The morphogenesis of melanotic lesions

A controlled trial of the relative efficacies of procaine penicillin G and pivampicillin for single dose treatment of uncomplicated gonorrhea in female was performed. Confirmation of the disease was obtained by bacteriological isolation of Neisseria gonorrhea from uretral, cervical or rectal exudates inoculated in suitable media. Based upon their previous experience, the authors used probenecid, along with both antibiotics, as a way of increasing the effectiveness of these drugs. Twentynine patients received probenecid 1 g. followed by oral pivampicillin, in a single dose of 1,4 g. Therapeutical results were evaluated in twenty-four, with clinical and bacteriological cure of eighteen. The other group included fifty-two patients treated with probenecid 1 g. followed by a single intramuscular dose of 3.000.000 U. of procaine penicillin G. The therapeutical results in the last group were evaluated in forty patients, with clinical and bacteriological cure of thirty-three. According to the above mentioned results procaine penicillin G seems to offer a slightly superior probability of cure.     

Gastric schwannoma

A rare case of gastric schwannoma is reported. A 36-year-old woman whose endoscopy showed a mucosa tumor, biopsy findings were suggestive for leiomyoma. Diagnosis was made only with postoperative histology that revealed the benign schwannoma. Immunohistochemical staining showed positivity for S-100 protein and the neuron specific enolase, schwannoma is often associated with Von Recklinghausen's disease. Surgical resection is recommended as their malignant potentiality. Gastric and small intestine localizations are often with bleeding. They also represent almost the 24% of all gastrointestinal stromal tumors (GIST) and the 4% of all primary retroperitoneal tumors.     

Unattached intracranial extra-axial schwannoma

We describe an intracranial extra-axial petroclival schwannoma which did not arise from any cranial nerve, nor was it attached to brain parenchyma or dura. The possible pathogenesis is discussed.     

Verocay body--prominent cutaneous schwannoma

The purpose of the present study was (1) to examine smear layer formation following different root planing modalities, and (2) to evaluate its removal and the exposure of collagen using an ethylenediaminetetraacetic acid gel preparation. Twenty-four periodontitis-affected human teeth were mechanically root planed. Twelve teeth were etched with an ethylenediaminetetraacetic acid gel preparation. The surfaces were examined by a scanning electron microscope. The results showed that root planing resulted in a smear layer covering the root surfaces, irrespective of treatment modality. The smear layer could be efficiently removed with the ethylenediaminetetraacetic acid gel preparation. During this process, collagen fibers were exposed to varying degrees.     

Dumbbell-shaped jugular foramen schwannoma

The authors present a case of dumbbell-shaped schwannoma arising from the vagus nerve. A 40-year-old woman was admitted with a 3-month history of hearing loss on the left ear without vertigo. Neuro-otological examinations revealed retrocochlear deafness with abnormal left vestibular function. Magnetic resonance imaging revealed a dumbbell-shaped tumor of the jugular foramen. The tumor was removed through a cervical-transmastoid approach using Cavitoron ultrasonic surgical aspiration. Two months after the operation, the patient's hearing loss had improved, although she still had some aspiration of saliva and hoarseness.     

Intrapelvic malignant schwannoma resected transsacrally

Chlorzoxazone (Parafon forte) overdose is rarely reported despite widespread use of this drug. This report describes a case of two episodes of chlorzoxazone overdose and coma in the same patient. Intubation and mechanical ventilation were required on the first presentation. Following the second overdose, intubation was averted and drug effects were reversed by use of the benzodiazepine antagonist, flumazenil. Although chlorzoxazone is not classified as a benzodiazepine, it may interact with benzodiazepine receptors, thus making flumazenil potentially useful in overdose states.     

Malignant schwannoma of the parapharyngeal space

We present a case of malignant schwannoma (MS) of the parapharyngeal space which completely encircled the internal carotid artery in close proximity to the skull base and required resection of the internal carotid artery along with the excision of the tumour. There have been three previous case reports in the literature of malignant schwannoma of the parapharyngeal space of which one case was associated with neurofibromatosis. Our patient did not exhibit any feature of neurofibromatosis.     

Gastric malignant schwannoma in a child

Malignant schwannoma (malignant peripheral nerve sheath tumour, MPNST) is a high grade sarcoma with a potential for local recurrence and distant metastasis that may occur at any site in the body where there is neural tissue. MPNST is rare in children and is unreported in the stomach in the paediatric age group. MPNST presents either as an expanding mass, with or without pain, or in the gastrointestinal tract with haemorrhage or obstruction. Many cases occur without evidence of neurofibromatosis but thers is a reported association between MPNST and neurofibromatosis of up to 50%. MPNST has a higher incidence at sites of previous irradiation. Treatment is by complete surgical excision. Radiology is of value in initial diagnosis and staging prior to surgery. The definitive diagnosis is made on the histopathological appearance and immunohistochemical profile. The findings on barium meal, abdominal ultrasound and CT are presented.     

Familial occurrence of unilateral vestibular schwannoma

Vestibular schwannoma (VS) may present clinically in one of two forms: sporadic unilateral or hereditary bilateral. Almost all cases of familial transmission have been associated with the diagnosis of neurofibromatosis type II (NF-2). In this report, we describe nine families (18 individuals) presenting with unilateral VS without evidence of NF-2. In four of the nine families, the affected individuals were of parent-offspring relationship, in three families they were cousin-cousin, and in the remaining two families, they were sibling-sibling and aunt-nephew. No other members of the families were diagnosed with NF-2. There was no evidence for gender predilection or genomic imprinting among affected individuals. This study suggests that familial occurrence of unilateral VS may be genetically inherited as it occurs more commonly than would be estimated by chance alone. Future genetic studies will elucidate whether occurrence of unilateral VS in these families represents a variable expression of NF-2, chance occurrence of unilateral VS in families, or a new genetic disorder.     

Photoinactivation of amelanotic and melanotic melanoma cells sensitized by axially substituted Si-naphthalocyanines

The incidence of risk factors for atherosclerosis was investigated in a group of 846 patients under 65 years of age, hospitalized with acute myocardial infarction (AIM) in coronary hospital units in 21 districts of the Czech Republic in 1996. The group of patients comprises 649 men and 197 women. The incidence of risk factors in patients was compared with the incidence of risk factors in the population of the Czech Republic: the mean values of the investigated indicators are in patients with AIM higher in both sexes (total serum cholesterol, triacylglycerols, BMI, WHR). As to anamnestic data, in the majority low or irregular physical activity predominates, a high percentage of patients reported that they "do not restrict" or "rather do not restrict" their total food intake nor the intake of animal fats. Among the patients 52.6% males and 42.1% females were smokers. The results indicate that patients with AIM have a higher incidence of risk factors for atherosclerosis, a higher percentage of patients have cumulated risks and a higher percentage of patients has a higher risk score than the general population. The incidence of AIM is markedly higher in subjects with lower education.     

Malignant schwannoma arising in a paranasal sinus

Bechterew's disease is a chronic-inflammatory condition of the spine, with a tendency toward stiffening and relatively frequent involvement also of the hip, knee and shoulder joints. Contrary to most other rheumatic diseases, drug therapy plays a rather minor role. The focus is on movement, in line with the motto that "Bechterew patients need movement". The sports therapy concept of the Münster University Bechterew group as well as initial experience are set out.     

Ancient schwannoma masquerading as parotid pleomorphic adenoma

BACKGROUND: The relationship between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) has been noted but the relationship is poorly understood. This study reports our experience with laparoscopic fundoplication and its effect on the pulmonary status of children with severe steroid-dependent reactive airway disease. METHODS: Fifty-six patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplications. Mean age was 7 years and mean weight was 20 kg. All patients had the procedure completed successfully laparoscopically with an average operative time of 62 min. Average hospital stay was 1.6 days. RESULTS: Forty-eight of 56 patients noted significant improvement in their respiratory symptoms in the first week. Fifty of 56 patients have been weaned off their oral steroids and four others have had a greater than 50% decrease in their dose. Sixteen patients had a documented increase in their FEV1 in the initial postoperative period (avg. 26%). CONCLUSION: Patients with steroid-dependent RAD and GERD refractory to medical management show improvement in their respiratory status following fundoplication and the majority can be weaned off of their oral steroids. Laparoscopic techniques allow this procedure to be performed safely even in this high-risk group of patients.     

Resection of giant schwannoma by combined surgical exposure

Contrary to the past experience the giant Schwannoma with symptoms of canalis vertebralis compression has been removed by combined surgical exposure in one sitting. Laminectomy, decompression of the canalis vertebralis and immediately subsequent extracanalicular resection of the tumour by retroperitoneal approach was performed in one sitting by two surgical teams. The advantages of the combined surgical exposure: 1. The affliction of the patients caused by the operation significantly decreased. 2. The expenses of the treatment, nursing and hotel decreased as well. 3. The surgical team of different specialists remove the tumour together in both approaches.     

Intraosseous schwannoma of the vault of the skull

Intraosseous schwannoma is a rare benign tumor of the bone with characteristic radiological and histological features. The most common sites of this tumor are mandible, sacrum, und vertebral bodies. Two cases, one of which is the first diagnosed with MRI, of this tumor in the vault of the skull are presented.     

Audit of regional screening guidelines for vestibular schwannoma

PURPOSE: To evaluate the cerebral oxygenation effects of hypotension induced by prostaglandin E1 (PGE1) during fentanyl-oxygen anaesthesia. METHODS: Ten patients who underwent elective cardiac surgery received infusion of PGE1. After measuring the baseline arterial, mixed venous and internal jugular vein blood gases, systemic haemodynamics, and regional cerebral oxygen saturation (rSO2) estimated by INVOS 3100R, PGE1 was continuously infused at 0.25-0.65 microgram.kg-1.min-1 (mean dosage: 410 +/- 41.4 mg.kg-1.min-1) intravenously. Ten, 20 and 30 minutes after the start of drug infusions, blood gases described above were obtained simultaneously with the measurement of systemic haemodynamics and rSO2. Thirty minutes from the start of drug infusions, administration of PGE1 was stopped. The same parameters were measured again 10, 30 minutes after the stop of drug infusion. RESULTS: PGE1 decreased mean arterial pressure (MAP) to approximately 70% of the baseline value (P < 0.05). PGE1 increased mixed venous saturation, but in contrast did not affect internal jugular pressure, internal jugular oxygen saturation and rSO2. CONCLUSIONS: These results suggest that PGE1 is a suitable drug for induced hypotension because flow/metabolism coupling of brain and regional cerebral oxygenation were well maintained during hypotension.     

Intradural extra-arachnoid schwannoma of the upper cervical spine

A very rare case of intradural extra-arachnoid schwannoma involving the upper cervical spine is described. The tumour most likely originated from the extra-subarachnoid angle region, with its unusual pattern of expansion within the spinal canal resulting from such characteristics of the upper cervical region as a relatively wide spinal canal, an extensive ventral subarachnoid space, and membranous ventromedian and lateral anchoring structures which influenced the direction of tumour enlargement.     

Infarcted spinal schwannoma: an unusual MR finding

We present a case of infarcted schwannoma of the thoracic spine in a patient with acute cord compression. MR images did not enhance after contrast administration, which is highly atypical for schwannoma, but was in keeping with the pathologic findings in this case.