Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime

Immunohistochemical localization of c-mos at the light and electron microscope level in non-small cell lung carcinomas

C-mos is a cytoplasmic upstream activator of the mitogen-activating protein kinase pathway with serine-threonine kinase activity. It plays a well established and vital role in oocyte maturation by participating in metaphase II arrest and meiotic asymmetric division, but little is known about its function in somatic cells. Recently, we observed overexpressed c-mos in a portion of non-small cell lung carcinomas (NSCLCS). In particular, c-mos immunoreactivity was detected in tumor cell nuclei in addition to its expected cytoplasmic localization, and c-mos overexpression was associated with chromosomal instability among other findings. To verify our earlier observations and to clarify further the role of c-mos in NSCLCS, we examined its distribution by both light and electron microscopy. We detected c-mos in the cytoplasm and/or nucleus of a portion of tumor cells and fibroblasts. In particular, granular immunoreactivity was observed in the cytoplasm closely associated with the rough endoplasmic reticulum. Nuclear staining was confirmed and was often found near the nuclear membrane, as well as in some large multilobular, possibly aneuploid, nuclei. C-mos positivity was also found in the nuclei of tumor cells undergoing apoptosis. Furthermore, c-mos was detected in areas with diminished vascularization. It should be noted that nuclear staining was found at the ultrastructural level more extensively than at the light microscope study. This suggests a masking effect by the hematoxylin nuclear counterstain

Chemotherapy of non small cell lung cancer. A prospectively randomized study of cisplatin-etoposide versus cisplatin-mitomycin-vinblastine

Based on preclinical studies showing synergism between cisplatin and etoposide, we randomized patients with non small cell lung cancer (NSCLC) to receive either the above combination (cisplatin 100mg/m(2) day 1, etoposide 130mg/m(2) days 1-3) or the combination of cisplatin-mitomycin-e and vinca drugs (MVP) (cisplatin 100mg/m(2), vinblastine 6mg/m(2), mitomycin 10mg/m(2) day 1), a regimen with a steady response rate. Partial responses were achieved in 12/44 (27%) of the cisplatin-etoposide group and in 11/43 (26%) of the MVR group. No difference in median survival could be demonstrated between the two groups (36 weeks versus 38 weeks). Myelotoxicity and alopecia were more severe in the cisplatin-etoposide group. Compared to international experience both regimens exhibited a relatively low response rate. It seems that for NSCLC new agents are required

PURE RED-CELL APLASIA ASSOCIATED WITH TRUE THYMIC HYPERPLASIA

Pure red cell aplasia was diagnosed in a 35-year-old otherwise healthy woman. Chest computed tomography (CT)-imaging investigation, detected an upper mediastinal mass corresponding to the thymus gland. A thoracotomy was performed and an enlarged thymus mass was removed, rapidly followed by a full hematologic recovery. Thymic histology confirmed a significant degree of hyperplasia. We conclude that not only thymomas but also other types of thymic pathology may be associated with this type of hematologic dyscrasia. Copyright (C) W.B. Saunders Compan

Prognostic factors in thymic epithelial tumors undergoing complete resection

Background. The prognostic factors in thymic epithelial tumors (TET) are investigated within a 27-year period in 104 patients submitted to surgical and pathologic complete resection of TET with a mean age of 53 +/- 14.6 years and a male to female ratio of 0.73. Methods. The medical records of all patients were reviewed and six variables that could affect the short-term and long-term survival were entered into a Cox regression model. Follow-up was obtained from medical records and telephone contacts up to September 2004 or until the patient’s death. Results. Overall 5-year and 10-year survival was 83% and 78%, respectively. Univariate Cox regression analysis showed that long survival was affected by the age of the patient at the time of operation, the response of myasthenia gravis to the operation, the tumor recurrence, the histologic type according to the World Health Organization (WHO) classification, and the Masaoka stage. Multivariate analysis revealed that recurrence of the tumor (P = 0.001), Nlasaoka stages II or III (p < 0.001), elder age of the patient at the time of operation (p = 0.045), and presence of the WHO histologic types B2 or B3 (p = 0.05) were bad prognostic factors. Conclusions. Recurrence of the tumor, the Masaoka staging, the WHO histologic type, and the age of the patient at the time of operation were the most important prognosticators for patients with TET submitted to complete resection of their tumor