Solitary fibrous tumours of the meninges: case series and literature review.

We report four new cases of meningeal Solitary Fibrous Tumour (SFT). Two patients presented with raised intracranial pressure from posterior fossa SFT, and the third developed hemiparesis and dysphasia due to a large lesion that originated in the left middle cranial fossa. These were successfully excised and the patients remain well at follow-up of between 1 and 3 years. The fourth patient, a 71-year-old man, suffered an intracerebral haemorrhage and later died from a malignant SFT that had invaded the falx cerebri, superior sagittal sinus, and brain. This is the first description of a locally aggressive meningeal SFT with multiple atypical histological features. The 31 previously reported cases of meningeal SFT are reviewed. They occur at all ages and may be relatively more common in the posterior fossa and spine. Intracranial SFT originate from the dura and are probably indistinguishable from meningiomas on imaging and at surgery. In contrast, approximately two-thirds of spinal SFT have no dural attachment. Histologically, SFT are spindle-cell neoplasms with a characteristic immunohistochemical profile of CD34, vimentin, and bcl-2 positivity. Data on outcome for patients with meningeal SFT are limited. At other sites, however, extent of resection is the most important prognostic factor, and invasion or metastasis can occur with histologically benign SFT. Meningeal SFT should, therefore, be excised as completely as possible and followed carefully in the long-term.

Effect of photodynamic therapy on recurrent pituitary adenomas: clinical phase I/II trial--an early report.

Pituitary adenomas, although histologically benign, are not always curable by surgery alone, principally because of dural infiltration, as well as their peculiar anatomical location. Radiotherapy has been employed as an adjuvant therapy to address residual disease with favourable results. This approach is, however, not without side effects, and it cannot be repeated. We are therefore investigating the effectiveness of photodynamic therapy (PDT) on recurrent pituitary adenomas in humans. This study details the protocol applied to 12 patients with recurrent pituitary adenomas, which involved systemic administration of photosensitizer (Photofrin) followed, after a period of 24-48 h, by intraoperative illumination of the tumour bed using 630 nm laser light. The primary end points were visual, endocrine and radiological improvement. The incidence of side effects was also monitored. The longest follow-up is 2 years. Most patients suffering from visual acuity or field defects have shown improvement when followed for 12 months or more. Three patients showed complete recovery of their visual fields. All those who presented with functional adenomas have shown reduction in their hormone levels. Tumour volume, relative to the preoperative size, was 122, 87, 66, 60 and 46% at 4 days, and 3, 6, 18 and 24 months, respectively. One patient developed severe skin photosensitization due to early exposure to direct sunlight and three others displayed minor skin reactions. There was no treatment-related mortality or morbidity. One patient (operated transcranially) developed hemiparesis postoperatively, which recovered completely. We think this is unrelated to the treatment. This prospective study demonstrates that PDT may be safely applied to the pituitary fossa by the trans-sphenoidal route and indicates the need for a randomized, controlled trial in order to establish its therapeutic potential.

A preliminary experimental in vivo study of the effect of photodynamic therapy on human pituitary adenoma implanted in mice.

As surgery alone may prove inadequate to effect a cure for invasive pituitary adenomas, photodynamic therapy (PDT) was investigated as a possible adjuvant treatment for this group of tumours. Different subtypes of human pituitary adenoma cells were implanted subcutaneously into nude mice to study the in vivo effect of PDT on such lesions. The photosensitizer used in this study was polyhaematoporphyrin at a dose of 10 mg/kg b.w., followed by light irradiation at a wavelength of 630 nm with varying light doses between 10 and 75 J/cm2. Histopathological examination of the treated implants consistently showed tumour vascular changes with acute inflammatory reaction, interstitial haemorrhage, and evidence of cell death at higher doses of light. These changes were absent in the control groups. These findings indicate that the cytotoxic effect of PDT demonstrated in vitro in previous studies, is also present in vivo.

Modern concepts in the management of flail chest.

Seven patients with varying degrees of paradoxical chest wall movement (flail chest) were managed conservatively at the University of Port Harcourt Teaching Hospital with frusemide, methylprednisolone, non administration of crystalloid fluids and limitation of fluid intake. Patients showed considerable improvement within the first 24-48 hours which was sustained throughout the period of management. All seven survived and showed no signs of respiratory distress in the resting state or while performing simple exercise. One patient however had slight to moderate chestwall deformity.