RESUMO
Adult T-cell leukemia (ATL) has a range of clinical characteristics. Phenotypically the leukemic cells usually express the helper/inducer associated antigen OKT4 with lack of OKT8. We have observed three patients with acute ATL cytologically indistinguishable from OKT4+/OKT8- ATL but whose neoplastic cells had the unusual phenotype, OKT3+, OKT4+, OKT6-, OKT8+ OKT9+/-, OKT11+, Tac+/-, TdT-. All patients had abnormal karyotypes and antibodies against anti-ATL associated antigens as well as proviral DNA of human T-cell leukemia virus in the leukemic cells. The clinical course was complicated by skin eruptions, hypercalcemia, pulmonary infection and disseminated intravascular coagulopathy. All died of complications shortly after diagnosis. The clinical features of these patients were similar to those of OKT4+/OKT8- ATL. However, their acute course suggests that co-expression surface antigens OKT4 and OKT8 may be a sign of aggressive nature of the disease with poor prognosis.
Assuntos
Anticorpos Monoclonais/imunologia , Antígenos de Superfície/análise , Infecções por Deltaretrovirus/imunologia , Idoso , DNA Viral/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Linfócitos TRESUMO
The mastoid air cell was illuminated to estimate the location of the sigmoid sinus in 12 cases of a retrosigmoid suboccipital craniotomy for cerebellopontine angle tumors. A special illuminator system was designed, and the tip of the illuminator was placed inside the external auditory canal. The posterior margin of the illuminated air cell was delineated on the outer surface of the skull after the skin flap was turned and the position of the sigmoid sinus was estimated with reference to the preoperative computed tomographic scan. The posterior margin of the mastoid air cell in an axial slice, including the internal auditory canal, usually exists within the breadth of the sigmoid sinus. A gap between the posterior margin of the mastoid air cell and the position of the sigmoid sinus was easily corrected by the computed tomographic finding. This method was found to be simple and reliable in performing the suboccipital craniotomy with safety and exactness.
Assuntos
Craniotomia/métodos , Iluminação , Processo Mastoide/citologia , Adulto , Idoso , Craniotomia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Osso Occipital , Tomografia Computadorizada por Raios XRESUMO
A very rare case of desmoplastic fibroma located in the frontal bone is presented. It was discovered in a 29-year-old female who complained of a painful swelling in the right frontal region. The tumour was resected en bloc and there has been no recurrence. Findings on magnetic resonance imaging, angiography and radionuclide bone scans of the tumour are reported. The clinical, neuroradiological and histopathological features are discussed.
RESUMO
A 75-year-old male with left abducens nerve paresis presented with an ectopic pituitary adenoma invading the posterior wall of the sphenoid sinus. The sphenoidal mass grew rapidly for 6 months with left ophthalmoplegia and was partially removed via the transsphenoidal approach. The histological examination showed a benign pituitary adenoma, but the MIB-1 proliferating cell index was 6.8%, reflecting the clinically malignant behavior. The symptom gradually improved without tumor regrowth over 1.5 years after conventional irradiation.
Assuntos
Adenoma/patologia , Coristoma/patologia , Neoplasias Hipofisárias/patologia , Adenoma/terapia , Idoso , Coristoma/terapia , Humanos , Masculino , Neoplasias Hipofisárias/terapia , Seio EsfenoidalRESUMO
A 42-year-old male presented with a prolactin-producing pituitary adenoma with an atypical radiological appearance. The tumor was incidentally found by magnetic resonance imaging, which demonstrated a cystic tumor in the enlarged and partially empty sella turcica. Computed tomography revealed the tumor was surrounded by calcification with an egg-shell appearance. The serum prolactin level was 37 ng/ml. The operative finding was a calcified shell-containing cystic tumor. Immunohistochemical staining revealed prolactin-positive cells. The combination of the unusual calcification, and enlarged and partially empty sella was considered to be a sequela of spontaneous degeneration of the tumor.
Assuntos
Calcinose/etiologia , Neoplasias Hipofisárias/complicações , Prolactinoma/complicações , Adulto , Calcinose/diagnóstico por imagem , Síndrome da Sela Vazia/diagnóstico por imagem , Síndrome da Sela Vazia/etiologia , Humanos , Hipogonadismo/etiologia , Masculino , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/patologia , Neoplasias Hipofisárias/irrigação sanguínea , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Prolactinoma/irrigação sanguínea , Prolactinoma/diagnóstico por imagem , Prolactinoma/patologia , Tomografia Computadorizada por Raios XRESUMO
Among 48 cases of subarachnoid hemorrhage, 21 cases (43.8%) showed symptomatic vasospasm. We attempted treatment, using a large amount of steroid therapy for them in accord with our own protocol. In the 21 cases who received steroid therapy for symptomatic vasospasm, 18 cases (85.7%) showed improvement of their symptoms. This was especially evident in about 8 cases where the steroid effect was remarkable. There was a serious side effect, GI--tract bleeding, in one case. Although the effect of the steroid therapy was evident for slight or moderate spasm cases, 5 severe spasm cases responded poorly. We concluded that a large amount of steroid therapy was effective for slight or moderate symptomatic vasospasm cases, and that in severe ones possibly another therapy combined with steroid therapy would be necessary.
Assuntos
Hidrocortisona/administração & dosagem , Ataque Isquêmico Transitório/tratamento farmacológico , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Avaliação de Medicamentos , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-IdadeRESUMO
A case of generalized choreic movement associated with subarachnoid hemorrhage is reported. A 71 year-old hypertensive woman suddenly developed severe headache 14 days before admission. Consciousness disturbance and involuntary movement involving the face and upper extremities appeared about 8 days after onset. The involuntary motion was diagnosed as generalized choreic movement. CT scans showed subarachnoid hemorrhage with ventricular dilatation and periventricular lucency involving bilateral caudate nuclei. On admission the patient was stuporous with Hunt & Kosnik Grade 4. She showed involuntary choreic movement in both arms, trunk and face; hemiparenis and hyperreflexia were absent. An angiography revealed a right internal carotid-anterior choroidal artery aneurysm with vasospasm. After clipping the aneurysm in the following day, the consciousness disturbance and choreic movement gradually improved. By eight days after operation, the choreic movement completely disappeared. An MRI showed lacunar infarcts in the bilateral basal ganglia, predominantly in the caudate nuclei. In our case, the choreic movement is supposed to have been caused by impaired circulation in the bilateral corpora striata due to vasospasm and hydrocephalus after subarachnoid hemorrhage, in addition to the preexisting lacunar infarcts in the basal ganglia. This is claimed to be the first reported case of generalized choreic movement in associated with subarachnoid hemorrhage, which improved after surgery.
Assuntos
Coreia/etiologia , Hemorragia Subaracnóidea/complicações , Idoso , Encéfalo/patologia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Imageamento por Ressonância Magnética , Movimento , Ruptura Espontânea , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgiaRESUMO
A case of intra-aortic balloon pumping (IABP) entrapment in which the ruptured catheter could be removed through the left axillary artery was reported. A 68-year-old man was admitted with persistent chest pain, and because of his poor cardiac condition, an IAB catheter was inserted by the Seldinger technique. During attempted extraction of the IAB catheter resistance was encountered and it turned out to be entrapped. Then a guide-wire was passed through the IAB lumen to the left axillary artery, the artery was exposed, and the tip of the guide-wire and IAB catheter were led to the arteriotomy site. After the balloon was dissected, the IAB catheter could be removed through the axillary artery. Finally, left femoro-left branchial artery bypass was performed with e-PTFE graft because of the arterial injury and ischemia of the involved arm. The patient recovered from this episode.
Assuntos
Artéria Axilar , Corpos Estranhos/cirurgia , Balão Intra-Aórtico/efeitos adversos , Idoso , Prótese Vascular , Falha de Equipamento , Humanos , MasculinoRESUMO
Two patients with advanced germ cell tumor who entered complete remission following intensive combination chemotherapy, radiation therapy and surgical intervention are reported. A 28-year-old businessman presented with abdominal pain and masses associated with an elevated HCG level for which he underwent exploratory laparotomy. Large retroperitoneal masses were found and microscopical examination of the masses were revealed seminoma. Three courses of combination chemotherapy consisting of CDDP, VLB and PEP were given to the patient followed by radiation therapy to the parailiac, paraaortic, mediastinal and supraclavicular lymph nodes with boost irradiation to the paraaortic lymph nodes where the large masses were located. The other patient was a 21-year-old student who developed sharp precordial chest pain which proved to be due to a large mediastinal mass accompanied by an elevated AFP level. He was treated with radiation therapy to the mediastinum, surgical resection and combination chemotherapy. However, he showed recurrence in the lungs associated with rising AFP levels, and was given a salvage chemotherapy consisting of 3 courses of CDDP, ADR, PEP and Etoposide. Both patients were successfully treated with combined modalities of treatment including intensive chemotherapy and have been off therapy without recurrence for over 12 and 4 months, respectively.