Non-communicating hydrocephalus from pork tapeworm obstructing the foramina of Monro and its endoscopic management; a case report from Europe.

Introduction: Taenia solium is the main causative agent of neurocysticercosis. The tapeworm can manifest inside the ventricles, usually in the form of intracranial hypertension. We present a case of hydrocephalus as a result of a neurocysticercosis lesion obstructing both foramina of Monro. Research question: A comprehensive review of the management is provided, as well as video footage (an invaluable resource to compare, critique and learn with other institutions). Material and methods: A 23-year-old female from Honduras presented with a 7-day complaint of headache. On exam, she was hyperreflexic, but otherwise normal. Magnetic resonance imaging (MRI) revealed a non-specific lesion at the level of the foramina of Monro, with associated hydrocephalus. Additional testing was normal. Results: The patient underwent an endoscopic ventriculoscopy with partial excision of the lesion and subsequent implantation of a ventriculoperitoneal shunt. On postoperative MRI, hydrocephalus resolved and pathological analysis identified the parasite as Taenia solium. Albendazole was administered for 14 days. Discussion and conclusion: Neurocysticercosis should be considered in patients presenting with hydrocephalus, especially those from endemic areas. The long-term prognosis of ventricular neurocysticercosis might be favourable, provided that adequate care is given timely. Endoscopic surgery seems to be effective for the removal of parasitic lesions. However, studies comparing open versus endoscopic surgery are lacking. The majority of cases in the literature correspond to America and Asia. This case shows that neurocysticercosis is also present in Europe, and that a high index of suspicion is necessary.

Aspergillus endocarditis in lung transplant recipients: case report and literature review.

We present a case of endocarditis caused by Aspergillus in a lung transplant (LT) patient and review 6 previously reported cases. All cases were caused by Aspergillus fumigatus. Five patients (71%) were transplanted due to cystic fibrosis. None of the patients had any previously known valvular heart disease. The time that elapsed between LT surgery and the diagnosis of Aspergillus endocarditis was 8±6 months. Large peripheral emboli were observed in 6 patients (85%); blood cultures were negative in all. Transthoracic echocardiography did not detect the presence of vegetations in 3 patients (43%); the vegetations measured >1.5 cm in all cases. Five patients (71%) died from disseminated disease. Both survivors underwent combined therapy with antifungal drugs and surgical treatment.

Cytological features of chromophobe renal cell carcinoma, classic type. A report of nine cases.

OBJECTIVE: To review our experience with nine cases of chromophobe renal cell carcinoma (ChRCC), classic type. The cytological descriptions of this entity are still rare, and information concerning the diagnostic value of cytology is needed. METHODS: Nine cases of ChRCC evaluated using fine needle aspiration (n = 6) or intraoperative scrape cytology (n = 3) were selected. Expression of vimentin was evaluated in four cases using immunocytochemistry, which was performed on alcohol-fixed material. In all cases a complete pathological study was available. RESULTS: The neoplastic cells were arranged mainly as single cells and small, discohesive, monolayered groups. A polymorphous cellular population was identified, with coexisting large, small and intermediate-sized cells. The large neoplastic cells showed clear, flocculent cytoplasm with small, eccentric nuclei and frequent binucleation. Dense, homogeneous cytoplasm was most commonly seen in smaller cells. Clear cytoplasmic spaces resembling perinuclear halos were frequently observed, best appreciated in cells with more dense cytoplasm. Binucleation and a marginal nuclear location were commonly seen. Necrosis, basement membrane or other stromal material were absent. Vimentin was not expressed in the four cases analysed. Precise cytological recognition was possible in the last five cases. CONCLUSIONS: There is increasing evidence that a cytological diagnosis of ChRCC is possible. In our experience the histopathological features of ChRCC were well reflected in cytological samples, allowing specific recognition. In our cases the main differential diagnosis considered was clear cell carcinoma. Cytology can be especially helpful in the evaluation of intraoperative samples.

Metformin Induces Cell Cycle Arrest and Apoptosis in Drug-Resistant Leukemia Cells.

Recent epidemiological studies indicate that the antidiabetic drug metformin has chemosensitizing and chemopreventive effects against carcinogenesis. Here, we demonstrate that metformin exerts varying degrees of antitumor activity against human leukemia cells, as reflected by differences in growth inhibition, apoptosis, and alterations to metabolic enzymes. In metformin-sensitive cells, autophagy was not induced but rather it blocked proliferation by means of arresting cells in the S and G2/M phases which was associated with the downregulation of cyclin A, cyclin B1, and cdc2, but not that of cyclin E. In 10E1-CEM cells that overexpress Bcl-2 and are drug-resistant, the effect of metformin on proliferation was more pronounced, also inducing the activation of the caspases 3/7 and hence apoptosis. In all sensitive cells, metformin decreased the Δψ m and it modified the expression of enzymes involved in energy metabolism: PKCε (PKCepsilon) and PKCδ (PKCdelta). In sensitive cells, metformin altered PKCε and PKCδ expression leading to a predominance of PKCε over PKCδ which implies a more glycolytic state. The opposite occurs in the nonresponsive cells. In conclusion, we provide new insights into the activity of metformin as an antitumoral agent in leukemia cells that could be related to its capability to modulate energy metabolism.

Hidrocefalia aguda secundaria a intoxicación por monóxido de carbono / Acute hydrocephalus secondary to carbon monoxide poisoning

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Disección aneurismática de la arteria cerebral media / Aneurysmal dissection of the middle cerebral artery

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Thoracic duct cyst presenting as an hour-glass shaped mass in the left supraclavicular area: case report.

Thoracic duct cyst presenting as an hour-glass shaped mass in the left supraclavicular area: case report. Thoracic duct cysts are a very rare entity in the head and neck pathology. We present a case of a 52 year-old man, who was referred to our service, complaining by a 30 days left cervical mass, with no other symptoms. A 6 cm cystic mass was revealed after ultrasonography and CT. Needle aspiration confirmed the presence of lymph in the cyst. The treatment was simple excision. Special care was taken to ligate the connected lymphatic vessels.

Obstructive uropathy following aortofemoral graft surgery.

Fifty patients who had undergone aorto-bifemoral bypass with a bifurcated Dacron graft for aortoiliac arteriosclerotic obliteration were examined with real-time sectorial ultrasound to screen for the presence of hydronephrosis. Hydronephrosis was detected in only 1 case. The low incidence of this complication in our cases may be due to the fact that all our patients were explored at least 1 year after surgery. Some may have developed hydronephrosis early, but this may have resolved spontaneously during the first year after the operation, thus remaining undiagnosed. Pathogenic mechanisms suggested for the development of hydronephrosis and therapeutic approaches are discussed. We conclude that pre- and postoperative ultrasound examination and follow-up beyond 1 year postoperatively seem to be fully justified in all patients who undergo aortoiliac or aortofemoral reconstructive surgery.

Hemodynamic changes from spinal cord stimulation for vascular pain.

The hemodynamic changes induced by spinal cord stimulation (SCS) have been studied in a group of 20 patients with peripheral vascular pain. The surgical technique consisted of the introduction of 1 or 2 electrodes in the subarachnoid space up to the level of the painful area, for mono or bipolar SCS. Several techniques have been used for evaluation of hemodynamic changes induced by SCS. Peripheral blood flow speed was measured by means of ultrasound Doppler, showing a raised maximum speed during stimulation, and a tendency of the pulse wave to return to normal. Thermography showed a marked increase of temperature in the painful area. Preoperatively, plethysmography showed an absence of the typical flow waveform, whilst postoperative recordings showed a small wave of progressively increasing amplitude. Scintigraphy with 201TI showed an increase in muscular blood flow in previously hypovascularized areas. The mechanism of action of SCS on peripheral blood flow and vascular pain is discussed.

Tratamiento de una fístula linfática post-colectomía total por colitis isquémica / Treatment of a total post-colectomy lymphatic fistula by ischemic colitis

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