Posterior reversible encephalopathy syndrome induced by pazopanib for renal cell carcinoma

WHAT IS KNOWN AND OBJECTIVE

Posterior reversible encephalopathy syndrome (PRES) can be the result of acute hypertension, eclampsia, renal failure and the use of immunosuppressive or cytotoxic agents. We report a case of PRES as a result of the use of pazopanib, a vascular endothelial growth factor inhibitor used for renal cell carcinoma (RCC).

CASE SUMMARY

A 76-year-old man treated with RCC develops PRES shortly after the initiation of pazopanib.

WHAT IS NEW AND CONCLUSION

There are no known reports of the association between PRES and pazopanib. We postulate that pazopanib can disrupt the normal endothelial function of the brain leading to the development of PRES.

Adopted children's behavior problems: a review of five explanatory models

Although the majority of adopted children are well-adjusted, adopted children evidence proportionately more behavior problems when compared to nonadopted children in both clinic and nonclinic populations. An extensive literature examining behavioral, diagnostic, and demographic characteristics of adopted children has provided several plausible explanations for the high rate of behavior problems among adopted children. In this review, the existing literature is organized into five explanatory models: (a) genetic or "biosocial" factors, (b) pathogenesis of the adoption process, (c) long-term effects of impaired preadoption childrearing, (d) referral bias in adoptive parents, and (e) impaired adoptive parent-adoptee relations. We conclude that evidence for each model is mixed at best. Especially noteworthy is the mixed results for genetic or biosocial studies and the relative absence of studies focused on identifying factors associated with disruptions in the adoptive parent-adoptee relationship. We propose that a psychosocial model to explain the high rate of behavior problems among adopted children is highly plausible and further suggest that it may be time for a new awareness and appreciation for the normative aspects of adoption. An overview of parenting and family characteristics associated with risk factors for antisocial behavior is provided as a guide for future research.

Role of nitric oxide in responses to renin-angiotensin system inhibition in sodium-depleted guinea pig and rat

Previous reports have suggested that NO is an important mediator of the antihypertensive effects of renin-angiotensin system (RAS) inhibition. We examined the effects of the NO synthase inhibitor L-NNA on the hypotensive effects of captopril, the Ang II antagonist EXP 3174, or the renin inhibitor terlakiren. In sodium-depleted guinea pigs (GPs), L-NNA (3 mg/kg) increased MAP by 15-21% for at least 5 hours. L-NNA partially blocked the hypotensive effects of captopril (1 mg/kg, iv), but not those of EXP 3174 (1 mg/kg, iv) or terlakiren (3 mg/kg). In sodium-depleted rats, 10 mg/kg L-NNA (iv) increased MAP by 16-22%, and partially or fully blocked the hypotensive effect of EXP 3174 (1 mg/kg, iv) or captopril (3 mg/kg, iv), respectively. Thus, in contrast to the rat, NO in GPs appears to participate only in the hypotensive action of ACE inhibition and does not appear to be strongly involved in the hypotensive action of AII antagonism or renin inhibition. The involvement of NO in the hypotensive effects of RAS antagonists other than ACE inhibitors may be species-dependent.

Disseminated and cerebral infection due to Nocardia farcinica: diagnosis by blood culture and cure with antibiotics alone

Systemic infections with Nocardia species continue to be a serious threat to immunosuppressed hosts. Diagnosis of these infections can be difficult despite their known tendency for cerebral and subcutaneous involvement. We describe a patient who presented with nonspecific constitutional symptoms and was found to have subcutaneous and cerebral abscesses due to Nocardia farcinica. In addition, a blood culture yielded the organism. The patient responded remarkably to oral therapy; resolution of the cerebral disease was observed on serial magnetic resonance images. We discuss the important clinical features on N. farcinica infection, the rarity of positive blood cultures, and the importance of susceptibility testing of Nocardia species in selecting drug therapy.

Autologous fibrin tissue adhesive for ossicular reconstruction in cats

Autologous fibrin tissue adhesive is currently the most promising adhesive for otologic use with respect to strength and biocompatibility without the risk of transmissable disease that is of concern with the commercially prepared fibrin adhesive. We set out to evaluate the practicality of preparing autologous fibrin adhesive in cats and to see if the adhesive's duration and strength of bonding was sufficient to allow natural tissue union to occur with various grafting materials. Autologous fibrin adhesive was prepared preoperatively from ten cats using the ammonium sulfate precipitation technique. Twenty otologic procedures were performed in which the incus long process was resected and the defect bridged with one of four grafting materials: autograft ossicular bone, bone pate-fibrin glue, porous hydroxylapatite, and Plastipore-bone pate. All grafts were secured with the autologous adhesive. The cats were sacrificed at 6 and 12 weeks. We found the the autologous adhesive provided adequate duration and strength of support to enable a firm tissue union between all the grafting materials and the adjoining incus and stapes.

Interobserver variability in the interpretation of fine-needle aspiration biopsy of head and neck masses

Fine-needle aspiration biopsy is gaining acceptance as a clinically useful tool. We set out to evaluate the accuracy of fine-needle aspiration biopsy at our institution by measuring the interobserver variability in cytopathologic interpretation, and by measuring the agreement between cytopathologic and histologic diagnosis. In a prospective study, 253 aspirations were performed on head and neck masses by the otolaryngology service. Specimens were interpreted independently by two cytopathologists (V.J.S. and P.Z.), and interpretations were compared with the surgical histopathologic diagnosis when available. The interobserver variability between cytopathologists was 8% with a specificity of 96% and a sensitivity of 97%. We conclude that fine-needle aspiration biopsy is a safe and useful tool in the diagnosis of head and neck masses. In the diagnosis of epithelial cysts and squamous epithelial malignancies, fine-needle aspiration biopsy is as accurate as open biopsy.

Magnet extraction of frontal sinus foreign body

We report a metallic foreign body that entered through the anterior table of the frontal sinus, and rolled down to lodge in the nasofrontal duct. An electromagnet was used to remove the foreign body through a trephination.

Pleomorphic adenoma of the middle ear and mastoid with posterior fossa extension

We describe the case of a pleomorphic adenoma of the middle ear and mastoid, with extension into the posterior cranial fossa. The lesion was characterized by extensive bony destruction and close proximity to the facial nerve. Ectopic or choristomatous salivary gland tissue within the middle ear cleft is the most probable origin of this tumor.