Diagnostic and therapeutic dilemmas of a large scrotal lesion in an AIDS patient.

In the setting of HIV infection, chronic genital ulcerations may be challenging both diagnostically and therapeutically. The differential diagnosis of these lesions is very broad, and the causes can be multifactorial. We present a case of a chronic, extensive, ulcerating scrotal mass and review the salient clinical, diagnostic, and therapeutic considerations.

False aneurysm of the cavernous carotid artery and progressive external ophthalmoplegia after transsphenoidal hypophysectomy. Case report.

A case is reported in which a large false aneurysm and small associated fistula formed in the cavernous carotid artery as the result of laceration at the time of transsphenoidal surgery. The clinical syndrome associated with the enlarging mass and the surgical management of the lesion itself are described. The value of the midline approach to the sella is stressed, along with anatomical variants of the carotid artery.

A review of recent advances in vascular smooth muscle pharmacology.

An understanding of the physiology of vascular smooth muscle and knowledge of the reaction of such muscle to certain drugs are essential for the development of a means of treating cerebral arterial spasm. The role of cyclic nucleotides in vascular smooth muscle activity is reviewed and possible therapeutic approaches are listed. Probably the safest and most effective treatment would be 1) stimulation of the adenyl cyclase-cyclic adenosine monophosphate system by a beta(2)-adrenergic drug combined with 2) inhibition of the phosphodiesterase system.

Treatment of experiment delayed cerebral arterial spasm with a beta2-adrenergic stimulator and a phosphodiesterase inhibitor.

Delayed cerebral arterial spasm was induced by subarachnoid hemorrhage in 11 rhesus monkeys. Ten monkeys (62%) developed spasm. Of seven monkeys treated with salbutamol (a beta2-adrenergic stimulating drug), five had relief of vasospasm. Four monkeys, one of which had failed to respond to salbutamol alone, were treated with salbutamol and aminophylline (a phosphodiesterase-inhibiting drug), and all four were relieved of their vasospasm. When considered as one group, the monkeys had an 81% response rate. The authors suggest that a combination of beta2-adrenergic stimulation and phosphodiesterase-inhibition might be of value in preventing or treating delayed cerebral arterial pressure.

"Painless" spinal epidural hematoma during anticoagulant therapy.

Severe back or radicular pain has previously been considered as the earliest and most prominent symptom in spinal epidural hematoma. In the patient described here, a "painless" spinal epidural hematoma developed during anticoagulant therapy. The absence of pain delayed recognition of the lesion and institution of therapy. The absence of pain is distinctively rare, but should not delay appropriate diagnostic procedures when other signs suggest the presence of a spinal epidural hematoma.

Intracerebral schwannoma.

A case is reported in which the authors describe a rare example of an intracerebral schwannoma in a 63-year-old woman having a clinical history suggesting the presence of the tumor for 40 years. Such an unusually prolonged course is ascribed to extensive regressive changes in the tumor. The occurrence of intracerebral schwannoma indicates the existence of schwann cells deep within the brain substance, although the precise source of these cells remains obscure.