Active immunotherapy for cancer patients using tumor lysate pulsed dendritic cell vaccine: a safety study.

Cancer vaccine therapy represents a promising therapeutical option. Consistently, with these new treatment strategies, the use of dendritic cell vaccines is becoming increasingly widespread and currently in the forefront for cancer treatment. The purpose of this study was to evaluate the feasibility and safety of tumor lysate-pulsed dendritic cell (DC) vaccine in patients with advanced cancers. For this purpose, eighteen patients with relapsed or refractory cancer were vaccinated with peripheral monocyte-derived DCs generated with GM-CSF and IL-4, and pulsed consequently with 100 microg/ml of tumor lysate before maturation in culture in the presence of IL-1beta, PGE2 and TNF alpha for two days. The first two vaccinations were given intradermally every two weeks while further injections were given monthly. Tumor lysate-pulsed dendritic cell injections were well-tolerated in all patients with no more than grade 1 injection-related toxicity. Local inflammatory response was mainly erythematous which subsided in 48 hrs time. No end organ toxicity or autoimmune toxicity was identified. Clinical responses observed in our study were satisfactory for a phase I clinical study. We observed 4 (22%) objective clinical responses. These responses are significantly correlated with delayed type hypersensitivity testing (DTH) (p < 0.01). The results showed that this active immunotherapy is feasible, safe, and may be capable of eliciting immune responses against cancer.

Intracranial and subcutaneous lipoma associated with sagittal sinus fenestration and falcine sinus.

Intracranial lipomas are rare lesions. Intracranial lipoma associated with a subcutaneous lipoma is extremely rare. Various vascular abnormalities have been described in association with intracranial lipoma, including distension, kinking, or narrowing of arteries and veins; arteriovenous malformation; and aneurysm. To our knowledge, association of sagittal sinus fenestration, falcine sinus, and absent straight sinus with intraextracranial lipoma has not been reported before. We report the imaging findings of an infant with interhemispheric and subcutaneous lipoma associated with falcine sinus and sagittal sinus fenestration.

Giant serpentine aneurysm with acute spontaneous complete thrombosis.

We report a case of a giant serpentine aneurysm (GSA) of the middle cerebral artery (MCA) that underwent complete spontaneous thrombosis after angiography. The patient was a 24-year-old man who had an acute headache. CT and MR examinations revealed a large partially thrombosed aneurysm of the MCA with residual flow in the artery. Angiography demonstrated a GSA arising from the left MCA. Thirteen days later, a second angiography showed complete thrombosis of the aneurysm.

Subacute spinal subdural hematoma associated with intracranial subdural hematoma.

We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.

Multifocal intradiploic cavernous hemangioma of the skull associated with nasal osteoma.

OBJECTIVE: To present a 42-year-old female patient with multifocal cavernous hemangioma of the skull associated with nasal osteoma. DESIGN: A case report. INTERVENTION METHODS: X-rays, computerized tomography, magnetic resonance imaging, and histopathology were used to achieve the diagnosis of this rare entity. The multiple cavernous hemangiomas were resected en-bloc and a curettage biopsy was obtained from the nasal osteoma. RESULTS: The patient healed well after the operation. No recurrences of the cavernous hemangiomas were observed after one-year follow-up. CONCLUSION: Multifocal cavernous hemangiomas are rare benign lesions of the calvarium, arising from the intrinsic vasculature of the bone. Although they are benign, radiological findings are not always characteristic and their multiple presentation may easily make surgeons consider the other malignancies of the skull in the differential diagnosis. Histopathologic confirmation of the tumor is the definitive method for diagnosis. The treatment of choice is early en bloc resection of the tumour where it is possible.

Ogilvie's syndrome after cervical discectomy.

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by abdominal distention and massive colonic dilatation without any mechanical cause of obstruction. Lumbar spine operations can be an etiologic factor. We had a case with Ogilvie's syndrome after cervical discectomy. We also treated successfully this case by parasympathetic agent, neostigmine.

Diabetes insipidus secondary to penetrating spinal cord trauma: case report and literature review.

STUDY DESIGN: Case report. OBJECTIVE: To present a case of central diabetes insipidus (CDI) that developed after a gunshot injury to the thorax and thoracic spinal cord and to discuss the disease process in light of the relevant literature. SUMMARY OF BACKGROUND DATA: Antidiuretic hormone (ADH) abnormalities may develop after spinal trauma and/or surgery. Although there are published reports of inappropriate ADH syndrome arising in this clinical picture, CDI is rare. METHODS: A 33-year-old woman with hemopneumothorax and a gunshot wound to her thoracic spine was treated with chest tube drainage. No surgery was performed for the spinal injury. The patient was paraplegic on admission and rapidly developed excessive urine output. Testing revealed that her serum ADH level was low, consistent with CDI. Desmopressin acetate nasal spray was the prescribed treatment. RESULTS: The patient responded well to the desmopressin acetate spray. CONCLUSIONS: CDI is a complicated hormonal disorder characterized by excessive urine output. It is typically linked to an abnormality in the hypothalamohypophyseal axis that markedly reduces ADH production. The most common inciting causes are craniocerebral trauma, brain tumor and/or surgery, and central nervous system infection. Although uncommon, CDI should be considered when a spinal trauma patient develops excessive urine output.

Unilateral Agenesis of Internal Carotid Artery with Subarachnoid Hemorrhage: Report of Two Cases.

Internal carotid artery (ICA) is a rare anomaly of embryologic development. Digital subtraction angiography examination showed no visualization of the ICA on the right side in a 30-year-old male patient and on the left side in a 47-year-old female patient. Computed tomography (CT) revealed the absence of the corresponding bony carotid canal. Doppler examinations of the common carotid and external carotid arteries on the affected sides demonstrated high-resistance flow characteristics. Two cases of ICA agenesis with subarachnoid hemorrhage were presented and the literature is reviewed.http://link.springer-ny.com/link/service/journals/00547/bibs/8n3p157.html

Cerebellar agenesis: a case report with clinical and MR imaging findings and a review of the literature.

We describe the clinical and MRI findings in a 22-year-old male patient with absence of the cerebellum, an extremely rare anomaly. Clinical features included ataxia of limbs, gait and stance, cerebellar oculomotor signs. MRI evaluation showed minute remnants of cerebellar tissue corresponding to the anterior quadrangular lobules. Nine previous cases of total or subtotal cerebellar agenesis have been reported, including Combettes's first report in 1831. We report an additional case and provide MRI of this unusual anomaly detected during life. Diagnosis in this case was made on the basis of MR findings. To our knowledge, this is the fifth report of this disorder being diagnosed in a living patient. Copyright 1998 Lippincott Williams & Wilkins

The anesthetic management of a patient with pemphigus vulgaris--a case report.

The anesthetic management of a patient with pemphigus vulgaris who required general anesthesia and endotracheal intubation for craniotomy operation is described. The anesthesia was assured with Diprivan. Vecuronium bromide/isoflurane/nitrous oxide in oxygen and fentanyl when necessary. No anesthetic and surgical complication occurred.

Epidermoid tumor of the interhemispheric fissure.

In this report, we present a case of an interhemispheric epidermoid presenting with generalized seizure. The tumor was demonstrated radiologically and discussed with the pertinent literature.

Primary Ewing's sarcoma of the temporal bone with intracranial, extracranial and intraorbital extension. Case report.

Primary cranial Ewing's sarcoma is a very rare malignant tumor. Primary temporal bone Ewing's sarcoma with intraorbital extension is also a very rare condition. In this article we describe a case of primary Ewing's sarcoma of the temporal bone which extended into intracranial, extracranial and intraorbital compartments; manifesting with a swelling in the zygomatic fossa and proptosis of the right eye. The tumor was excised partially, and the patient underwent radiochemotherapy. The patient died 6 months after the therapy, with lung metastasis. The case is discussed with the pertinent literature.

Hirsutism as a first manifestation of a giant arachnoid cyst of the sylvian fissure.

In this report, we present a case presenting with hirsutism. In this case, there was a large sylvian fissure arachnoid cyst demonstrated by radiology. This case is discussed in view of clinical findings and a literature review is presented.

Epidermoid tumor of the occipital bone.

Intradiploic epidermoid tumor of the occipital bone was presented. There were neither intracranial extensions nor neurologic deficits. The lesion started as a painless mass under the scalp. The total removal of the tumor was associated with a good prognosis.

Clinical and radiological evaluation of angiographically occult, calcified intracranial vascular malformation. Case report.

In this study, we present an angiographically occult, calcified intracranial vascular malformation. This lesion is rare and has some therapeutic difficulties and different approaches by authors. In this article, we also discuss the clinical, radiological characteristic features of this lesion. We pay attention on the totally calcified malformation.

Epidermoid cyst of the brain stem. Case report.

Brain stem epidermoid cysts are extremely rare lesions. Only nine cases have been reported. Management of the epidermoid cyst is decompression of cyst contents and removal of cyst capsule. But in some cases resection of the cyst may result in a poor outcome because of cyst wall adhesion into the brain stem.

Primary intraosseous meningioma of the temporal bone in an infant. A case report.

Primary intraosseous meningioma of the skull bone is a very rare entity. Although it can occur at any age, it is very rare in children. We present a case and review the literature.

Solitary plasmacytoma of the skull. A case report.

A case of solitary plasmacytoma of the skull is presented. The tumor was radically removed. There was no systemic involvement and the patient was not submitted to radiotherapy. Lytic lesions of the skull are discussed.

Giant cell tumor of the fronto-parietal bone. A case report.

Giant cell tumor of the skull is very rare clinical entity. This paper presents a case of giant cell tumor of the fronto-parietal bone and a brief review of the literature.

A case of acute encephalopathy after iohexol lumbar myelography.

A case of acute encephalopathy after lumbar myelography is reported in a female aged 26 years. Fourteen hours after the procedure, the patient developed coma (GCS 6) and had generalized slowing of EEG activity. This state lasted about 12 h, followed by gradual and full recovery.