1/40. Unusual late extrapulmonary metastasis in osteosarcoma.The major site of metastasis from osteosarcoma is the lung, and over 90% of fatalities in patients with this disease die from pulmonary metastases. Extrapulmonary disease is developing in an increasing proportion of patients, usually after pulmonary metastasis. This study reports three cases of patients with osteosarcoma that metastasized to the brain, mediastinum, intramuscular site, and pelvic cavity. The physician must be aware that extrapulmonary metastases may be present at the time a pulmonary metastasis becomes evident.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/40. occipital lobe meningioma in a patient with multiple chemical sensitivities.BACKGROUND: The concurrent diagnosis of meningioma with increased intracranial pressure has not been reported previously in a patient who meets diagnostic criteria for multiple chemical sensitivities (MCS). methods: A patient who had been evaluated in an occupational medicine practice, and by several other physicians for sensitivity to chemical odors was found to have papilledema and a visual field deficit. The patient met the clinical criteria set forth by Cullen in 1987 for MCS. A magnetic resonance imaging (MRI) scan was performed. RESULTS: The MRI revealed a large occipital lobe meningioma, which was surgically resected. Removal of the meningioma had little effect on the patient's symptoms. She has been unable to return to her job as a custodian. DISCUSSION: The etiology of MCS has been disputed and is currently unresolved. Those who evaluate patients with MCS are reminded that meningiomas and other intracranial mass lesions can affect olfaction, and that patients with MCS can have treatable intracranial abnormalities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/40. Gamma surgery for intracranial metastases from renal cell carcinoma.OBJECT: The goal of this study was to evaluate the effectiveness and limitations of gamma surgery (GS) in the treatment of renal cell carcinoma that has metastasized to the brain. methods: The authors performed a retrospective analysis of a consecutive series of 21 patients with 37 metastatic brain deposits from renal cell carcinoma who were treated with GS at the University of virginia from 1990 to 1999. Clinical data were available in all patients. No patient died of progression of intracranial disease or deteriorated neurologically following GS. Eight patients clinically improved. Follow-up imaging studies were available for 23 tumors in 12 patients. Nine patients did not undergo follow-up imaging. One patient lived 17 months and succumbed to systemic disease: no brain imaging was performed in this case. Another patient refused further imaging and lived 7 months. Seven patients lived up to 4 months after the procedure; however, their physicians did not require these patients to undergo follow-up imaging examinations because of their general conditions-all had systemic progression of disease. Of the 23 tumors that were observed posttreatment, one remained unchanged in volume, 16 decreased in volume, and six disappeared. No tumor progressed at any time, and there were no radiation-induced changes on follow-up imaging an average of 21 months after GS (range 3-63 months). CONCLUSIONS: Gamma surgery provides an alternative to surgical resection of metastatic brain deposits from renal cell carcinoma. Neurological side effects were seen in only one case; freedom from progression of disease was achieved in all cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/40. Neurocutaneous melanosis: a case of primary intracranial melanoma with metastasis.Neurocutaneous melanosis is a rare disorder characterized by the presence of large or multiple congenital melanocytic naevi and benign or malignant pigment cell tumours of the leptomeninges. Distant metastasis is unusual in primary leptomeningeal/intracranial melanomas. We present the case history of an adult male who had multiple primary intracranial melanomas associated with neurocutaneous melanosis (naevus of Ota) in the ophthalmic division of the left trigeminal nerve. Excision of the intracranial tumours was carried out in two stages, but the patient died 2 days after the second operation. autopsy showed multiple metastatic deposits in the liver. Symptoms and signs of raised intracranial pressure, the presence of Ota's naevus, and a dural-based mass or masses should alert the treating physician to suspect a primary leptomeningeal/intracranial melanoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/40. Clinical evaluation of thallium-201 single photon emission computed tomography in equivocal neuroradiological supratentorial lesions.BACKGROUND: We performed cerebral 201Tl SPECT study on 38 presurgical patients with equivocal neuroradiological supratentorial lesions to detect differences in 201Tl uptake index between tumor/non-tumor and high-grade/low-grade samples. methods: Authors identified 38 cases with presurgical equivocal neuroradiological supratentorial mass lesions. All cases were submitted to histological confirmation of the lesion by biopsy, sub-total or gross-total removal of the tumor. Between 23 patients suffering from gliomas, 13 were histologically classified as being of low-grade malignant tumors and 10 were classified as being of high-grade malignancy. Fifteen non-tumor histopathological specimens were also detected. The 201Tl index was defined as the ratio of average counts per pixel in the lesion to these in the opposite region. analysis of variance (ANOVA) and unpaired Student's OtO-test statistical methods were applied. Actuarial survival time from the date of diagnosis was calculated using the Kaplan-Meier method. Follow-up evaluation and survival time were obtained through referring physicians. Cerebral CT or MR images were obtained every three months after discharged, or more often if indicated. RESULTS: Results showed that the 201Tl uptake index ranged from 1.10 to 3.00 in the tumors lesions (mean /-SD: 1.68 /-0.51) and from 0.80 to 1.40 in the non-tumors lesions (mean /-SD: 1.07 /-0.17), (alpha < 0.0006 percent;). The 201Tl uptake index ranged from 1.10 to 2.30 in 13 patients with low-grade tumors (mean /-SD: 1.45 /-0.34) and from 1.30 to 3.00 in 10 patients with high-grade tumors (mean /-SD: 1.98 /-0.55), (alpha < 0.5 percent;). CONCLUSIONS: Our results demonstrate the clinical utility of 201Tl brain SPECT to differentiate equivocal neuroradiological supratentorial lesions and to correlate relationship between preoperative diagnosis, histological tumor grade and prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/40. Rapidly growing tumor-like brain lesion.listeria monocytogenes accounts for 8-11% of the cases of bacterial meningitis which is associated with high mortality in patients with serious underlying diseases or those receiving immunosuppressive treatment. brain abscess due to L. monocytogenes is a very rare occurrence. The case reported here concerns a 54-year-old female patient with a rapidly growing tumor-like brain lesion. L. monocytogenes type 4b could be cultured from blood and brain biopsy. Despite antimicrobial therapy with ampicillin and gentamicin, the patient died 11 days after admission to the hospital. The growing numbers of elderly and immunocompromised patients will increasingly confront physicians with patients with listeriosis. Delayed therapy in patients treated with corticosteroids may result in a fatal outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/40. Hemorrhagic cystitis as an unexpected adverse reaction to temozolomide: case report.A case is reported in which temozolomide, a promising new dna alkylating agent, was successfully used to treat radiation refractory metastatic brain tumors arising from primary breast cancer. However, the treatment had to be terminated after the second round of treatment due to the development of hemorrhagic cystitis. This side effect was totally unexpected. Another class of alkylating agents (cyclophosphamide and related compounds) exhibits this side effect caused by a prevalent acrolein metabolite. Temozolomide and its sister compounds, dacarbazine and 5-(3-methyltriazen-1-yl)imidazole-4-caroxamide, have never been reported to have this adverse reaction. This case serves to alert physicians to the existence of a possible subpopulation of patients who may experience hemorrhagic cystitis on treatment with imidazotetrazines by a mechanism that is yet to be established.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/40. hiv-related Hodgkin's disease with central nervous system involvement and association with Epstein-Barr virus.central nervous system (CNS) involvement is a rare occurrence in the course of human immunodeficiency virus (hiv)-related Hodgkin's disease (HD). We report the clinical course of a patient with hiv infection who developed systemic HD, mixed cellularity subtype, later complicated by leptomeningeal involvement. The patient died from his illness, and autopsy was performed. Examining the brain lesion, Epstein-Barr virus (EBV) presence was demonstrated in reed-sternberg cells by immunohistochemistry using an EBER probe for EBV rna. This is the second case report in the English literature of HD involving the CNS in an hiv-positive individual, and the first demonstrating EBV presence. Extranodal presence of Hodgkin's disease in patients with hiv infection is probably related to immunosuppression, and physicians treating this illness should be alert to the potential of unusual sites of involvement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/40. Development and implementation of a problem-focused neurological assessment system.A menu-driven, problem-focused neurological assessment system was constructed and implemented after concerns at a six-hospital teaching center about the quality of nursing assessments for patients with neurological diagnoses were validated. This system enables the physician to guide the nurse's assessment by ordering specific neurological tests for each patient. Extensive staff training took place to develop competence with this system. This new system has resulted in positive changes for this facility. nurses acknowledge greater comfort with performing neurological assessment; documentation of assessment has improved; and the assessments are becoming more individualized for each patient. This system resulted in a higher quality of neurological care for patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/40. Neurological toxicity during metastatic melanoma treatment with fotemustine.Fotemustine is a cytotoxic drug belonging to the group of nitrosourea derivatives, and is used in the treatment of metastatic melanoma, particularly when secondary brain lesions are present. We report the case of a female patient in partial response following 10 courses of fotemustine and featuring a rapidly progressing mental impairment. The clinical and radiological patterns were consistent with a fotemustine-related toxic encephalopathy, as described previously in a recent report. The physician should be aware of this neurological complication of fotemustine, so that it may be recognized early and not attributed erroneously to tumour evolution.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |