Craniectomy in severe, life-threatening encephalitis: a report on outcome and long-term prognosis of four cases

OBJECTIVE

To report the feasibility of craniectomy with duraplasty in four patients with life-threatening encephalitis and, in particular, their long-term outcome.

DESIGN

Report of four cases, analysis of the acute clinical course and neurological long-term sequelae.

RESULTS

Generous craniectomy with duraplasty was performed in four patients with life-threatening encephalitis leading to decortication and decerebration. This treatment approach reduced intracranial pressure. The long-term sequelae (1.5-8 years after craniectomy) confirmed its appropriateness, having led to full neurological (cerebral) function, resocialization, and reintegration into their professional life in all four patients.

CONCLUSION

Craniectomy with dural augmentation is a treatment approach in cases of severe space-occupying encephalitis, not only saving the patient's life but also leading to favorable long-term outcome.

[Preoperative classification of malignant stomach tumors]

Based on the case report of a 51 year-old patient presenting with a lymphoepithelioma like gastric cancer, we discuss the diagnostic challenge to differentiate this entity from gastric non-Hodgkin lymphoma. Since high-level lymphoid stromal reactions are rarely associated with gastric adenocarcinoma, misinterpretation can occur easily. In addition to the lymphoepithelioma like gastric cancer that is often associated with a demonstrable EBV association of the tumor cells, synchronous development of gastric carcinoma and lymphoma must be considered. Establishment of a correct diagnosis requires multiple, deep and multifocally sampled gastric biopsies, and immunohistochemical and molecular techniques to supplement conventional histology. Only through this procedure are correct characterization and classification of these unusual gastric neoplasms possible.

Lymphoepithelioma-like carcinoma of the stomach: a subset of gastric carcinoma with distinct clinicopathological features and high prevalence of Epstein-Barr virus infection

BACKGROUND/AIMS

To evaluate the clinicopathological features of lymphoepithelioma-like carcinoma of stomach in Taiwan.

METHODOLOGY

Of 379 patients with gastric adenocarcinoma, from 1993 to 1996, 6 of them with lymphoepithelioma-like carcinoma of stomach were retrospectively studied.

RESULTS

Five patients were females and one patient was male. Their age ranged from 51-75 years with a mean age of 61.5 years. Endoscopically, 2 patients were initially diagnosed as early gastric cancer and the other 4 were diagnosed as advanced gastric cancer. Three patients had tumors located in the lower third of the stomach, while the other three tumors were located in the middle and upper third. Two tumors invaded into the serosal layer and the other four lesions were confined at submucosal and muscular layers. Using the in situ hybridization method, all 6 patients (100%) had positive nuclear Epstein-Barr virus-encoded small RNA signals in the tumor cells but not in the surrounding lymphoid stroma and non-neoplastic gastric mucosa. Helicobacter pylori was found in 4 (66.7%) of the cases. The mean follow-up period of the 6 patients was 27 months. Five patients were free of the disease. Lymph node involvement and mesenteric implantation was noted in one patient in which cancer recurred 1 year after gastrectomy.

CONCLUSIONS

Lymphoepithelioma-like carcinoma of stomach in this study revealed a female predominance, preferential localization in the proximal part of the stomach, better prognosis, and a high association with Epstein-Barr virus infection.

Basal cell carcinoma of the genitalia

BACKGROUND

Basal cell carcinomas (BCC) arising on the genitalia are exceedingly rare with an unclear pathogenesis.

OBJECTIVE

To better understand risk factors, tumor characteristics, and the possible role of human papillomavirus (HPV) in the development of BCC of the genitalia.

METHODS

1543 records of Mohs micrographic surgery performed during a 6-year period were reviewed to identify cases of BCC arising on the genitalia. Tumor tissue was analyzed for HPV DNA by in situ hybridization.

RESULTS

Four patients with BCC of the genitalia were treated with Mohs micrographic surgery. The malignancies were located on the scrotum, perineum, and perianal areas in the three male patients and on the vulva in the female patient. The mean age was 67 years. None of the patients had prior history of skin cancers. Histologic evaluation of the tumors revealed two nodular subtypes, one superficial subtype, and one with follicular differentiation. In situ hybridization failed to reveal DNA of HPV types 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52.

CONCLUSION

In this small series, genital BCC occurred in an older age group with no identifiable predisposing risk factors and did not show evidence of HPV infection.

Endoscopic and pathologic features of Epstein-Barr virus-associated gastric carcinoma

BACKGROUND

Although the presence of Epstein-Barr virus has been documented in approximately 7% of patients with gastric carcinoma, the clinical features of Epstein-Barr virus-associated carcinoma have not been well documented. We studied the histologic and endoscopic characteristics of Epstein-Barr virus-associated gastric carcinoma.

METHODS

We tested 124 gastric carcinomas from 117 patients using in situ hybridization for Epstein-Barr virus encoded small RNA1. The histologic and endoscopic findings in the Epstein-Barr virus-associated groups and the negative control groups were analyzed and compared.

RESULTS

Twelve tumors (9.7%) were identified as Epstein-Barr virus associated. These lesions were located mainly in the upper part of the stomach (p < .05) and had a diffuse-type histology (p < .05) compared with those in the control group. Six of seven (85.7%) early Epstein-Barr virus-associated lesions were type 0 IIc (superficial depressed) or a combined type, and 42.9% were accompanied by submucosal nodules of carcinoma with lymphoid stroma. Four of five (80%) advanced Epstein-Barr virus-associated tumors were type 3 (ulcerated without definite limits), thought to be the advanced shape of superficial depressed lesions.

CONCLUSIONS

Epstein-Barr virus-associated gastric carcinomas often appear as superficial depressed or ulcerated lesions in the upper part of the stomach and have a diffuse-type histology with lymphoid infiltration.

Evidence of type 2 herpes simplex infection in human coronary arteries at the time of coronary artery bypass surgery

OBJECTIVE

To examine histologically biopsies from the coronary arteries of patients undergoing coronary artery bypass grafting (CABG) for evidence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) antigen and to correlate the incidence with pathological and clinical data.

DESIGN

Sequential patients undergoing CABG in whom adequate tissue could be obtained for histology.

SETTING

University teaching hospital.

PATIENTS

Forty-six patients were enrolled. Thirty-one provided sufficient tissue and clinical information for the analysis.

METHODS

Biopsy material was collected in the operating room and prepared immediately for histology and electron microscopy. Slides were prepared by staining with hematoxylin and eosin, Masson trichrome, avidin biotin complex immunoperoxidase for HSV-1 and HSV-2 protein and specific DNA probes for HSV-1 and HSV-2 by hybridization. Clinical data were obtained in structured interviews.

RESULTS

Sixty-one per cent of biopsies demonstrated evidence of inflammation, 45% were positive for antigen to HSV-2 and only one to HSV-1. Significant positive correlations were detected between inflammatory cells in the biopsy and a recent history of cold sores and between the presence of the infiltrate and positivity to HSV-2 antigen.

CONCLUSION

A correlation exists between HSV-2 infection and the inflammatory response associated with atherosclerosis.

The treatment of herpetic whitlow--a new surgical concept

Characteristics of cutaneous lesions caused by herpes simplex virus (HSV-1) are: Acquired by skin-to-skin contact; humans are the only natural host. Often on the hands of health care personnel. Painful swelling, erythema, vesicles, and ulcerations. Possible involvement of cutaneous digital areas of paronychium, eponychium, and subungual matrix. Similar to a bacterial (septic) or fungal felon. Self-limiting--14- to 21-day course. An aseptic felon, which provides a contraindication to surgical incision and drainage of the deep pulp space. Severe pain: the major complaint from all patients. Relieved of pain by decompression of the involved nail bed, either by segmentally excising or perforating the overlying nail or both to unroof the vesicles.