[Endolymphatic sac tumor: a rare tumor of internal ear. Report of two cases]

Papillary tumors of the temporal bone are rare and aggressive neoplasms. Recently described, these tumors had initially a presumed middle-ear origin. Only recently, convincing anatomic, morphological and immunohistochemical arguments exist for an endolymphatic sac origin (inner-ear origin). We report two cases of endolymphatic sac tumor. These tumors can be encountered sporadically or in Von Hippel-Lindau disease. They classically grow very slowly, resulting in late clinical manifestations with expansive mass invading temporal bone and extending in posterior fossa. Radiologically, these endolymphatic sac tumors can mimic metastatic carcinoma, paraganglioma, or cerebellar haemangioblastoma specially in von Hippel-Lindau disease. Histology shows a papillary epithelial tumor with hypervascular stroma, without atypia. The treatment for these tumors is surgical and curative when early diagnosed. In apparently sporadic cases, genetic analysis for Von Hippel-Lindau disease should be considered.

Increased cyclooxygenase-2 and 5-lipoxygenase activating protein expression in peritoneal macrophages during ovalbumin immunization of mice and cytosolic phospholipase A(2) activation after antigen challenge

The present study investigates phenotypic and functional differentiation of peritoneal macrophages during ovalbumin-induced subcutaneous immunization of mice. For the first time we show that, in mouse peritoneal macrophages, ovalbumin immunization induces an increase in cyclooxygenase-2 (COX-2) and 5-lipoxygenase activating protein (FLAP) expression whereas it inhibits cytosolic phospholipase A(2) (cPLA2) expression. The study of arachidonic acid (AA) metabolism in peritoneal macrophages from control (cPM) and ovalbumin-immunized (iPM) mice shows that the reduced cPLA2 expression is correlated to a reduced basal AA metabolism, but is not a limiting factor for the opsonized zymosan-, PMA-, or A23187-triggered AA metabolism. We also show that in vitro ovalbumin challenge induces, only in iPM, cPLA2 activation through phosphorylation of serine residues, via a mechanism involving MAP kinases, and through increased intracellular calcium concentrations, leading to eicosanoid production. In parallel, we report that, in peritoneal macrophages, ovalbumin immunization induces the expression of CD23, the low affinity receptor for IgEs known for its involvement in allergic diseases. Thus, the modified expression of the enzymes involved in AA metabolism and the difference of response of cPM and iPM toward the antigen are important elements to understand the underlying mechanisms of ovalbumin-induced allergic responses.

Visual and phonological codes in letter and word recognition: evidence from incremental priming

Critical issues in letter and word priming were investigated using the novel incremental priming technique. This technique adds a parametric manipulation of prime duration (or prime intensity) to the traditional design of a fast masked priming study. By doing so, additional information on the time course and nature of priming effects can be obtained. In Experiment 1, cross-case letter priming (a-A) was investigated in both alphabetic decision (letter/non-letter classification) and letter naming. In Experiment 2, cross-case word priming was investigated in lexical decision and naming. Whereas letter priming in alphabetic decision was most strongly determined by visual overlap between prime and target, word priming in lexical decision was facilitated by both orthographic and phonological information. Orthographic activation was stronger and occurred earlier than phonological activation. In letter and word naming, in contrast, priming effects were most strongly determined by phonological/articulatory information. Differences and similarities between letter and word recognition are discussed in the light of the incremental priming data.

An extended study of heavy metal deposition in Galicia (NW Spain) based on moss analysis

This paper describes the first attempt to determine the levels of heavy metal contamination in Galicia (NW Spain) by analysis of moss species. Samples of Scleropodium purum and Hypnum cupressiforme were collected from 75 sites, in 1995 and 1997, and analysed by atomic absorption spectrophotometry and atomic fluorescence for Al, As, Co, Cr, Cu, Fe, Hg, Ni, Pb and Zn. Comparisons were made between the two moss species used and, for those elements present at different concentrations in the two species, regression lines were made for interspecies calibration. Distribution maps were drawn up for each of the elements according to their concentration in the moss. In certain areas it was possible to relate deposition to the existence of known sources of contamination. The study demonstrates that the highest levels of elements were found in the most heavily industrialised and populated areas. Concentrations of As, Cu, Hg and Ni, recorded during the 1997 sampling were significantly higher than those found in 1995, possibly due to agricultural and industrial activities.

Radiotherapy and radical surgery for treatment of patients with bulky stage IB and II cervical carcinoma

The aim of this study was to evaluate prognostic factors and to study combination radiotherapy-surgery as treatment for patients with bulky stage Ib and II cervical carcinoma. From 1985 to 1994, 187 patients with cervical cancer >/= 4 cm, were treated by combined radiation therapy and radical surgery including systematic para-aortic lymphadenectomy. Complications were observed in 34 (18%) patients. In a multivariate analysis, young age, tumor size less than 5 cm, metastatic nodes with capsular rupture, and bilateral nodes were independent prognostic factors. Overall survival at 3 years was 85%, 56%, and 40% in patients with negative nodes, positive pelvic nodes, and positive para-aortic nodes, respectively (P < 0.001). These results confirm the prognostic significance of young age, tumor size, and nodal involvement. Radical surgery combined with radiotherapy is feasible, with an acceptable rate of complications and yields satisfactory survival results in patients with bulky stage IB and II cervical carcinoma. Recent randomized published studies have demonstrated that concomitant chemotherapy and radiotherapy should be the gold standard in this setting. The role of surgery is questioned.

Graphemes are perceptual reading units

Graphemes are commonly defined as the written representation of phonemes. For example, the word 'BREAD' is composed of the four phonemes /b/, /r/, /e/ and /d/, and consequently, of the four graphemes 'B', 'R', 'EA', and 'D'. Graphemes can thus be considered the minimal 'functional bridges' in the mapping between orthography and phonology. In the present study, we investigated the hypothesis that graphemes are processed as perceptual units by the reading system. If the reading system processes graphemes as units, then detecting a letter in a word should be harder when this letter is embedded in a multi-letter grapheme than when it corresponds to a single-letter grapheme. In Experiment 1A, done in English, participants were slower to detect a target letter in a word when the target letter was embedded in multi-letter grapheme (i.e. 'A' in 'BEACH') than when it corresponded to a single-letter grapheme (i.e. 'A' in 'PLACE'). In Experiment 1B, this effect was replicated in French. In Experiment 2, done in English, this grapheme effect remained when phonemic similarity between the target letter alone and the target letter inside the word was controlled. Together, the results are consistent with the assumption that graphemes are processed as perceptual reading units in alphabetic writing systems such as English or French.

[Clinical application of the multichannel auditory brainstem implant]

OBJECTIVE

To investigate the surgical techniques and speech performance of multichannel auditory brainstem implant (ABI) in patients with bilateral acoustic neuromas (neurofibromatosis type 2).

METHODS

The nucleus 21 channel auditory brainstem implant was implanted into the lateral recess of the fourth ventricle through the translabyrinthine approach in 7 patients after removal of the tumor. The accurate placement of electrode array was ensured by the electromyogram monitoring of the 7th and 9th nerves and the electrically evoked auditory brainstem responses (EABR). Initial switch-on occurred six weeks postoperatively. Speech evaluation was performed every 3 months for the first year and annually thereafter.

RESULTS

During the surgery, the lateral recess could be found and the typical EABR could be recorded in 6 cases. They later reported a significant benefit from the device. Two of the cases have achieved functional open-set speech understanding. In contrast, one patient with no EABR because of difficulty of the anatomic location during the surgery had no sensations postoperatively.

CONCLUSION

The multichannel ABI could effectively restore auditory sensations in patients deafened by bilateral acoustic neuromas. The accurate location of the cochlear nucleus complex during surgery was the key factor for the success of the operation.

Analysis of clinicopathologic prognostic factors for 157 uterine sarcomas and evaluation of a grading score validated for soft tissue sarcoma

BACKGROUND

Uterine sarcomas (US) are rare and carry a poor prognosis characterized by high rates of local recurrence and metastasis. The aim of this study was to test, for what the authors believe was the first time with US, the prognostic impact of the histologic grade validated by the French Federation of Anticancer Centers (FNCLCC) for soft tissue sarcomas (STS). The grade is the sum of the scores allocated for three major histologic criteria: tumor differentiation, mitotic count, and tumor necrosis. Other histologic and clinical factors were tested as well.

METHODS

The study included 157 patients in whom 78 leiomyosarcomas (LMS), 52 malignant mixed müllerian tumors (MMMT), and 27 endometrial stroma sarcomas (ESS) were documented.

RESULTS

The median follow-up was 54 months (range, 6-230 months). The median OS and EFS were 33 and 13 months, respectively. The FNCLCC grade validated in soft tissue sarcomas was not a prognostic factor for survival or relapse for any of the US histologic subtypes. For LMS, stage and mitotic count were the only factors that had an influence on survival and relapse. For MMMT, stage and age were the only prognostic factors, and none of the histologic criteria impacted on the outcome. For ESS, the grade defined by Norris and Taylor was an important prognostic factor, particularly for survival.

CONCLUSIONS

The FNCLCC grading score could not be used as a prognostic indicator for uterine sarcomas. The diagnosis of US is in itself an unfavorable prognostic factor, except when the diagnosis is low grade ESS.

Tirapazamine plus cisplatin versus cisplatin in advanced non-small-cell lung cancer: A report of the international CATAPULT I study group. Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors

PURPOSE

A phase III trial, Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors (CATAPULT I), was designed to determine the efficacy and safety of tirapazamine plus cisplatin for the treatment of non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients with previously untreated NSCLC were randomized to receive either tirapazamine (390 mg/m(2) infused over 2 hours) followed 1 hour later by cisplatin (75 mg/m(2) over 1 hour) or 75 mg/m(2) of cisplatin alone, every 3 weeks for a maximum of eight cycles.

RESULTS

A total of 446 patients with NSCLC (17% with stage IIIB disease and pleural effusions; 83% with stage IV disease) were entered onto the study. Karnofsky performance status (KPS) was >/= 60 for all patients (for 10%, KPS = 60; for 90%, KPS = 70 to 100). Sixty patients (14%) had clinically stable brain metastases. The median survival was significantly longer (34.6 v 27. 7 weeks; P =.0078) and the response rate was significantly greater (27.5% v 13.7%; P <.001) for patients who received tirapazamine plus cisplatin (n = 218) than for those who received cisplatin alone (n = 219). The tirapazamine-plus-cisplatin regimen was associated with mild to moderate adverse events, including acute, reversible hearing loss, reversible, intermittent muscle cramping, diarrhea, skin rash, nausea, and vomiting. There were no incremental increases in myelosuppression, peripheral neuropathy, or renal, hepatic, or cardiac toxicity and no deaths related to tirapazamine.

CONCLUSION

The CATAPULT I study shows that tirapazamine enhances the activity of cisplatin in patients with advanced NSCLC and confirms that hypoxia is an exploitable therapeutic target in human malignancies.

Laboratory and field evaluation of metallic copper on Aedes albopictus (Diptera: Culicidae) larval development

Laboratory bioassays and field trials were carried out to study the effect of metallic copper on the development of Aedes albopictus (Skuse). Multiwire electric cable was used as a source of metallic copper. Three different doses were used in laboratory tests (5, 10, and 20 g/liter) and two in field tests (20 and 40 g/liter). In the laboratory, 10 g/liter induced high mortality and a lack of development in Ae. albopictus larvae and doses of 20 g/liter completely inhibited development. Larval mortality was higher in earlier instars than in third through fourth instars and pupae. No effects were reported on egg hatching. Copper ion concentration in water increased up to 574 ppb for 5 g/liter dose, 710 ppb for 10 g/liter dose, and 1,210 ppb for 20 g/liter dose, within week 6. The increasing concentration of copper in water was correlated positively with the decreasing production of adults. Copper ions concentration < 500 ppb did not or only slightly affected larval development and mortality of Ae. albopictus in laboratory tests. Copper concentrations between 500 and 1,000 ppb delayed larval development and caused high mortality. Copper concentrations > 1,000 ppb inhibited larval development completely killing all the larvae. This last result has been achieved by the use of a 20 g/liter dose of metallic copper in water. Copper also affected adult weight. In field trials, 20 g/liter reduced the number of larvae in treated pots by 90%, and 40 g/liter completely prevented oviposition. Moreover, the persistence of the toxic action of metallic copper in the field lasted for several months.

Complete necrosis induced by preoperative chemotherapy in Wilms tumor as an indicator of low risk: report of the international society of paediatric oncology (SIOP) nephroblastoma trial and study 9

BACKGROUND

The SIOP Nephroblastoma therapeutic protocols include a period of preoperative chemotherapy followed by nephrectomy and a period of postoperative chemotherapy. From the outset, identification of low-risk groups has been an aim of the SIOP Nephroblastoma Trials and Studies. Now that 90% of children with Wilms tumor can be cured, attention is even more focused on the identification of patients who could benefit from less aggressive postoperative therapy, thus minimizing the morbidity and late effects associated with treatment. The prognostic implications of total necrosis in nephroblastoma after chemotherapy have not been investigated hitherto.

PROCEDURE

Between November 1, 1987 and June 30, 1993, 599 patients referred to the SIOP-9 Nephroblastoma Trial and Study were preoperatively treated and classified as stages I-IV nonanaplastic Wilms tumor.

RESULTS

Of these 599 patients, pathologic examination of the nephrectomy specimen revealed a completely necrotic Wilms tumor (CNWT) with no viable tumor remaining in 59 (10%): these comprised 37 stages I-III and 22 stage IV. Of these patients, 58 (98%) had no evidence of disease at 5 years vs. 90% for the rest of the cohort (P < 0.05). Stages I-III patients represented 63% of CNWT and had a 97% overall survival rate. The only death was related to veno-occlusive disease and occurred in a stage I patient in the month following nephrectomy. Stage IV patients represented 37% of CNWT (vs. only 10% of all other cases of unilateral nonanaplastic Wilms tumor) and had a 100% rate of survival. Children with CNWT were older (mean 59 months vs. 43 months); their tumor at diagnosis was larger and had regressed more significantly at subsequent ultrasound examination. The data also uphold the hypothesis that Wilms tumors of blastemic pattern are most aggressive, but also are extremely responsive to chemotherapy.

CONCLUSIONS

Patients with unilateral nonanaplastic WT that showed total necrosis following preoperative chemotherapy had excellent outcome and should benefit from less aggressive postoperative treatment in further trials. Other very responsive tumors, such as Wilms with <10% viable tumor, should also be assessed.

Perinatal toxicology of Ruta chalepensis (Rutaceae) in mice

Dried leaf infusions of Ruta chalepensis L. (Rutaceae), 'rue', 'ruda', were found to cause perinatal changes in mice, at daily doses of 0.16, 0.80 and 1.60 g/kg, administered p.o. from 1 to 14 days post coitum. Significant decreases in the appearance time of physical signs, righting reflex and cliff avoidance together with minus scores in string test and swimming ability were observed. Moreover, histological studies showed progressive angiogenic development on placenta blood supply and weakness at blood barrier in brain, thymus and pery-lymph vestibule. We found out that the results tend to confirm the embryotoxic effect of the plant and its harmful use.

[Surgical management of cerebral metastases]

Surgical treatment of metastatic brain tumors had been controversial until two prospective randomized trials demonstrated that surgery followed by radiation is superior to radiation alone in patients with single metastasis. In this report, we reviewed current perspectives on the neurosurgical treatment of brain metastasis. The goals of surgery is to establish a histologic diagnosis, relieve symptoms and provide local cure through gross total resection. The results which established surgery as the preferred treatment for single brain metastasis were largely a result of advances in neurosurgical techniques of localization and neuroimaging, microdissection, and functional mapping. These modern methods have reduced the operative mortality to 3% and the morbidity to less than 10%. The indications of surgical treatment should be related to clinical and radiological criteria. Surgical treatment is best indicated for single and accessible metastasis and is also accepted for patients with multiple lesions especially when there is a life-threatening lesion or when two lesions are accessible through the same craniotomy or for recurrent brain metastasis. Surgery can also be a good option for recurrent metastasis. Altogether, surgery improves quality of life and the median survival time, all the more as pronostic factors are present such as age>60 years, long interval between diagnosis of the primary tumor and the metastasis, the absence of systemic disease and a Karnofsky score> 70.

Ca(2+)-independent phospholipase A2 is required for alpha2-adrenergic-induced preadipocyte spreading

In the present study, we studied the involvement of A2 phospholipases (PLA2) in alpha2-adrenergic receptor-control of preadipocyte actin cytoskeleton. For that, various PLA2 inhibitors were tested on the ability of the selective alpha2-adrenergic agonist UK14304 to induce the spreading in alpha2AF2 preadipocytes. We observed that, whereas several Ca(2+)-dependent PLA2 blockers were ineffective, the Ca(2+)-independent phospholipase A2 (iPLA2) inhibitor, broenolactone (BEL), specifically blocked alpha2-adrenergic-dependent preadipocyte spreading without affecting the spreading activity of lysophosphatidic acid (LPA) or serum. BEL inhibition was completely restored by lysophosphatidic acid, but not by arachidonic acid or other fatty acids. The presence of the lysophospholipase (phospholipase B) suppressed the effect of LPA on preadipocyte spreading, but had no influence on alpha2-adrenergic-induced spreading. Thus, the extracellular production of LPA or fatty acids is not involved in iPLA2-dependent preadipocyte spreading. iPLA2 protein was found in preadipocytes but, conversely to cPLA2, did not exhibit any modification of its electrophoretic mobility after alpha2-adrenergic stimulation. We concluded that iPLA2 is involved in alpha2-adrenergic control of preadipocyte actin cytoskeleton.

[Radiotherapy using a combination of photons and protons for locally aggressive intracranial tumors. Preliminary results of protocol CPO 94-C1]

PURPOSE

From October 1993 through July 1998, 48 assessable adult patients with non-resectable aggressive intracranial tumors were treated by a combination of high dose photon + proton therapy at the Centre de Protonthérapie d'Orsay.

PATIENTS AND METHODS

Grade 1 and 4 gliomas were excluded. Patients benefited from a 3D dose calculation based on high-definition CT and MRI, a stereotactic positioning using implanted fiducial markers and a thermoplastic mask. Mean tumor dose ranged between 63 and 67 Gy delivered in five weekly sessions of 1.8 Gy in most patients, according to the histological types (doses in Co Gy Equivalent, with a mean proton-RBE of 1.1).

RESULTS

With a median 18-month follow-up (range: four-58 months), local control in tumors located in the envelopes and in the skull base was 97% (33/34), and in parenchymal tumors, 43% (6/14) only. Two patients (5%) presented with a clinically severe radiation-induced necrosis (temporal lobe and chiasm).

CONCLUSION

In our experience, high-dose radiation combining photons and protons is a safe and highly efficient procedure in selected malignancies of the skull base and envelopes.

IL-13 induces serine phosphorylation of cPLA2 in mouse peritoneal macrophages leading to arachidonic acid and PGE2 production and blocks the zymosan-induced serine phosphorylation of cPLA2 and eicosanoid production

In a recent investigation, we demonstrated that long-term treatment of macrophages with IL-13 enhances cPLA2 expression and modulates zymosan-stimulated AA mobilization. In the present study, we examine the ability of IL-13 to modify the cPLA2 activity and the AA mobilization of macrophages after a short-period of treatment. We demonstrate that in resting macrophages, IL-13 induces, through a MAP kinase-dependent process, (1) an increase of free AA release within 15 min, followed by increased PGE2 production and (2) a time-dependent serine phosphorylation of cPLA2. Conversely, in macrophages stimulated by zymosan, IL-13 added 30 min before zymosan inhibited the AA release and the serine phosphorylation of cPLA2 induced by the phagocytic agonist. In conclusion, these findings show for the first time that a Th2-type cytokine can upregulate cPLA2 activity and downregulate zymosan-induced AA metabolism. Thus, establishment of the connection between these two events may help to understand the complex regulatory role of IL-13 on the macrophage AA metabolism.

Occupational asthma in a grain worker due to Lepidoglyphus destructor, assessed by bronchial provocation test and induced sputum

BACKGROUND

Occupational asthma (OA) can be a debilitating disease even when removal from the workplace is achieved. Today, the "gold standard" in the assessment of OA is the bronchial provocation test (BPT). Induced sputum is a non-invasive method of exploring airway inflammation which can provide additional information about such challenges and thus could be applied in OA diagnosis and monitoring.

METHODS

We report the study carried out in a grain worker sensitized to Lepidoglyphus destructor (Ld), who suffered from mild asthma at the workplace. Skin prick test and specific serum IgE were measured. Ld-BPT was performed, and the changes in eosinophil rates, and ECP and tryptase levels in induced sputum were studied 30 min and 18 h after Ld-BPT. We also determined the changes in nonspecific bronchial hyperresponsiveness (NSBH), given as PD20 values. To assess the specificity of the changes, we also carried out sputum induction and methacholine challenge after barley-BPT.

RESULTS

An isolated immediate response was obtained with Ld-BPT, while barley-BPT was negative. Induced sputum showed higher tryptase levels 30 min after Ld-BPT, and higher eosinophil and epithelial cell percentages and ECP levels 18 h after Ld-BPT. There was also a decrease in methacholine PD20 values after Ld-BPT. Those changes were not observed after barley-BPT.

CONCLUSIONS

The study of eosinophilic and mast-cell markers in induced sputum provides additional knowledge about the inflammatory process occurring in the airways, suggesting that the study of induced sputum should be considered in the assessment of OA.

Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils

PURPOSE

To evaluate the stability of aneurysm occlusion at follow-up angiography after endovascular treatment (EVT) with detachable coils in intracranial berry aneurysms.

MATERIALS AND METHODS

A total of 203 berry aneurysms (< 1.5 cm) were treated with EVT. Follow-up angiography at least 3 months later was performed in 169 cases.

RESULTS

Complete occlusion of the aneurysm sac and neck was achieved in 148 aneurysms, subtotal occlusion in 18, and incomplete occlusion in three. Recurrence occurred between 3 and 40 months in 20 (14%) of the 148 totally occluded aneurysms. A second treatment was performed in five cases, was scheduled in one, and failed in one. The small neck remnant increased in size but did not require any retreatment in three cases, and the size of the neck remnant remained stable in 10 cases. Remnant regrowth occurred in six of the 18 subtotally occluded aneurysms. A second treatment was performed in three. Of the 169 cases, last follow-up angiography showed total occlusion in 133 cases, subtotal in 30, and incomplete in six. No rebleeding occurred.

CONCLUSION

A very small recurrence may be observed at the level of the neck of the aneurysm at long-term follow-up angiography despite achieving total occlusion initially with detachable coils.

Conservative treatment for girls with nonmetastatic rhabdomyosarcoma of the genital tract: A report from the Study Committee of the International Society of Pediatric Oncology

PURPOSE

To report the results of a conservative multimodal approach in girls with nonmetastatic rhabdomyosarcoma (RMS) of the genital tract, treated in International Society of Pediatric Oncology (SIOP) Malignant Mesenchymal Tumors 84 and 89 protocols.

PATIENTS AND METHODS

From 1984 to 1994, 38 girls with RMS of the genital tract (vulva, vagina, uterus) were treated in SIOP protocols. With the exception of patients with rare small tumors, which were resected at the start of the studies, all patients received initial chemotherapy (CHT) (ifosfamide, vincristine, and actinomycin D). Local treatment including surgery, brachytherapy (BT), and external-beam radiotherapy (ERT) was given only to girls who did not achieve complete remission (CR) with CHT or who subsequently relapsed.

RESULTS

The primary tumor originated in the vulva or vagina in 27 girls and in the uterus in 11. The overall survival rate (+/- SE) was 91% +/- 6% at 5 years, and the event-free survival rate was 78% +/- 7%. At a median follow-up of 5 years, 30 girls were alive and in first CR and five were alive and in second CR. Four patients treated with complete resection of the tumor at diagnosis received less CHT. Thirteen patients were treated with CHT alone. In 17 patients, local treatment was necessary to achieve complete local control, for a residual mass after initial CHT (10 patients), for viable tumor on biopsy (three patients), or for local relapse (four patients). The local treatment used was radiotherapy (RT) (ERT in three patients, BT in seven), radical surgery with uterine ablation (three patients), RT and radical surgery (three patients), and conservative surgery with RT (one patient).

CONCLUSION

Girls with nonmetastatic RMS of the genital tract have an excellent prognosis. We found no difference in outcome between uterine and vulvovaginal RMS. Local treatment does not seem necessary in patients who have a complete response to CHT. When a local treatment is needed, BT may be an alternative to radical surgery or ERT.

[Intracranial abscess and empyema: neurosurgical management]

Brain abscesses and empyemas are severe infections with lethal outcomes in the case of inappropriate treatment. The files of 34 patients with brain abscesses, and nine with intracranial empyemas treated over eight years (1990-1997) were analyzed retrospectively. Cases were evaluated for treatment and compared with data from the literature. Patients with brain abscess underwent either aspiration of the lesion through a burr hole (79.5% of the cases), or craniotomy and excision (8.8% of the cases); 11.7% were treated only with antibiotics. The operative mortality was 2.9% and the outcome was satisfactory in 85% of patients. These results are in agreement with data from the literature. Prognosis is strongly related to the initial clinical status. Current methods of treatment include surgical aspiration of large abscesses with a mass effect, and are usually associated with a poor clinical status. Excision is suggested whenever aspiration procedures have failed, or in the presence of foreign material or fungal abscess. Medical treatment is indicated for small and deeply located abscesses in patients with satisfactory clinical states. Empyemas in our series were treated with burr hole and pus aspiration. The mortality rate was 11%, and 62.5% of the patients made a good recovery. In agreement with other reported studies, the method of treating subdural empyema is much less significant than an aggressive early drainage of the infection. Although brain abscesses and empyema remain a significant neurosurgical concern, aggressive treatment can result in an excellent outcome in the majority of patients.

Treatment of distal aneurysms of the cerebellar arteries by intraaneurysmal injection of glue

Distal aneurysms of the cerebellar arteries are associated with a poor prognosis, as surgery or embolization with GDCs is very difficult. We report our experience with a new therapeutic method involving intraaneurysmal injection of glue. Three aneurysms were catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysms. In two cases, treatment resulted in total occlusion of the aneurysm with preservation of the parent artery. In one case, the aim was to occlude both the aneurysm and parent artery.