Renal (Uremic) Encephalopathy in a Goat

Renal encephalopathy was diagnosed in a 2‐year‐old male boar goat with a history of chronic weight loss and ataxia. Histopathological examination of the brain revealed a striking myelin vacuolation distributed mainly in two patterns: (i) along the junction of the neocortex and corona radiata, and (ii) in the bundles of the internal capsule as it dissects through the basal nuclei. The kidneys had diffuse severe tubular and glomerular necrosis and degeneration. The neural lesions are consistent with renal (uremic) encephalopathy. To the authors’ knowledge, this is the first report of renal encephalopathy in a goat.     

Degenerative Myelopathy Associated with Cobalamin Deficiency in a Cat

A severe myelopathy was observed in a 9‐year‐old neutered male cat with a clinical history of chronic pancreatitis associated with deficiency of serum cobalamin and folates concentrations, and progressive spinal ataxia. The spinal cord lesions mainly involved the dorsal columns of the caudal cervical and cervico‐thoracic segments, and were characterized by diffuse vacuolated myelin sheaths and axonal degeneration, marked gliosis, fibrosis and presence of gitter cells. The pancreas showed severe atrophy of the exocrine tissue, periductular fibrosis and infiltration of inflammatory cells, consistent with chronic interstitial pancreatitis. This condition can be accountable for cobalamin deficiency, as the pancreas is the only source of intrinsic factor in cats. The spinal cord lesions in the cat of this report resembled the subacute combined degeneration of the spinal cord described in human beings with cobalamin deficiency and hence a similar pathogenetic mechanism is hypothesized.     

Necrotizing Cerebellitis due to Neospora caninum Infection in an Old Dog

A severe, necrotizing, non‐suppurative inflammation of the cerebellum associated with Neospora caninum infection was identified in a 14‐year‐old male Labrador Retriever. On presentation, clinical signs included mild depression and head tremor, marked ataxia of both thoracic and pelvic limbs, and abnormal postural reactions. In the central nervous system, inflammatory lesions were mainly restricted to the cerebellar leptomeninges and cerebellar cortex, which appeared necrotic and atrophic. Protozoal organisms were positively stained with an anti‐N. caninum antibody in an immunohistochemical procedure.     

Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis

Abstract

Background

Tabes dorsalis is a late manifestation of untreated syphilis that is characterized by ataxia, lancinating pains, and urinary incontinence. A form of tertiary syphilis or neurosyphilis, it is the result of slow, progressive degeneration of the nerve cells in the spinal cord.

Method

Case report.

Findings

A 39-year-old man presented with tingling paresthesia in the lower limbs, difficulty in walking, and loss of vision. Magnetic resonance imaging (MRI) of the dorsal spine showed intramedullary hyperintensity and cord atrophy, similar to changes seen in subacute combined degeneration. MRI features of tabes dorsalis have not been described previously to the best of our knowledge.

Conclusion

MRI findings in this patient with tabes dorsalis were similar to those seen in subacute combined degeneration, which is characterized predominantly by cord atrophy and intramedullary hyperintensities.     

Cerebellar Granuloprival Degeneration in an Italian Hound

A severe atrophy of the cerebellum was observed in a 7‐month‐old male Italian hound with a history of progressive ataxia and head tremor from the age of 3 months. On clinical examination, signs included severe hypermetric gait, head tremors and proprioception deficits in all limbs. At necropsy, a pronounced symmetrical reduction in size of the cerebellum was the only gross lesion observed. Histological examination of the cerebellum revealed marked thinning of the granular and molecular layers with almost complete loss of granule cells. Purkinje cells had normal morphology and distribution. These findings differ from those of previous reports of cerebellar cortical abiotrophy in dogs, which were mainly characterized by prominent Purkinje cell degeneration and loss.     

Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis

Background

Tabes dorsalis is a late manifestation of untreated syphilis that is characterized by ataxia, lancinating pains, and urinary incontinence. A form of tertiary syphilis or neurosyphilis, it is the result of slow, progressive degeneration of the nerve cells in the spinal cord.

Method

Case report.

Findings

A 39-year-old man presented with tingling paresthesia in the lower limbs, difficulty in walking, and loss of vision. Magnetic resonance imaging (MRI) of the dorsal spine showed intramedullary hyperintensity and cord atrophy, similar to changes seen in subacute combined degeneration. MRI features of tabes dorsalis have not been described previously to the best of our knowledge.

Conclusion

MRI findings in this patient with tabes dorsalis were similar to those seen in subacute combined degeneration, which is characterized predominantly by cord atrophy and intramedullary hyperintensities.     

Laser arytenoidectomy for bilateral vocal cord paralysis

The CO2 surgical laser was found to be a useful tool for the performance of endoscopic arytenoidectomy for bilateral vocal cord paralysis. The dog was found to be a less-than-perfect experimental model for human bilateral abductor vocal cord paralysis. Documentation by measurements of arterial blood gases and direct in vivo measurements of airway resistance following bilateral recurrent laryngeal nerve section and endoscopic arytenoidectomy was attempted.     

Nucleus pulposus cells expressing hBMP7 can prevent the degeneration of allogenic IVD in a canine transplantation model

We have previously explored the possibilities of allogenic intervertebral disc (IVD) curing disc degeneration disease in clinical practice. The results showed that the motion and stability of the spinal unit was preserved after transplantation of allogenic IVD in human beings at 5‐year follow‐up. However, mild degeneration was observed in the allogenic transplanted IVD cases. In this study, we construct the biological tissue engineering IVD by injecting the nucleus pulposus cells (NPCs) expressing human bone morphogenetic protein 7 (hBMP7) into cryopreserved IVD, and transplant the biological tissue engineering IVD into a beagle dog to investigate whether NPCs expressing hBMP7 could prevent the degeneration of the transplanted allogenic IVDs. At 24 weeks after transplantation, MRI scan showed that IVD allografts injected NPCs expressing hBMP7 have a slighter signs of degeneration than IVD allografts with NPCs or without NPCs. The range of motion of left–right rotation in the group without NPCs was bigger than that of two cells injection group. PKH‐26‐labeled cells were identified at IVD allograft. The study demonstrated that NPCs expressing hBMP7 could survive at least 24 weeks and prevent the degeneration of the transplanted IVD. This solution might have a potential role in preventing the IVD allograft degeneration in long time follow‐up. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1366–1373, 2013     

An experimental study on fracture healing in paraplegic rats

Fracture healing in denervated limbs was studied using paraplegic rats of Wistar stain. Femoral fractures were made at the same time as spinal cord injury or at regular intervals after spinal cord injury, for roentgenological and histological observation. In the former, proliferation and differentiation of osteogenic cells derived from the periosteum was almost the same as controls, with earlier bone union than controls. In the latter, with longer intervals between spinal cord injury and fracture, osteogenic cells were less proliferated and differentiated resulting in scant callus or delayed union. The environment of paralytic limbs was evidently altered substantially from 2 to 3 weeks after spinal cord injury, because thereafter fracture healing seemed to become poor. Circulatory disturbance plays a major role in fracture healing in paralytic limbs. Although healing is accelerated by increased circulatory volume at the acute phase of spinal cord injury, this potentiality is gradually decreased because of the regressive degeneration of long-term vasomotor nerve insufficiency.     

Third Degree Atrioventricular Block and Accelerated Idioventricular Rhythm Associated with A Heart Base Chemodectoma in A Syncopal Rottweiler

A 7‐year‐old male intact Rottweiler was presented with a 1‐week history of lethargy, anorexia, vomiting and multiple syncopal events. The results of the clinical examination and electrocardiography were consistent with a third degree atrioventricular block and an intermittent accelerated idioventricular rhythm. Haematology, serum biochemistry, serology for Borrelia burgdorferi, blood culture, total T₄, thoracic radiography and echocardiography did not reveal the cause of the arrhythmia. Response to medical treatment with isoproterenol was poor. Pacemaker placement was declined by the owners and the dog was euthanized at their request. Histopathological examination of the heart revealed a chemodectoma at the base of the heart. There was no neoplastic infiltration of the conduction tissue. Potential mechanisms explaining the association of the arrhythmias and the tumour, such as vagal stimulation and neuroendocrine factors are discussed.     

Dynamische Versorgung der Lendenwirbels?ule

Total disc replacement and posterior dynamic stabilization represent alternatives to lumbar spinal fusion which should reduce the risk of adjacent segment degeneration. Disc replacement is indicated for pure discopathy without facet joint degeneration. Spinopelvic balance influences the implant's biomechanics. Therefore pelvic incidence, sacral slope, segmental lordosis and the mean axis of rotation need to be considered. Dynamic stabilization is indicated in moderate discopathy and facet joint degeneration, in degenerative spondylolisthesis grade I with a hypermobile segment and in dynamic lumbar stenosis. The combination of caudal fusion and cranial dynamic stabilization allows a better maintenance of lordosis with multiple level instrumentation and prevents adjacent segment degeneration. If pelvic incidence and sacral slope are high, L5-S1 should be fused because of elevated shear forces.     

Hypotension orthostatique sévère et tumeur intramédullaire. À propos d’un cas et revue de la littérature

A 55-year-old woman presented with bilateral neuropathic pain of the upper limbs, motor palsy of the right arm, urinary dysfunction, and postural dizziness. MRI showed an intramedullary cervical tumor with a solid portion extended from C1 to C3 surrounded by a cystic portion. A macroscopic complete resection was performed and histological examination confirmed the diagnosis of ependymoma. Postoperatively, the patient's neuropathic pain and postural dizziness worsened, with syncopal attack while upright because of severe orthostatic hypotension (OH). On physical examination, her supine systolic blood pressure was 130 mmHg and fell to 80 mmHg while sitting with no change in heart rate. We found motor palsy of the left arm, bilateral ataxia, and urinary retention. Three months later, the patient was still bedridden, notably because of the OH. After 6 months, with the association of preventative measures of OH and high doses of a direct α1-adrenoreceptor agonist, a vasoconstricting agent, the patient recovered an independent gait permitting her to walk unassisted. The main causes of OH include medication, nonneurogenic causes such as cardiac insufficiency, and central or peripheral neurogenic causes such as diabetic insufficiency. Brainstem tumors are known to provide severe OH but this symptom has been seldom described in a purely spinal cord lesion. We report an interesting case of severe OH that had complicated the surgical treatment of a high cervical spinal cord ependymoma and we review the literature.     

Bilateral negative airway pressure pulmonary edema (NPPE)--a case report--

A case of negative pressure bilateral pulmonary edema in a 28 years old healthy female patient, scheduled for diagnostic pelvic laparoscopy for infertility. Following extubation and apparent recovery from anesthesia, she had strong inspiratory efforts due to airway obstruction caused by coughing and laryngeal spasm, that lead to negative pressure bilateral pulmonary edema. The pulmonary edema disappeared within few hours. She was breathing spontaneously through CPAP system (mask-bag-expiratory valve). Diuretics and lungs physiotherapy helped in controlling patient's complication.     

Differential effect of spinal cord injury and functional impairment on human brain activation

Reorganization of human brain function after spinal cord injury (SCI) has been shown in electrophysiological studies. However, it is less clear how far changes of brain activation in SCI patients are influenced by the extent of SCI (neuronal lesion) or the consequent functional impairment. Positron emission tomography ([15O]-H2O-PET) was performed during an unilateral hand movement in SCI patients and healthy subjects. SCI patients with paraplegia and normal hand function were compared to tetraplegic patients with impaired hand movements. Intergroup comparison between paraplegic patients and healthy subjects showed an increased activation of contralateral sensorimotor cortex (SMC), contralateral thalamus, ipsilateral superior parietal lobe, and bilateral cerebellum. In contrast to this, tetraplegic patients with impaired upper limb function revealed only a significant activation of supplementary motor area (SMA). Correlational analysis in the tetraplegic patients showed that the strength of hand movement was related to the activation of contralateral SMC. However, the severity of upper limb sensorimotor deficit was related to a reduced activation of contralateral SMA and ipsilateral cerebellum. The findings suggest that in paraplegic patients with normal hand function the spinal neuronal lesion itself induces a reorganization of brain activation unrelated to upper limb function. Compared to this, in tetraplegic patients changes of brain activation are related to the impaired upper limb function. Therefore, in patients with SCI a differential impact of spinal lesion and functional impairment on brain activation can be shown. The effect of impaired afferent feedback and/or increased compensatory use of non-impaired limbs in SCI patients needs further evaluation.     

Accumulated Spinal Axial Biomechanical Loading Induces Degeneration in Intervertebral Disc of Mice Lumbar Spine

Objective

To investigate the effect of accumulated spinal axial biomechanical loading on mice lumbar disc and the feasibility of applying this method to establish a mice intervertebral disc degeneration model using a custom‐made hot plate cage. In previous studies, we observed that the motion pattern of mice was greatly similar to that of humans when they were standing and jumping on their lower limbs. There is little data to demonstrate whether or not accumulated spinal axial biomechanical loading could induce intervertebral disc degeneration in vivo.

Methods

Twenty‐four 0‐week‐old mice were randomly divided into model 1‐month and 3‐month groups, and control 1‐month and 3‐month groups (n = 6 per group). The model groups was transferred into the custom‐made hot plate cage three times per day for modeling. The control group was kept in a regular cage. The intervertebral disc samples of the L₃–L₅ were harvested for histologic, molecular, and immunohistochemical studies after modeling for 1 and 3 months.

Results

Accumulated spinal axial biomechanical loading affects the histologic, molecular, and immunohistochemical changes of mice L_3–L₅ intervertebral discs. Decreased height of disc and endplate, fissures of annulus fibrosus, and ossification of cartilage endplate were found in morphological studies. Immunohistochemical studies of the protein level showed a similar expression of type II collagen at 1 month, but a slightly decreased expression at 3 months, and an increased expression level of type X collagen and matrix metalloproteinase 13 (MMP13). Molecular studies showed that ColIIa1 and aggrecan mRNA expression levels were slightly increased at 1 month (P > 0.05), but then decreased slightly (P > 0.05). ColXa1, ADAMTS‐5, and MMP‐13 expression levels werer increased both at 1 and 3 months (P < 0.05). In addition, increased expression of Runx2 was observed.

Conclusion

Accumulated spinal axial loading provided by a custom‐made hot plate accelerated mice lumbar disc and especially endplate degeneration. However, this method requires further development to establish a lumbar disc degeneration model.     

The neuroprotective effects of intrathecal administration of the selective N-type calcium channel blocker ziconotide in a rat model of spinal ischemia.

PURPOSE: Spinal cord ischemia and resulting paraplegia represent a major complication associated with surgical repair of the thoracoabdominal aorta. Although the mechanism of spinal neuronal degeneration during ischemia is unclear, it may involve excessive calcium influx via N-type voltage-sensitive calcium channels (VSCCs). The neuroprotective capacity of intrathecal (IT) administration of the selective N-type VSCC blocker ziconotide, previously shown to be potently analgesic, was studied. METHODS: In a rat aortic occlusion model, spinal cord ischemia was induced for 8, 9, or 10 minutes by occluding the descending thoracic aorta. Ziconotide was administered IT as (1) a continuous infusion of 300 or 600 ng/kg/h initiated 24 hours before ischemia and continuing an additional 24 hours or (2) a 0.3 microgram bolus injected 45 minutes before the induction of ischemia. Animals were allowed to live for 24 hours, and recovery of motor function was evaluated during this period. Spinal cords were processed using a silver impregnation technique and microtubule-associated protein type II (MAP2) immunohistochemistry. RESULTS: Continuous IT infusion of ziconotide provided significant protection against 8- and 9-minute occlusions, but not 10-minute occlusions, as indicated by recovery of motor function, degree of spinal neuronal degeneration, and loss of MAP2 immunoreactivity. Acute IT pretreatment with ziconotide provided transient protection during the initial 4 hours of reperfusion; however, this protective effect was no longer present at 24 hours. CONCLUSION: These data implicate N-type VSCC activation in spinal neuronal degeneration caused by transient spinal ischemia, because selective blockade of this channel by continuous IT infusion of ziconotide was protective against injurious intervals of spinal ischemia. Based on these findings, ziconotide may provide both neuroprotection and preemptive analgesia for aortic aneurysm surgery.     

CD instrumentation in pelvic tilt

Our realistic definition of pelvic obliquity is: any fixed malalignment existing between the spinal and pelvic structure in the frontal, sagittal and horizontal plane. The pelvic unit--with rare exceptions--must be considered one unique vertebra, an intercalary bone between the trunk and lower limbs. Like a structural vertebra in a scoliotic spine, the pelvic unit can be distorted in structure. The etiologies of pelvic obliquity can be divided into three major levels: below, inside and above the pelvis. Preoperative surgical planning must consider the position of the pelvis in the three dimensions. The technical options of pelvic fixation are described: alar staples, sacral screws, the cannulated iliosacral screw and finally the Galveston technique. The surgical technique is described. The results are presented in about 80 cases of CD instrumentation with pelvic fixation. For preoperative hyperlordosis a mean correction of 40 degree was achieved and for preoperative hyperkyphosis a mean correction of 66 degree.     

The effect of stellatectomy on gastric acid secretion in the dog

The stellate ganglion is the major contributor of adrenergic fibers to the vagus nerve and stellatectomy causes a degeneration of vagal adrenergic fibers. The purpose of this experiment was to evaluate the effect of stellatectomy on gastric acid secretion (GAS) and gastrin levels in the dog. GAS in response to pentagastrin stimulation was measured in six gastric fistula dogs before and after stellatectomy. Likewise, blood was collected for basal and meat meal-stimulated serum gastrin levels before and after stellatectomy. After bilateral stellatectomy acid secretion increased in response to submaximal doses of pentagastrin stimulation whereas maximal secretion was unchanged. Resting and meal-stimulated gastrin levels did not change. A Horner's syndrome developed in each dog. It is concluded that bilateral stellatectomy increases GAS in response to submaximal stimulation while not altering gastrin release. These results suggest that the vagal adrenergic innervation of the stomach has an inhibitory role in the control of GAS in the dog.     

Thalamic stimulation for disabling tremor in a patient with spinocerebellar degeneration

Thalamic stimulation alleviated coarse action tremor in a patient with spinocerebellar degeneration (SCD) and led to substantial improvement in daily functioning, though disability from ataxia remained. Intraoperative microrecording revealed a significant correlation between neuronal activity of the ventral intermediate nucleus (Vim) and tremor electromyograms. The tremor-correlated activities of Vim neurons and abolition of the tremor by Vim stimulation suggest that Vim may be related to the generation of action tremor in SCD. Thalamic stimulation can be a useful treatment option for SCD patients with disabling tremor.     

Anesthetic management of a child with Schwartz-Jampel syndrome

A 6-year-old child with Schwartz-Jampel syndrome (SJS) underwent tenotomy of bilateral lower limbs under general anesthesia. Patient with SJS has problems such as difficulty of intubation owing to microstomia and jaw muscle rigidity, and is susceptible to malignant hyperthermia by using volatile inhalation anesthetics. In this case, we used a laryngeal mask for airway management and anesthesia was maintained with inhalation of nitrous oxide and continuous i.v. infusion of propofol with caudal block, and his clinical course was uneventful.