No abstract

The pedunculopontine nucleus is part of the reticular ascending arousal system and is involved in locomotion and sleep. Two patients with Parkinson disease received electrodes that stimulated the pedunculopontine nucleus area to alleviate their severe gait impairment. Instead, we found that low‐frequency stimulation of the pedunculopontine nucleus area increased alertness, whereas high‐frequency stimulation induced non‐rapid eye movement sleep. In addition, the sudden withdrawal of the low‐frequency stimulation was consistently followed by rapid eye movement sleep episodes in 1 patient. These data have the potential to benefit patients who suffer from sleep disorders. ANN NEUROL 2010;67:546–549

The objective of this study is to assess the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the diagnosis and staging of colorectal cancer. The study includes patients who underwent EUS-FNA at our institution for staging of colorectal carcinoma or for evaluation peri-rectal masses or distal metastases from August 2000 to November 2010. We assessed the frequency with which EUS-FNA procedure confirms the diagnosis of malignancy and the percent of cases in which it modifies staging of colorectal carcinoma. Using histology as a reference standard, we also assessed the diagnostic performance. We identified 79 cases of EUS-FNA from 77 patients, mean (SD) age of 60 (12.5), 44 males. Twenty-seven (34%) aspirates were from patients with primary rectal/peri-rectal masses, 15 (19%) were from patients with suspected regional lymph node metastasis, and 37 (47%) were cases of suspected of distal metastasis. All lesions were clinically suspicious for primary or metastatic colorectal carcinoma. On cytologic examinations, 43 (54%) cases were confirmed as malignant, 6 (8%) were benign neoplasms, 4 (5%) were suspicious for malignant neoplasm, 2 (3%) showed atypical cells, and the rest 24 (30%) were negative for neoplasms. Fourteen of 27 (52%) of the local rectal masses were confirmed as colorectal carcinoma. Eleven of 15 (73%) regional lymph nodes were positive for metastasis-all, but two of these metastases, were of colorectal origin. Twenty of 37(54%) distal lesions were metastatic neoplasms and 15 of those were colorectal in origin. Diagnosis of primary colorectal carcinoma was confirmed in 52% of the clinically suspicious primary lesions and in 42% regional or distal metastatic lesions. Using histology as a reference standard in 27 of 79 (29%) cases, we calculated an overall sensitivity, specificity, and positive and negative predictive values (C.I) of EUS-FNA of 89% (74-100%), 79% (50-100%) 89% (74-100%), and 79% (51-100%). EUS-FNA is useful for assessing primary and metastatic colorectal lesion. This technique improves staging of suspected nodal or distant metastases.

A 69-year-old man sought medical care because of persistent cough. Imaging work up revealed multiple nodules involving both lungs. Fine needle aspiration biopsy (FNA) of the right lower lobe mass was performed and revealed atypical alveolar cells in a lymphoid background. The initial cytologic interpretation was "atypical alveolar cells, probably reactive." The patient underwent wedge resection of the right lower lobe. Intraoperative touch preparation revealed an atypical lymphoid proliferation. Histologic findings revealed multiple nodules of small and medium-sized lymphocytes replacing the lung parenchyma; lymphoepithelial lesions, and type II pneumocytes hyperplasia were also noted. Flow cytometry demonstrated the presence of a monoclonal B-cell population. A diagnosis of bronchial associated lymphoid tissue (BALT) lymphoma was established. The patient was treated with rituximab and was disease free 2 years after initial diagnosis.