A case of moyamoya-like disease associated with an intracerebral hemorrhage and an unusual aneurysm is reported. The patient's clinical status and the initial and follow-up angiographic appearance of the aneurysm are presented. The etiology of the moyamoya phenomenon and of associated aneurysms is discussed.
Two hundred seventy consecutive patients operated upon by standard discectomy were compared to 270 patients treated with microlumbar discectomy. All patients had back and leg pain, as well as positive clinical findings and positive myelograms suggestive of disc herniation. The results demonstrated a 98% success rate in the microsurgical group as compared to a 95% success rate in the standard laminectomy group. Of microdiscectomy patients, 95% had an excellent result, as compared to 89% of the standard laminectomy group. Patients with pending compensation cases did only slightly poorer than those with no secondary gain regardless of what procedure was used. The postoperative hospital stay of the microsurgical patients averaged 3.7 days as compared to 7.1 for the standard technique. The time before return to work was significantly shorter in patients undergoing microdiscectomy. Microdiscectomy proved to be superior in both clinical results and cost effectiveness.
Brain metastasis from papillary thyroid carcinoma (PTC) is extremely rare and carries a poor prognosis. We report nine cases (five females and four males) of brain metastasis of PTC. The age of patients ranged from 46 to 87 years old. The patients presented with nonspecific symptoms such as headaches. Brain metastasis was the first clinical presentation in three of nine patients; two of which had the aggressive tall cell variant of PTC. Six patients had prior history of PTC (four classic, one oncocytic variant, and one columnar cell variant) for 2 to 17 years with a median of 12 years. Gross total resection of brain metastasis was achieved for eight of our patients. Eight patients were treated with radioactive iodine. The median follow-up time was 12 months, ranging from 1 month to 4 years. Three patients died of their disease in 6 months, 21 months and 4 years, respectively after their first presentation of brain metastasis. It seems that these rare aggressive variants of PTC, such as tall cell variant, not only have higher propensity to develop brain metastasis, but also more frequently present with brain metastasis as their first clinical presentation than classic PTC. Furthermore, patients with PTC can develop brain metastasis even after many years.
Child psychiatric evaluation and treatment is described for a single case of Munchausen by proxy syndrome with a good outcome. The literature is reviewed, and the medical management of the case summarized. With careful case selection and preparation and with modifications to existing treatment approaches, we conclude that the generally poor prognosis for this condition may be improved. Safe rehabilitation of the child to the family can be a reasonable treatment goal in selected cases.
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