A case of cervical lymph node metastasis resulting from glioblastoma multiforme.

This article presents a rare case of metastatic glioblastoma multiforme (GM) to the cervical lymph node. In spite of very aggressive tumor behavior, extracranial metastasis from intra-cerebral GM is rare. Only a few cases are reported in the world literature. This infrequent extracranial metastasis may be due to the fact that patients do not live long enough to manifest metastases or result from the fact that brain tissue has some structural differences from other tissues in the body. This tumor can be easily mistaken for other anaplastic tumors like malignant melanoma, malignant lymphoma, or anaplastic carcinoma. Positive glial fibrillary acidic (GFA) protein stain (an immunoperoxidase stain) of this metastatic tumor can eliminate all other time consuming, expensive, and exhausting procedures for the patient.

Glutaraldehyde cross-linked collagen in the treatment of faecal incontinence.

BACKGROUND: The treatment of faecal incontinence secondary to internal anal sphincter dysfunction is unsatisfactory. The aim of the study was to evaluate the efficacy of anal glutaraldehyde cross-linked (GAX) collagen injections in patients with a surgically incorrectable disorder. METHODS: Seventeen patients were studied: nine had idiopathic faecal incontinence, three had incontinence following haemorrhoidectomy, two following internal sphincterotomy, two following an internal sphincter defect from obstetric injury and one following treatment for fistula in ano. All patients were refractory to conservative treatment and were unsuitable for surgical repair. All had anorectal physiology and endoanal ultrasonography before and after GAX collagen injections. RESULTS: All patients tolerated the injection without side-effects. All patients had an intact external anal sphincter. Following injection, 11 patients showed marked symptomatic improvement. One patient reported symptomatic improvement but remained in clinical grade 3, and two reported minimal improvement. There was no improvement in three patients, but one of these had a repeat injection and showed significant improvement subsequently. CONCLUSION: Injection of GAX collagen in the anal canal is a simple and well tolerated method of treating faecal incontinence due to internal sphincter dysfunction. Early results suggest it provides an easy and reliable alternative to the currently available methods that are often unsuccessful and at best unpredictable.

Carotid endarterectomy without shunt.

This series of 280 consecutive carotid endarterectomies was performed on 222 patients without an indwelling shunt or electroencephalograpic monitoring. Symptomatic patients with lateralized and nonlateralized transient ischemic attacks, ulcerated atherosclerotic plaques. One-third of the patients had severe bilateral stenosis or unilateral stenosis and contralateral occlusion. Adequate cerebral protection was provided during operation by general anesthesia and moderate hypertension. The carotid occlusion time averaged 10 minutes. There was no operative mortality within 30 days. There were no strokes during carotid occlusion and only three strokes (1.1%) within 1 month of operation. Follow-up data are available on 93% of the patients. Indwelling shunts, electroencephalographic monitoring, and carotid back pressure measurements are not necessary for the safe performance of carotid endarterectomy.

Middle cerebral artery fenestration.

Fenestration of the middle cerebral artery (MCA) is an unusual anomaly. We recognized and photographed MCA fenestration during an operation performed to clip an internal carotid artery aneurysm. The incidence of angiographic demonstration of this anomaly has been reported to be 0.26%. The clinical significance of fenestration of the vertebral and basilar arteries has primarily been the relationship of fenestration with other intracranial vascular anomalies. This is the first report of MCA fenestration associated with an aneurysm.

An automated tumor resection device for neurological surgery.

A pneumatically activated cutting probe has been designed for the neurosurgical removal of nervous system tumors or diseased tissue. The hand-held probe is formed of concentric slender tubes, one reciprocating inside the other. A scalpel-sharp edge on the tip of the inner tube moves in a shear motion past a stationary port on one side near the distal end of the outer tube. The reciprocating motion of the inner tube is provided by a pneumatic power source housed in a separate control console.