摘要:

Primary small cell carcinoma of the prostate (SCCP) is rare. Natural history of this tumor is similar to that of bronchogenic small cell carcinoma. A majority of patients with SCCP have distant metastasis at presentation. Because the disease is rapidly fatal, the incidence of brain metastasis from SCCP is not known. A case of primary SCCP with multiple subcutaneous and lymph node metastases is presented. The patient failed to respond to systemic hormone therapy but had a near complete response to multiple agent chemotherapy consisting of cyclophosphamide, adriamycin, and vincristine. Multiple brain metastases subsequently developed, and he responded poorly to cranial irradiation. The clinical behavior of this cancer being similar to that of bronchogenic small cell carcinoma, it supports the recommendation of computerized axial tomography of the brain to be included in the staging workup of patients with SCCP. Prophylactic cranial irradiation might be of value in patients with a complete response to chemotherapy.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Heterotopic brain tissue reportedly occurs occasionally in various sites, including rare occurrences in the middle ear. Association with cholesteatoma in middle ear cases, however, has not been reported yet. In this article, the authors describe three cases of heterotopic brain tissue in the middle ear associated with cholesteatoma: a 3-year-old boy with recurrent meningitis resulting in right acute otitis media and bony dehiscence of the right attic; a 36-year-old man with chronic right ear infections, right radical mastoidectomy 2 years previously, and brain herniation through the tegmen tympani; and a 65-year-old man with chronic otitis for many years, right ear surgery 25 years previously, and extensive involvement of right middle ear ossicles and mastoid antrum by cholesteatoma. The heterotopic brain tissue in each of these cases was diagnosed by histologic examination, and its glial component was confirmed by immunohistochemical staining for glial fibrillary acidic protein. After a microscopic review of 40 additional surgical pathology cases of cholesteatoma, no evidence of heterotopic brain tissue was found. With these findings, it is suggested that the unusual occurrence of heterotopic brain tissue in the middle ear associated with cholesteatoma may result from local destruction of bone secondary to the cholesteatoma, otitis media, meningitis, or previous surgery.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although anaerobic bacterial meningitis is uncommon, patients subjected to resection of head and neck malignancy appear at special risk. In this article, the authors report on a 72-year-old man in whom meningitis developed after extensive resection of the right sinuses for squamous cell carcinoma; initial treatment consisted of intravenous vancomycin and ceftazidime. Intravenous penicillin G was added after the fortuitous early finding of intracellular cocci in Wright-Giemsa stained cerebral spinal fluid submitted for cell count. Cerebral spinal fluid cultures then grew out a pure culture ofPeptostreptococcus magnus.The patient had a complete recovery, without neurologic sequelae, recurrence of malignancy, or evidence of infection. Appropriate handling of cerebral spinal fluid specimens is crucial to ensure the correct diagnosis when anaerobic organisms are suspected.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Purpuric lesions have been described previously in 10 patients with disseminated strongyloidiasis. We identified three additional patients in whom purpura developed as a manifestation of disseminated strongyloidiasis. Nine (69%) of the 13 patients were men, and the median age of patients was 61 years (range, 32–75 years). Six patients were from the southeastern United States. Six patients had underlying malignancy and four patients had chronic lung disease. All patients had received prior corticosteroids. The parasite was identified in 11 (92%) of 12 patients where stool or sputum examination was performed. Skin biopsies of purpuric lesions were obtained in 12 patients, in 10 (83%) of which larvae were found. Despite recommended treatment with thiabendazole in 12 of 13 patients, 11 (85%) of the patients died, and at least 6 died within 16 days of onset of purpura. Physicians, particularly those in the southeastern United States, should strongly consider the diagnosis of disseminated strongyloidiasis in patients receiving corticosteroids and in whom purpura and systemic toxicity develops.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Cutaneous cryptococcosis usually is associated with concurrent systemic infection and actually may develop before clinical manifestations of cryptococcal meningitis become apparent. It is rare for a cryptococcal infection to be localized only to the skin. A case of cutaneous cryptococcosis is described in an immunocompromised patient who initially had a rash and a positive serum cryptococcal antigen titer, but no central nervous system involvement. The papular pustular skin lesions disappeared after 8 weeks of therapy with amphotericin B, which was stopped secondary to progressive azotemia. Less than 2 months after therapy, the skin lesions recurred, again without evidence of systemic disease. Treatment with oral fluconazole resulted in a gradual resolution of the cutaneous lesions. The pathogenesis of cryptococcosis is discussed, with emphasis on the management of cutaneous cryptococcosis.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID