1/16. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
2/16. Continuous brachial plexus block at the cervical level using a posterior approach in the management of neuropathic cancer pain.BACKGROUND AND OBJECTIVES: Neuropathic cancer pain due to tumor growth near the brachial plexus is often treated with a combination of nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, anticonvulsants, and oral or transdermal opioids. We propose placement of a catheter along the brachial plexus using a posterior approach for patients not responding to the above-mentioned treatment. CASE REPORT: We describe 2 patients with neuropathic cancer pain in the arm and shoulder despite treatment with dexamethasone, amitriptyline, gabapentin, opioids, and, in 1 patient, oral ketamine. An increase in daily opioid dosage did not relieve the pain but caused unacceptable side effects of nausea, vomiting, and sedation. Continuous administration of local anesthetics via a brachial plexus catheter inserted at the cervical level using a posterior approach resulted in a markedly improved analgesia and decreased opioid requirement. CONCLUSION: Continuous brachial plexus block should be considered in patients with severe neuropathic cancer pain in the arm and shoulder. To achieve sufficient pain relief for prolonged periods of time, a catheter was inserted to block the brachial plexus using a posterior approach. This technique may be a valuable alternative to the interscalene approach because of the improved fixation of the catheter in the muscle sheet of the trapezius, splenius cervicus, and levator scapulae muscles, and the decreased likelihood of catheter dislodgment during neck movements.- - - - - - - - - - ranking = 7keywords = posterior (Clic here for more details about this article) |
3/16. Cancer-prone syndrome of mosaic variegated aneuploidy and total premature chromatid separation: report of five infants.Five infants (two girls and three boys) from four families all had severe pre- and postnatal growth retardation, profound developmental delay, microcephaly, hypoplasia of the brain with Dandy-Walker complex or other posterior fossa malformations, and developed uncontrollable clonic seizures. Four infants developed Wilms tumors, and one showed cystic lesions in bilateral kidneys. All five infants showed variegated mosaic aneuploidy in cultured lymphocytes. In two infants whose chromosomes were prepared by us, 48.5%-83.2% lymphocytes showed total premature chromatid separation (PCS). Their parents had 3.5%-41.7% of their lymphocytes in total PCS. The remaining three infants and their parents, whose chromosomes were prepared at outside laboratories, tended to show lower frequencies of total PCS. Another five infants reported with the disorder were reviewed together with the five infants we described. Together, their clinical and cytogenetic manifestations were similar enough to suggest a syndrome. Seven of the 10 infants developed proven or probable Wilms tumors. The age at diagnosis of the tumors was younger than usual at 2-16 months. The tumors were bilateral in four infants and unilateral in three infants, and cystic changes were present in six infants. Two infants developed botryoid rhabdomyosarcoma. The carriers of the syndrome are thus liable to tumorigenesis. The possible role of mitotic checkpoint defects, proven in two infants with the syndrome (Matsuura et al. [2000: Am J Hum Genet 69:483-486]), was discussed in connection with tumor development and progression.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
4/16. Hereditary infantile hemiparesis, retinal arteriolar tortuosity, and leukoencephalopathy.BACKGROUND: The main hereditary vascular conditions involving both retinal and cerebral vessels include cerebroretinal vasculopathy, HERNS (hereditary endotheliopathy with retinopathy, nephropathy, and stroke), and hereditary vascular retinopathy; all are linked to the same locus on chromosome 3p21. Hereditary retinal arteriolar tortuosity is a distinct, autosomal dominant condition characterized by retinal arteriolar tortuosity and recurrent retinal hemorrhages. This condition is known to affect only retinal vessels. methods: Clinical and brain MRI investigations of eight members of a three-generation family and extensive biological and systemic vascular investigations within one affected family member were conducted. RESULTS: Six of eight family members were clinically symptomatic; disorders included infantile hemiparesis (2), migraine with aura (3), and retinal hemorrhage (1). Five individuals had retinal arteriolar tortuosities. A diffuse leukoencephalopathy in association with dilated perivascular spaces was observed in six individuals. Two family members had silent, deep cerebral infarcts as demonstrated on MRI. genetic linkage analysis strongly suggests that this disorder is not linked to the 3p21 hereditary vascular retinopathy/cerebroretinal vasculopathy/HERNS locus. CONCLUSIONS: The authors describe a novel hereditary autosomal dominant condition affecting both retinal and cerebral vessels and characterized by infantile hemiparesis, migraine with aura, retinal hemorrhage, retinal arterial tortuosity, and leukoencephalopathy with dilatation of perivascular spaces and microbleeds on brain MRI. Investigation of additional families should help to map the gene and to better categorize the spectrum of hereditary cerebroretinal small vessel diseases.- - - - - - - - - - ranking = 1187.4609769626keywords = leukoencephalopathy (Clic here for more details about this article) |
5/16. Reversible posterior leukoencephalopathy syndrome in children with cancers.We report three cases of reversible posterior leukoencephalopathy syndrome (RPLS) in children with cancers. All patients presented with sudden confusional state, visual disturbance, and transient mild hypertension under the treatment of childhood cancers. magnetic resonance imaging of the brain demonstrated cortical and subcortical lesions predominantly in the occipital region, which showed high intensity signal on fluid-attenuated inversion recovery images. All patients completely recovered from their neuropsychologic deficits only with antihypertensive therapy or discontinuation of the possible offending drugs. Early recognition of RPLS as a complication during cancer therapy in childhood may facilitate precise diagnosis and appropriate treatment.- - - - - - - - - - ranking = 6249.1719424338keywords = posterior leukoencephalopathy, leukoencephalopathy, posterior (Clic here for more details about this article) |
6/16. Toxic leukoencephalopathy: a review and report of two chemotherapy-related cases.Leukoencephalopathy syndrome is a rare disorder that results from structural alterations of cerebral white matter, is characterized by cerebral edema, and can occur in patients of any age. cranial irradiation and certain chemotherapy agents, especially those used in high-dose protocols, are causal agents. The prevalence of toxic leukoencephalopathy is unknown; however, this syndrome has been reported increasingly in the literature in patients who develop neurobehavioral changes following exposure to various toxins. diagnosis must confirm exposure to a toxin and the presence of neurobehavioral deficits and neuroradiologic abnormalities. In most reported cases, clinical symptoms are reversible after the offending toxin is withdrawn. This article describes two cases of chemotherapy-related leukoencephalopathy and reviews the nursing care of patients experiencing this syndrome.- - - - - - - - - - ranking = 1187.4609769626keywords = leukoencephalopathy (Clic here for more details about this article) |
7/16. Chemotherapy-induced toxic leukoencephalopathy causes a wide range of symptoms: a series of four autopsies.We have observed an increasing number of autopsies on patients with chemotherapy-related complications. One complication is toxic leukoencephalopathy, which is due to a direct toxic effect of chemotherapeutic agents on the central nervous system white matter. Autopsies of four cases of toxic leukoencephalopathy were performed following standard protocols. The brain and spinal cord were examined routinely, and histological sections were taken for evaluation. We report here three patients with hematologic malignancies and one patient with metastatic carcinoma with chemotherapy-induced leukoencephalopathy. The first was a 56-year-old male treated with multiple chemotherapeutics for multiple myeloma. He presented with confusion and focal seizures with a rapid progression to coma and decerebrate posturing. The second was a 36-year-old male who developed mental status changes, ataxia and dysarthria following treatment for lymphoma. The third was a 16-year-old male who developed a profound peripheral and central neuropathy after chemotherapy treatment for T-cell acute lymphoblastic leukemia. The fourth was a 49-year-old female patient who was treated with multiple chemotherapeutics for Stage II breast carcinoma and subsequently developed visual acuity and field defects. The neuropathologic findings in these cases, although similar, varied in severity and distribution. The white matter was affected by severe myelin pallor, edema, and a prominent macrophage infiltrate in each of the cases. The location and extent of the central nervous system pathology correlated with the type and severity of clinical symptoms. These four cases, with their varied presenting symptoms, clinical courses, and degree of pathology, emphasize the importance of considering toxic leukoencephalopathy as an etiology of acute neurologic deterioration following high-dose chemotherapy.- - - - - - - - - - ranking = 1583.2813026168keywords = leukoencephalopathy (Clic here for more details about this article) |
8/16. Cerebrovascular complications in patients with malignancy: report of three cases and review of the literature.A cerebrovascular thromboembolic event may precede the identification of cancer, and be the first clinical evidence of an underlying malignancy. The malignancy can cause either nonbacterial thrombotic endocarditis or hypercoagulable state, both of which may have clinical manifestions such as thrombotic or embolic occlusion of multiple major cerebral vessels. We present three cases with unusual cerebrovascular events. The first case is a 62-year-old woman who was admitted due to acute left limbs weakness and consciousness disturbance. brain computed tomographic (CT) scan showed right middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions with uncal herniation. The second case is a 44-year-old woman who was hospitalized due to acute bilateral limb weakness and consciousness disturbance. Bilateral MCA, left PCA, anterior cerebral artery (ACA) infarctions and deep vein thrombosis in the left leg were diagnosed. The third case is a 63-year-old man who developed sudden onset of right hemiplegia and consciousness disturbance. brain CT scan showed bilateral MCA and left ACA infarction. The results of a series of examinations including biochemistry, lipid profile, carotid duplex, and transthoracic and transesophageal echocardiography were unremarkable. All patients had positive disseminated intravascular coagulation (DIC) tests with elevated D-dimers and fibrinogen degradation products (FDP). Further systemic evaluation for malignancy revealed ovarian cancer in the first patient, endometrial carcinoma in the second patient, and adenocarcinoma of lung in the third patient. They all died of the underlying malignancy. Because the hemostatic system can be altered by malignancy, intravascular coagulation abnormalities of these malignancy-related strokes may be disclosed by laboratory assays of hemostasis.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
9/16. Cotyledonoid dissecting leiomyoma of the uterus: a case report of a benign uterine tumor with sarcomalike gross appearance and review of literature.Cotyledonoid dissecting leiomyoma (Sternberg tumor) is a very rare variant of uterine smooth muscle tumor with an unusual and alarming gross appearance. Including our case, approximately 20 cases were reported in the literature. A 27-year-old woman presented with pelvic mass. A 41-cm fungating rubbery mass with placenta-like appearance adhering to the posterior uterine surface and extending to the left broad ligament and pelvic cavity was observed. An intraoperative frozen section was requested, and a diagnosis of a benign smooth muscle tumor was given. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed with removal of the pelvic tumor extension. Thorough tumor sampling was performed and showed nodules of interlacing bundles of bland-looking smooth muscle cells, separated by expanded, edematous, and highly vascularized stroma. No atypia, mitotic activity, or coagulative necrosis was seen. Immunohistochemical studies confirmed the smooth muscle nature of the tumor. Cotyledonoid leiomyoma has a distinctive gross appearance which usually raises the suspicion of sarcoma. Intraoperative frozen section is a mandatory and helpful procedure to avoid overtreatment of such cases.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
10/16. Ossifying fibromyxoid tumor of soft parts.A histologically uncommon soft-tissue tumor of the extremities and neck of a 54-year-old male is reported. The solid, bony-hard tumors occurred at the inner region of the right thigh at 44 years of age with additional tumor formation at the posterior region of the same thigh, at the inner region of the right upper arm and at the neck during the following 10 years. All tumors were located in the deep muscle layer. The neck tumor directly invaded the fifth cervical vertebra and later the upper mediastinum. Histologically, all three tumors of the extremities contained mixed lobular growths of round-to-fusiform cells with myxoid matrix and an extensive bone formation. The tumor cells showed a small round nucleus and eosinophilic cytoplasm lacking cytoplasmic glycogen. The myxoid matrix was stained significantly by alcian blue and colloidal iron and was digested completely by pretreatment with hyaluronidase. Another major component was mature bone trabeculae showing a dense meshwork throughout the entire tumor with active bone formation toward the periphery. Positive immunostaining was obtained against antivimentin and S-100 protein antibodies. We suggest that this uncommon tumor can be tentatively distinguished as an ossifying fibromyxoid tumor of soft parts, (an entity defined by Enzinger et al.) differing from other previously described soft-tissue tumors.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
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