Does Size Matter? On the Role of Stereotactic Radiosurgery for Large Vestibular Schwannomas as Seen in an Institutional Experience of Gamma Knife Radiosurgery for High-Grade Tumors.

Objective: Management of large vestibular schwannoma (VS) is controversial. Surgery has historically been the treatment of choice, but emerging literature suggests that definitive stereotactic radiosurgery is feasible. We report our institutional experience of control and morbidity outcomes treating Koos grade 3-4 VS with Gamma Knife radiosurgery (GKRS).

Racial segregation and disparities in breast cancer care and mortality.

Background: Questions have existed as to whether residential segregation is a mediator of racial/ethnic disparities in breast cancer care and breast cancer mortality, or has a differential effect by race/ethnicity.

Methods: Data from the Surveillance, Epidemiology, and End Results-Medicare database on white, black, and Hispanic women aged 66 to 85 years with breast cancer were examined for the receipt of adequate breast cancer care.

Results: Blacks were less likely than whites to receive adequate breast cancer care (odds ratio [OR], 0.

Myocarditis and pericarditis with tamponade associated with disseminated tuberculosis.

Tuberculous involvement of the myocardium is relatively rare. Tuberculous pericarditis with tamponade and myocarditis in a young woman with no evidence of immunosuppression and disseminated tuberculosis is described. Three distinct forms of myocardial involvement are recognized: nodular tubercles (tuberculomas) of the myocardium; miliary tubercles of the myocardium; and an uncommon diffuse infiltrative type.

Differential lung physiotherapy using a double lumen tube in flail chest and refractory lung atelectasis.

The management of refractory lung atelectasis in a patient with flail chest can be difficult. Treatment of lung atelectasis is complicated by practical problems with the application of chest physiotherapy, postural drainage and incentive spirometry. Although double lumen endotracheal tubes have been used in such cases for the purpose of differential lung ventilation, the use of differential lung physiotherapy has not been reported before.

Left atrial myxoma presenting with embolism to the aorta.

We present a patient with left atrial myxoma embolizing to the ascending aorta. The features have not been reported previously and were diagnosed with transesophageal echocardiography.

Cystic papillary adenocarcinoma of the submandibular gland in a child.

A 12-year-old boy reported that a mass in his left jaw had been growing slowly for 8 months. Axial and coronal contrast-enhanced spiral CT showed a 5-cm cystic mass within an enhancing, mildly enlarged submandibular gland. Excisional biopsy revealed a cystic papillary adenocarcinoma of the left submandibular gland, very rare in children.

Squamous cell carcinoma of the cervix metastatic to an ovarian Brenner tumor.

Metastatic tumors account for approximately 10 to 15% of surgically excised ovarian malignancies (Semin Diagn Pathol 8:250-276, 1991). Although the majority of tumors arise within the female genital tract, cervical cancer is a rare source of metastasis to the ovary. Cervical carcinomas with ovarian involvement are usually advanced lesions with lymph node involvement (Am J Obstet Gynecol 166:50-53, 1992; Cancer 71:407-418, 1993).

Peripheral nerve blocks for paediatric day-stay surgery: one year's experience in a district general hospital.

Two hundred children underwent day-care surgery using peripheral nerve blockade as an adjunct to general anaesthesia during a twelve month period. Total post-operative analgesia was achieved in 86%, simple oral analgesia was needed in 9% and the remaining 5% of patients required systemic opiate administration for pain.

Plasminogen activator inhibitor-1 in the cerebrospinal fluid as an index of neurological disease.

Plasminogen activator inhibitor-1 (PAI-1) is a serpin proteinase inhibitor which regulates fibrinolysis and the proteinase cascade of tumour invasion. In this study, PAI-1 was identified in the cerebrospinal fluid (CSF) from patients without neurological disease and patients with various neurological disorders. The mean level of PAI-1 in the CSF of 28 patients without central nervous system (CNS) disease was 0.

Plasminogen activators and inhibitors in gliomas: an immunohistochemical study.

The tissue (tPA) and urokinase (uPA) types of plasminogen activator and the plasminogen activator inhibitor 1 (PAI-1) are enzymatic proteins that may play an important role in the degradation of the extracellular matrix in physiologic and neoplastic conditions. In particular, urokinase may underlie key properties of malignant cells, such as invasiveness and dissemination. We have studied the immunohistochemical distribution of tPA, uPA, and PAI-1 in 24 human gliomas, including seven well-differentiated astrocytomas, three oligodendrogliomas, six anaplastic astrocytomas, and eight glioblastomas multiforme.

A split laryngeal mask as an aid to training in fibreoptic tracheal intubation. A comparison with the Berman II intubating airway.

Thirty patients were randomly allocated to one of two groups in order to compare the use of a split laryngeal mask airway with the Berman II airway as aids to training in fibreoptic laryngoscopy. In both groups anaesthesia was induced with propofol and maintained with isoflurane in N2O/O2 (FIO2 = 0.5).

Hormonal therapy for metastatic renal cell carcinoma combined androgen and provera followed by high dose tamoxifen.

The purpose of this phase II study was to determine the effectiveness of hormonal therapy with combined high dose androgen and provera or tamoxifen in patients with advanced renal cell carcinoma. 30 patients with metastatic renal cell carcinoma received testosterone propionate 100 mg intramuscularly (i.m.

Secretion of alpha 2-macroglobulin, alpha 2-antiplasmin, and plasminogen activator inhibitor-1 by glioblastoma multiforme in primary organ culture.

Explants from a glioblastoma multiforme were maintained for 4 weeks in a three-dimensional Gelfoam matrix culture in order to study the synthesis of alpha 2-antiplasmin (alpha 2AP), alpha 2-macroglobulin (alpha 2M), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (t-PA). Since the organ culture system promotes cellular differentiation in gliomas with increasing time in vitro, secretion of the proteinase inhibitors and t-PA was examined at weekly intervals. Increased immunohistochemical staining for glial fibrillary acidic protein, a marker of astroglial differentiation, was observed in the explants with advancing time in culture.

Pituitary-containing benign cystic teratoma arising from the uterosacral ligament.

We report on the incidental finding of pituitary tissue in a mature teratoma on the uterosacral ligament of a 56-year-old woman who underwent exploratory laparotomy for ovarian masses. While the occurrence of pituitary tissue has been reported rarely in benign cystic teratoma of the ovary, and while pituitary adenomas can occur in ectopic sites, we have found only one report in the literature of benign cystic teratoma of extragonadal origin composed of mature adenohypophyseal and neurohypophyseal elements.

Angiosarcoma of the left atrium mimicking myxoma: case report.

The case of a 65-year-old female patient with a pedunculated left atrial angiosarcoma is presented. Histologically, the tumor was composed of vascular spaces lined by atypical cells with similar cells in the solid portion of the tumor. Immunohistochemical stain for factor VIII-related antigen was positive in the cells forming vascular spaces.

Small bowel carcinoma in Crohn's disease. Distinguishing features and risk factors.

An 86-year-old woman who developed small bowel adenocarcinoma 40 years following in-continuity bypass of a 60-cm segment of regional ileitis represents the 22nd reported patient with this complication of bypassed Crohn's disease. Her case demonstrates several of the typical clinical features of such cancers: late recrudescence of disease following a 40-year period of relative quiescence; delayed diagnosis due to misinterpretation of the clinical picture (intestinal obstruction, abdominal mass, intraabdominal abscess, and fistula formation) as due to inflammatory bowel disease; and an exceedingly poor prognosis with rapid widespread local dissemination and death. Histologically, severe dysplasia was demonstrated both in close proximity to and at a distance from the lesion.

Subdiaphragmatic bronchogenic cyst with communication to the stomach: a case report.

A case of an infradiaphragmatic bronchogenic cyst in an adult patient presenting with nausea, vomiting, and epigastric discomfort is reported. An upper gastrointestinal series showed a multiloculated cyst communicating with the stomach via a patent fistulous tract. At laparotomy the cyst was found to be connected to and communicating with the posterolateral portion of the stomach.

Infantile hemangioendothelioma of heterotopic intrathoracic liver associated with diaphragmatic hernia.

An autopsy of a six-hour-old term neonate, who died during surgery for repair of a left diaphragmatic hernia, revealed an infantile hemangioendothelioma type I arising in a heterotopic lobe of liver in the left thorax. The upper pole of the tumor was attached by fibrovascular tissue to the lower lobe of the left hypoplastic lung. A pedicle attached to the lower pole of the heterotopic liver pierced through the diaphragm to the left lobe of the normal liver.

Improved local control of thoracic disease in small cell lung cancer with higher dose thoracic irradiation and cyclic chemotherapy.

Over the past decade, improvement in survival has developed for patients with small cell lung carcinoma (SCLC) due to treatment strategies that include: cyclic combination chemotherapy, thoracic irradiation, and prophylactic cranial irradiation. In this study, we assess the outcome of treatment with initial cyclic combination chemotherapy including: cyclophosphamide, VP 16-123 and methotrexate combined with radiotherapy (RT), 6000 cGY [corrected] to the thorax for patients with limited disease and 3000 cGy [corrected] for patients with extensive disease. Forty-six patients are evaluated: 26 patients with limited disease and 20 with extensive disease.

Oat cell carcinoma metastatic to ureter.

A rare and perhaps unique case of oat cell carcinoma metastatic to the ureter is presented.