MESA Hospital

A literature review revealed no data on the effects of topical anaesthetic on patient comfort during flexible sigmoidoscopy. We therefore aimed to evaluate this in a randomized manner. One hundred and forty-six patients who underwent flexible sigmoidoscopy were randomly allocated to one of three groups. Vaseline (n = 49), 2% lidocaine gel (n = 51) or a cream of 2.5% lidocaine plus 2.5% prilocaine (n = 46) were applied to the patients 30 min before the procedure. Demographic data and haemodynamic monitoring during procedures were recorded. Pain was assessed by visual analogue scale (VAS) and anxiety levels by the State-Trait Anxiety Inventory (STAI-I and STA-II). Median pre-procedural STAI-I scores were 45, 46 and 40.5 and median post-procedural STAI-I scores were 35, 34 and 33.5 for the vaseline, lidocaine, and lidocaine/prilocaine treatments, respectively. There was no statistical difference among the groups in terms of STAI-I and II scores. However, post-procedural STAI-I scores were significantly lower than pre-procedural values in each group (P < 0.001). There was no significant difference in VAS scores among the groups. In all groups there were statistically higher VAS scores during the procedure compared with the pre- and post-procedural scores (P < 0.001). Perianal application of topical anaesthetic does not influence patient comfort during sigmoidoscopy.

Objective of this double-blind placebo-controlled study was to determine the efficacy of thermosensitive mucoadhesive gel loaded with 5-fluorouracil (5-FU):hydroxypropyl-s-cyclodextrin (HP-s-CD) complex via topical administration or intralesional injection for the treatment of human papilloma virus induced condyloma in 44 women. The diagnosis of human papilloma virus was established with clinical, histopathological and polymerase chain reaction techniques. Subjects were randomized into four parallel groups to evaluate topical or intralesional administration of drug-loaded or blank gel. The formulation used in the study consisted of 20% Pluronic PF 127 and 0.2% hydroxypropylmethylcellulose (HPMC) to render thermosensitive and mucoadhesive properties to the blank and drug-loaded gels. 5-FU was complexed to hydroxypropyl-s-cyclodextrin to improve its solubility and this complex was loaded into thermosensitive gel to obtain controlled release of the cytotoxic drug in administration site over a two-week period cure regimen aiming therapeutic efficacy with lower 5-FU doses. Complete response was achieved in 61% of patients through intralesional administration while topical administration resulted in only 29% complete cure. Relapse rates of all therapy groups were significantly low in the 6-month follow-up time.

This retrospective study was designed to estimate the cumulative incidence of glaucoma in viral uveitis. Seventy-six consecutive patients with viral stromal keratouveitis were divided into two groups according to the etiologic agents herpes simplex virus (HSV) keratouveitis (n = 58) and herpes zoster virus (HZV) keratouveitis (n = 18). The groups were evaluated for the incidence and prognosis of ocular hypertension. Etiologic agents were determined with the help of clinical observation supported by the polymerase chain reaction (PCR) of aqueous humor. All patients received oral acyclovir therapy for at least six months and topical prednisolone in tapered doses. There was no significant difference in the recurrences of HSV and varicella zoster virus (VZV) keratouveitis between groups (P = 0.431). The total incidence of secondary glaucoma was 13.1%. Most of the patients responded to antiviral and antiglaucomatous therapy. Trabeculectomy with mitomycin C was performed in only two patients. Secondary glaucoma can be regarded as a frequent complication of viral uveitis. As it has a good prognosis, surgical intervention is rarely required.

Jugular foramen (JF) tumours are uncommon with paraganglioma, schwannoma and meningioma occurring most commonly in this location. JF schwannoma with extension to the retro-tympanic area has been described only once. 20-year-old man presented with headache, blurred vision, vomiting and diplopia. A left pulsatile retro-tympanic mass was seen at otoscopy. A jugular foramen tumour was found on CT and MR images. The intracranial portion of the tumour later diagnosed as schwannoma was removed. Control ENT examination confirmed that the residual retro-tympanic mass was no-longer pulsatile. Jugular foramen schwannomas may also extend into the retro-tympanic area.

I read the article by Kim et al with great interest [1].Supratentorial occurrence of hemangioblastoma is anexceedingly rare event. Over almost a century since thefirst report of such a case by Bielschowsky in 1902, atotal of 112 cases appeared in the medical literature [2].Even rarer is the occurrence of a supratentorialhemangioblastoma in infancy. Kim et al cited only twocases from English literature [3, 4] and an additionalcase from Korean neurosurgical literature.I felt obliged to contribute to their data because Irecently had experience with such a case and during anextensive literature search I came to realize that firstinfantile supratentorial hemangioblastoma case waspublished as early as 1948. This is an exceptional casesince there is no record of this citation anywhere in thepediatric neurosurgery literature. In 1948, WallaceLeibner of Brooklyn, NY published a series of six in-fants under the 2 years of age in whom brain tumorswere found at operation or at autopsy [5]. One of thesecases was a 22 months-old-baby-boy who presentedwith left hemiparesis. Positive diagnostic findings werepapiledema, separated sutures on plain x-rays andEEG abnormality from the centro-parietal right cere-bral hemisphere. Surgery was performed on February7, 1947 by Dr Max Tarlov. Surgeon’s description ofoperative findings were as follows(... ‘‘the bone in thisarea was paper thin. A needle introduced to a depth ofabout 0.5 cm from the surface yielded yellow fluid.Following an incision into the brain, a large cysticcavity was disclosed. It contained 60 cc of yellow fluidwhich coagulated spontaneously. Along the anteriorwall of the cavity was a brown, slightly nodular andvery vascular tumor which was extremely tough. Itmeasured about 3–4 cm in diameter. Elsewhere thecavity was lined by slightly yellowish stained tissue thatappeared to be brain. As far could be determined, theentire tumor was removed’’. The child tolerated theprocedure well. When last seen about 8 months afterthe surgery, the boy was cheerful and playful and usedall extremities equally well. I want to emphasize thefact that the surgeon noted xanthochromic cyst fluidwith high protein representing previous or organizedhemorrhage.The case reported by Johnson et al in 2004 was a4 weeks-old-baby-boy who presented with acute onsetof projectile emesis, lethargy and irritability and lefthemiparesis [4]. MR imaging of the brain demon-strated multilobular cysts with enhancing mural nod-ules, displacing the right temporal, parietal and theoccipital lobes. At surgery the multiloculated cystsagain contained xanthochromic fluid under pressure.Several pink-brown tissue masses were identified uponcyst fenestration and tumor biopsy.My patient (e-published in March 2006) was an18 month-old-girl with increasing head size, an openanterior fontanelle and irritability [6]. Although late inreaching her milestones the child was able to stand andbabble at around 15 months of age. Fundoscopy re-vealed elevation of the optic disc. Plain x-rays revealed‘‘beaten copper sign’’. MR scans demonstratedtriventricular hydrocephalus and a cystic mass withinthe left lateral ventricle. There was a 18 · 15 · 13 mmenhancing mural nodule along the medial aspect of thecyst somewhere over the left thalamus. The cystic masswas mainly supratentorial but there was an infraten-