Low-grade gliomas account for 10-15% of all adult primary intracranial tumours. Currently, there is no consensus on the treatment strategy for low-grade gliomas. This study was designed to evaluate the treatment outcomes, prognostic factors and radiation-related late complications, as well as to assess whether or not post-operative radiotherapy has benefit on local control and overall survival in this population. We retrospectively reviewed 93 consecutive adult patients with supratentorial low-grade gliomas diagnosed at our institution from July 1985 to December 1997. All patients underwent surgical intervention and 60 of them received post-operative radiotherapy. With a median follow-up of 110 months for surviving patients, the 5-year overall and progression-free survival rates were 57% and 47%, respectively. 46 patients experienced local progression of disease during the follow-up period. In multivariate analysis, age at diagnosis, extent of surgery and post-operative Karnofsky performance status showed independent prognostic significance for progression-free and overall survival rates. Post-operative radiotherapy had independent prognostic value for progression-free survival. This analysis has changed our practice and we suggest that aggressive surgical resection and post-operative radiotherapy might be considered for patients with low-grade gliomas. Further efforts should be made to optimize radiotherapy techniques and to integrate new therapeutic modalities.

Fifteen paediatric patients with Salmonella meningitis were retrospectively reviewed. Presenting symptoms and signs included fever, vomiting, seizures, poor activity, diarrhoea and bulging anterior fontanelle in most patients. Seven out of eight patients with prolonged fever for > 10 days had neurologic sequelae; therefore, prolonged fever is a significant prognostic factor of a poor outcome (p < 0.005). All 15 patients had a brain ultrasound or computed tomography in the acute stage and 11 patients had abnormal findings. The 14 surviving patients were treated with a third-generation cephalosporin for at least 3 weeks. Seven patients (47%) made complete recoveries; two of them were treated solely with a third-generation cephalosporin. Only one mortality (6%) occurred and there were no relapses. In conclusion, high frequencies of prolonged fever, neuroimaging abnormalities and neurologic sequelae were seen in patients with Salmonella meningitis treated with third-generation cephalosporins.

No abstract

Intracerebral abscess in humans may be caused by a wide variety of microorganisms, including bacteria, fungi and parasites, which gain entry by (i) direct extension from a contiguous infectious focus; (ii) hematogenous spread from a remote site of infection; or (iii) direct implantation following a penetrating head trauma or neurosurgical procedures [1]. Microaerophilic and anaerobic bacteria such as Streptococcus species and Bacteroides species are the most frequently encountered pathogens [1]. Other microorganisms are relatively rare. Here, we report a case of intracerebral abscess caused by non-O1 Vibrio cholerae. The route of infection in this case is suggested to be directly from the contaminated seawater through a previous skull wound. This manifestation and infectious course is so rarely encountered that only one similar case has ever been described in the English literature [2].A 58-year-old male presented with fever and headache of 3 days' duration and was admitted due to the insidious onset of left hemiparesis and disturbed consciousness. He was a chronic alcoholic and had undergone a craniotomy 5 years previously to treat a traumatic left subdural hematoma, with no apparent residual sequelae. Liver cirrhosis was also diagnosed by echo study 3 years previously. The patient was a fisherman and, as a hobby, dived in the ocean near his home. His most favored place to dive was a delta, where the river met the sea.On evaluation, the physical examination showed left limb weakness and a positive Babinski's sign over the left side. The oculocephalic reflex was intact. His neck was stiff, and positive meningeal signs were observed. No scalp wound was found, but an ecchymotic patch with a vesiculobullous eruption was present. Routine blood examination showed leukocytosis with normal biochemical data. Brain computed tomography (CT) examination revealed a scattered right parietal lesion. Contrast enhancement showed multiple small surrounding lesions (Fig. 1A). Under a tentative diagnosis of meningitis and possible focal cerebritis, a cerebrospinal fluid (CSF) study was performed. The data showed pleocytosis (134/mm 3 ) with a high neutrophil count (55%), elevated lactate (42.3 mg/dl; control 11-19 mg/dl) and protein (88 mg/dl; control 10-45 mg/dl) levels and depressed glucose level (35 mg/dl; control 50-80 mg/dl).The patient was treated with penicillin and chloramphenicol in accordance with the standard dosage at that time for broad-spectrum coverage. Antibiotic therapy was continued for 5 days, and the patient resumed consciousness. Blood culture was negative, but CSF culture using a blood agar plate (Becton Dickinson Microbiology Systems, France) yielded a curved, mobile, gram-negative rod. The bacterium was oxidase positive and was further identified as Vibrio cholerae serogroup non-O1 by using a Bacto Vibrio cholerae antisera (Difco Laboratories, USA). The identification of the isolate was later confirmed by the National Institute of Preventive Medicine as non-cholera toxin-producing, non-O1, non-O139 Vibrio ch...

We report a case of traumatic false aneurysm developed in the right glabella in a 5-year-old boy 3 weeks after an innocuous fall. Ultrasound, CT and facial arteriography did not reveal the feeding artery. After direct puncture of the glabellar bulge and rapid aspiration of blood, percutaneous contrast agent infusion revealed that the false aneurysm was supplied by the contralateral angular artery. Intralesional obliteration with cyanoacrylate was subsequently performed smoothly. Succeeding excision was easy and the cosmetic outcome was excellent.