Comparative results of infratemporal fossa approach with or without facial nerve rerouting in jugular fossa tumors.

Jugular fossa tumors are uncommon diseases. During the surgery and due to the interposition of the facial nerve in the tumor approach, the facial nerve must be elevated from the fallopian canal and placed permanently into an anterior position. Although this maneuver provides a wide exposure, most of the patients suffer a long-term total or partial facial palsy. The purpose of this article is to check whether the infratemporal fossa approach without transposition of the facial nerve is equivalent to the approach with rerouting of the facial nerve regarding postsurgical morbidity. The clinical records of 52 patients who underwent an infratemporal fossa approach were reviewed in which 34 patients were segregated into two comparable groups regarding the presence or absence of transposition of the facial nerve. There were 19 women and 15 males. The majority of the patients (73%) had jugular paragangliomas. The mean follow-up of the full series was 66 months. It was statistically significant that the worst facial nerve function at hospital discharge was in the patients who underwent facial nerve transposition (p = 0.001). Equally the facial nerve function in the no-rerouting group 1 year after the surgery was significantly much better than in the rerouting group (p = 0.003). Regarding to survival, recurrence or complications no significant differences were observed between both groups. Our study suggests that most of cases avoiding facial nerve transposition allow significant better functional results thereof without affecting other parameters such as recurrence, complications or survival.

Hemangioblastoma quístico de bulbo raquídeo / Cystic bulbar hemangioblastoma

Introducción. Los hemangioblastomas son neoplasias de naturaleza vascular y de características benignas. Representan entre el 2 y el 3% de los tumores cerebrales, y entre el 7 y el 12% de los procesos neoformativos localizados en la fosa posterior. La primera descripción de esta enfermedad se remonta al año 1904, cuando von Hippel hizo pública la primera descripción del hemangioma retiniano. Caso clínico. Varón de 41 años que acudió a su médico, tras presentar durante tres semanas episodios intermitentes de hipo, autolimitados y de duración variable, en ocasiones relacionados con la ingesta y en otras aparecían de forma espontánea. En la exploración neurológica llamaba la atención la presencia de hipoestesia toracoabdominal izquierda. Mediante técnicas de neuroimagen se diagnosticó una lesión tumoral, bien delimitada, quística, de localización bulbar. El abordaje quirúrgico se realizó mediante craniectomía suboccipital, y se llevó a cabo una extirpación completa de la lesión. El estudio anatomopatológico confirmó el diagnóstico de hemangioblastoma. El paciente evolucionó satisfactoriamente, sin presentar nueva clínica neurológica. Conclusión. La localización más frecuente de los hemangioblastomas es en el vérmix y los hemisferios cerebelosos, siendo infrecuente la localización bulbar, que representa un porcentaje inferior al 5% de los hemangioblastomas cerebrales, así como la forma de presentación clínica mediante hipo persistente

Introduction. Hemangioblastomas are neoplasm of vascular type having benign characteristics. They representbetween 2-3% of brain tumors and 7-12% of neoformative processes in the posterior fossa. The first description of the disease goes back to the year 1904, when Eugene von Hippel made the description of retinal haemangioblastoma. Case report. A male patient of 41 years-old who went to his doctor after three weeks of having intermittent episodes of hiccups. In the neurological examination the presence of left thoracic-abdominal hypoesthesia was shown. Brain tumor was diagnosed by neuroimagetechniques. It was well defined, cystic and placed in bulbar region. Surgical approach was carried out by means of suboccipital craniectomy, with the complete removal of the lesion. The histological study confirmed the hemangioblastoma diagnosis. The patient evolved satisfactory, without presenting new neurological symptoms. Conclusion. The most frecuent localization of hemangioblastomas is in vermix and cerebellum hemispheres. The bulbar localization is infrequent (whichrepresents less percentage than 5% of cerebral hemangioblastomas) likewise the clinical manifestation though hiccups

[Cystic bulbar hemangioblastoma]. / Hemangioblastoma quístico de bulbo raquídeo.

INTRODUCTION: Hemangioblastomas are neoplasm of vascular type having benign characteristics. They represent between 2-3% of brain tumors and 7-12% of neoformative processes in the posterior fossa. The first description of the disease goes back to the year 1904, when Eugene von Hippel made the description of retinal haemangioblastoma. CASE REPORT: A male patient of 41 years-old who went to his doctor after three weeks of having intermittent episodes of hiccups. In the neurological examination the presence of left thoracic-abdominal hypoesthesia was shown. Brain tumor was diagnosed by neuroimage techniques. It was well defined, cystic and placed in bulbar region. Surgical approach was carried out by means of suboccipital craniectomy, with the complete removal of the lesion. The histological study confirmed the hemangioblastoma diagnosis. The patient evolved satisfactory, without presenting new neurological symptoms. CONCLUSION: The most frecuent localization of hemangioblastomas is in vermix and cerebellum hemispheres. The bulbar localization is infrequent (which represents less percentage than 5% of cerebral hemangioblastomas) likewise the clinical manifestation though hiccups.

Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments.

BACKGROUND: The treatment of multidrug-resistant Acinetobacter baumannii meningitis is a serious therapeutic problem due to the limited penetration of antibiotics into the CSF. We describe the clinical features and the outcome of a group of patients with nosocomial neurosurgical meningitis treated with different therapeutic options. METHODS: All patients with nosocomial post-surgical meningitis due to A. baumannii diagnosed between 1990 and 2004 were retrospectively reviewed. RESULTS: During the period of study, 51 cases of this nosocomial infection were identified. Twenty-seven patients were treated with intravenous (iv) monotherapy: carbapenems (21 cases), ampicillin/sulbactam (4 cases) and other antibiotics (2 cases). Four patients were treated with iv combination therapy. Nineteen patients were treated with iv and intrathecal regimens: colistin by both routes (8 cases), carbapenems plus iv and intrathecal (4 cases) or only intrathecal (5 cases) aminoglycosides, and others (2 cases). Seventeen patients died due to the infection. One patient died without treatment. The mean (SD) duration of therapy was 17.4 (8.3) days (range 3-44). Although no patients treated with colistin died, we did not observe statistically significant differences in the mortality among the groups with different treatments. CONCLUSIONS: Nosocomial Acinetobacter meningitis has a high mortality. Combined therapy with iv and intrathecal colistin is a useful and safe option in the treatment of nosocomial Acinetobacter meningitis.

Effects of fluoxetine on the development of lung metastases induced by operative stress in rats.

Experiments were performed in order to evaluate the effects of fluoxetine, a selective inhibitor of neural serotonin transporter antidepressant, on the development lung metastases in rats subjected to laparotomy and injected (i.v.) with 10(4) Walker 256 (W-256) carcinosarcoma cells. The number of metastatic nodules on the surface of the lungs, as well as the percentage-area of metastases in the frontal section through pulmonary hilus were increased in rats subjected to sham-surgery or laparotomy. Treatment with fluoxetine (5 mg/kg) partially reversed those adverse effects of surgery, but the difference was clearer when it was administered before surgery was performed. Survival periods were also assessed and fluoxetine was found to decrease the lethality of rats exposed to surgery.

Effects of amphetamine on the development of Moloney sarcoma virus-induced tumors in mice.

Experiments were conducted to evaluate the effects of amphetamine (0. 4 mg/kg) on the development of autochthonous tumors induced by the Moloney sarcoma virus (MSV) in Balb/c female mice. Enhancement of MSV-induced tumor incidence and tumor growth was observed, together with a delay in the usual prompt regression of the tumors, when mice were daily injected with amphetamine for 3 days after MSV-inoculation. However, no effects of amphetamine on tumor development were observed when it was administered during the 3 days before tumor inoculation.

Effects of alprazolam on the development of Moloney sarcoma virus-induced tumors in stressed mice.

Experiments were conducted to evaluate the effects of alprazolam (1 mg/kg i.p.) on the development of autochthonous tumors induced by the Moloney sarcoma virus (MSV) in BALB/c female mice subjected to stress. Enhancement of MSV-induced tumor incidence and growth was observed, together with a delay in the usual prompt regression of the tumors, when programmed white sound anxiety-stress was administered immediately following MSV i.m. inoculation. However, a depressant effect on tumor size and incidence was observed when stress was administered before virus inoculation. Treatment with alprazolam was found to reverse partially the adverse effects of postinoculation stress, and also to inhibit the beneficial effects of the preinoculation administration of stress on tumor development. Pretreatment with Ro 15-1788 (10 mg/kg s.c.), a central benzodiazepine antagonist, resulted in a suppression on both effects of alprazolam in stressed mice.

Effects of buspirone on the immune response to stress in mice.

Several experiments were conducted to evaluate the effects of buspirone, a selective 5-hydroxytryptamine-1A (5-HT1A) anxiolytic, on the immune system of mice exposed to a chronic auditory stressor. Daily injection with 0.5 and 1 mg/kg (intraperitoneally) of buspirone resulted in a dose-dependent reduction in the stress-induced suppression of the natural killer (NK) cell activity and the in vitro and in vivo activity of phagocytosis. Higher doses of buspirone (2.0 mg/kg) showed less robust immunoenhancing effects in stressed mice, and caused a significant suppression of these immune parameters in unstressed mice.

Effects of alprazolam on influenza virus infection in stressed mice.

The review of the literature shows that stress can adversely affect influenza A virus infection. In this report, we study the effects of chronic alprazolam (1 mg/kg/day), a central benzodiazepine agonist anxiolytic, on the influenza A (PR-8/34) virus specific immune injury in mice exposed to a chronic auditory stressor. Treatment with alprazolam resulted in a significant reduction of stress-induced increase of virus titters and pulmonary vascular permeability. A correlation with the lethality of mice was also observed.

Effects of alprazolam on cellular immune response to surgical stress in mice.

Mice exposed to surgical stress induced by laparotomy and treated with chronic alprazolam (0.5-2 mg/kg) showed a dose-dependent reduction in stress-induced suppression of the natural killer (NK) cell activity. These immunoenhancing effects of alprazolam were more intense when it administered before the surgery was performed.

Effects of buspirone on the resistance, development and passive transfer of immunity to Listeria monocytogenes in mice submitted to stress.

Mice exposed to a chronic auditory stressor and treated chronically with buspirone (1 mg/kg) showed a reduction in stress-induced suppression of the resistance and development of immunity to Listeria monocytogenes. Attempts to passively transfer immunity with spleen cells were also performed. Stressed, immunized mice had a reduced capacity to transfer immunity passively to nonimmunized mice and buspirone was found to partially suppress this inhibitory effect of stress.

Phagocytic activity in stressed mice: effects of alprazolam.

Mice exposed to a chronic auditory stressor and daily injected with alprazolam (1 mg/kg/day, s.c.) showed a reduction in stress-induced suppression of the in vitro and in vivo activity of phagocytosis, measured using the zymosan particle uptake method and the carbon clearance test, respectively. Pretreatment with Ro-15-1788 (10 mg/kg, s.c.), a central nervous system benzodiazepine antagonist, resulted in suppression of the effects of alprazolam in stressed mice.

Effects of amphetamine on influenza virus infection in mice.

Several experiments were conducted to evaluate the effects of chronic amphetamine on the influenza A (PR-8/34) virus specific immune injury in CD-1 mice. Treatment with amphetamine resulted in a significant increase of lung virus titers and pulmonary vascular permeability. Amphetamine also increased the lethality of infected mice.

Effects of amphetamine on the activity of phagocytosis in mice.

Experiments were conducted to evaluate the influences of chronic treatment with amphetamine (0.4 mg/kg/day) on the activity of phagocytosis in mice. Results show a decrease of the in vitro and in vivo phagocytosis measured by using the zymosan-particle uptake method and the carbon clearance test, respectively.

Effects of amphetamine on T-cell immune response in mice.

Mice chronically injected with amphetamine (0.4 mg/kg/day) showed a reduction in thymus and spleen cellularity, and in peripheral T lymphocyte population. The blastogenic response of spleen lymphoid cells was assessed and amphetamine was found to inhibit T-cell proliferation. Amphetamine also reduced the capacity of mice to the development and passive transfer of immunity to Listeria monocytogenes.