RESUMEN
Malignant skin cancer of the scalp with skull invasion, dural infiltration and brain involvement is a uncommon lesion. This scenario is most often encountered in patients where initial scalp lesions are not appropriately diagnosed or their extent is underestimated by the patient and/or the doctor. Our study is a retrospective review of 25 patients treated using a multidisciplinary approach (combined plastic surgery/neurosurgery procedure and neuro-oncological management). After a mean follow-up of 7 years, 22 patients did not show local recurrence or distant metastases of their primary disease. Overall, these 22 patients had excellent quality of life; however, three patients died from causes not related to their primary pathology. To obtain a complete and definitive cure, prompt diagnosis of scalp cancers followed by appropriate multidisciplinary management is strongly advised.
Asunto(s)
Carcinoma/secundario , Carcinoma/terapia , Invasividad Neoplásica/patología , Cuero Cabelludo/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Anciano , Neoplasias de la Mama/secundario , Carcinoma/mortalidad , Senos Craneales/patología , Senos Craneales/cirugía , Duramadre/patología , Duramadre/cirugía , Femenino , Humanos , Comunicación Interdisciplinaria , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/secundario , Persona de Mediana Edad , Invasividad Neoplásica/fisiopatología , Invasividad Neoplásica/prevención & control , Recurrencia Local de Neoplasia/prevención & control , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/normas , Grupo de Atención al Paciente/normas , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/normas , Estudios Retrospectivos , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/mortalidad , Cráneo/patología , Cráneo/cirugía , Colgajos Quirúrgicos , Tasa de SupervivenciaRESUMEN
A case of cervicothoracic spontaneous spinal epidural hematoma (SSEH) following coronary thrombolysis with r-TPA and intravenous heparin is reported. The clinical picture is discussed, as well as the importance of rapid neuroradiological diagnosis (with spinal MRI being the method of choice) and surgical treatment. Anyway, in these patients, thorough cardiac function evaluation and rapid correction of any clotting disorder is necessary prior to surgery. With the increasing use of fibrinolytic therapy this complication would be more frequent. This underlines the importance of prompt recognition and adequate treatment.
Asunto(s)
Hematoma Epidural Craneal/patología , Infarto del Miocardio/tratamiento farmacológico , Enfermedades de la Columna Vertebral/patología , Terapia Trombolítica/efectos adversos , Vértebras Cervicales/patología , Femenino , Fibrinolíticos/efectos adversos , Fibrinolíticos/uso terapéutico , Hematoma Epidural Craneal/etiología , Heparina/administración & dosificación , Heparina/efectos adversos , Humanos , Infusiones Intravenosas , Imagen por Resonancia Magnética , Persona de Mediana Edad , Enfermedades de la Columna Vertebral/etiología , Vértebras Torácicas/patología , Activador de Tejido Plasminógeno/efectos adversos , Activador de Tejido Plasminógeno/uso terapéuticoRESUMEN
The authors report a series of five cases of non tuberculous cervical spinal epidural abscesses. There were neither patients suffering from immunodeficiency syndromes nor drug addicts; all the patients were in their seventh decade; two patients were affected by diabetes mellitus refractory to medical treatment. Retropharyngeal abscess was the main etiological risk factor (two cases); Staphylococcus aureus was cultured in two cases. Gadolinium MRI was necessary for a preoperative diagnosis, planning surgical approach and postoperative prognosis. Surgical debridement was performed via an anterior approach in those cases where the collection was located lower than C4 and did not span more than three vertebral segments; posterior approach, via a laminectomy, was performed in a case of C1-C2 location of the lesion and in a case of involvement of the whole cervical spine. Surgical results were poor in those patients affected by diabetes mellitus, a lesion involving the high cervical segments (higher than C4) or a lesion spanning more than three levels. Medical treatment with MRI follow-up was not undertaken in any of the patients and we opted for surgical drainage in all the cases due to the possibility of a sudden neurological deterioration, caused both by spinal cord mechanical compression and vascular compromission.
Asunto(s)
Absceso/etiología , Cuello/inervación , Compresión de la Médula Espinal/etiología , Absceso/diagnóstico , Anciano , Espacio Epidural , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores de Riesgo , Compresión de la Médula Espinal/diagnósticoRESUMEN
We retrospectively analyzed our experience with the Quinton-Mahurkar dual-lumen hemodialysis catheter as short-term central venous access for harvesting peripheral blood stem cells (PBSC) for autologous transplantation. For intensification therapy for various malignancies 370 leukaphereses were performed in 110 candidates. The catheter was placed percutaneously under local anesthesia only for the time of blood collection and in no case was it used for the PBSC transplant. No systemic antithrombotic prophylaxis was administered. PBSC were collected using a continuous flow cell separator, COBE Spectra, after mobilization with chemotherapy followed by cytokine: rhGM-CSF and rhG-CSF s.c. (35 patients) or rhG-CSF s.c. alone (75 patients). The median number of aphereses was two (1-13). Eighty-nine patients (81.3%) required three or fewer sessions to collect the minimum mononuclear cell target number of 6 x 10(8) MNC/kg. The volume of blood per kg body weight processed for each apheresis was 240 ml (range 150-560 ml) equivalent to 13 l (6-30 l) and the median flow rate was 61 ml/min (range 30-90 ml/min). The total CD34+ cell yield per patient was 3.55 x 10(6)/kg (0.26-34.8) and the MNC yield was 6.1 x 10(8)/kg (2.96-12.6). We observed the following complications: local infection in four cases (3.6%), catheter occlusion for local thrombosis in two cases (1.8%) and pneumothorax in one case (0.97%). In our experience the Mahurkar-Quinton catheter, when placed specifically for apheresis sessions, was very effective and safe for PBSC harvesting with a low incidence of complications.
Asunto(s)
Cateterismo Venoso Central/instrumentación , Trasplante de Células Madre Hematopoyéticas , Leucaféresis/instrumentación , Trasplante de Células Madre Hematopoyéticas/instrumentación , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Estudios Retrospectivos , Trasplante AutólogoRESUMEN
A case of achondroplasia is presented in which cervico-medullary junction compression by foramen magnum stenosis and generalized seizures by bilateral subdural effusions were relieved by suboccipital craniectomy with C1 laminectomy and drainage of the collections. The important role played by NMR in the diagnosis of foramen magnum stenosis is stressed; the possible causes of hydrocephalus and subdural collections in achondroplasic patients are discussed. According to the authors surgical drainage of benign subdural collections in these patients is indicated in case of intractable seizures.
Asunto(s)
Acondroplasia/diagnóstico , Acondroplasia/cirugía , Foramen Magno/patología , Efusión Subdural/etiología , Acondroplasia/complicaciones , Constricción Patológica , Epilepsia Generalizada , Cabeza/anomalías , Humanos , Lactante , Masculino , SíndromeRESUMEN
A case of intramedullary neurinoma of the cervical spinal cord in a patient with no sign of von Recklinghausen's disease is reported. This case was diagnosed by computed tomography and magnetic resonance imaging and treated surgically. The literature covering 46 other cases is reviewed. The discussion, examines the possible etiology, the role of diagnostic procedures and the difficulties of the surgical treatment of these tumors.
Asunto(s)
Neurilemoma/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Neurofibromatosis 1/diagnóstico , Médula Espinal/patología , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Tomografía Computarizada por Rayos XRESUMEN
It is unclear whether a linear contrast enhancement at the edges of the operative site on early CT scan indicates a residual tumor or rather reflects postoperative changes. We have studied 15 patients treated with surgical removal of malignant brain tumor, submitted to periodic CT scan. The enhancement of linear contrast was due to a residual tumor, when seen on very early CT scan (within 24 hours after surgery). If occurring later, this enhancement was either generated by a residual tumor or by post-operative changes.
Asunto(s)
Neoplasias Encefálicas/cirugía , Encéfalo/diagnóstico por imagen , Medios de Contraste , Yohexol , Recurrencia Local de Neoplasia , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Astrocitoma/diagnóstico por imagen , Astrocitoma/radioterapia , Astrocitoma/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Cerebelosas/diagnóstico por imagen , Neoplasias Cerebelosas/tratamiento farmacológico , Neoplasias Cerebelosas/cirugía , Terapia Combinada , Femenino , Glioblastoma/diagnóstico por imagen , Glioblastoma/radioterapia , Glioblastoma/cirugía , Gliosarcoma/diagnóstico por imagen , Gliosarcoma/radioterapia , Gliosarcoma/cirugía , Humanos , Masculino , Meduloblastoma/diagnóstico por imagen , Meduloblastoma/tratamiento farmacológico , Meduloblastoma/cirugía , Persona de Mediana Edad , Neoplasia Residual , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Neoplasias Supratentoriales/diagnóstico por imagen , Neoplasias Supratentoriales/radioterapia , Neoplasias Supratentoriales/cirugíaRESUMEN
Spinal intramedullary teratoma is a rare tumor. A case of intramedullary teratoma of the conus medullaris with caudal exophytic development is presented. The patient underwent magnetic resonance imaging and then the tumor was removed surgically. This is the sixth case of intramedullary teratoma reported in the literature.
Asunto(s)
Neoplasias de la Médula Espinal , Teratoma , Cauda Equina/patología , Cauda Equina/cirugía , Humanos , Región Lumbosacra , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/cirugía , Teratoma/diagnóstico , Teratoma/cirugíaRESUMEN
The Authors report an analysis on 40 cases of craniocerebral gunshot wounds treated in a civil hospital over a 8-year period. The important role of CT for a correct diagnosis and treatment planning is stressed even though patients with a G.C.S. lower than 4 die regardless of their CT findings; subdural and intracerebral hematomas are not a serious complication unless patient's neurological status is poor; timing of surgical treatment plays a major role in order to avoid infection of the wound.