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Cerebrovasc Dis. 2002;13(4):285-7.
Centenarian stroke treated with tissue-type plasminogen activator.

Gorman MJ, Tanne D, Lewandowski CA.

Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA. mgormaoose.med.wayne.edu

BACKGROUND: Elderly patients with acute ischemic stroke often do worse than younger counterparts independent of thrombolytic therapy. Further, tissue-type plasminogen activator, (t-PA) is frequently withheld from the very old. This may be the result of comorbid conditions prohibiting its use or possibly the fear of causing more harm than good. We present a case of a 100-year-old woman who was treated with t-PA for acute ischemic stroke with rapid resolution of symptoms. CASE DESCRIPTION: A 100-year-old woman presented to the emergency department with slurred speech, right hemiparesis and right hemisensory loss. Computed tomography revealed neither hemorrhage nor early ischemic changes. Intravenous t-PA was administered at 0.9 mg/kg 3 min prior to the 3-hour limit. She improved rapidly (NIHSS from 12 on admission to 4 at 1 month) and was discharged to the care of her family after 4 hospital days. CONCLUSION: Intravenous thrombolysis may be beneficial in the very elderly and should be considered in any eligible elderly patients with acute ischemic stroke, with a risk/benefit analysis individualized to each case. 2002 S. Karger AG, Basel


Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12011555&dopt=Abstract hemorrhage



Cancer Immunol Immunother. 2002 Jun;51(4):179-89. Epub 2002 Apr 04.
Irradiated tumor cell vaccine for treatment of an established glioma. I. Successful treatment with combined radiotherapy and cellular vaccination.

Graf MR, Prins RM, Hawkins WT, Merchant RE.

Department of Anatomy and Division of Neurosurgery, Virginia Commonwealth University/Medical College of Virginia, 1101 E. Marshall Street, P.O. Box 980709, Richmond, VA 23198-0709, USA. mgrasc.vcu.edu

Rats bearing a 5-day intracranial (i.c.) syngeneic glioma were treated with a subcutaneous (s.c.) vaccination consisting of irradiated glioma cells or a multimodality approach composed of radiotherapy plus s.c. vaccination. Vaccination of rats harboring a T9 glioma with 5 x 10(6) irradiated T9.F glioma cells (a clone derived from the T9 glioblastoma cell line) resulted in a marked enhancement of i.c. glioma growth and a significant decrease in survival. Histopathology of the tumors from vaccinated rats revealed a massive glioma composed of healthy tumor tissue lacking any marked inflammation, edema or hemorrhage. Analysis of the tumor-infiltrating mononuclear cells indicated that gliomas from vaccinated rats contained a 10-fold greater lymphoid infiltrate per milligram of tumor as compared to tumors from non-vaccinated rats, suggesting that the vaccination had induced immune cells to localize to the i.c. glioma. Combined treatment consisting of 15 Gy of whole head irradiation of the 5-day glioma followed by vaccination with T9.F cells resulted in a significant increase in survival compared to that of non-treated rats, 45% of which remained tumor-free. Microscopic evaluation in survivors of the tumor implantation site revealed the presence of hemosiderin-laden macrophages and other mononuclear cells, with the absence of tumor cells within the residual lesion. When survivors were challenged s.c. with viable T9.F glioma cells, a delayed-type hypersensitivity (DTH) reaction appeared at the challenge site. T cells purified from these rats proliferated and secreted Th(1)-associated cytokines when stimulated with irradiated T9.F glioma cells, and lysed T9.F target cells. In contrast, when these rats were challenged s.c. with the unrelated MadB106 adenocarcinoma, tumor formation was observed. These findings indicate that the treatment of an established i.c. glioma with a cellular vaccination alone may induce enhanced tumor growth; however, when the vaccination is combined with radiation therapy, the results are beneficial in terms of increased survival time or complete remission that is accompanied by the development of tumor-specific cellular immunity.


Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12012105&dopt=Abstract hemorrhage



Neuroradiology. 2002 May;44(5):407-10. Epub 2002 Apr 04.
Gender-related differences in prolactin secretion in pituitary prolactinomas.

Nishioka H, Haraoka J, Akada K, Azuma S.

Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Japan. nishiokokyo-med.ac.jp

In pituitary prolactinomas, serum prolactin (PRL) levels usually parallel the tumor size. We conducted a retrospective study to determine differences in PRL production between men and women with prolactinomas. A total of 51 patients, 16 men and 35 women, was studied. We investigated clinical, endocrinological, radiological and histological findings, and estimated the tumor volume (TV) by high-resolution magnetic resonance imaging (MRI). Correlation between PRL level and TV was low in men (R=0.458), in contrast to women (R=0.953), c. Men with prolactinomas showed predominance of large tumors (P=0.0009) with high PRL levels (P=0.0009) and had greater tendencies for cyst formation (P=0.0047). Large prolactinomas tended to be accompanied by cyst(s) (P=0.0051) and hemorrhage ( P=0.0015), both of which were associated with reduced PRL secretion (P=0.0004 and P<0.0001, respectively). When the volume of the cysts and hemorrhage was subtracted from the total TV, correlation between PRL level and TV became greater (R=0.905) with no gender difference. Histological examination demonstrated a sparsely granulated type of lactotroph adenoma with occasional fibrosis, particularly in tumors with hemorrhage and cysts. Although a significant discrepancy between PRL level and TV may exist in prolactinomas when intratumoral hemorrhage and/or cysts are present, there is no essential difference in PRL secretion between the sexes.


Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12012125&dopt=Abstract hemorrhage



J Perinat Med. 2002;30(2):176-8.
HPA-1 carrier status and thrombocytopenia in preterm infants with a birth weight below 1500 grams.

Gopel W, Fehlau K, Kohl M, Schultz C, Moller J.

Department of Pediatrics, University of Lubeck, Germany. goepeaedia.ukl.mu-luebeck.de

OBJECTIVE: In cohorts of infants with proven neonatal alloimmune thrombocytopenia (NAIT) an unusual high rate of preterm infants has been reported, raising the question of whether NAIT contributes to the high rate of intracranial hemorrhage in preterm infants. METHODS: We genotyped the HPA-1-allele in a large cohort of term (n = 205) and very low birth weight infants (VLBW-infants, n = 299) with polymerase-chain-reaction and restriction enzyme digestion. RESULTS: HPA-1a/b is the only fetal HPA-1-genotype in which alloimmunization and NAIT could occur. Genotype distribution did not differ between term and VLBW-infants (p = 0.26). Furthermore, neither HPA-1a/b genotype nor platelet count at birth were of significant prognostic value in predicting subsequent intracranial haemorrhage or death in VLBW-infants (p = 0.93 and p = 0.19 respectively). CONCLUSION: Our data did not support the hypothesis that routine screening of preterm infants or their mothers for HPA-1-genotype is of additional value in the care of these infants.


Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12012640&dopt=Abstract hemorrhage



J Reprod Med. 2002 Apr;47(4):332-4.
Multiple-dose methotrexate for pregnancy in a cesarean section scar. A case report.

Lam PM, Lo KW.

Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. lampomuuhk.edu.hk

BACKGROUND: Pregnancy developing in a cesarean section scar is a very rare but possibly life-threatening condition because of the risk of rupture and excessive hemorrhage. CASE: A woman with previous cesarean section had transvaginal sonography performed at 7 weeks of gestation that showed a gestational sac implanted in the anterior isthmus wall of the uterus with 3 mm of myometrium between the sac and bladder wall. A diagnosis of pregnancy in the cesarean section scar was made. The patient was asymptomatic, and her hemodynamic condition was stable. Two courses of multiple-dose systemic methotrexate-folinic acid (1 mg/kg methotrexate intramuscularly on days 1, 3, 5 and 7 with 0.1 mg/kg folinic acid intramuscularly on days 2, 4, 6 and 8) were given. The patient tolerated it and remained stable during treatment. The serum hCG dropped to < 5 IU/L on day 56. CONCLUSION: Treatment with methotrexate is a non-surgical option that can improve preservation of the uterus in patients who desire fertility. A multiple-dose regimen causes rapid interruption of the pregnancy. This is very important because the risk of rupture and hemorrhage directly correlates with the duration of the pregnancy.


Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12012889&dopt=Abstract hemorrhage







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