Research and the problems of litter and medical wastes on the UK coastline

OBJECTIVE AND IMPORTANCE: Symptomatic cerebral vasospasm can occur after resection of tumors in or adjacent to the basal cisterns, causing delayed neurological deterioration. This potentially treatable condition may go unrecognized. Delay in its recognition will adversely affect the outcome of the patients. There has been a few cases of vasospasm after tumoral resection reported in the literature, mostly in adults. We report a case of vasospasm after resection of a third nerve schwannoma in a pediatric patient. This is the youngest patient reported to date with vasospasm after resection of a brain tumor. CLINICAL PRESENTATION: A six years old girl presented with sudden onset diplopia. Radiological work-up revealed a third nerve mass. She underwent a craniotomy for resection of her mass. Pathological findings were consistent with a third nerve schwannoma. One week postoperatively, her mental status deteriorated. A CT scan revealed a diffuse hypodense area involving the right frontal and temporal lobes in the middle cerebral artery distribution as well as the midbrain. The absence of these findings on the MRI imaging performed on the first postoperative day made us evoke a vascular etiology. A cerebral angiogram was performed and revealed vasospasm in the right internal carotid artery and in the right middle and posterior cerebral arteries. Hyperdynamic hypervolemic hemodilutional therapy was instituted. CONCLUSION: Delayed clinical deterioration from vasospasm is a potentially reversible condition, if recognized early. A high index of suspicion should be maintained in case delayed clinical deterioration occurs after surgery of tumors in the basal cisterns. Cerebral angiography will confirm the diagnosis. Early institution of hyperdynamic hypervolemic hemodilutional therapy and angioplasty may reverse the deficit and improve outcome.     

Acute migratory polyarthritis associated with antibiotic-induced pseudomembraneous colitis

An unusual case of chromophobe adenoma occurring in the third ventricle is reported. Ventriculography revealed a filling defect in the third ventricle and at autopsy the tumour was found in the posterior part of the third ventricle. No tumour was detected in the pituitary gland.     

Eosinophilic granuloma of the proximal tibial epiphysis

This is a 3-year follow-up report of an eosinophilic granuloma of bone occurring in a growing epiphysis. The lesion occurred in a 6-year-old boy and is only the third such case reported in the literature. Eosinophilic granuloma should be considered in the differential diagnosis of lytic lesions of the epiphysis in childhood.     

A plant transformation vector with a minimal T-DNA II. Irregular integration patterns of the T-DNA in the plant genome

Except for villous hypertrophy of the choroid plexus that may not be true tumors, multiple choroid plexus papillomas are extremely rare. The authors report a case involving multiple choroid plexus papillomas that were distinct from villous hypertrophy. These lesions were localized, one in the atrium of the right lateral ventricle and the other in the inferior horn of the left lateral ventricle. A review of the literature revealed that this case represented the first reported case of true multiple choroid plexus papillomas documented by findings on magnetic resonance imaging.     

Nocardia abscess of the choroid plexus: clinical and pathological case report

OBJECTIVE: Cerebral Nocardia abscesses are rare, accounting for approximately 1 to 2% of all cerebral abscesses. Prompt aggressive surgical treatment involving craniotomy and excision of these lesions has been advocated by many authors, because these lesions have significantly higher morbidity and mortality rates than do most other cerebral abscesses. We report an atypical presentation of cerebral nocardiosis localized to the choroid plexus of the lateral ventricle. CLINICAL PRESENTATION: A 56-year-old man presented with a 3-week history of fever, cough, and progressive headache and an ensuing 3-day history of progressive lethargy, confusion, and gait ataxia. Radiographic studies demonstrated a loculated contrast-enhancing left lateral ventricular lesion with significant perilesional parenchymal edema that was thought preoperatively to be a neoplasm. INTERVENTION: The patient underwent a craniotomy for resection of the lesion. Intraoperatively, a reddish gray lesion with purulent exudate was encountered within the left lateral ventricle intimately adherent to the choroid plexus as well as to the ependyma and subependymal veins. A frozen section demonstrated an organizing abscess wall. The lesion was resected in its entirety, and multiple cultures were sent for analysis. CONCLUSION: Microbiology cultures grew Nocardia asteroides. A course of intravenous antibiotics was started, which included trimethoprim-sulfamethoxazole, amikacin, and ceftriaxone. Two weeks after surgery, at the time of discharge, the patient's neurological status had improved considerably. Although Nocardia abscesses have been documented to occur throughout the central nervous system, the presentation of a lesion confined to the choroid plexus of the lateral ventricle with significant parenchymal edema is unusual and demonstrates that Nocardia abscesses must be considered in the differential diagnosis of a contrast-enhancing intraventricular mass lesion involving the choroid plexus.     

Peritoneal benign polycystic mesothelioma

BACKGROUND: Benign multicystic peritoneal mesothelioma (BMPM) is an uncommon condition. CASE REPORT: We observed a typical case of BMPM occurring in a 57-year-old man who presented with a painful mass of the lower right quadrant. The pathology using immunostaining gave the diagnosis. DISCUSSION: The diagnosis of BMPM can be suspected on the basis of imaging findings, but is usually confirmed by pathology. The only treatment for BMPM is surgical resection. Prognosis is good despite frequent recurrences. Two main hypotheses based on etiopathology can be discussed: does BMPM consist of a mesothelioma proliferative and reactional lesion or is it a real mesothelioma tumor?     

Intramedullary brain stem cyst and trapped IV ventricle after infection with Listeria monocytogenes

We present the rare case of a girl surviving intrauterine listeria brain stem meningoencephalitis, who subsequently developed hydrocephalus, a trapped IV ventricle and an intramedullary cyst. Such cases have been reported only infrequently, and in earlier cases modern imaging studies were not available. Magnetic resonance imaging has been helpful in our patient to delineate the lesions and plan further treatment.     

Interactive intraoperative localization during the resection of intraventricular lesions

Mass lesions located in the ventricular system can be surgically challenging. These tumors are often slow growing and reach considerable size before they are diagnosed. These lesions commonly cause multiple obstructions to the circulation of cerebrospinal fluid with subsequent hydrocephalus. They are deeply located in the brain, surrounded by vital neurological and vascular structures, and often have irregular configurations. All these characteristics may pose real problems during surgery in terms of orientation and a optimal resection. For the surgical approach to such intraventricular lesions we are currently using an infrared-based system implemented at Wayne State University that allows intraoperative real-time localization. Three infrared cameras continuously track the position of multiple light-emitting diodes in relation to a predetermined "rigid body". This system can be used with different surgical instruments, and does not interfere with standard neurosurgical techniques. We present our preliminary experience in 18 patients with intraventricular tumors that were operated on between December 1992 and March 1995. Their lesions were located in the lateral ventricles, third ventricle, and pineal region with extension into the posterior aspect of the third ventricle. The use of the interactive infrared-based localizing unit allowed a total resection in 15 cases and a subtotal resection in 3 cases. We report 3 complications, but only one of them was related to the surgical procedure. The postoperative follow-up period ranged from 2 to 24 months. All patients were followed clinically and with postoperative magnetic resonance imaging scans. This interactive infrared system has proven to be a very useful tool, flexible, safe and reliable, increasing surgical efficiency, without a significant increase in the length of resection.     

Weight-bearing effects on skeletal muscle during and after simulated bed rest

The authors present two case studies of giant cell tumor of tendon sheath. This uncommon lesion of the lower extremity is presented in these two cases in correlation with clinical, radiographic, and intraoperative findings. After the pathologic diagnosis was made, the patient in the first case decided not to have the tumor resected. This patient's postoperative course continues uneventfully without expansion of the tumor. In the second case, a local recurrence was noted 13 months after en bloc resection. A review of the literature shows that treatment modalities for such lesions range from marginal excision to radiation therapy. The authors wish to emphasize the high risk of local recurrence of these tumors. Early marginal resection is the treatment of choice.     

Dermatomyositis treated with high-dose intravenous immunoglobulins and associated with panniculitis

A case of a vascular tumor clinically and pathologically consistent with acquired progressive lymphangioma (benign lymphangioendothelioma) in a 48-year-old woman is reported. The lesion appeared in the skin close to a mastectomy scar 3 years after surgery and radiotherapy for invasive ductal carcinoma. On histologic examination, it mimicked an aggressive vascular neoplasm because of its infiltrative pattern. However, follow-up studies confirmed the benign nature of the lesion, clinically and histologically. This case indicates that acquired progressive lymphangioma may follow radiotherapy and must be considered in the differential diagnosis of other vascular proliferations occurring in the skin of the breast, especially of low-grade postradiation angiosarcoma, a recently described neoplastic entity.     

Visual failure caused by suprasellar extramedullary hematopoiesis in beta thalassemia: case report

OBJECTIVE AND IMPORTANCE: Small deposits of extramedullary hematopoiesis, acting as epileptogenic foci, have been observed near convexity dura and adjacent to falx cerebri. These foci could potentially grow and act as space-occupying lesions, producing focal neurological deficits. This condition was observed in a unique case of thalassemia major, with progressive visual loss caused by extramedullary hematopoiesis originating from the base of the cranium and extending up to the inferior third ventricle. The patient had been operated on 4 years earlier to relieve the compressive effects of ectopic marrow in the thoracolumbar epidural space. CLINICAL PRESENTATION: A 21-year-old man is reported with progressive visual loss caused by compressive optic neuropathy as a result of extramedullary hematopoiesis. Computed tomography of the head revealed a suprasellar and parasellar enhancing mass originating from the pre-sphenoid cranial base and approaching the lower third ventricle. INTERVENTION: Partial resection of the tumor was accomplished by a transsphenoidal approach. Monthly blood transfusions and low-dose radiotherapy of the appropriate anatomic structures were then performed. The patient's visual acuity improved only modestly. CONCLUSION: Extramedullary hematopoiesis, although extremely rare, could arise from the base of the cranium and act as a parasellar tumor. When any patient with thalassemia major requiring multiple transfusions develops visual failure, appropriate studies should be performed to rule out compression of visual pathways by ectopic marrow, especially if the patient is receiving deferoxamine.     

Partners for two decades: AOA and the National High Blood Pressure Education Program

A case of a single molluscum contagiosum occurring on the surface of a preexisting soft fibroma in an adult patient is reported. The most common clinical form of this viral lesion is multiple grouping papules with a central umbilication and its histologic feature is characteristic. Previous cases of mollusca combining with other lesions have been rarely described. Our lesion was probably due to its localization on the soft fibroma, whose exophytic growing represented a favoring factor for trauma and the consequent occurrence of the viral disease.     

Clinical relapses and disease activity on magnetic resonance imaging associated with viral upper respiratory tract infections in multiple sclerosis

Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma. Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus. Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another. By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk. The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography. In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation. At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases. Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes. Other fragments resembled granulation tissue, and some consisted of acellular debris. Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a. Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages. There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi. Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris. We propose the term "xanthomatous hypophysitis" for this lesion.     

Galactorrhea-amenorrhea syndromes: etiology and treatment

Clinical and renal morphologic studies are reported in a 3 1/2 month old infant with congenital syphilis and nephrotic syndrome. Renal lesions were consistent with membranous proliferative glomerulonephritis, and the presence of glomerular deposits of IgM, C3, and of less intensity of IgE and fibrin, were demonstrated by means of immunofluorescence. These findings identify the renal lesion as an immune glomerulopathy. A therapeutic course of penicillin resulted in resolution of clinical manifestations without any evidence of persistent renal damage.     

Extramedullary intracranial solitary plasmocytoma. Report of 2 cases

Multiple myeloma frequently affects the C.N.S with a high prevalence of spinal cord compression following vertebral neoplastic infiltration. On the other hand, solitary plasmacytomas, tumors that arise in a wide variety of locations due to the universal distribution of plasma cells, are infrequent within the cranial vault and rarely present as extramedullary lesions, arising from the intracranial soft tissues without affecting neighboring bony structures. Only 33 such cases have been reported in the medical literature. The authors report two additional cases of solitary intracranial, extramedullary plasmacytoma. Case 1.--54 year-old woman with a chief complaint of severe headache and behavioral changes of three months duration. C.N.S. imaging revealed a bifrontal mass lesion, arising from the anterior third of the falx cerebri. Case 2.--45 year old-man who complained of headache and blurred vision of a month duration C.N.S. imaging displayed a third ventricle mass lesion. In both cases the neuropathological diagnosis was extramedullary plasmacytoma. Postoperatively the confirmation of solitary intracranial plasmacytoma was achieved only after a thorough work-up to rule out the presence of neoplasm elsewhere in the body. Radiotherapy was given to both patients and follow-up has failed to reveal neoplastic disease 4 and 3 years, respectively, after the diagnosis.     

Benfluorex, a hypotriglyceridemic drug, reduces lipid peroxidation and alleviates adverse metabolic complications of copper deficiency

To provide histological diagnoses of brain diseases, CT-guided stereotactic brain biopsy (CT-SBB) has been widely used because of its less invasive technique compared with open brain biopsy (OBB). However, CT-SBB is not always diagnostic. We report a case of multiple intracranial tuberculoma whose diagnosis was not made by CT-SBB but by OBB. The patient is a 46-year-old man with insulin-dependent diabetes mellitus who had been receiving immunosuppressive agents (azathioprine, cyclosporin, and prednisolone) after renal transplantation for diabetic renal failure for 9 years. He gradually developed febrile, headache and unsteady gait. Brain MRI demonstrated multiple intracranial lesions involving left fronto-temporal and right parietal lobes, left cerebellar hemisphere, and the fourth ventricle. Although the MRI findings were consistent with those of previously reported cases of intracranial tuberculoma, other conditions, such as malignant lymphoma and toxoplasmosis, were not ruled out. Therefore, CT-SBB targeting the left temporal lobe lesion was done for definitive diagnosis, but it revealed only mild perivascular infiltration of mononuclear cells and hemorrhage. He was transferred to our clinic for further evaluation. On examination, mild truncal and limb ataxia on the left were noted in addition to the neurological findings corresponding to diabetic retinopathy and neuropathy. Despite vigorous laboratory examinations, including repeated bacterial cultures and PCR of cerebrospinal fluid, no evidence of tuberculous infection was obtained. A tentative diagnosis of multiple intracranial tuberculoma was made, and anti-tuberculous drugs (isoniazid 400 mg, ethambutol 750 mg, and pyrazinamide 1.5 g) were administered. Since his symptoms deteriorated because of ventricular dilatation resulting from the enlarged lesion in the fourth ventricle after a temporary clinical improvement, VP-shunting and OBB from the left temporal lobe lesion were done. The excised lesion was firmly encapsulated and the histological examination revealed typical pathology of tuberculoma. Ziehl-Neelsen staining and PCR for Mycobacterium tuberculosis of the biopsied specimen were also positive. Further administration of increased doses of anti-tuberculous drugs (isoniazid 600 mg, ethambutol 500 mg, pyrazinamide 2.0 g and intramuscular injection of streptomycin 0.3 g twice a week) eventually ameliorated the symptoms and shrank the lesions. In case of intracranial tuberculoma, the needle of CT-SBB may not penetrate the firm capsule of tuberculoma and only the surrounding brain tissue may be obtained as in the present case. Therefore, it is recommended to consider OBB from the beginning for definitive diagnosis of intracranial tuberculoma. Paradoxical worsening of the clinical and laboratory findings of tuberculosis in spite of appropriate anti-tuberculous therapy as seen in the present case has been described in both pulmonary and extra-pulmonary tuberculosis. The phenomenon, called transient worsening, could happen and we have to keep it in mind during the treatment of intracerebral tuberculoma.     

Idiopathic avascular necrosis of a vertebral body. Case report and literature review

STUDY DESIGN: Case report and literature review. OBJECTIVES: To review the English literature pertaining to idiopathic avascular necrosis of a vertebral body. As an illustrative example, the case of a 60-year-old woman with idiopathic avascular necrosis of L4 is presented. SUMMARY OF BACKGROUND DATA: Avascular necrosis of a vertebral body is an uncommon entity. Avascular necrosis has been described in the context of other underlying lesions, such as with malignancy, infection, radiation therapy, and systemic steroid treatment. The intravertebral vacuum cleft phenomenon seen on plain films has been strongly associated with vertebral body avascular necrosis. METHODS: Literature and chart review was carried out. Vertebral body avascular necrosis was initially identified with imaging studies and confirmed with biopsy. A comprehensive preoperative evaluation did not identify a specific cause of avascular necrosis. The patient underwent vertebral body resection with fibula allograft struts. CONCLUSIONS: Although vertebral body collapse in an osteoporotic individual is relatively common, a case is reported of vertebral body collapse and subsequent necrosis without evidence of underlying disease at 48-month follow-up. The current findings support the diagnosis of idiopathic avascular necrosis of L4.     

Increased intrusions during verbal recall in traumatic and nontraumatic lesions of the temporal lobe.

The mesial temporal and lateral frontal lobes were the most common sites of parenchymal abnormality on magnetic resonance imaging (MRI) scans for 12 patients with chronic traumatic brain injury (TBI). Ventricular widening was also common, and 3 patients showed increased size of the upper third ventricle. Of 10 right-handed TBI patients with no evidence of learning disability, 6 showed dominant temporal lesions and 3 showed an increase in the size of the upper third ventricle. Only patients with dominant temporal lesions (4 of 6) exceeded the normal confidence interval (based on 20 non-TBI controls) for intrusion errors on delay trials of the California Verbal Learning Test (CVLT), though other patients also demonstrated impaired recall. The pattern of increased intrusions during CVLT delay trials was confirmed in non-TBI patients who had undergone dominant temporal surgery or had dominant or bilateral temporal lesions, even when frontal changes could be ruled out. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Choroid plexus cyst of the left lateral ventricle with intermittent blockage of the foramen of Monro, and initial invagination into the III ventricle in a child

A cyst of the choroid plexus of the left lateral ventricle with intermittent blockage of the foramen of Monro and initially with invagination of the III ventricle in a child is described. In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ballvalve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. Choroid plexus cysts localised in the anterior part of lateral ventricles are very rare, and all reported cases have been in male patients. According to the literature our case is only the third ever described in a child.