Cryptococcosis in Gilbert's and long-nosed potoroo.

Two cases of fatal cryptococcosis are described, one of Cryptococcus neoformans infection in a Gilbert's potoroo (Potorous gilbertii) and one of Cryptococcus gattii infection in a long-nosed potoroo (Potorous tridactylus). The diagnoses were confirmed by culture and specific immunohistochemistry, respectively. The long-nosed potoroo tested positive using the latex cryptococcal antigen test (LCAT), whereas the Gilbert's potoroo had a negative LCAT result despite having advanced disease of some duration. In both cases, the clinical presentation was a progressive neurologic disease associated with a central nervous system infection. Pulmonary infection was also observed in the long-nosed potoroo. Specific treatment with antifungal agents was unsuccessful in the long-nosed potoroo.

Cavum septum pellucidum and obstructive hydrocephalus.

Five patients presented with symptoms related directly to pressure effects from their cavum septum pellucidum with persistent or intermittent obstructive hydrocephalus. The most characteristic presenting symptoms were intermittent postural headache and postural loss of consciousness. If cysts of the cavum septum pellucidum are symptomatic and stereotactic cyst puncture or fenestration are ineffective, ventriculoperitoneal shunting should be carried out before resorting to more radical excision of the cyst.

Palisades in primary cerebral neuroblastoma simulating so-called polar spongioblastoma. A light and electron microscopical study of an adult case.

A frontal lobe neoplasm in a 25-year-old Caucasian man showed the typical histological pattern of a "polar spongioblastoma." Immunoperoxidase staining for glial fibrillary acidic protein (GFAP) was negative while silver stains in paraffin-embedded tissue, and electron microscopy displayed neoplastic cells with neuritic processes. Ultrastructurally there were microtubules, synapses and dense-core neurosecretory granules, all features of a neuroblastic neoplasm. It is suggested that this new growth with its polar spongioblastic appearance is, in fact, a moderately malignant primary cerebral neuroblastoma.

Management of extra-sellar pituitary tumours with bromocriptine: comparison of prolactin secreting and non-functioning tumours using half-field visual evoked potentials and computerised tomography.

To determine whether prolactin secreting and non-functioning pituitary tumours respond differently in terms of shrinkage to bromocriptine, we prospectively studied ten consecutive patients (five with prolactinomas and five with non-functioning tumours) complicated by extra-sellar extensions. No patient had received prior radiotherapy or bromocriptine and the mean dose and duration of bromocriptine treatment were identical in the two groups of patients. Objective evidence of tumour shrinkage was provided by serial half-field visual evoked potentials (VEPs) and computerised tomography (CT). All five prolactinomas were shown to shrink as assessed by improvement in VEP and four of the five as assessed by CT. In contrast, only one of the five patients with non-functioning tumours showed any improvement in VEP or CT. Macroprolactinomas frequently shrink rapidly when treated with bromocriptine, whereas non-functioning tumours seldom show such a dramatic response.

Primary malignant lymphomas of the brain. A clinicopathological study of five cases.

We report here the cases of five patients with primary malignant lymphoma of the brain; all died and a necropsy was performed in each case. Although these lymphomas remain localized, their prognosis is worse than that of lymphomas arising in any other site. Our five cases confirmed the reported natural history of this lesion as a highly malignant neoplasm. There was a discrepancy between the macroscopic appearance of the new growth and its microscopic extent; and the extensive infiltration of the surrounding tissue was not always detected by CT scan. Although primary malignant lymphomas of the brain are radiosensitive and radiotherapy can prolong life, careful clinical judgment is necessary to assess the desirability of the poor quality of life that may follow. Patients with severe intellectual impairment may receive no benefit from aggressive radiotherapy.

The response to acupuncture therapy in patients with chronic disabling pain.

Twenty-one patients had acupuncture treatment for chronic, disabling pain. Ten (47.5%) thought they had obtained worthwhile relief by the time treatment was completed. Six (30%) had no or negligible benefit and five (25%) had some aggravation of their pain at some stage of the procedure. In this group of patients, with the technique we describe, we were unable to achieve the high degree of short-term success claimed by other workers. Until further scientific studies can confirm the value of acupuncture in medical practice, we urge caution in the use of this procedure.