Objective-To determine the ability of ErbB inhibitors to reduce the growth of vestibular schwannoma (VS) xenografts.Methods-VS xenografts were established in the interscapular fat pad in nude mice for 4 weeks. Initially, a small cohort of animals was treated with the ErbB2 inhibitor, trastuzumab, or saline for 2 weeks. Animals also received BrdU injections to label proliferating cells. In a longer-term experiment, animals were randomized to receive trastuzumab, erlotinib (an ErbB kinase inhibitor), or placebo for 12 weeks. Tumor growth was monitored by magnetic resonance imaging (MRI) over the treatment period. Cell death was analyzed by terminal dUTP nick end labeling (TUNEL).Results-Tumors could be distinguished with T2 weighted MRI sequences. Trastuzumab significantly reduced the proliferation of VS cells compared to control (p<0.01) as determined by BrdU uptake. Control tumors demonstrated slight growth over the 12 week treatment period. Both trastuzumab and erlotinib significantly reduced the growth of VS xenografts (p<0.05). Erlotinib, but not trastuzumab, resulted in a significant increase in the percent of TUNEL-positive VS cells (p<0.01).Conclusions-In this preliminary study, the ErbB inhibitors trastuzumab and erlotinib decreased growth of VS xenografts in nude mice raising the possibility of using ErbB inhibitors in the management of patients with schwannomas, particularly those with neurofibromatosis type 2.

Painful salivary swelling in patients with Sjögren syndrome presents the clinician with a difficult-to-manage condition, and treatment options are limited. We report 2 cases that demonstrate the utility of a clinic-based intraductal corticosteroid infusion for the treatment of painful salivary swelling associated with Sjögren syndrome. Steroid infusion is a cost-effective, simple-to-perform, well-tolerated gland-sparing procedure that may yield good clinical results in selected patients.

Right-sided aorta and ALSA indicate embryologic regression of the left fourth primitive aortic arch. The absence of Kommerell's diverticulum at the origin of the ALSA indicates the lack of high-pressure blood flow from the pulmonary artery to the ALSA through the ductus arteriosus during embryogenesis, suggesting the embryologic regression of the left sixth primitive aortic arch. The presence of all 3 radiologic features thus highly suggests the possibility of a LNRLN.

Our study demonstrates the potential to create a growth model of the normal trachea based on cross-sectional area of the trachea using MRIs. Even with the relatively small number of patients used to build it, the model has demonstrated some ability to be used as an objective prediction tool when deciding a treatment path for a patient. With continued development of precise, objective measures to diagnose the severity of the tracheal stenosis, more patients can be given early and accurate prognosis and be treated appropriately.