Aggressive plasmablastic lymphoma of the thoracic spine presenting as acute spinal cord compression in a case of asymptomatic undiagnosed human immunodeficiency virus infection

Background contextPlasmablastic lymphoma (PBL) is a rare aggressive variant of diffuse large B-cell lymphoma.PurposeWe describe a rare case of an aggressive PBL presenting as acute spinal cord compression requiring thoracic decompression and fusion, in a case of previously undiagnosed human immunodeficiency virus (HIV) infection.Study designA case report.Patient sampleA patient with PBL of the thoracic spine.Outcome measuresPreoperative magnetic resonance imaging, pathologic findings from the operative specimen, and serum HIV testing confirmed the diagnosis.MethodsWe present the case of a 33-year-old Caucasian woman with a 10-day history of thoracic back pain and a 1-day history of sudden-onset bilateral lower limb weakness and paresthesia from below the level of the umbilicus (American Spinal Injury Association [ASIA] Grade C). Magnetic resonance imaging demonstrated an extradural mass extending from T3 to T6 within the left posterior canal, resulting in significant cord compression. A complete debulking of the tumor mass and an instrumented posterior thoracic fusion was performed.ResultsHistopathologic examination of the specimen revealed tumor cells of PBL, and subsequent HIV testing was positive. She was treated with intravenous and intrathecal chemotherapy to prevent recurrence. Her lower limb neurologic status improved to ASIA Grade D over the subsequent 2 weeks.ConclusionsWe report the case of an aggressive PBL presenting as acute spinal cord compression requiring urgent surgical intervention, on a background of undiagnosed HIV infection.     

Invasive Aspergillosis of the Hand Caused by <Emphasis Type="Italic">Aspergillus ustus</Emphasis>: a Case Report

This is a case report of a 61-year-old cardiac transplant patient who developed a disseminated infection involving the upper extremity with a rare fungus known as Aspergillus ustus. The patient was successfully treated with aggressive serial debridements, antifungal medications, and reduction of immunosuppression. With these interventions, the patient avoided amputation despite the aggressive nature of this infection.     

A Comparison of Lipoatrophy and Aging: Volume Deficits in the Face

Background  Insight into the physical processes of aging can be gained by comparing the loss of facial volume that occurs during aging with the dramatic fat loss resulting from acquired lipoatrophy, including human immunodeficiency virus (HIV) treatment-associated lipoatrophy. The superficial effects of aging, such as rhytid formation, often are the focus of investigations into this phenomenon. However, age-related volume loss often is ignored. Methods  A review of the relevant literature was conducted to provide an overview of age-related lipoatrophy and its etiology and to compare it by facial region with HIV-associated facial lipoatrophy. Results  As a side effect of highly active antiretroviral therapy, HIV-associated lipoatrophy results in fat lipodystrophy (including both lipoatrophy and lipohypertrophy) and progresses toward nearly complete subdermal facial fat loss. Aging is accompanied by changes in the soft tissues of the face, leaving atrophic regions of generalized tissue ptosis. Some facial regions are affected differently by fat loss, depending on its cause. In the aging patient, certain parts of the face display only minimal fat loss. Conclusions  The role of fat loss in facial aging is slight compared with its considerable role in HIV-associated lipoatrophy. The losses of various facial tissues and the ptosis of some soft tissues are strong contributors to the appearance of the aged face. This regional anatomic assessment of the face engenders a more thorough understanding of the progression that characterizes volume changes associated with aging.     

肝移植治疗HIV合并HCV阳性患者的研究进展

随着高效抗逆转录病毒治疗（HAART）时代的到来,获得性免疫缺陷综合征（AIDS）已经从不可治愈的绝症逐渐演变为可控型慢性疾病。由于AIDS患者生命周期的延长,慢性肾衰竭和（或）慢性肝衰竭已经成为其主要的死亡原因,而慢性肝衰竭的AIDS患者往往伴有丙型肝炎病毒（HCV）感染。人类免疫缺陷病毒（HIV）感染曾被认为是肝移植的禁忌证,随着医学界认知的不断深入和手术管理经验的提高,HIV阳性肝移植受者的数量日渐上升,并且取得了较好的远期生存率。但是HIV合并HCV阳性受者肝移植术后3、5、10年生存率仍然很低。为此,本文主要总结了近年来HIV阳性患者肝移植手术的开展情况、HIV合并HCV阳性患者的疾病进程及术后丙型病毒性肝炎复发的治疗措施。     

Caustic burn caused by intradermal self administration of muriatic acid for suicidal attempt: optimal wound healing and functional recovery with a non surgical treatment

Background

Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts.

Case report

We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start^®), hyaluronic acid-based matrix (Hyalomatrix^®) and Vacuum-Assisted Closure (VAC) Therapy^®.

Results

We obtained complete healing in 6 weeks.

Conclusions

Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient’s compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full.     

Reduced mechanical competence of bone by ovariectomy and its preservation with 24R,25-dihydroxyvitamin D3 administration in beagles

Summary To examine changes in mechanical competence of bone caused by ovariectomy, and to assess the effect of 24R,25-dihydroxyvitamin D₃ (24R,25(OH)₂D₃) administration on mass and structure, we conducted mechanical tests on canine lumbar vertebrae and femur 31 months after surgery. Beagles weighing 9–10kg were ovariectomized (OVX) or sham operated (n=3, group 1). OVX dogs were divided into three groups. Group 2 (n=3) received only the agent vehicle, groups 3 (n=4) and 4 (n=4) received daily 24R,25(OH)₂D₃ doses of 2 and 10 mcg/kg, respectively from 1 month after surgery. In group 4, the dose level was increased up to 100 mcg/kg by the 17 month. Then, L3 and L4 vertebrae and left femur were excised from each animal. Torsional tests at the femoral diaphysis were conducted. On the L3 specimen, the circumferential shell was removed to obtain a cancellous core specimen. The shell was left intact on the L4 specimen. In compression tests, the loading was stopped just after maximal strength was reached for minimum specimen collapse, from which 7-mcm thick, undecalcified, midcross sections parallel to the base of the specimen were obtained. Neither femoral morphology, bone mineral contents (BMCs) nor structural stiffness indicated a significant difference among groups. Though L3 and L4 BMCs were reduced in group 2, in group 3 and 4 they were significantly larger than in group 2. Compression tests on lumbar vertebral specimens showed a significant decrease in mechanical parameters in group 2. On the cancellous core specimen of L3, the mean structural stiffness in group 2 was 31.8% of that in group 1. Decrease in trabecular number was apparent, but the bone area of the circumferential shell showed no remarkable decrease after ovariectomy. The percent value of the stiffness distributed on the circumferential shell was 42.2% of the structural stiffness in group 1 and this ratio increased up to 67.4% in group 2. The structure and mechanical parameters of vertebral bone in animals of group 3 were almost preserved. However, in group 4 the effect on the structure and mechanical parameters of cancellous bone were not significant. The preservation of trabecular continuity appears to be critical in maintaining the mechanical property of vertebral bone after ovariectomy.     

Regulation of bone turnover and prevention of bone atrophy in ovariectomized beagle dogs by the administration of 24R, 25(OH)2D3

Summary In order to determine whether the administration of 24R,25(OH)₂D₃ had any beneficial effect on the regulation of bone turnover and the prevention of bone atrophy, we examined beagles for 31 months after ovariectomy (OVX). Fourteen beagle dogs (8.54±1.22 kg body wt-b.w.) were divided into four groups. Group 1 (n=3) was the sham, and Group 2 (n=3) served as the OVX control. In Group 3 (n=4) and Group 4 (n=4), 24,25-dihydroxyvitamin D₃(24R,25(OH)₂D₃) was given daily at dose levels of 2 and 10 mcg/kg B.W., respectively. In Group 4, the dose level was increased to 100 mcg/kg by 17 months. During the experiments, urinary hydroxyproline (U-HPr), serum chemistry, serum bone gla-protein (BGP), and vitamin D metabolite levels were monitored. At the end of the experiment, bone mineral content (BMC) in the 6th and 7th lumbar vertebrae and right femur was determined by single photon absorptiometry. The left iliac bone sample was obtained after tetracycline labeling, and undecalcified sections were observed. In Group 2, excretion of U-HPr increased after OVX and had reached a level of approximately twice the baseline values by 10 months; then it gradually came down to the original level. In Group 3, however, U-HPr excretion remained at the same level as the baseline value, as it did in Group 1. In Group 4, it was remarkably reduced down to 50–60% of the baseline values. Serum BGP level was markedly reduced in Group 4. Serum 24,25(OH)₂D levels were markedly increased in Groups 3 and 4. BMC levels of both vertebrae and epi-metaphyseal regions in the femur showed a significant reduction of approximately 25% in Group 2. In Groups 3 and 4, however, they remained at the same level as in Group 1. Histomorphometrical data showed a reduction in the parameters of osteoblast functions in Group 2. In Group 3, both kinetic and static parameters maintained the same level as in Group 1. In Group 4, eroded surface and osteoclast number decreased significantly, but mineral appositional rate and wall thickness maintained the same level as in Group 1. From these findings, it was concluded that, in beagle dogs, the administration of 24R,25(OH)₂D₃ inhibited the increase of bone turnover and prevented the reduction of cancellous bone mass after a long time postovariectomy.     

Osteonal remodeling and mechanical properties of the femoral cortex in rabbits treated with 24R,25(OH)2D3

Summary The increase of bone mass by therapeutics does not always mean the enhancement of bone quality. The purpose of this study is to clarify the changes of osteonal remodeling and the mechanical properties of femoral cortex in rabbits treated with 24 R, 25 (OH)₂D₃. Fifteen NZW rabbits (3 kg B.W.) were divided into three groups of 5 animals each. Groups 1, 2, and 3 were given vehicle, 10 g/kg, and 100 g/kg 24R,25(OH)₂D₃, respectively, daily for 8 weeks. At the end of the experiment, the left femur was removed and bone mineral content (BMC) was measured with single photon absorptiometry. Serum 24,25(OH)₂D concentrations reached levels of approximately 15 and 200 times that of the controls in groups 2 and 3, respectively. Neither 25(OH)D nor 1,25(OH)₂D level showed any significant change in either group. Group 3 showed significant increase in mineral content and density in the epimetaphyseal regions, but the increase at the diaphyseal region did not reach a statistically significant level. Mechanical test for torsion was conducted for mid-cortical regions. After the test, bone pieces were bonded together with adhesive to reconstruct the original form, and undecalcified cross-sectional sections were made at the diaphyses. Fluorescent microscopy disclosed a marked reduction of remodeling in secondary osteonal bone area. The numbers for double-labeled osteons for groups 1, 2, and 3 were 2.47±0.819, 1.14±1.02^* and 0.137±0.307^* N/mm², respectively, and the numbers for osteons with resorption lacunae were 1.37±0.721, 0.412±0.370^* and 0.268±0.339^** N/mm², respectively. However, neither structural stiffness nor strength correlated with the indices of osteonal remodeling; instead, they were significantly correlated with bone mineral contents. Normalized mechanical parameters for torsion were almost the same for all three groups. This study clearly demonstrated that reduced osteonal remodeling by 24R,25(OD)₂D₃ does not affect the mechanical properties of the cortex, and the increase in bone density by the agent is considered to be accompanied by an increase in its mechanical strength (^* P< 0.05, ^** P< 0.01).     

Modulation of autoantibody production by mycophenolate mofetil: effects on the development of SLE in (NZB x NZW)F1 mice.

BACKGROUND: Mycophenolate mofetil (MMF) has been successfully used to improve or prevent the development of systemic lupus erythematosus (SLE) in both humans and in several lupus-prone mice. In the present study, we evaluated mechanisms through which MMF may exert its therapeutic effect on the development of systemic autoimmunity. METHODS:(NZBxNZW)F(1) female mice were continuously treated with 100 mg/kg/day (high dose) or 30 mg/kg/day (low dose) MMF beginning at 3 months of age. The development of an autoimmune syndrome was evaluated by measuring immunoglobulin (Ig) isotypes of autoantibodies and their levels, as well as by evaluating immunopathological kidney abnormalities and mortality curves. RESULTS: At both doses, MMF efficiently modulated the development of SLE. Although the higher dose of MMF directly inhibited the production of autoantibodies, 30 mg/kg/day MMF promoted qualitative but not quantitative changes in autoantibodies in (NZB x NZW)F(1) female mice. These qualitative changes were manifested as a selective reduction in total or antigen-specific IgG2a antibody levels. CONCLUSIONS:The mechanisms through which MMF controls the development of SLE in (NZB x NZW)F(1) females is highly dependent upon immunosuppressor dose. Interestingly, lower dose MMF selectively reduced IgG2a antibody levels, suggesting that this dose may modulate T(H1) CD4+ activity.     

Attempting homicide by inserting sewing needle into the brain: Report of 6 cases and review of literature

Background and objectives

Child abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons.

Material and methods

The authors had the chance of managing 6 patients referred to their trauma center harboring one or more sewing needles within their cranium. There were 3 male and 3 female patients, with 2 patients in their first decade of life, and the others, each in either decade of life. The youngest was 6, and the eldest 51 year old. The elder patients were having vague headaches, for which a plain skull x-ray or CT of the brain lead to the diagnosis of persisting intracranial foreign bodies. Chronic headache was the main complaint of the patients. Four patients underwent surgical removal of the sewing needle, and 2 are being followed.

Results

Among the 4 patients who underwent surgery, 1 died after a short period of ‘akinetic mutism.’ Headache and limb paresthesia improved 6 months after the operation in 2 cases, and the other 1 remained unchanged. The cases under observation have been doing well. Biochemical analysis of the rusted needle showed a composite of oxidant form of some of the elements of needle such as Fe, Mn, and Cr.

Conclusion

In spite of standard algorithms proposed for management of penetrating head wounds, selection of the best treatment in the victims harboring sewing needles in their brain needs close cooperation between neurosurgeons, pediatricians, psychiatrists, and social workers. Furthermore, there is no absolute indication for removing sewing intracranial needles detected in the later decades of life.     

Ultrasonographic assessment of liver fibrosis with computer-assisted analysis of liver surface irregularities

PurposeThe goal of this study was to evaluate the diagnostic accuracy of a software program that automatically analyzes the liver surface to diagnose significant fibrosis, by comparing it to the subjective analysis of a radiologist and to transient elastography (Fibroscan^®).Patients and methodsOne hundred fourteen patients with chronic liver disease were included in the study. They underwent liver biopsy, FibroScan^® and ultrasonographic examination of the liver surface. The liver surface was analyzed by a software program that gave a score of surface irregularities. This evaluation was compared to subjective analysis by a radiologist expert in liver imaging and by two general radiologists.ResultsFifty percent of the patients had significant fibrosis according to the METAVIR score. The AUROC for the diagnosis of significant fibrosis by the software program was 0.80 (95%CI: 0.71–0.87), which was equivalent (P = 0.86) to that of FibroScan^® (0.81; 95%CI: 0.71–0.89). Results of the subjective analysis by the expert radiologist were poorer than those of the software analysis (P = 0.02) (AUROC = 0.66; 95%CI: 0.56–0.75). Interobserver agreement among radiologists was poor (0.25 < kappa < 0.37).ConclusionComputer-assisted liver surface analysis was better than subjective analysis, and similar to that of the FibroScan^®. This method could be useful for the diagnosis of significant fibrosis in patients with chronic hepatitis and complementary to the other non-invasive diagnostic tests.