Long term exposure to toxic

Long-term exposure to toxic agents, including various types of herbal medicine and Chinese medicine, may be related to idiopathic mesenteric phlebosclerosis. Diseases previously reported to be associated with idiopathic mesenteric phlebosclerosis include hypertension, cerebral vascular accident, chronic hepatitis, diabetes, and hyperlipidemia; however, the relationship between the disease and drugs or associated diseases requires further elucidation. In previous reports, approximately half of the investigated patients received surgical intervention. The symptoms resolved spontaneously following conservative treatment only in the remaining patients. Surgery is not necessary, unless postischemic stricture causes intestinal obstruction.
Introduction Brain tumors, specifically large intracranial tumors, are rare during pregnancies. The low detection rate is attributable to the reluctance of patients to undergo computed tomography (CT) and other imaging studies during pregnancy. In addition, the common symptoms of pregnancy, such as nausea, vomiting, and lethargy, mimic and thus mask some symptoms and signs of intracranial tumors. However, several intracranial tumors in younger females were discovered during their pregnancies, mostly through nonemergency symptoms and signs.
Case Report With and without contrast BTS CT scans revealed a large tumor (8.3 × 6.8 × 7.1 cm3) in the left frontal region with mass effect, thickening of the adjacent skull base, and perifocal edema (Figures 1A and 1B). After the CT examination, the patient was transferred to the neurosurgical intensive care unit without extubation of the endotracheal tube. The patient was observed over a 2-day recovery period, and her imaging workup was completed. Magnetic resonance imaging (MRI) revealed a large hypervascular parasagittal meningioma (Figures 1C and 1D). Subsequently, a cerebral angiogram was performed, followed by transarterial embolization to decrease the blood supply to the tumor. After completing the imaging studies, a craniotomy was arranged to remove the parasagittal meningioma. The patient received an intravenous infusion of 100 g of mannitol and 10 mg of decadron to manage the tumor-induced increased intracranial pressure and vasogenic edema. A wide, standard, cross-midline, left craniotomy was performed to provide an adequate surgical field for dissection. The parasagittal hypervascular tumor was identified, and its attachments to both the dura and the falx were determined. A peritumoral plane was identified after the debulking procedure on the central tumor mass, and the tumor was carefully dissected. No vessels supplying blood to the brain parenchyma were sacrificed. Substantial blood loss was noted from the location of the tumor attachments to the superior sagittal sinus. Vital signs were maintained stable. The pathological reports of the fresh frozen tumor confirmed meningioma. A gross total resection of the tumor was performed. The tumor had invaded the adjacent skull base; hence, instead of returning the original bone graft to the craniotomy site, it was sent to the pathology department for investigation. Bone cement was used for cranioplasty. Subsequently, the patient was then admitted to the neurosurgical intensive care unit for close postoperative observations. The pathology reports confirmed a meningothelial meningioma characterized by proliferation of neoplastic cells in a syncytial pattern, displaying meningothelial appearance with whorled or lobulated architecture, round to oval nuclei with dispersed chromatin, inconspicuous nucleoli, and eosinophilic cytoplasm. The mitotic activity was infrequent (<4/10 high-power fields; Figure 2A). The overlying bone was directly involved with the tumor. Immunohistochemical study for the progesterone receptor demonstrated diffused strong positive immunoreactivity (Figure 2B). The immunohistochemical study revealed a Ki-67 index of <4% (only focal immunoreactivity; Figure 2C). The patient showed complete neurological recovery and no adverse side effects or complications.