Malignant epidermoid arising from the third ventricle: A case report

BACKGROUND

Third epidermoid tumors are a rare finding. The appearance of these tumors often makes them difficult to diagnose, and thus they require multimodality imaging.

CASE SUMMARY

A 48-year-old male patient reported to our hospital with complaints of vomiting and severe headache. The patient also complained of involuntary micturition for the past five days. We used a combination of computed tomography (CT) and magnetic resonance imaging (MRI) imaging modalities to confirm the presence of a malignant epidermoid cyst arising from the third ventricle. A contrast-enhanced CT of the head demonstrated minimal perilesional enhancement while an MRI revealed a large, lobulated and septated T2 hyperintense mass arising from the third ventricle. The maximum size of the lesion measured 73 mm × 65 mm × 64 mm in size.

CONCLUSION

Malignant epidermoid arising from the third ventricle in an adult male was reported using a combination of CT, MRI, and MR spectroscopy.

Random synchronous malignancy in male breast: a case report

We report here a case of a random synchronous male breast malignancy in a patient with a known base of tongue malignancy that was incidentally detected on a whole body 18-fluorine deoxyglucose positron emission tomography and computed tomography (¹⁸F-FDG PET/CT). Patient was referred to us for PET/CT staging and radiotherapy planning for a poorly differentiated squamous cell carcinoma of base of tongue. Histopathologically, the incidentally detected breast lesion was proven to be an invasive ductal carcinoma. ¹⁸F-FDG PET/CT being a whole body imaging modality is known to detect a considerable number of synchronous primaries. Synchronous malignancies in the head and neck area and the upper aerodigestive tract are well established. However, synchronous malignancy in male breast is reportedly uncommon. Our case is unique for the fact that a random synchronous dual malignancy of base of tongue and breast in a male patient was detected during a whole body ¹⁸F-FDG PET/CT imaging.

Enhanced myocardial fluorodeoxyglucose uptake following Adriamycin-based therapy: Evidence of early chemotherapeutic cardiotoxicity?

AIM: To analyze changes in myocardial glucose metabolism using fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients treated with adriamycin and to investigate the clinical significance of these changes.

METHODS: Considering that FDG-PET scanning has the ability to show changes in glucose metabolism in the myocardium, we retrospectively analyzed the FDG-PET studies of 18 lymphoma patients treated with adriamycin-based chemotherapy in both the pre- and post-therapy setting. Cardiac contractile parameters such as left ventricular ejection fraction were not available for correlation in all patients due to the short duration and the level of cumulative dose administered in these patients during the time of the follow-up FDG-PET study. The change in myocardial glucose utilization was estimated by change in standard uptake values (SUV) in the myocardium.

RESULTS: We observed a significant change in SUVmean values in the myocardium (defined as more than ± 20% change in cardiac SUVmean between pre- and post-chemotherapy PET) in 12 patients, whereas 6 patients did not show any significant cardiac FDG uptake in both pre- and post-therapy PET scans. Patients were divided into three groups based on the changes observed in myocardial tracer uptake on the follow-up ¹⁸F-FDG-PET study. Group A (n = 8): showed an increase in cardiac ¹⁸F-FDG uptake in the post-therapy scan compared to the baseline scan carried out prior to starting adriamycin-based chemotherapy. Group B (n = 6): showed no significant cardiac ¹⁸F-FDG uptake in post-therapy and baseline PET scans, and group C (n = 4): showed a fall in cardiac ¹⁸F-FDG uptake in the post-therapy scan compared to the baseline scan. Mean cumulative adriamycin dose (in mg/m²) received during the time of the follow-up FDG-PET study was 256.25, 250 and 137.5, respectively.

CONCLUSION: Our study shows three different trends in the change in myocardial glucose metabolism in patients undergoing adriamycin-based chemotherapy. A further prospective study with prolonged follow-up of ventricular function is warranted to explore the significance of enhanced FDG uptake as a marker of early identification of adriamycin-induced cardiotoxicity.

Severe spontaneous intracranial haematoma in a HIV-negative 66-year-old mild haemophiliac. Complete recovery with the use of 1-month factor VIII replacement

Intracranial haemorrhage is the most feared manifestation of haemophilia and is usually seen in severe forms. We report herein the case of a 66-year-old HIV-negative patient with mild haemophilia (factor VIII: 7%) who presented with a spontaneous and massive intracranial haematoma causing hemiplegia and aphasia. We discuss the management of this peculiar situation emphasizing the need for rapid and adapted FVIII replacement. A complete recovery was obtained using this strategy combined with initial resuscitation measures and subsequent physical therapy.

[Malaise and loss of consciousness in the elderly patient: prospective evaluation of methods of investigation]

60 consecutive patients (mean age: 80,7 yrs; s.d.: 6,1 yrs; range 70-94 yrs) referred to a geriatric medicine department with syncope or dizziness were proposectively compared with 40 age and sex matched controls. A battery of non-invasive investigations including tilt-test, glycemia, 12 lead ecg., eeg, 24 hour ambulatory ecg recording,. M--mode echocardiogram and cervical Doppler velocimetry was applied blindly to patients and controls. The proportion of abnormalities was similar in both groups having sick sinus syndrom or complete atrio-ventricular block versus no control (p less than 0.05). By contrast history-case was of great predictive value: 6 of 13 patients reporting abrupt syncope had a 24 ecg recording showing sick sinus syndrom or complete atrio ventricular block, versus 2 of 47 other patients (p less than 0,01); 11 of 14 patients reporting orhostatic dizziness or syncope had a tilt-test consistent with orthostactic hypotension versus 6 of 46 other patients (p less than 0,01).

[Measurement of the intestinal clearance of alpha 1-antitrypsin and the exchangeable potassium pool in elderly patients treated with anthraquinone glycosides]

In order to check the long-term tolerance of a laxative treatment, the authors supervised during six months a group of 14 elderly people (12 women and 2 men) with a mean age of 81.3 years suffering from long-standing constipation without any organic cause. The laxative was given in a daily dosage corresponding to 20 mg of sennosides. Alpha 1-antitrypsin (alpha 1-AT) clearance and exchangeable potassium pool (PPE) were measured, at the beginning (T0), and at the end of the third (T3) and the sixth (T6) months of the study. No abnormal variation of intestinal protein loss (alpha 1-AT: T0, 6.74 +/- 3.16; T3, 2.96 +/- 1.35; T6, 4.15 +/- 1.45 ml/24 h; T0-T3; p less than 0.05, T0-T6, T3-T6: NS) and exchangeable potassium pool (PPE: T0, 19.54 +/- 2.55; T3, 20.29 +/- 3.46, T6, 23.56 +/- 4.92 mEq/kg; T0-T3, T0-T6, T3-T6: NS) was observed. In opposition to current views, all long-term laxative treatments do not necessarily induce significant intestinal protein and potassium losses.

[Medium-stay for geriatric patients: a long-stay waiting room or an active rehabilitation unit?]

From May 1979 to April 1980, 223 patients were discharged from a "medium stay" unit (mean length of stay: 45 days) for geriatric patients in Bordeaux (France). The outcome at discharge was established from retrospective data, and the long-term outcome (18 months) through a letter sent to general practitioners (rate of response: 88,5% with, in some instances, a prompting phone-call). The mortality rates were 22,5% in hospitalized patients and 38% in survivors after discharge. When those hospitalized for social reasons only are excluded, 62,9% of the remaining patients returned to their former place of residence at discharge. Moreover, 83% were still living at the same place after 18 months (range: 12-24 months). Considering the patients' ages and the seriousness of their conditions, "medium stay", geriatric units seem efficient in helping to maintain the aged at home.

Filterability and cerebro-vascular disease

800 mg of pentoxifylline 400 was administered daily to two groups of elderly patients (average age 80 years) with the aim of increasing cerebral efficiency. Fifty patients (Group I) were treated for 30 days and of these, 25 patients (Group II) were treated for a further, 60 days. The programme included a battery of psychometric tests (Rey's R.P.M. Recit of Barbizet, coupled image tests, immediate memory test) two geriatric scales (Geriatric Rating Scale and Nosie 30) and study of the deformability of red cells. Results at the 30th and 90th day were compared with pre-experimental results: corrected filterability was increased (Group I and II, P less than 0.05), memory tests showed significant improvement (Group I and II, P less than 0.005), geriatric rating scale showed no modification. There was no correlation between changes in corrected filterability and improvement in psychometric tests.

[Wolff-Parkinson-White syndrome after 50 yars of age. Clinical and electrophysiological data]

The Wolff-Parkinson-White syndrome is usually observed in young people and is much rarer in patients over 50 years old. This fact may be explained by the demise of a certain number of patients before the age of 50 and/or a change in the clinical features of the syndrome with age and/or of the electrophysiological properties of the normal and accessory conduction pathways. To test the latter hypothesis, the clinical and electrophysiological data of 15 patients over 50 years old with the Wolff-Parkinson-White syndrome (Group I) were compared with that of 10 patients under 30 years old with the same syndrome (Group II). The same protocol of electrophysiological investigation was used in both groups of patients. The results showed a significant difference (p < 0.001) between the two groups in the incidence of associated cardiac disease. This was more common in Group I (1 4 out of 15 patients) than in Group II (2 out of 10 patients). The cardiothoracic ratio was significantly higher in Group I (p < 0.01). The two groups also differed in the age at which tachycardia first occured. 9 out of 11 patients in Group I only had symptoms after thirty years. On the other hand, there was no significant difference in the types of tachycardia and the frequency of attacks. There was no significant difference in QRS, PR, AH, HV intervals, in the ventriculo-atrial conduction time and the effective refractory periods of the atrium, right ventricle or atrio-ventricular node. There was no significant difference in the anterograde and retrograde refractory periods of the accessory pathways between the two groups. Reciprocating tachycardia, initiated by electrical stimulation in 7 patients in Group I and 6 patients in Group II, was conducted anterogradely to the ventricles through the normal pathway and retrogradely to the atria through the the accessory pathway. This study suggest that age-related changes in the electrophysiological properties of the accessory are not an important prognostic factor in the Wolff-Parkinson-White syndrome.

[Ventricular tachycardia. A possible complication of intravenous atropine in the coronary patient]

Ventricular tachycardia occurred with chest pain in a 64 year old man with coronary artery disease after an intravenous injection of atropine. The particular feature of this case as compared to the other 8 reported cases is the restoration of sinus rhythm after a passage of accelerated idioventricular rhythm by the administration of oxygen and nitroglycerin. The increased oxygen consumption and myocardial ischaemia due to the tachycardia seem to be the factors responsible for these ventricular arrhythmias. Such cases, though rare, incite caution in the administration of atropine to patients with coronary artery disease.