A case of cerebellar tuberculoma

We report a case of cerebellar tuberculoma presenting with headache, without any specific data. A 22-year-old male had headache for recent three months. Because of detection of the tubercle bacillus in his sputum, he was suspected the pulmonary tuberculosis and the tuberculous meningitis. On admission the cerebrospinal fluid revealed no abnormal data and the tubercle bacillus was not detected in the culture. We started medication for the tuberculosis. MRI demonstrated a mass lesion at the right cerebellum, suggesting the presence of a tuberculoma. He underwent total removal of the tumor via the supracerebellar route. Histological examination revealed tuberculoma when there are no abnormal data. The intracranial tuberculoma may be confused with an intracranial neoplasm. It is important to make an overall evaluation to diagnose tuberculosis; for instance, compromised high age, HIV, and the type of steroid administered, will increase intracranial tuberculoma. In this report, we describe a cerebellar tuberculoma without any abnormal data, suggesting that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial mass lesion.     

Ischemia of the sternocleidomastoid muscle following occipital artery embolization for dural arteriovenous fistula

We report a case of localized ischemia of the sternocleidomastoid muscle (SCM) occurring after occipital artery embolization of a dural arteriovenous fistula (dAVF). A 45-year-old man presented intracerebral hemorrhage from a dAVF at the left transverse-sigmoid sinus. The dAVF had a high flow fistula from the left occipital artery (OA). Endovascular therapy was carried out one month later. Transarterial embolization of the OA was carried out prior to the transvenous approach to decrease the shunt flow. During obliteration of the proximal portion of the OA with fiber platinum coils and polyvinyl alcohol particles, the patient reported severe neck pain. The fistula was successfully embolized after transvenous packing of the left sigmoid sinus with detachable coils. The neck pain persisted for one week and disappeared after conservative treatment. T2-MR imaging 3 days after the embolization showed a hyperintensity in the left SCM. This ischemic lesion was probably induced by occlusion of the muscular branch of the OA. We discuss this common but rarely reported complication of OA embolization.     

Myometrial invasion and cervical invasion by endometrial carcinoma: evaluation by CO2-volumetric interpolated breathhold examination (VIBE)

PURPOSE: To assess myometrial invasion and cervical invasion by endometrial carcinoma, using CO2-volumetric interpolated breathhold examination (VIBE) enabling more precise evaluation of depth of tumor invasion. MATERIALS AND METHODS: CO2-VIBE was performed in 21 cases of endometrial carcinoma (Stage Ia-IIb) prior to treatment. The images were interpreted by performing multiplanar reconstruction (MPR), and the findings obtained from the images (degree of myometrial invasion and presence or absence of cervical invasion) were assessed in comparison with the histopathological diagnosis. RESULTS: The sites of the endometrial carcinoma lesions were clearly visualized by the CO2-VIBE method. Evaluation of the degree of myometrial invasion enabled a high correct diagnosis rate of 90.5%, and evaluation for the presence of cervical invasion also allowed a high correct diagnosis rate of 90.5%. CONCLUSION: VIBE permits evaluation of any plane desired by means of thin slices, and it is a truly revolutionary method for preoperative evaluation of depth of invasion of endometrial carcinoma that enables highly accurate determination of the extent of lesion sites and degree of invasion before treatment.     

Steroid resistance in prolonged type I membranoproliferative glomerulonephritis and accelerated disease remission after steroid withdrawal

Two cases of severe proteinuria and hypocomplementemia were referred to our out patient clinic for continuous follow-up. Initial onset of clinical symptoms was at the age of 15 years in both cases. They had already been diagnosed as type I membranoproliferative glomerulonephritis (type I MPGN) by renal biopsy when oral prednisolone administration had been initiated. Several courses of steroid pulse therapy were performed for the flares of the disease, resulting in only temporary amelioration of renal symptoms. Percutaneous renal biopsy was performed during admission on both cases, showing severe glomerular and tubulointerstitial damages, in addition to typical type I MPGN findings such as mesangial cells and matrix interposition and subendothelial deposits. Because the continuous administration of steroid for more than 10 years did not ameliorate the clinical symptoms, steroid was markedly reduced or stopped in these cases. Such withdrawal from steroid therapy accelerated the amelioration of renal symptoms, including decrease in proteinuria, elevation of plasma protein and complement levels, and disappearance of generalized edema. The clinical courses of these cases indicate clinical choice of withdrawal from steroid therapy as one of the treatments in prolonged type I MPGN, which presents in childhood and shows steroid resistance.     

Stereotactic radiosurgery for recurrent pleomorphic adenoma invading the skull base--case report--

A 38-year-old man presented with a recurrent pleomorphic adenoma in the parapharyngeal space invading the skull base 19 years after the first operation for a parotid gland tumor. Stereotactic radiotherapy was performed to control the tumor growth using a marginal dose of 8 Gy and maximum dose of 18 Gy with care taken to minimize the dose to nearby structures. The symptoms were reduced within a few months. Magnetic resonance imaging over 5 years showed that the tumor was controlled with no regrowth. Stereotactic radiotherapy is a therapeutic option for the treatment of pleomorphic adenomas.     

Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution

PURPOSE: We investigated the risk factors having an impact on the achievement of stone-free status and on the success rate, as well as on the likelihood of recurrence, in patients undergoing shockwave lithotripsy. PATIENTS AND METHODS: We evaluated the characteristics and outcomes of 3023 patients (3254 renal units) with upper urinary-tract stones who underwent SWL at the Funabashi Clinic over a 13-year period. We assessed the stone-free and success rates for 2844 patients (3061 renal units) 3 months post-SWL. We also determined the recurrence rate for the 1078 patients (1139 renal units) who had achieved stone-free status at that time. RESULTS: Overall, stone-free status was achieved in 65.1% of patients, and the success rate was 85.7%. There were significant differences in the stone-free rates depending on patient age, history of urolithiasis, and presence of pyuria before SWL, as well as the number, location, size, and composition of the stones. Stones recurred in 326 of 1139 renal units (28.6%) during a mean follow-up of 36 months. The recurrence rates were 7.5%, 24.1%, and 33.0% after 1, 3, 5 years, respectively. Multiple stones, a history of urolithiasis, and stones located in the kidney or both kidneys plus the ureter significantly influenced recurrence. Multivariate analysis demonstrated that multiple stones were most significantly related to recurrence. CONCLUSION: Treatment with SWL has a low morbidity and high effectiveness. The number and location of stones and a history of urolithiasis significantly influence recurrence. Further studies of prophylactic therapy are required, especially for patients with these factors.     

Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study

BACKGROUND: Major pulmonary resection with systematic node dissection (SND) for early lung cancer by video-assisted thoracic surgery (VATS) is performed in many institutes, but the feasibility of SND for early lung cancer by VATS remains controversial. The aim of this study was to elucidate the feasibility and safety of SND by VATS. METHODS: Three hundred fifty patients with clinical stage I lung cancer who underwent pulmonary major resection with SND between 1998 and 2003 were enrolled in this study. Of these patients, 191 (VATS group) underwent pulmonary resection with SND by VATS; 159 patients (open thoracotomy [OT] group) did so through anterolateral thoracotomy. The clinical and pathologic data, including the number of dissected nodes in each nodal station, of the 2 groups were compared to evaluate the feasibility of SND by VATS. RESULTS: Pathologic data showed that, in the VATS group, more patients had adenocarcinoma (P = .0078) and fewer patients had advanced factors than the OT group. The greatest tumor diameter was 24.5 mm and 29.6 mm in the VATS group and OT group, respectively (P < .0001). The total number of mediastinal nodes dissected in right upper lobectomy plus right middle lobectomy (RUL+RML), right lower lobectomy (RLL), left upper lobectomy (LUL), and lower left lobectomy (LLL) also did not differ between the 2 groups. The total number of mediastinal nodes dissected in RUL+RML, RLL, LUL, and LLL was 19.7 in the VATS group versus 22.0 in the OT group (P = .122), 23.4 versus 21.0 (P = .241), 14.8 versus 17.5 (P = .123), and 18.8 versus 15.8 (P = .202), respectively. The number of dissected nodes in each nodal station in RUL+RML, RLL, LUL, and LLL was similar between the 2 groups. Operative mortality, morbidity, or recurrence did not differ between the 2 groups. CONCLUSIONS: With regard to the number of dissected nodes, SND by VATS was not inferior to that of OT. SND by VATS is technically feasible and safe, and seems acceptable for clinical stage I lung cancer.     

Knowledge and attitudes about deceased donor organ donation in Filipinos: a qualitative assessment

Fewer ethnic minorities, especially Asian-Americans, become organ donors. There are cultural, religious, and personal barriers to becoming a designated organ donor. Factors that promote or inhibit organ donation in Asians, especially Filipinos, are not well understood. We conducted a series of focus groups to identify barriers and facilitators to organ donation (deceased donor) among Filipinos. Six focus groups were conducted with church members, adolescents, nurses, physicians, organ recipients, and organ donor families. The mean age of adult participants (n = 57) was 52.3 +/- 15 years, 83% were Catholic, and 72% were female. A qualitative theme analysis methodology identified dominant themes related to organ donation in the participants. The major themes were: awareness of organ donation (38%), family beliefs (25%), religion/spirituality (10%), attitude/emotions (10%), personal experience with organ donation (8%), health profession (6%), and cultural issues (3%). Seventy-five percent of the comments about awareness reflected a positive awareness of cultural issues regarding organ donation, and the rest reflected a lack of awareness or misconceptions. Almost every theme was mentioned in all six focus groups. Understanding a specific ethnic group's knowledge, attitudes, and cultural beliefs regarding organ donation is important in the development of educational campaigns to encourage organ donation in ethnic minority populations.