Everolimus-associated Acute Kidney Injury in Patients with Metastatic Breast Cancer.

Recently, everolimus (Evl) has been introduced in the management of hormone receptor-positive metastatic breast cancer, in combination with aromatase inhibitors. Evl-induced acute kidney injury has hitherto been described in other malignancies, especially renal cell cancer, but only once before in a patient with breast cancer. We describe two cases of Evl-associated nephrotoxicity in patients with breast cancer, one of whom underwent a renal biopsy showing acute tubular necrosis. Both our patients improved after withdrawal of the offending agent and have normal renal functions on follow-up.

Oral mucositis in head and neck cancer.

This module explores the risk factors, pathogenesis and development of oral mucositis. It considers the early diagnosis and accurate management of oral mucositis in head and cancer patients undergoing treatment.

Scalp meningioma.

Primary extracranial meningiomas occur very rarely. We present a rare case of extracranial meningioma of the transitional variant which was excised satisfactorily. There was no suggestion of any connection to the intracranial compartment or cranial nerves. The underlying galea was uninvolved, suggesting the true extracranial nature of this tumour. This rare diagnosis should nonetheless be kept in the differential diagnosis of scalp tumors.

Neuro-endoscopic management of intraventricular neurocysticercosis (NCC).

OBJECTIVE: Various approaches including endoscopy have been used for the treatment of intraventricular and cisternal NCC. We present our technique of Neuro-endoscopic management of intraventricular NCC. METHODS: Twenty-one cases, 13 females and 8 males (age range 12-50 years; mean, 25.7 years), of intraventricular NCC [lateral (n = 6), third (n = 6), fourth (n = 10) ventricles including a patient with both lateral and third ventricular cysts] producing obstructive hydrocephalus formed the group of study. Gaab Universal Endoscope System along with 4 mm 0 degrees and 30 degrees rigid telescopes were used through a frontal burr-hole for removal of intraventricular including intra-fourth ventricular (n = 10) NCC. Endoscopic third ventriculostomy (ETV) was done for internal cerebrospinal fluid (CSF) diversion. Average follow up was 18 months. RESULTS: Complete (n = 18) or partial (n = 2) removal of NCC was done in 20 patients, while a cyst located at foramen of Monro slipped and migrated to occipital or temporal horn in 1 patient. Thirty-degree 4-mm rigid telescope provided excellent image quality with ability to address even intra-fourth ventricular NCC through the dilated aqueduct using a curved tip catheter. No patient required further surgery for their hydrocephalus. There was no operative complication and post-operative ventriculitis was not seen in any case despite partial removal of NCC. CONCLUSION: Neuro-endoscopic surgery is an effective treatment modality for patients with intraventricular NCC. It effectively restores CSF flow and is capable of removing cysts completely or partially from accessible locations causing mass effect. Partial removal or rupture of the cyst does not affect the clinical outcome of the patients.

Dumbbell-shaped paraganglioma of the cervical spine in a child.

Paragangliomas are tumors arising from extra-adrenal paraganglia and account for 0.3% of all neoplasms. The carotid body and temporal bone are the most frequent sites of paraganglioma, though it has been reported to occur in almost every part of the body. Spinal paragangliomas are uncommon and mainly take the form of intradural compression of the cauda equina or thoracic cord. Extradural paragangliomas are still rare; only few cases involving the dorsolumbar spine have been reported. We are reporting an interesting case of a dumbbell-shaped primary extradural paraganglioma of the cervical spine in an 8-year-old boy that presented with progressively increasing spastic quadriparesis.

Magnetic loop basket: a "two-in-one" instrument.

BACKGROUND AND STUDY AIMS: Ingested coins are the most common foreign bodies encountered in the upper gastrointestinal tract in India and if they remain in the stomach for more than 5 days they need to be removed. Ferromagnetic retrieval instruments only work if the coins are ferromagnetic; and it is difficult to maneuver a loop basket in the fundus of the stomach. A magnetic loop basket was designed in an effort to overcome these difficulties and we assessed its feasibility, safety, and effectiveness in the removal of coins from the fundus of the stomach. PATIENTS AND METHODS: Twenty patients with a history of ingested coins were scheduled for removal of the coins using the magnetic loop basket. The time taken, complications, and failure rates were recorded. RESULTS: Twelve ferromagnetic coins were removed in a mean time of 60 seconds (range 30 - 90 seconds) and eight non-ferromagnetic coins were removed in a mean time of 150 seconds (range 90 - 180 seconds) without any failures or complications. CONCLUSION: The magnetic loop basket is a safe, effective, and quick method for removing both ferromagnetic and non-ferromagnetic metallic coins.