Aortic valve replacement in a patient with a brain tumor

We report a case of aortic stenosis with a brain tumor in a 67-year-old man. Although he showed no clinical neurological abnormality, a computed tomography scan revealed a brain tumor. We performed aortic valve replacement under several management techniques to avoid cerebral injury. Two biochemical markers for brain injury, S-100beta and neuron-specific enolase, were measured perioperatively. The postoperative course was uneventful without neurological complication, and the biochemical markers were within the control ranges.     

Off-pump CABG for a patient with a brain tumor.

Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) was performed on a patient with a brain tumor. A patient with effort angina of the left anterior descending artery (LAD), and diagonal branch stenosis was referred to us for CABG. He had a mass lesion in the brain that was diagnosed as meningioma involving the internal carotid artery and a middle cerebral artery. To avoid brain complications, we performed off-pump CABG using the internal thoracic and radial arteries to the LAD and a diagonal branch. Off-pump CABG was an effective method to avoid brain complications for patients with a brain tumor involving cerebral vessels.     

Coagulopathy and warfarin-associated breast necrosis in a patient with a primary brain tumor

Although the association of coagulopathy and neoplastic disease is well documented, there have been few reports of patients with primary central nervous system tumors who exhibited hypercoagulable states. We report the case of a 58-year-old woman with a recurrent falcine meningioma and repeated episodes of venous thrombosis who developed warfarin-associated breast necrosis on the fifth day of coumadin therapy. Laboratory evaluation at that time demonstrated an elevated prothrombin time and normal activated partial thromboplastin time. Of the 24 cases of warfarin-associated massive necrosis of the breast described in the literature, only one other case was associated with a neoplasm, a resected craniopharyngioma.     

Prevention of postoperative venous thromboembolism in patient with brain tumor

The surgical treatment results in 610 patients with brain tumors and thromboembolic complications were analyzed. Deep venous thrombosis was registered in 8 (1.3%) patients; 0.65% of patients died from pulmonary thromboembolism. We used complex prevention measures including low molecular weight heparin (LMWH) fraxiparine to prevent thromboembolic complications after operation. LMWH may be considered as a part of treatment standards in patients with brain tumors.     

Anesthetic management of a hemodialysis-dependent patient for the brain tumor resection with CHDF

A 64-year-old man was scheduled for resection of brain tumor in the prone position. He had been on hemodialysis for three years. Anesthesia was induced using propofol, fentanyl, and vecuronium, and maintained with isoflurane and nitrous oxide in oxygen. Transesophagial echocardiography (TEE) was useful for maintaining fluid balance. To prevent bleeding tendency and to maintain electrolyte balance, continuous hemodiafiltration (CHDF) without anti-coagulant drugs was utilized for fluid management. Surgery was performed in the lateral position since the application of CHDF was impossible in the prone position. Approximately 3500 ml of blood was lost and 18 units of packed blood cells and 18 units of flesh frozen plasma were administered. We occasionally checked activated clotting time and platelet count during surgery, but they were kept in normal ranges. In this case, we were able to achieve proper intraoperative fluid management using TEE and CHDF.     

A clinical and magnetic resonance spectroscopy study of a brain tumor in a patient with segmental neurofibromatosis

Introduction

Segmental neurofibromatosis 1 (segmental NF-1) is a rare genodermatosis caused by somatic mutations in the NF-1 gene. It consists of localized characteristic skin lesions. A serial study using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of a brain tumor in a 16-year-old patient with segmental NF-1 is reported.

Case report

A 16-year-old boy with congenital dorsal scoliosis and segmental NF-1 was evaluated for bilateral optic atrophy. Neurological examination showed an isolated tetra pyramidal syndrome. The cerebral MRI showed a bilateral brain lesion involving the basal ganglia, optic pathways, temporal lobes, and the midbrain. Serial MRSs showed a decreased N-acetylaspartate (NAA)/creatine ratio and increased choline/creatine ratio. An increase in the myoinositol (MYO)/creatine ratio and the presence of a lipid/lactate peak were also recorded. A neuroimaging follow-up with MRI and MRS performed 2 years later showed similar findings.

Comments and conclusion

We describe an MRS study of a brain tumor in a patient with segmental NF-1 for the first time. The MRS study showed similar findings, described earlier in rare studies of patients with the classic form of NF-1. MRS is a noninvasive technique for detecting the presence of tumor tissue in the brain through its metabolic activity. MRS plays an important role in clinical studies and it can be used to differentiate malignant and nonmalignant brain lesions from normal brain tissue.     

Contralateral deafness following unilateral suboccipital brain tumor surgery in a patient with large vestibular aqueduct--case report

A 68-year-old female developed contralateral deafness following extirpation of a left cerebellopontine angle epidermoid cyst. Computed tomography showed that large vestibular aqueduct was present. This unusual complication may have been caused by an abrupt pressure change after cerebrospinal fluid release, which was transmitted through the large vestibular aqueduct and resulted in cochlear damage.     

Tetanus in a patient with a uterine tumor.

A 45-year-old woman developed tetanus in a necrotic 5 Kg leiomyoma of the uterus; she was treated successfully by a combined surgical and anesthesiology team. A hysterectomy was performed despite the considerable controversy in the older publications. This literature was reviewed, and it was noted that there have been only two previously published cases of uterine tetanus other than in a post-abortal situation. The practical aspects of the management of severe tetanus are tabulated.     

Giant cell tumor in a patient with osteopoikilosis

A giant cell tumor developed in the distal femur of a 26-year-old man with preexisting osteopoikilosis. The authors are not aware of previous similar reports. Both conditions are rare, but a causal relationship between them remains unconfirmed.     

Giant cell tumor in a patient with osteopoikilosis

A giant cell tumor developed in the distal femur of a 26-year-old man with preexisting osteopoikilosis. The authors are not aware of previous similar reports. Both conditions are rare, but a causal relationship between them remains unconfirmed.     

Refractory generalized convulsions in a patient undergoing brain tumor resection during propofol anesthesia

Propofol has been used to treat convulsions, while the drug is known to induce convulsions. We described a case of generalized convulsions during brain tumor resection under propofol anesthesia. A 24-year-old man was scheduled to undergo brain tumor resection. He had no history of epilepsy. Anesthesia was induced and maintained with propofol and fentanyl. During the craniotomy, the patient developed generalized convulsions. Diazepam, thiamylal, and phenytoin were given intravenously and the seizure activity resolved. Generalized convulsions recurred three times during the operation. Postoperative course was uneventful. On the 16 th postoperative day, the patient underwent ventriculoperitoneal shunt under general anesthesia using sevoflurane, nitrous oxide and oxygen. Convulsions were not noted intra- and postoperatively. Because convulsions did not occur during sevoflurane anesthesia and the patient had no history of epilepsy, propofol may have induced a generalized convulsions on the first operation.     

Total calcanectomy in a patient with a giant cell tumor

Total en-bloc calcanectomy was performed in a 36-year-old male patient with a giant cell tumor in his right calcaneus. A year after surgery, the patient had no complaints, and a good functional result was obtained. He was able to return to his work. No local or metastatic recurrences were encountered.     

Hypothalamic papillary tumor in a patient with tuberous sclerosis

We here report an unusual tumor of the suprasellar region featuring a papillary growth pattern and cytokeratin expression in a 10-year-old boy with tuberous sclerosis. This hitherto undescribed low-grade hypothalamic tumor extends the spectrum of tumors associated with the tuberous sclerosis complex.     

Brown tumor with atypical localization in a normocalcemic patient

Brown tumor is a bone lesion secondary to hyperparathyroidism of various etiologies. It is frequently seen in the head and neck region. Brown tumor presents itself on foot very rarely. Hyperparathyroidism is usually associated with high levels of calcium. Being normocalcemic and having the tumor on foot only without any other skeletal system involvement have led to a difficulty in establishing the diagnosis in our case. In our case, Brown tumor was surgically resected en-bloc and reconstructed with nonvascularized tricortical iliac crest. This is the first case in the literature with regard to its localization. Even though serum calcium levels are routinely checked in many clinics parathormone levels should also be looked for differential diagnosis, as this case confirms, in cases with osteolytic bone tumors that causes expansion even if the patient is normocalcemic.     

Metastatic hernial sac tumor in a patient with FUO

The presence of primary or metastatic cancer within a hernia sac is uncommon, which occurs in fewer than 0.5% of all surgically excised sacs (1). This article demonstrates a case of a metastatic pancreatic cancer, one of which presented as an inguinal hernia with fever of unknown origin (FUO). A 44-year-old male presented with a history of FUO and a painful inguinal hernia. Inguinal canal exploration revealed a mass like lesion in the sac without any correlation to abdominopelvic viscera. Postoperative evaluations confirmed moderately differentiated metastatic adenocarcinoma from pancreatic origin.     

Steroid-induced tumor lysis syndrome in a patient with preleukemia

Tumor lysis syndrome (TLS) is a well recognized complication of chemotherapy and radiotherapy for leukemia, lymphoma as well as rapidly growing malignancies. Less described is the occurrence of TLS following steroid therapy alone. Herein, we report on a 32-year-old male with myelodysplastic syndrome, characterized by refractory anemia with excess blasts in transformation, who developed acute oliguric renal failure 12 hours after methylprednisolone 1.0 g for presumed autoimmune thrombocytopenia. Laboratory investigations revealed typical findings of TLS, including hyperkalemia, marked hyperuricemia, hyperphosphotemia, hypocalcemia and urine uric acid to creatinine ratio 1.8 (> 1.0). Long hemodialysis (8 hours) was initiated for 3 consecutive sessions. Renal function recovered 1 week later. This case high-lights that single-dose steroid administration in a patient with hematological malignancy may cause the potential life-threatening complications of TLS. Prophylactic management prior to the use of steroid therapy for a variety of purposes is absolutely required in high-risk patients.     

Cerebrospinal rhinorrhea in a patient with a posterior cranial fossa tumor

A rare case of a meningioma of the posterior margin of the petrous temporal bone associated with cerebrospinal fluid rhinorrhea is presented. After a careful review of the literature, the possible pathogenesis of the fistulous tract is discussed.