Nasoethmoid schwannoma with intracranial extension. Case report and review of literature

A 27-year-old woman presented with a six-month history of intermittent headache and a 2-week history of blurring of vision. Subsequently a 4 cm large enhancing lesion in the left frontal parafalcine region with a small extension into the nasoethmoid sinus was found. This was thought to be either an anterior cranial fossa meningioma or an esthesioblastoma. However after uneventful gross total excision of this lesion via a frontal craniotomy, the histology came back as a schwannoma. Only seven cases of nasoethmoid schwannoma with intracranial extension have been reported before and this case is unique in that almost all of the tumour was intracranial. We review the literature and discuss the origin of these tumours.

Who calls the breast care nurses – the rich, the poor or the poorly?

Abstract #6094

Introduction: Breast care nurses (BCNs) are valuable members of the team; they provide advice, counselling and act as patients' advocates. We have previously demonstrated the worth of BCNs in our UK centre1 and the high number of calls they receive from patients and family. In this study, we investigate factors that might influence call rates from individual patients. We have examined the effect of patient age, prognosis and social deprivation on demand for this service.
 Methods: Our BCNs collect prospectively daily call sheets. These sheets include hospital number, age, type of call (phone or face to face), duration of call, purpose of call and outcome. We have examined breast nurse call sheets over a six-month period. The patients' home zip codes were also collected and allocated to the correct electoral ward (small geographical areas with average population of 5500). Using data from the UK National Census in 2000, information on social status was derived from the patients' zip codes and given as the Index of Multiple Deprivation (ID2000). The ID2000 has both an ID2000 score and ID2000 ranking for different electoral wards across England. Low ID2000 scores and high ID2000 rankings correspond to areas of affluence. Prognostic information was derived using the Nottingham Prognostic Index (NPI). The data were analysed by Spearman rank correlation using Statview 5.0 (SAS Inc) software comparing call rate to age, NPI and ID2000 scores & rankings.
 Results: During a six-month period, 1188 patients contacted the breast cancer nurse specialists in the NHS and private setting. 204 (17.1%) patients contacted their BCN once; 228 (19.1%) twice; 264 (22.2%) three times and 492 (41.4%) of patients called four times or more.
 Analysis by Spearman rank correlation of number of calls against age (Rho = -0.009, p=0.90), NPI (Rho = 0.068, p=0.40), ID2000 scores (Rho = 0.058, p=0.41) & ID20000 rank (Rho = -0.060, p=0.40) show no evidence of a relationship between age, prognosis or deprivation and the need to access BCNs.
 Conclusions: The BCNs provide a valuable service to patients with breast cancer. This support continues throughout the individual patient's cancer journey. In Gloucestershire, the need for support appears to be independent of age, prognosis and social status.
 1 Counselling women with breast cancer - whose line is it anyway?
 F G Court, S Scarrott, M Cassidy-Gray, A Thomas, S Vestey, J Bristol, M Ghilchik, H Y Chan
 Abstract 6045 - SABCS 2007.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6094.

Choosing breast reconstruction – for richer, for poorer?

Abstract #5094

OBJECTIVE
 To assess whether the age or socio-economic status of patients undergoing mastectomy play any part in influencing their decision to undergo breast reconstruction.
 METHODS
 Details were collated from all patients undergoing mastectomy with or without reconstruction under the care of a single surgeon at Cheltenham General Hospital over a 5 year period. All patients having a mastectomy were offered a reconstruction. Zip codes were used to assign government deprivation scores and the corresponding national rank for each patient's residential district, according to the 2000 UK national census. Affluent areas have low scores and high rank; deprived areas have high scores and low rank. The Mann-Whitney U test was used to determine whether there was a statistical difference in age or social status between those patients in the mastectomy only group and those who were reconstructed.
 RESULTS
 50 patients underwent mastectomy only (median age 63.5, IQR 52-72), 30 opted for reconstruction (median age 53.5, IQR 44.5-58). There was a statistically significant difference (at the 95% confidence interval) between the average age of the 2 groups (P=0.0002).
 Median deprivation score for the mastectomy group was 10.4 (6.28-17.84) and for the reconstruction group 9.67 (6.52-17.37). This was not significant (P=0.26).
 Median ranks were 6224 (4008-7525) and 6511 (2502-7213) respectively (P=0.29).
 CONCLUSIONS
 The socio-economic status of patients does not affect their decision on whether or not to undergo post-mastectomy reconstruction. However, younger patients are statistically more likely to opt for a reconstructive procedure.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5094.

Anterior cervical microforaminotomy for cervical radiculopathy--results and review

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented.

METHODS

A retrospective-prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique.

RESULTS

Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65% (i.e., complete resolution of all symptoms), good in 29% (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6% (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2-48 months. The average pain score, neurological outcome and functional outcome improved after this operation. RE-OPERATION: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later.

CONCLUSION

Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.

Human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis: viral load and muscle tone are correlated

Human T-lymphotropic virus type 1 (HTLV-1) infections are associated with varying degrees of HTLV-1 viral load and spasticity. Increased viral load is associated with higher risk of developing HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The authors performed a cross-sectional study of 24 people with HAM/TSP in Lima, Perú, to determine if higher HTLV-1 viral load was correlated with increased muscle tone, measured with a device providing quantitative spasticity assessment (QSA). Median HTLV-1 viral load was 17.0 copies/100 peripheral blood mononuclear cells and QSA value was 39.9 Newton-meters/radian. HTLV-1 viral load was significantly correlated with QSA value (Spearman rho = .48, P = .02), suggesting viral load may play a role in expression of symptomatic neurologic disease. Longitudinal studies are needed to determine if treatments that reduce viral load will reduce muscle tone.

Treatment of the first known case of king cobra envenomation in the United Kingdom, complicated by severe anaphylaxis

We report the first known case of envenomation following snake bite by a king cobra in the UK. The patient required tracheal intubation and ventilation. Treatment with king cobra antivenom resulted in anaphylaxis (bronchospasm and hypotension), requiring adrenaline infusion. The patient's trachea was extubated 11 h after administration of antivenom.

The Influence of Surfactant on PLGA Microsphere Glass Transition and Water Sorption: Remodeling the Surface Morphology to Attenuate the Burst Release

PURPOSE

The stability of protein unloaded and loaded poly(lactic-co-glycolic acid) (PLGA) microspheres fabricated with surfactant was challenged through exposure to environmental conditions of different relative humidity.

METHODS

Polyvinyl alcohol (PVA) or Triton X-100 was added to the primary emulsion of the double-emulsion solvent evaporation technique. After storage at ambient humidity and 75% relative humidity, the mechanical stability of the polymer was tested to reveal PLGA chain mobility using differential scanning calorimetry. Subsequent surface modifications were examined by atomic force microscopy (AFM), and protein release profiles were collected.

RESULTS

Residual amounts of PVA and particularly Triton X-100 raised the hydrophilicity of the microspheres. When exposed to ambient humidity or 75% relative humidity, PVA and Triton X-100 had, respectively, an antiplasticizing and a plasticizing effect upon PLGA, and both led to physical aging. The high-resolution AFM imaging of microspheres containing model protein and Triton X-100 showed that the depth of the surface pores was reduced when exposed to 75% relative humidity, and the initial burst release subsequently decreased.

CONCLUSION

These studies suggested that the mechanical stability of PLGA was influenced by the addition of surfactants, which, depending on the formulation, led to surface pore remodeling under high humidity, reducing the initial burst release while maintaining the spherical integrity of the microsphere.

Investigation into the influence of polymeric stabilizing excipients on inter-particulate forces in pressurised metered dose inhalers

Colloid probe atomic force microscopy (AFM) was utilised to quantify the cohesive forces of salbutamol sulphate in a model non-pressurised fluorinated liquid (mHFA), in the presence of increasing concentrations of poly(ethylene glycol) (PEG; molecular weight (MW) 200, 400 and 600). In addition, samples of PEG 400 (0.05-0.5%, v/w), were analysed in the presence of 0.001% (w/w) of poly(vinyl pyrrolidone) (PVP). In the absence of any stabilizing agents, strong attractive forces were present between particles. Increasing the concentration of the different MW PEG solutions in the mHFA system (up to 0.5%, v/w), significantly decreased the force of interaction (ANOVA, p<0.05). The decrease in cohesion was particularly evident at very low concentrations of PEG (0.05-0.1%, v/w). Further data analysis (p<0.05) suggested that the reduction in the force of cohesion was dependent on the concentration and molecular weight of PEG. The addition of low concentration of PVP to the PEG 400-mHFA system had the most significant influence on drug particle cohesion. In the presence of PVP, increasing addition of PEG 400 (0.05-0.5%, v/w) to the mHFA, resulted in no significant reduction in the force of cohesion (p>0.05). Clearly, an understanding of the conformation of polymer molecules at interfaces is of vital importance when controlling the stability/flocculation behaviour of sterically stabilized pMDI suspensions. In this context, the use of the colloid probe AFM technique has provided a quantitative insight into the interactions of these complex systems and may be an invaluable asset during the early phase of formulation product development.