]

BACKGROUND

Fetal growth standards of preterm infants are different from one study to another, especially for extremely preterm babies.

POPULATION AND METHODS

Between 1976 and 1990, a cross-sectional study of the resulting intrauterine growth of premature newborns from Haute-Normandie (France) was conducted by collecting data of the compulsory health certificate set up in the first week after birth. In spite of exclusions, curves for obstetrical terms ranging from 28 to 36 weeks of gestational age were settled. Equivalents of 8,042 birth weights, 7,792 statures, 8,041 head circumferences and 6,737 ponderal index were used.

RESULTS

Comparing our results with those published in the literature, we observed short differences for mean or middle values: from less than 170 to more than 180 g for weight, from less than 1 to more than 2.6 cm for stature and from less than 1 to more than 1.9 cm for head circumference.

CONCLUSION

The selected normal lower threshold for each parameter and the varieties of fetal growth inadequacy are under discussion.

In vivo antitumor activity of S 16020-2, a new olivacine derivative

The antitumor activity of S 16020-2, a new olivacine derivative, was investigated in vivo and compared with that of Adriamycin and elliptinium acetate in a panel of murine (P388 leukemia, M5076 sarcoma, Lewis lung carcinoma, and B16 melanoma) and human (NCI-H460 non-small-cell lung and MCF7 breast carcinomas) tumor models. S 16020-2 given i.v. was active against P388 leukemia implanted i.p., s.c., or intracerebrally. The therapeutic effect of an intermittent schedule (administration on days 1, 5, 9) was superior to that of single-dose treatment, allowing the i.v. administration of high total doses of S 16020-2 and resulting in the cure of 60% of mice in the i.p. P388 model. In this model, S 16020-2 was more active than elliptinium acetate and showed a better therapeutic index than Adriamycin: > or = 8 versus 2. A good therapeutic effect of S 16020-2 was also observed in three P388 leukemia sublines displaying the classic multidrug-resistance phenotype, namely, P388/VCR, P388/VCR-20, and P388/MDRC.04, the latter being totally insensitive to vincristine and Adriamycin. However, S 16020-2 was not active against the P388/ADR leukemia, a model highly resistant to adriamycin in vivo. S 16020-2 was both more active than Adriamycin and curative in the M5076 sarcoma and Lewis lung carcinoma implanted s.c. In the B16 melanoma implanted i.p. or s.c., S 16020-2 was less active than Adriamycin. Against the NCI-H460 human tumor xenograft, S 16020-2 demonstrated activity superior to that of Adriamycin (T/C = 20% versus 43% on day 21). Against the MCF7 breast cancer xenograft, S 16020-2 was active, but less so than Adriamycin (T/C = 23% versus 9% on day 21), whereas elliptinium acetate was marginally active (T/C = 49% on day 24). The hematological toxicity of S 16020-2 given to B6D2F1 mice at pharmacological dose appeared to be less severe than that of Adriamycin, particularly in bone-marrow stem cells. These results demonstrate that S 16020-2 is a highly active antitumor drug in various experimental tumor models and is markedly more efficient than elliptinium acetate. Because of its pharmacological profile, which is globally different from that of Adriamycin, S 16020-2 is considered an interesting candidate for clinical trials.

[Primary intramedullary melanoma. Apropos of a case]

Primary melanoma is a rare spinal tumour first reported by Hirschberg in 1906. Since then, only 34 cases have been reported. When present here a new case of primary intramedullary thoracic melanoma developed in a 64-year old male patient. MRI showed a paramagnetic signal with reactive cysts. Macroscopy and histology confirmed the diagnosis. Spinal cord melanoma is presumed to be primary when no other melanoma is found outside the CNS. The tumour is often located in the middle or lower thoracic cord, may be intra- or extra-medullary and leptomeningeal or extradural. It frequently progresses slowly. MRI is the essential examination as it demonstrates a lesion with paramagnetic properties. Its image is not specific and may correspond to other pigmented tumours (meningeal melanocytoma, melanotic schwannoma), to a lipoma or to a vascular or tumoral haemorrhagic lesion. Treatment is uncertain, but surgery is frequently associated with radiation. Postoperative follow-up aims at detecting a local regrowth of the tumour or leptomeningeal dissemination which affects the prognosis.

Radiation-induced meningioma

We report a case of radiation-induced meningioma that appeared 12 years after the discovery and treatment of a posterior fossa medulloblastoma. The features of the case that support the diagnosis of radiation-induced meningioma are discussed.

Massive osteolysis of the cervical spine. A case report

STUDY DESIGN

This study described the course of a case of massive osteolysis (Gorham's disease) of the cervical spine and discussed the literature data.

OBJECTIVES

To describe a case of massive osteolysis of the cervical spine with fatal outcome and to discuss the classification of the disease among osteolysis and its therapeutic modalities.

SUMMARY OF BACKGROUND DATA

Massive osteolysis is a rare condition (fewer than 100 cases reported in the literature) of unknown etiology, which may involve any bone in the body, with a propensity for the shoulder and pelvic girdle. Few cases of cervical spine involvement were reported.

METHODS

The case of a 32-year-old man with fatal progressive massive osteolysis of the cervical spine despite multiple attempts to achieve surgical stabilization was reported.

RESULTS

Massive osteolysis was characterized by complete destruction of all or part of a bone by angiomatous tissue and may have represented a local disturbance of osteoclastic activity. No successful therapy was proposed, and the prognosis of spine involvement was very poor.

CONCLUSIONS

Massive osteolysis is a rare condition with no successful therapy. The hypothesis of involvement of circulating preosteoclasts in the osteolytic process may suggest treatment attempts with diphosphonates because of the futility of standard bone grafting techniques in spine involvement.

Granular cell tumor of the pituitary stalk. Case report

The case is described of a granular cell tumor of the pituitary stalk in a 40-year-old woman with secondary amenorrhea. A computerized tomography scan showed a large contrast-enhancing mass, and T1-weighted magnetic resonance images demonstrated a tumor isointense to the brain parenchyma with nonhomogeneous enhancement after intravenous administration of gadolinium diethylenetriamine penta-acetic acid. Histopathological examination, especially immunocytochemical and electron microscopic studies, showed elements supporting an astrocytic origin for this type of tumor, a hypothesis advanced by many authors but still controversial.

Fronto-orbital sphenoidal fibrous dysplasia

We report the clinical, radiological, and histological features of an 8-year-old boy with an unusual presentation of fronto-orbital sphenoidal fibrous dysplasia. The various forms of fibrous dysplasia are outlined and the differential diagnosis discussed. An approach to surgical management is proposed.

Postoperative assessment of cerebral blood flow in subarachnoid haemorrhage by means of 99mTc-HMPAO tomography

Regional hypoperfusion is a very frequent complication of subarachnoid haemorrhage (SAH), being related to vasospasm in the majority of cases. Twenty-six patients who were admitted for SAH underwent follow-up with technetium-99m hexamethylpropylene amine oxime single photon emission tomography (SPECT) 3 and 8 days after surgery. Fifteen patients of these had one more examination 15 days after surgery. The degree of hypoperfusion was quantified using an index of asymmetry which allow the comparison of two symmetrical regions of interest (ROIs) on the transaxial slice which presented the greatest perfusion defect. Comparison of CT data, transcranial Doppler data and clinical signs with the perfusion as quantified by 99mTc-HMPAO SPECT indicates that a difference in counts of less than 10% between the two symmetrical ROIs is of no diagnostic value. Follow-up of the brain perfusion clearly shows that the most pronounced hypoperfusion was observed just after surgery, with progressive normalization at 8 and 15 days after surgery. 99mTc-HMPAO SPECT performed 8 days after surgery allows prediction of the clinical outcome. For these reasons, 99mTc-HMPAO SPECT, which is the only method for follow-up of cerebral perfusion in routine clinical practice, should be the first examination to be performed after surgery in patients with SAH.

Effects of glucose starvation on mitochondrial subpopulations in the meristematic and submeristematic regions of maize root

Mitochondria isolated from 3-mm long maize (Zea mays L. var Dea) root tips were found to be heterogeneous on Percoll density gradients. The ultrastructure of these isolated mitochondria correlated well with that of mitochondria observed in situ and was consistent with the existence of mitochondria at different stages of maturation during cell development. The mitochondria of higher density presented an ultrastructure with many cristae and a dense matrix. These mitochondria showed classic respiratory properties, although with low ADP/O ratios. In contrast, the mitochondria of lower density showed few cristae and a clear matrix and did not seem to be fully functional because their rate of respiration was low and showed weak respiratory control. Lower- and higher- density mitochondria were shown to be differentially affected during the first stages of glucose starvation. The higher-density mitochondria from glucose-starved maize root tips retained the ultrastructure and most of the respiratory properties of nonstarved mitochondria, whereas lower- and intermediate-density mitochondria were absent in the mitochondrial preparations from glucose-starved maize root tips and were not observed in situ. Quantitatively, there was a decrease of the total mitochondrial pool when expressed as the amount of mitochondrial protein per root tip. However, this decrease affected low- and intermediate-density mitochondria, but not higher-density mitochondria. Thus, it was shown that a significant pool of functional mitochondria is maintained in maize root tips during the first stages of glucose starvation. The reasons for these apparently selective effects of glucose starvation on mitochondria are discussed in relation to effects on mitotic and differentiation processes.

Multiple cerebral angiomas and Rendu-Osler-Weber disease: case report

A 25-year-old man was hospitalized after suffering a subarachnoid hemorrhage. Arteriograms disclosed two arteriovenous malformations, one of which was asymptomatic. Rendu-Osler-Weber disease was suspected because of the concomitant existence of cutaneous telangiectases. Review of the literature shows that in 12 previously published cases involving multiple arteriovenous malformations, this diagnosis was established five times. The indications for surgical treatment are discussed.

Multiple Cerebral Angiomas and Rendu-Osler-Weber Disease: Case Report

A 25-year-old man was hospitalized after suffering a subarachnoid hemorrhage. Arteriograms disclosed two arteriovenous malformations, one of which was asymptomatic. Rendu-Osler-Weber disease was suspected because of the concomitant existence of cutaneous telangiectases, Review of the literature shows that in 12 previously published cases involving multiple arteriovenous malformations, this diagnosis was established five times. The indications for surgical treatment are discussed.

Hydrocephalus and cavernoma of the cauda equina

The association of a tumor of the cauda equina and hydrocephalus is unusual. We report a case of hydrocephalus with normal pressure associated with an equally rare affliction, a cavernous angioma of the cauda equina, which regressed after surgical ablation. The physiological mechanism involved is discussed.

Hydrocephalus and Cavernoma of the Cauda Equina

The association of a tumor of the cauda equina and hydrocephalus is unusual. We report a case of hydrocephalus with normal pressure associated with an equally rare affliction, a cavernous angioma of the cauda equina, which regressed after surgical ablation. The physiological mechanism involved is discussed.

[Does nimodipine improve the outcome of perioperative complications of aneurysm rupture? Results of systematic treatment]

Morbidity after aneurysmal subarachnoid hemorrhages is proceeding from many factors; ischemic etiology is underestimated and frequently thought to be vasospasm related only. Other undoubted mechanisms are in the setting of ischemic disorders after ruptured aneurysms. The management of these disorders is relevant of new calcium blockers. Early administration of prophylactically oral nimodipine, with temporary intravenous administration of the therapy after surgery or in the setting of delayed ischemic deterioration, were assigned to 36 patients with aneurysm surgery. Efficacy was judged on prevention and outcome of ischemic disorders at discharge and three months later using the Glasgow Outcome Scale. On all, twenty-nine patients were disabled from any etiology; twenty made full or improved recoveries at discharge; twenty-eight get independent conditions of life at 3 months. Fourteen patients have return to their pre-rupture activity. Twenty-two surgical patients (61%) set an undoubtly ischemic disability during any time of their hospitalization, but many etiologies were identified in majority of cases. Spasm is the main factor of stroke in only 6 patients, and one of the ischemic factors in 15 cases. Among these ischemic deteriorations, twenty improved or made full recovery at discharge and get independent life at 3 months. No death with spasm. These data support the assumption that vasodilatating is not the only mode of nimodipine action. Hypervolemia must be adjunct with nimodipine to prevent regional hypoperfusion.