Treatment of Exuberant Granulation Tissue in an Umbrella Cockatoo (Cacatua alba) with Strontium Radiation.

A 26-year-old female umbrella cockatoo (Cacatua alba) was presented for reoccurrence of a soft tissue mass extending from a fractured area of the rhinotheca. The mass was originally observed 12 years before, after unknown trauma. Histopathology after initial removal was consistent with inflammatory granulation tissue. The mass reoccurred 3 additional times in the same location despite surgical removal and cryogenic therapy. On the fourth surgical resection, strontium-90 radiotherapy was applied to the site immediately after the surgical procedure. No recurrence of the tissue mass from this location has been observed for almost 2 years. This case demonstrates the novel use of strontium radiotherapy to treat exuberant granulation tissue in a bird.

Successful treatment of a recurrent granulation polyp in the airways with high-dose-rate brachytherapy: a case report.

BACKGROUND: Benign central airway tumors are very rare diseases. Their unspecific symptoms are responsible for late diagnosis. Endoscopic interventions with different techniques and tools are widely used for their treatment. However, in certain cases interventional endoscopy might be unsuccessful and therefore other methods such as high-dose-rate brachytherapy could be a therapeutic option. CASE PRESENTATION: A 76-year-old white German woman was referred to our clinic for an endoscopic treatment of a recurrent granulation polyp in her left main bronchus. She had dyspnea, coughing, and mucus retention. Three times resections via bronchoscopy were performed within less than a year. After each intervention the polyp regrew inside her left main bronchus causing a repeat of the initial symptoms. She presented to our clinic less than 1 month since the last intervention. Twice we performed a rigid bronchoscopy in total anesthesia where we resected the granulation polyp with a snare wire loop and did an argon plasma coagulation of its base. Due to the recurrent growing of the granuloma, we performed a high-dose-rate brachytherapy in conscious sedation after another interventional bronchoscopy with a resection of the polyp and argon plasma coagulation of the base. Three months after brachytherapy our patient came to our clinic for a follow-up with none of the initial symptoms. Only a small remnant of the polyp without a significant occlusion of her bronchus was visualized by bronchoscopy. Furthermore, 6 months after brachytherapy she was not presenting any of the initial symptoms. CONCLUSIONS: This case report shows that high-dose-rate brachytherapy is a therapeutic option for the treatment of benign airway stenosis when other interventional treatments are not or are less than successful. However, further investigations are needed to prove the effectiveness and reliability of the method.

Java brucea and Chinese herbal medicine for the treatment of cholesterol granuloma in the suprasellar and sellar regions: A case report and literature review.

RATIONALE: A cholesterol granuloma (CG) is usually found in the middle ear, papilla, orbits, petrous apex, and choroid plexus, but is highly uncommon in the skull. In spite of benign clinicopathological lesions, bone erosion can be seen occasionally in the patient with CG. The optimal treatment strategy is radical surgery, but complete excision is usually impossible due to anatomical restrictions and a risk of injury to the key structures located nearby. Here, we report a patient with CGs in the suprasellar and sellar regions who was successfully treated with Java brucea and Chinese herbal medicine. PATIENT CONCERNS: A 31-year-old man presenting with progressive decreased vision in both eyes was analyzed. DIAGNOSES: A skull magnetic resonance imaging (MRI) scan showed a low-density tumor in the uprasellar and sellar regions and histopathological examination revealed a CG. INTERVENTIONS: The patient was referred the surgery and radiotherapy. In the meantime, brucea soft capsules and herbal medicine combined were administered to him. OUTCOMES: The related clinical symptoms and signs resolved significantly after several months, as his therapy progressed. The patient showed no sign of recurrence during the treatment period. Furthermore, he was still alive and disease-free at 37 months of follow-up visit. LESSONS: Overall, brucea soft capsules and a Chinese herbal formula treatment combined could be beneficial in improving the patient's quality of life with CG in the skull.

Failure of radiation therapy in orbital xanthogranuloma.

PURPOSE: The efficacy of radiation therapy in orbital xanthogranuloma in patients who fail medical therapy is unclear. The purpose of this study was to ascertain its effectiveness. METHODS: The records of 11 cases were reviewed retrospectively for histopathologic findings, age, gender, site of involvement, clinical manifestations, and outcomes of treatment. The case histories of the 4 patients treated with radiation, all of whom had failed medical treatment, were described. RESULTS: Of 11 patients, 5 were female, and all were white. The age range at the time of presentation was 25 to 85 years. Nine patients had bilateral involvement. Five patients, all of whom had bilateral disease, had systemic manifestations or autoimmune disease thought to be related to their orbital disease. In general, patients treated with systemic corticosteroids had at least a partial response of their lesion. However, none of the 4 patients treated with orbital radiation (3 of whom had not responded to steroid treatment and 1 of whom had responded only to high-dose steroids) experienced improvement, and at least 3 experienced exacerbation of their disease. The histologic features before treatment in all cases were similar and consistent with xanthogranuloma. CONCLUSION: Orbital xanthogranuloma may be a unilateral or bilateral condition. Particularly when bilateral, it may be associated with similar lesions elsewhere or with systemic autoimmune disorders. The results of this study suggest that fractionated radiotherapy not only may be ineffective but also may exacerbate the progression of the orbital lesions in patients who do not respond to medical therapy or who are steroid dependent on intolerable doses of medication.

Solitary extramedullary plasmacytoma and granulomatous sialadenitis of the parotid gland preceding a B-cell non-Hodgkin's lymphoma.

A patient with swelling of the left parotid gland of four-months' duration, sicca syndrome (xerophthalmia and xerostomia) and a history of progressive systemic sclerosis with an incomplete form of the CREST syndrome was referred to our department. On ultrasound a parotid mass of reduced echogenicity without any enlarged cervical lymph nodes was found. Ultrasonographically guided fine-needle biopsy could not provide any definitive diagnosis. After partial parotidectomy with complete tumor removal the histologic exam showed an extramedullary plasmacytoma with concurrent non-necrotizing granulomatous sialadenitis of the parotid gland. Complete systemic work-up excluded multiple myeloma, leukemia, lymphoma and sarcoidosis. Post-operative radiotherapy of the left parotid region and left neck including the supraclavicular lymph node area was performed. Six months after surgery an aggressive B-cell non-Hodgkin's lymphoma was diagnosed.

Granuloma faciale treated with the pulsed-dye laser: a case series.

Granuloma faciale (GF) is a rare cutaneous condition of unknown origin with characteristic clinicopathological features. It predominantly affects the face and in some causes an unacceptable cosmetic appearance. Numerous medical and surgical treatments have been used with varying degrees of success. Several single-patient case reports have demonstrated the successful use of the pulsed dye laser (PDL) in treating GF. This study assesses the results of four patients with facial GF from one dermatological laser centre that were treated with the Candela Vbeam PDL at 595 nm. Resolution of the GF was achieved in only two of the four patients (50%). Nevertheless this study provides further evidence that the PDL can help some patients with GF. Subsequently it is still a valuable treatment option for GF, especially as it is safe, well tolerated and quick.

Germinoma with a granulomatous reaction. Problems of differential diagnosis.

The patient was a 6 year-old girl with a progressive loss of visual acuity. Magnetic resonance imaging showed a suprasellar mass lesion with enhanced gadolinium which was resected. Histopathological study showed a remarkable granulomatous reaction, but a diagnosis was difficult. However, immunohistochemical study showed a few cells that were positive for placental alkaline phosphatase and it was diagnosed as germinoma. Intracranial germinoma with a remarkable granulomatous reaction is rare. However, when germinoma is suspected clinically, an immunohistochemical study is able to identify germinoma even if granulomatous disease is diagnosed histopathologically.

Treatment of granuloma faciale with the pulsed dye laser.

Granuloma faciale is a chronic benign vasculitis that generally affects the skin of the face. The lesions are commonly refractory to therapy. A patient with long-standing granuloma faciale refractory to topical corticosteroid and dapsone therapy had an excellent response to treatment with the pulsed dye laser.

Application of low intensity laser radiation in extravasal infiltrates caused by cytostatics in children with acute leukemia.

Application of low intensity laser radiation in the field of infantile oncohematology has not been discussed in the available medical literature. The possible adverse effect of the physical factors on the main disease and the controversial character of their application prevent their being used in the treatment of these diseases. The aim of the present study was to assess the feasibility of using low intensity laser radiation (LILR) in treating extravasal infiltrates caused by cytostatics (vincristin, daunorubicin) administered in children with acute leukaemia (AL). We applied laser therapy in a group of children with AL in the stage of exacerbation. The children were undergoing chemotherapy with cytostatics. Immediately after formation of the extravasal infiltrates the constant leaders in the venous duct were removed and low intensity laser therapy with LMS "Prometheus" was administered. This apparatus is a semi-conducting soft laser in the infrared spectrum (890-910 nm wavelength, depth of penetration 25-30 mm) working in an impulse mode. We used minimal doses in the range of the anti-inflammatory enthrophic frequencies. We found that the extravasal infiltrates rapidly decreased the local inflammatory response and the pain was relieved. The strong anti-inflammatory effect can be accounted for by the nonspecific action of the LIRR on the tissues, which is manifested by better microcirculation, removal of toxic substances and stimulated regeneration capabilities of the cells. This study is an attempt to work successfully in this very delicate field of the contemporary medicine despite the abstention from using it before.

Granuloma faciale in a child successfully treated with the pulsed dye laser.

Granuloma faciale, a rare, chronic, cutaneous disorder, is uncommon in children. Numerous treatment modalities have been used to treat granuloma faciale but none are consistently effective. In addition, many of the previously used therapies have unwanted side effects or are not well tolerated by children. We report a case of granuloma faciale in an 11-year-old child successfully treated with the pulsed dye laser. To our knowledge, this is the first report of this treatment modality for granuloma faciale.

Radiation therapy of canine brain masses.

This article evaluates the responses of 14 dogs with brain masses using orthovoltage irradiation for definitive treatment. Dogs were anesthetized for computed tomography (CT) examination, formation of head immobilization and positioning devices, radiation treatment simulation, and treatments. Total doses of 39 Gy (9 dogs) or 45 Gy (5 dogs) to the tumor were administered over 25 to 41 days. Two or three portals (parallel opposed lateral with or without a dorsal field) were used. Treatment volumes included the tumor and peritumoral edema, as determined by CT scan, and a 1-cm margin. Histopathologic diagnoses were available in 9 of 14 dogs. There were 4 meningiomas, 1 lymphosarcoma, 1 pituitary adenoma, 1 metastatic anaplastic carcinoma, 1 anaplastic oligodendroglioma and 1 dog with granulomatous meningoencephalitis. At the end of radiation therapy, 10 dogs could be evaluated for progression of clinical signs: 3 dogs deteriorated or failed to improve, and 7 dogs improved. At the time of analysis, all dogs were dead. Mean and median survival times, measured from the beginning of radiation, were 345 and 489 days, respectively. This was compared with mean survival times of 30 to 81 days reported in the literature for dogs with brain tumors that did not receive treatment. The median survival time of 9 dogs treated with 39 Gy was 153 days, versus 519 days for 5 dogs that received 45 Gy. It appears that radiation therapy prolongs survival times for dogs with brain masses. Although megavoltage therapy would be optimal, orthovoltage radiation can be applied in total doses of 45 Gy in 3.75 Gy fractions over 28 days without adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic effect of Ga-Al-As diode laser irradiation on experimentally induced inflammation in rats.

We produced experimental inflammation models in rats by carrageenin and studied the effect of Ga-Al-As diode laser irradiation (780 nm, continuous wave, 31.8 j/sec/cm2, spot size of 0.2 mm) on inflamed regions compared with those of indomethacin, a potent anti-inflammatory agent. We found that a low-power infrared laser has an anti-inflammatory effect on carrageenin inflammation. A low-power laser inhibits: (1) the increase of vascular permeability during the occurrence of an acute inflammation in the carrageenin-air-pouch model, (2) edema in the acute stage in the carrageenin-paw-edema model, and (3) the granuloma formation in the carrageenin-granuloma model after receiving laser irradiation once daily. In all cases, irradiation for less than 10 min was sufficient to inhibit the inflammation by 20-30%. The inhibitory effect of laser irradiation was not comparable to that of indomethacin (4 mg/kg, i.o.) in the air-pouch model and the paw-edema model, whereas laser irradiation was more potent than that of daily administration of indomethacin (1 mg/kg, i.o.) in the granuloma model. In future studies of the mechanism of laser effect, it should be noted that irradiating a rat twice, before and after the provocation of inflammation, was essential in order to achieve an effective inhibition of paw-edema.

[Nd-YAG laser treatment of tracheobronchial lesions].

From January 1987 to May 1988, 32 cases with tracheobronchial lesions were treated with Nd-YAG laser. Complete restoration of the airway was achieved in one case of leiomyoma, adenoma, carcinoid and mucous epithelioma each, 2 cases of polyp and 7 cases of granuloma. Significant restoration was seen in one case of granuloma, 2 cases of hematoma and papilloma, each, 3 cases of amyloidosis and partial restoration in one case of granuloma. The remaining 10 cases with squamous cell carcinoma and adenocarcinoma with severe airway obstruction were treated by Nd-YAG laser for palliative purpose only. Four of them revealed significant remission and 6 responded with partial remission. No severe complication was observed during or after the procedures. Nd-YAG laser treatment provides a new curative method avoiding resection of the lung in benign lesions and a palliative therapy for unresectable obstructive malignant tumors.