Transsphenoidal removal of an intra- and suprasellar epidermoid cyst.

A case with an intra- and suprasellar epidermoid cyst removed by transsphenoidal route is presented. Problems in radiological and histologic differential diagnosis and advantages of transsphenoidal approach besides indications are discussed.

Traumatic subdural pneumocephalus causing rise in intracranial pressure in the early phase of head trauma: report of two cases.

This paper presents two unique cases of subdural tension pneumocephalus which has deteriorated in the early phase of head trauma. Subdural pneumocephalus accounts for about 25% of all intracranial pneumocephalus cases. In the literature subdural pneumocephalus is describes as a benign and spontaneously resolving condition. Contrary to the available literature and our experience in 1341 trauma cases in the past ten years of whom 76 had subdural pneumocephalus, both cases deteriorated in the early hours following head trauma due to an increase in subdural air volume which was evacuated by craniotomy.

Is it necessary to use the angular artery to feed the scapular tip when preparing a latissimus dorsi osteomyocutaneous flap?: case report.

This report demonstrates the possibility of elevation of the scapular tip with the latissimus dorsi muscle based on the thoracodorsal artery only, when an additional and substantial amount of bone is required for complex reconstruction. The patient was a 37-year-old man who developed an epidermoid carcinoma arising from the left maxillary sinus. After wide excision and radical resection of the tumor and the invaded structures, an osteomyocutaneous latissimus dorsi flap was prepared. With the muscle, the 12th rib was included in the flap to reconstruct the orbital floor and zygomatic arch, and the scapular tip was also elevated to reconstruct the hard palate. The skin island over the muscle was designed according to reconstructive requirements, including the buccal lining, nasal lateral wall lining, and coverage of the scapular tip at its new location to reconstruct the hard palate. All of these structures were successfully reconstructed with a single pedicle branch arising from the thoracodorsal artery. Postoperative early and late bone scans showed living bone at the zygomatic arch and hard palate.

Conventional external radiotherapy in the management of clivus chordomas with overt residual disease.

Cranial chordomas are uncommon tumors accounting for less than 1% of all intracranial neoplasms. Although they are slowly growing, rarely metastasizing tumors, cranial chordomas are challenging to treat due to their critical location, invasive nature and aggressive recurrence. The aim of this retrospective study was to evaluate the role of conventional irradiation in the treatment of clival chordomas with overt residual disease after incomplete surgery. Between January 1979 and December 1997, 18 patients with histologically confirmed clival chordoma were treated with radiotherapy. Median age at the time of diagnosis was 32 years. The mean duration of the symptoms before diagnosis was 33.9 months. Median tumor diameter at initial presentation was 5 cm (range, 3-7 cm). The type of surgical procedure was subtotal excision in 11 patients and biopsy in 7. Radiation treatment was delivered with megavoltage units, and total doses between 50 Gy and 64 Gy (median, 60 Gy) were administered with conventional daily fractions. One patient received additional 12.50 Gy with linear accelerator-based stereotactic radiosurgery after subtotal excision and external irradiation. The mean follow-up time was 43.2 months. Overall survival at 5 years was 35%. Eleven patients showed progression after radiotherapy. The median time to progression after radiotherapy was 40.8 months (38.4-43.2) with a 5-year progression-free survival of 23%. Five patients (29.4%) showed symptomatic relief after radiotherapy while persistent symptoms were recorded for 6 patients. Incomplete surgery and conventional external radiotherapy with a dose of around 60 Gy seem to be inadequate in the treatment of clival chordomas.

Tramadol encapsulated into polyhydroxybutyrate microspheres: in vitro release and epidural analgesic effect in rats.

BACKGROUND: Controlled release techniques are used to increase the duration of action and decrease the toxicity of drugs. Any controlled release form of tramadol in spinal or epidural blocks has not been studied previously. Tramadol was encapsulated into polyhydroxybutyrate (PHB) microspheres and release kinetics was studied. The epidural analgesic effect of this solution in rats was also compared with free tramadol. METHODS: Controlled release of tramadol from PHB microspheres into 10 ml of phosphate buffer solution at pH 7.4 and 37 degrees C was studied in vitro. In vivo studies were performed in 40 rats. Epidural catheters were placed during general anaesthesia. Rats were randomly allocated into one of the four study groups to receive normal saline, 4 mg of tramadol, PHB microspheres without tramadol, or 4 mg of tramadol encapsulated into PHB microspheres. Analgesia was evaluated with tail flick tests performed at 52.5 +/- 0.5 degrees C before injection and at intervals up to 30 h after injection. Catalepsy and loss of corneal reflexes were considered as signs of supraspinal toxicity. RESULTS: In vitro drug release was observed for more than 6 days. Epidural analgesic effects of tramadol released from PHB microspheres were observed for 21 h, whereas an equal dose of free tramadol was effective for less than 5 h. No signs of toxicity were observed. CONCLUSION: Controlled release of tramadol from PHB microspheres is possible, and pain relief during epidural analgesia is prolonged by this drug formulation compared with free tramadol.

HMFG1 antigen: a new marker for carcinomatous meningitis.

Carcinomatous meningitis is a devastating metastatic complication of systemic carcinoma, which may occur insidiously, accompanied by a confusing spectrum of clinical symptoms and signs. In the absence of reliable diagnostic tumour markers, the diagnosis is established by the demonstration of malignant cells within the cerebrospinal fluid (CSF). Cytological techniques requiring skillful interpretation are occasionally negative in the presence of established disease, and when positive may indicate leptomeningeal malignancy of such advanced nature that effective palliation is difficult. Biochemical tumour marker technology offers the potential of reliable diagnosis in early disease states, prior to the appearance of exfoliated malignant cells. In a series of 100 patients, we assayed for an epithelial associated glycoprotein (HMFGI antigen) in CSF obtained at lumbar puncture. In 18 of 20 patients with carcinomatous meningitis, this high-molecular-weight glycoprotein was detectable in the CSF. The antigen was also present in 2 patients with neoplastic meningitis complicating lymphoma and medulloblastoma, but was not detected in the CSF of the remaining 78 patients.