The effects of quantum energy surgical device and of bipolar coagulation: a comparative experimental study.

OBJECTIVE: The quantum energy surgical device (QESD) employs an innovative, "no-touch" thermal coagulation, incision and evaporation technique in which thermal energy is delivered to tissue in the format of high-energy neutral argon gas atoms. The aim of this study is to compare QESD and bipolar coagulation (BC) through assessment of both haemostasis and histological damage to isolated femoral arteries of rats. METHODS: Sixty rats were randomly divided into acute and short-term experimental groups. In the acute group (n=20) histopathological evaluation was performed immediately following coagulation, whereas in the short-term experimental group (n=20) the evaluation was performed 10 days later. Each sham group consisted of ten rats. Viewed under the surgical microscope, only normal-appearing, freshly sectioned, and bleeding femoral arteries were studied. Right femoral arteries subject to QESD coagulation, and left femoral arteries to BC. Haemorrhaging was controlled using the minimal coagulation time necessary to stop it. All vascular layers, including endothelium, internal elastic lamina, media and adventitia were examined histologically and ultrastructurally in a "blind" fashion to critically compare morphological damage due to QESD and BC. RESULTS: Surgical haemostasis induced by QESD was found to be as safe as BC. Light microscopy revealed more marked histopathological changes in the BC than in the QESD group. These involved mainly the endothelial and medial compartments and, at the ultrastructural level, consisted of endothelial degeneration and exfoliation, irregularity of internal elastic lamina, degeneration, and loss of medial smooth muscle. CONCLUSION: The results indicate that QESD coagulation induces significantly less histological damage than does BC. Thus QESD coagulation is a safe, less tissue destructive, and equally effective method of haemostasis.

Gliosarcoma associated with neurofibromatosis type I: a case report.

Neurofibromatosis type I (NF I) is the most common hereditary syndrome predisposing to neoplasia. We report the third case in the literature, documenting the combination of gliosarcoma with NF I. The patient's son was known at our center because of a history of pleomorphic xanthoastrocytoma (PXA) with NF I. A 48-year-old man who had a number of café-au-lait spots with neurofibroma since birth presented with severe headache. Neuroradiological studies revealed a cystic tumor of the right temporal lobe of high grade nature. Surgical excision was performed and the tumor was found to be located on the surface of the temporoparietal area with cystic formation and vascular and infiltrative features. Postoperative MRI Key words: gliosarcoma, neurofibromatosis I, temporal lobe. showed no detectable contrast enhancing tissue. Immunohistochemical examination evidenced the characteristics of typical gliosarcoma. The patient received radiation therapy but five months following surgery recurrence of the tumor was diagnosed. Reoperation was performed and histopathological studies confirmed the diagnosis of gliosarcoma. We believe that the neurofibromatosis was inherited by the son with PXA from the father with gliosarcoma. The rarity of the combined occurrence of gliosarcoma and NF I, in addition to this uncommon family history, makes this case remarkable. Our findings suggest that NF I is a multifaceted disease associated with benign as well as malignant astrocytic tumors.

Cervical spinal cord intramedullary abscess. Case report.

A case of progressive symptoms and signs of cervical spinal cord damage due to intramedullary abscess is reported. The literature is reviewed and the radiological features, particularly magnetic resonance image, are analyzed.

Tumor in tumor: metastasis of breast carcinoma to intracranial meningioma.

This report presents magnetic resonance imaging (MRI) findings of a breast carcinoma metastasis in an intracranial meningioma with correlated pathological findings. MRI showed multiple foci of intense enhancement with hypointense surrounding areas. The described foci appeared to be metastatic disease from the patient's known breast carcinoma. In addition, this is the first study reported in the literature to have investigated the expression of a possibly common carcinogenic molecule in breast carcinoma metastatic to a coexisting meningioma: overexpressed c-myc oncogene was found both in the breast carcinoma compartment and in the meningioma component of the tumor.

Chiasmal cavernous malformation. A rare cause of acute visual loss.

A rare cause of acute visual loss due to a chiasmal cavernous malformation is presented. Acute visual loss was due to local hemorrhage and volume expansion of the cavernous malformation inside and outside of the optic chiasma. This unique location of cavernous malformation is associated with a risk of permanent loss of the vision. Cavernous malformations of optic chiasma should be carefully evaluated and considered for possible preventative surgical resection before it becomes symptomatic.

Hemimegalencephaly and Hirschsprung's disease: a unique association.

A 2-year-old boy with hemimegalencephaly and Hirschsprung's disease is reported. The unique association of these two entities is considered to be the presence of a common insult or insults that affect the innervation of the bowel and the formation of the cerebral cortex. Short-segment subtype of Hirschsprung's disease may suggest that this effect occurred between the eighth and twelfth weeks of gestation. Although there is a well-known coexistence of Hirschsprung's disease with the malformations that share a common neurocristopathic origin (abnormalities of neural crest cell growth, migration, or differentiation), a few extremely rare cases, as in this case, might reflect the coexistence of Hirschsprung's disease with a cerebral malformation (i.e., hemimegalencephaly) that is a nonneurocristopathic entity by itself.

Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases.

BACKGROUND: Chemotherapy-induced acral erythema is a distinct localized cutaneous response to certain systemic chemotherapeutic agents. METHODS: Between January 1990 and December 1994, from a total of 76 leukemic patients who have received combination chemotherapy consisting of cytosine arabinoside and anthracycline antibiotics, 15 patients developed chemotherapy-induced acral erythema. Fourteen of the patients had acute myelocytic leukemia, and one of them had chronic myelogenous leukemia in blast phase. Clinical features of these 15 patients have been analysed. Biopsy specimens obtained from eight of the patients were also evaluated for histopathologic alterations. RESULTS: The overall incidence of this reaction was found to be 19.7% in our group of patients receiving this chemotherapy protocol. The onset of reaction varied from the fourth to the seventeenth days of the chemotherapy and resolved within 2 weeks in most of the patients. Lesions appeared as well-defined erythema and edema involving the palmar surfaces in all of the patients. In nine of the patients the reaction recurred with subsequent chemotherapies. Scattered necrotic keratinocytes, vacuolar alterations of the basal layer, and mild to moderate perivascular lymphocytic infiltration in the dermis were the histopathologic findings observed in the biopsy specimens. CONCLUSIONS: Chemotherapy-induced acral erythema is a frequent reaction in patients who are receiving high-dose chemotherapy. For patients in whom this self-limited condition develops, reassurance is the mainstay of therapy. Awareness of this reaction is also important to be able to differentiate it from acute graft versus host disease in patients who receive bone marrow transplants.