Petrous Face Meningiomas: Classification, Clinical Syndromes, and Surgical Outcomes.

BACKGROUND: Petrous face meningiomas (PFMs) are challenging tumors because of their proximity to the cranial nerves, brainstem, and critical vasculature. The objective of this study is to present surgical outcomes and support an anatomic classification for PFM based on clinical presentation. METHODS: A retrospective chart review was performed, and 51 PFMs were identified. Tumors were classified by location along the petrous face into anterior, middle, and posterior. Presentation and outcomes were analyzed with logistic regression. RESULTS: The median follow-up was 31.6 months. Tumors were World Health Organization grade I (n = 50), with 1 World Health Organization grade II tumor. Location was anterior (22%), middle (14%), posterior (53%), and overlapping (12%). Median tumor diameter was 3.0 cm (range, 0.8-6.2 cm). Anterior location was associated with facial pain/numbness on presentation (P < 0.0001), middle location with hearing loss/vestibular dysfunction (P = 0.0035), and posterior with hydrocephalus (P = 0.0190), headache (P = 0.0039), and vertigo (P = 0.0265). Extent of resection was gross total (63%), near total (14%), and subtotal (25%). The observed radiographic recurrence rate was 15%. Mean progression-free survival after diagnosis was 9.1 years with 2-year, 5-year, and 10-year progression-free survival of 91.8%, 78.6%, and 62.9%, respectively. The complication rate was 27%. Age, location, and approach were not associated with complications. CONCLUSIONS: PFMs present with distinct clinical syndromes based on their location along the petrous face: anterior with trigeminal symptoms, middle with auditory/vestibular symptoms, and posterior with symptoms of mass effect/hydrocephalous. Surgical resection is associated with excellent long-term survival and a low rate of recurrence, which can be managed with radiotherapy.

Field evaluation of the Merlin immediate HIV-1 and -2 test for point-of-care detection of human immunodeficiency virus antibodies.

The Merlin Immediate HIV-1 and -2 Test (Merlin point-of-care [POC] test; Merlin Biomedical & Pharmaceutical) is a nitrocellulose membrane flow immunoassay performed at the POC with the use of blood obtained from a fingerprick. The results of this test were compared with those of enzyme immunoassay (EIA) performed on venous blood samples in the laboratory. Positive results of both tests were confirmed by a Western blot (WB). The study included 553 adults with known HIV (human immunodeficiency virus) seropositivity (all of whom had positive Merlin POC test results) and 2659 adults with unknown HIV serostatus (20 of whom had positive EIA/WB results; 19 of the 20 also had positive Merlin-POC test results). The sensitivity of the Merlin POC test was 95.0% for patients with an unknown HIV serostatus and 99.83% for those with a positive serostatus. For previously untested subjects, the test's specificity and positive predictive value were 100%, its negative predictive value was 99.96%, and its overall accuracy was 99.96%. The Merlin POC test is highly accurate for the detection of HIV antibodies.

Evolution of legionnaires' disease in an urban hospital - abstract

Ongoing epidemiological surveillance for nosocomial Legionnaires' Disease (LD) was initiated after control of an initial outbreak involving eight cases at a Nova Scotia Hospital in 1984. All cases of nosocomial pneumonia were screened for LD, and water samples were cultured for Legionella at intervals. No clinical cases of LD were identified until April, 1987, although there were occasional positive cultures from water samples in different areas of the hospital. Subsequently, six to seven cases have been identified over each 12-month period with no more than two cases in any month. The mean age of patients was 67.7 years (range 54 - 83) with a male to female ratio 2.5:1. The mean time of onset of pneumonia after admission was 19.9 days (range 8 - 27) with diagnosis being made in most cases by sputum culture. Risk factors included smoking, immunosuppressive therapy and admission to a specific wing of the hospital. Water samples from the specific wing of the hospital were persistently positive at high levels until certain plumbing revisions were instituted. In contrast to the initial outbreak, these cases represent an endemic level of nosocomial LD related to a specific area of the hospital. Ongoing surveillance is required for detection and control (AU)

The epidemiology of pseudomonas cepacia in adult cystic fibrosis - abstract

A large proportion of patients attending our adult cystic fibrosis (CF) clinic have lung colonization with P. cepacia. We present a review of these patients with regard to clinical course and survival, lung function and immunological parameters. Twenty-two of 44 patients (50 percent) have P. cepacia colonization (17 males, 5 females, aged 20-33 years). All patients acquired the organism after the age of 10 years with 17 of 22 (77 percent) acquiring it after the age of 15 years. All but one patient were followed up in the same paediatric CF clinic with documented acquisition before transfer to the adult clinic. Both members of the one pair of siblings are colonized. Three of 22 (14 percent) are also colonized with other organisms (P. aeruginosa, 1; P. maltophilia, 1; S. aureus, 1). There was no significant difference in frequency of hospitalizations or lung function tests between patients with and without P. cepacia. However, patients with P.cepacia had significantly higher ESR, C-reactive protein and immunologlobulin than those without P.cepacia. To date, two of 22 (9 percent) with P.cepacia have died as a result of deteriorating lung disease. P.cepacia has become a more common pathogen in our adult CF patients. It appears to be nosocomially acquired and although not specifically associated with increased mortality may be associated with a more severe immunological response. However, in this setting, it presents a greater challenge for control of acquisition and selection of antimicrobial therapy (AU)

Pneumocystis pneumonia in the acquired immune deficiency syndrome (AIDS) - abstract

We present a retrospective analysis of Pneumocystis carinii pneumonia (PCP) in patients with AIDS at our institution. Data were collected by chart and radiological review. Since February 1983 we have treated 24 patients with AIDS and PCP. All except three were homosexual males, with seventeen (17 percent) having PCP as the initial manifestation of AIDS. All patients had CXR changes on presentation. Three had atypical changes including lobar consolidation and multiple cavities. Arterial pO2 on room air ranged from 33 to 83 (av. 59). Diagnosis was made in 28 of 30 episodes (93 percent) using bronchoalveolar lavage. One patient was positive on induced sputum, and one had a positive open lung biopsy. Other respiratory pathogens were also isolated in 20 of 30 episodes (67 percent). Therapy was initiated with trimethoprim-sulpha (T-S) or pentamidine (P). Seven of 21 episodes (33 percent) were successfully treated with T-S alone vs one of nine (11 percnet) with P alone. Eight of 21 (38 percent) experienced adverse effects with T-S vs six of nine (67 percent) with P. Adjunctive steriod therapy was required in 11 of 30 episodes (37 percent) with four deaths subsequently. Overall, six of 30 episodes (20 percent) resulted in death, three in association with concomitant CMV infection. Six of 24 patients (25 percent) had two or more episodes of PCP occurring within 5-17M. (av. 9M) of successful therapy. Our experience parallels that reported from other centres in North America (AU)

Effect of pseudomonas aeruginosa and staphylococcus pyogenes on the rate of wound healing in mice

The effects of Pseudomonas aeruginosa and Staphylococcus pyogenes and sterile dirt on the rate of wound healing in Albino Swiss mice have been studied. Framycetin sulphate, Alfamel, cod liver oil and honey were used to treat all three groups. The rate of healing was unaffected by treatment, but was significantly dependent on the infecting organism (AU)