Restricted Ketogenic Diet Therapy for Primary Lung Cancer With Metastasis to the Brain: A Case Report.

A high-fat and low-carbohydrate diet was administered as a complementary and alternative therapy to a 54-year-old man suffering from non-small-cell lung cancer (NSCLC) with brain metastasis. Three months after the cessation of chemotherapy and radiotherapy, a ketogenic diet (KD) was initiated. This approach was an attempt to stabilize the disease progression after chemotherapy and radiotherapy. Computed tomography following radiation and chemotherapy showed a reduction in the right frontal lobe lesion from 5.5 cm × 6.2 cm to 4 cm × 2.7 cm, while the mass in the upper-right lung lobe reduced from 6.0 cm × 3.0 cm to 2.0 × 1.8 cm. Two years after KD initiation and without any other therapeutic intervention, the right frontal lobe lesion calcified and decreased in size to 1.9 cm × 1.0 cm, while the size of the lung mass further decreased to 1.7 cm × 1.0 cm. The size of the brain and lung lesion remained stable after nine years of KD therapy. However, dyslipidemia developed after this time which led to the discontinuation of the diet. No tumor relapse or health issues occurred for two years after the discontinuation of the diet. This case report indicates that the inclusion of ketogenic metabolic therapy following radiation and chemotherapy is associated with better clinical and survival outcomes for our patient with metastatic NSCLC.

Breast necrosis following coronary artery bypass grafting.

We present a case of left breast necrosis following coronary artery bypass grafting which was misdiagnosed as a breast cancer. Breast necrosis after myocardial revascularization is an extremely rare complication of the surgical procedure using the most conventional graft which is the left internal mammary artery. The left internal mammary artery is the main blood supplying artery of the left breast.

Disc-like herniation in association with gas collection in the spinal canal: CT evaluation.

Gas production as a part of disk degeneration can occur but rarely causes nerve compression syndromes. Few cases have been reported in which lumbar intraspinal epidural gas cause nerve root compression symptoms. We present 12 cases of gas collection in the spinal canal that were presented to the orthopaedic out-patient department with symptoms of low back pain and sciatica. CT showed the presence of free epidural gas collections adjacent to or over the affected nerve roots. Relief of symptoms was noted with the change of positions, lying down or sleeping. In this study, we conclude that the presence of lumbar intraspinal epidural gas that causes radicular compressing phenomena, can be easily detected with the use of CT.

MR cholangiography in the evaluation of patients with duodenal periampullary diverticulum.

OBJECTIVE: This retrospective study evaluates the relationship between periampullary duodenal diverticula and the common bile duct (CBD). MATERIALS AND METHODS: The patients were examined with HASTE breath hold MR cholangiography (MRC) using a 1 T Siemens Expert Plus Scanner. Axial T2-weighted images were also obtained in all patients. RESULTS: From the 66 patients, only 23 clearly depicted to have deverticula, while 31 patients were suspected to have diverticula and for the rest 12 patients, the MRC results were negative. From these 66 patients, the 18 patients proved to have stones in the CBD. CONCLUSION: MRC has very low sensitivity in the detection of duodenum diverticula, but is the method of choice to evaluate their relationship with the distal part of the CBD.

Arachnoid cyst of the frontal part of the temporal lobe producing exopthtalmos CT and MRI evaluation.

Twenty-three patients with an arachnoid cyst in the frontal part of the temporal bone, which produced exopthtalmos, were evaluated with CT and MRI. The majority of the patients had the peak of the bowing of the bony orbit wall in the posterior third (20/23) and only three in the middle. Arachnoid cyst are classified as small (13/23), medium (5/23) or large (5/20) size. Exopthtalmos are also classified as mild, moderate or large. CT and MRI clearly revealed the exopthtalmos, the bone remodelling process and the relationship of the orbit muscles, optic nerve and posterior bony wall of the orbit.