Cerebellar tumour presenting with pathological laughter and gelastic syncope

There is no report of patients in whom pathological laughter, a rare condition characterized by uncontrollable episodes of laughter usually triggered by unrelated stimuli, was ever closely associated with a loss of consciousness overtly linked with the onset of such uncontrollable laughter, also referred to as a gelastic syncope. A 53-year-old man presented with a 4-month history of syncope following intense and uncoordinated laughter. Physical and neurological examination was normal and the patient had no other typical cerebellar signs. We found a mass in the cerebellar vermis abutting the floor of the fourth ventricle, which upon histological examination after surgery proved to be an ependymoma. We emphasize that pathological laughter and gelastic syncope could represent unique and sole features of a cerebellar disorder.     

Chronic bronchitis: when and how to treat

Chronic bronchitis, as defined by the magnitude and duration of sputum production, is a diagnosis that encompasses a variety of patients with physiological abnormalities ranging from mild to severe. The first element of therapy is the cessation of smoking, the single most frequent cause of chronic bronchitis. In assisting patients to stop cigarette abuse, nicotine-containing gum has been useful. Therapy directed at airway narrowing continues to be the most widely prescribed. The use of metered dose inhalers containing either beta-adrenergic stimulants or, more recently, ipratropium bromide, an atropine-like agent, continues to be the mainstream of therapy. Theophylline remains a widely prescribed bronchodilator. The use of corticosteroids remains controversial in the stable patient, but appears to be indicated clearly in the patient with an acute exacerbation. The usefulness of antibiotics in acute exacerbations is still uncertain; further studies are needed. Augmentation of survival by the use of chronic supplemental O2 is now certain; more efficient ways to administer O2 are now available. Finally, pulmonary rehabilitation provides a means of improving quality of life in severely disabled patients.     

A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.