We have investigated the role of high-resolution ultrasound (US) in the analysis of sentinel node(s) in melanoma patients in pre-operative staging and follow-up. One hundred and six lymph node basins in 88 melanoma patients undergoing sentinel node biopsy (SNB) were examined: 25 (23.6%) were US positive for metastases and 81 (76.4%) were negative. Subsequent histological analysis of the 81 negative lymph nodes confirmed the absence of metastases in 80 cases (98.8%), whereas, in the 25 US-positive lymph nodes, metastases were found in 16 cases (64%). The follow-up of all patients submitted to SNB in our unit included a US investigation of operated and contralateral nodal basins every 4 months for the first 3 years and then every 6 months. Of a total of 300 patients, four (1.6%) were found to have locoregional nodal disease during follow-up. In three of these four patients, US was crucial in indicating the presence of nodal metastases, which would have gone undetected on physical examination. The result of this study (negative predictive value of 98.7%) introduces the possibility of selecting patients who may avoid an SNB procedure based on the results of pre-operative US examination.
In light of the knowledge accumulated during the past couple of decades, it is apparent that schizophrenia is a complex and heterogeneous disease (Lieberman and Koreen 1993). Even though, classical neuroleptics are clearly useful in the treatment of positive aspect of the disease, they have a limited efficacy on negative symptoms and cognitive deterioration (Meltzer 1991). Conversely, clozapine and the novel antipsychotics have been termed 'atypicals' because they have a lower incidence of extrapyramidal side effects and can be effective in the treatment of negative symptoms (Deutch et al. 1991;Kinon and Lieberman 1996).The molecular basis of these differences has not been clearly established, but could be related to receptor profiles, regional specificity within the CNS and the possibility to produce adaptive changes in specific neurotransmitter systems whose function is altered in schizophrenia (Ellenbroek 1993). Among the others, dopamine, glutamate, and their reciprocal interactions within discrete neuronal circuitry, can be viewed as major players in schizophrenia imbalance (Weinberger 1987;Carlsson and Carlsson 1990;DiChiara et al. 1994). Hyperdopaminergic activity is thought to be relevant for positive symptoms of the disease, whereas alterations in glutamatergic system could explain several features of the disorder including negative symptoms and cognitive dysfunctions (Olney and Farber 1995;Weinberger and Lipska 1995). Hence, on the basis of its functional interaction with dopamine, glutamate and Received September 15, 1998; revised February 15, 1999; accepted February 25, 1999. Recently, a number of different laboratories, including our own, have examined the regulation of glutamate receptors in response to treatment with haloperidol and clozapine (Fitzgerald et al. 1995;Riva et al. 1997;Healy and Meador-Woodruff 1997;Brené et al. 1998). In the present study, we investigated the modulation of the mRNA encoding for NMDA and AMPA glutamate receptor subunits in response to the atypical antipsychotic drug "Seroquel (quetiapine fumarate, quetiapine)" (Goldstein 1996).In order to gain insight in the possible relationships between the changes in glutamate receptor expression and the clinical properties of the drug, we have compared the effects elicited by quetiapine to those observed with haloperidol and clozapine, the prototypes for classical and atypical antipsychotics. MATERIALS AND METHODMale Sprague Dawley rats (Charles River, Calco, Italy) weighing 250-350 g were used throughout the experiments. The animals were maintained under a 12 hr light/12 hr dark cycle with food and water available ad libitum. Animals received daily subcutaneous injections with saline, haloperidol (1 mg/kg), clozapine (30 mg/ kg), or quetiapine (25 mg/kg) for 21 days. Rats were sacrificed by decapitation 6 hr after the last injection. The brain regions were rapidly dissected, frozen in liquid nitrogen, and stored at Ϫ 70 Њ C for further analysis. All animal manipulations have been carried out in accordance with the Guide for...
The purpose of this study was to register the accuracy and reproducibility of the multidetector computed tomography (MDCT) estimate of hypopharyngeal and laryngeal tumor volumes. Eighteen consecutive patients with larynx or hypopharynx squamous cell carcinoma were enrolled in this prospective trial, scheduled for surgery and examined by MDCT. A total of 72 tumor volume measurements were reported by two different operators, one of them in three different sessions, using the sum-of-areas method. The results were compared with the volume calculated by surgical sampling. The mean tumor volume measured by MDCT was 5.7 +/- 9.3 ml (range 0.1-41.6). The mean volume measured from the surgical specimens was 5.6 +/- 8.6 ml (range 0.06-33.6). The level of agreement between histological and MDCT volumes was high, with a slight tendency of MDCT to overestimation, proportional to the size. The analysis of interoperator variability showed a tendency of the more expert operator to make more accurate estimates, but the differences were not significant (P = 0.62, 0.75 and 0.63). The evaluation of the three different sessions of the less expert operator revealed a good repeatability. According to our study, MDCT estimate of tumor volume is an effective, reproducible method. MDCT tends to produce more dispersed results in case of large tumors.
Abbreviations: ( 18 FDG)-PET, 18 fluorodeoxyglucose positron emission tomography; ADC, apparent diffusion coefficient; CT, computed tomography; DWI, diffusion-weighted imaging; PET, positron emission tomography
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