Successful Treatment of Enterocutaneous Fistula in a Hemodialysis Patient with Somatostatin

Although cysticercosis is the most common parasitic disease affecting the central nervous system, spinal cysticercosis is rare. A rare form of spinal cysticercosis involving the whole spinal canal is presented. A 45-year-old Korean male had a history of intracranial cysticercosis and showed progressive paraparesis. Spinal magnetic resonance scan showed multiple cysts compressing the spinal cord from C1 to L1. Three different levels (C1-2, T1-3, and T11-L1) required operation. Histopathological examination confirmed cysticercosis. The patient improved markedly after surgery.     

Spinal intramedullary cysticercosis: a case report and literature review

Neurocysticercosis, involvement of the central nervous system by taenia solium, is one of the most common parasitic diseases of the CNS. However, spinal involvement by neurocysticercosis is uncommon. Here, we reported a 40-year-old woman with intramedullary cysticercosis in the thoracic spinal cord. MRI revealed two well-defined round intramedullary lesions at T4 and T5 vertebral levels, which were homogeneously hypointense on T1WI and hyperintense on T2WI with peripheral edema. Since the patient had progressive neurological deficits, surgery was performed to decompress the spinal cord. Histopathology examination of the removed lesion proved it was intramedullary cysticercosis. In this report, we also discussed the principles of diagnosis and treatment of intramedullary cysticercosis in combination of literature review.     

Cysticercosis in Guadeloupe

We report two cases of cysticercosis proved by histology, one in the brain, the other in the orbit. The first case was observed in a traveller, heavy smoker, serologically negative to cysticercosis in whom an isolated cerebral tumoral metastasis was suspected and resected. The lesion was centered by a typical cysticercus of Taenia solium. The second was a periorbital intramuscular nodule observed in a child who had never left our island. The fibroinflammatory nodule was centered by a cysticercus with a scolex without rostellum and without suckers. Its histological aspect led us to the diagnosis of cysticercosis. Three species of Taenia are discussed : T. solium, T. crassiceps and T. bovis. This case shows that the human transmission of the disease may exist in Guadeloupe.     

The Computed Tomographic Spectrum of Cerebral Cysticercosis

A review of the disease cerebral cysticercosis is presented. The pathogenesis, symptomatology, diagnosis, and treatment of this disease is discussed with an emphasis on the role of computed tomography in the diagnosis of cerebral cysticercosis.     

Cysticercosis in the elderly

The immunosenescence, a peculiarity of the aging process, increases the susceptibility of elderly individuals to neoplasia, infections, and parasitosis, among them, cysticercosis. The aim of this study was to compare the epidemiological and anatomopathological characteristics of cysticercosis in elderly or nonelderly patients. We reviewed 72 autopsies, protocols and specimens, performed in the School Hospital of the Triangulo Mineiro Federal University. We selected 3 groups: elderly with cysticercosis, nonelderly with cysticercosis, and control group without cysticercosis. From the patients with cysticercosis, 27.8% were elderly. Of these, 80% presented with neurocysticercosis and 20% cardiac cysticercosis. In the elderly, the early stages of the parasitic development, vesicular and colloidal vesicular, prevailed (75%). In relationship with the causes of death, death in 40% of the elderly was by neoplasic and 35% by cardiovascular, whereas for the nonelderly, death in 63.5% was by cardiovascular and 25% by infectious. There was a significant difference between groups with relation to neoplasic and cardiovascular causes. Therefore, cysticercosis was frequent in elderly patients, and probably patients are continuously infected with cysticercosis as they age. Perhaps, decurrence of the immunosenescence associated with immunological alterations caused by cysticercosis form favorable conditions to the development of neoplasias in the elderly attacked by the parasitosis.     

Cysticercosis and epilepsy: a case-control study in Mbam Valley, Cameroon

The impact of neurocysticercosis in Africa is not well known, and its role in the occurrence of epilepsy is not well defined. The concomitant high prevalence of both diseases in this region suggests a causal association of cysticercosis and epilepsy. The few attempts to find such a link in Africa have yielded discordant data. In order to answer this question, we conducted a case-control study between June and August 1998 in the Bilomo village in Central Cameroon, where a recent study had demonstrated very high epilepsy prevalence of 58/1000. Ninety-three epilepsy patients and eighty-one age matched controls were included. All subjects were examined by a neurologist and serology for cysticercosis was performed using an ELISA method. Serologies for cysticercosis were positive in twenty-nine out of one hundred and seventy four patients (16.7%; 95% CI: 11.6-23.2). Seventeen cases (18.3%) and twelve controls (14.8%) had a positive serology The odd ratio was 1.3 (95% CI: 0.6-3.0). This study was not in favour of an epidemiological relationship between cysticercosis infection and epileptic disorders.     

Spinal arachnoid calcifications

Arachnoid calcifications have been imaged on axial-CT and MRI. These often clinically asymptomatic deposits have been attributed to trauma, myelography (particularly with the use of oil-based contrast), subarachnoid hemorrhage, and spinal anesthesia. This report describes calcified arachnoid plaques in an 86-year-old male cadaver located in the dorsal thoracic level. A laminectomy from C4 to the lumbo-sacral junction was performed and the dura mater was transected and pinned aside. Three plaques between T2-T3, 3 at T7, 2 at T9 were noted. Plaques were 1.0 mm in thickness and ranged from 0.5 cm to 1.0 cm in diameter. The spinal cord or nerve roots were not displaced. The plaques stained positively with Von Kossa and Alizarin Red S staining, confirming that the deposits included calcium phosphate and calcium. Arachnoid calcifications are an incidental finding in cadavers and typically do not compress the spinal cord or nerve roots. However such plaques may be precursors to spinal arachnoid ossificans, a more serious condition that may cause spinal cord or nerve root compression.     

First Case of Human Cerebral Taenia martis Cysticercosis

Taenia martis is a tapeworm affecting mustelids, with rodents serving as intermediate hosts. The larval stage (cysticercus) has been found before only rarely in humans or primates. We hereby describe a case of cerebral T. martis cysticercosis in a French immunocompetent patient, confirmed by DNA analyses of biopsy material.     

脑囊虫病的诊断与治疗——20例临床,头颅CT,手术和病理

目的 探讨脑囊虫病的诊断及外科治疗.方法 分析脑囊虫病20例临床资料,其中18例行脑囊虫切除术,1例行颞肌下减压术,1例行测脑室腹腔分流术.结果 在18例脑囊虫切除术中,17例治愈,1例明显好转.结论 本病的治疗原则上应先药物治疗,但如出现颅内高压,脑积水时应及早手术治疗,并对不同部位、不同类型的病变提出了不同的治疗方法,并强调术后还应给予驱虫治疗.     

Cysticercosis of the eye in South India--a case series

Purpose: To study the clinical presentation and treatment outcome of patients with ocular cysticercosis in southern India. Methods: This study included 10 patients who were diagnosed to have ocular or adnexal cysticercosis over a period of one year in Pondicherry, India. The clinical presentation, results of investigation and treatment outcome of the cases were analysed retrospectively. Results: Age of these patients ranged from 12 to 55 years. Four presented with loss of vision, two with a swelling in the eyelid, one with proptosis, one with diplopia and two with conjunctival involvement. ELISA for cysticercus antibodies in serum was positive in all cases. Albendazole and prednisolone were given for the treatment of these cases. Two patients responded well to treatment and were completely cured of the disease. There was partial improvement in 6 cases. Surgery in the form of excision was performed in two cases following a course of medical therapy. There was no significant change in visual acuity in eyes with intraocular cysticercosis following treatment. Conclusion: Ultrasonography B scan and ELISA for anticysticercal antibodies help to establish the diagnosis of ocular cysticercosis. A combination of oral albendazole and corticosteroids is found to be effective in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.     

断层成像技术对脊柱创伤的诊断价值

目的：探讨断层成像技术MRI在脊椎骨折和脊髓损伤中的诊断价值.方法：回顾性分析89例脊柱创伤患者的临床和MRI资料,MRI检查使用1.5T扫描仪,行矢状位T1WI和T2WI、横切位T2WI、脂肪抑制（STIR）扫描.结果：89例中,骨挫伤3例、小骨折5例、Chance骨折4例、单纯性脊椎压缩性骨折33例、爆裂骨折26例、骨折脱位18例,合并脊髓损伤43例 脊椎骨折和脊髓损伤分别具有较为特征性的MRI表现.结论：断层成像技术MRI可清晰地显示脊椎骨挫伤、骨折、脱位、椎管狭窄、椎间盘突出、韧带损伤和脊髓损伤,对脊柱创伤的诊断有重要价值.     

Application of Color Transformation Techniques in Pediatric Spinal Cord MR Images: Typically Developing and Spinal Cord Injury Population

The purpose of this study was to evaluate an improved and reliable visualization method for pediatric spinal cord MR images in healthy subjects and patients with spinal cord injury (SCI). A total of 15 pediatric volunteers (10 healthy subjects and 5 subjects with cervical SCI) with a mean age of 11.41 years (range 8–16 years) were recruited and scanned using a 3.0T Siemens Verio MR scanner. T2-weighted axial images were acquired covering entire cervical spinal cord level C1 to C7. These gray-scale images were then converted to color images by using five different techniques including hue-saturation-value (HSV), rainbow, red-green-blue (RGB), and two enhanced RGB techniques using automated contrast stretching and intensity inhomogeneity correction. Performance of these techniques was scored visually by two neuroradiologists within three selected cervical spinal cord intervertebral disk levels (C2-C3, C4-C5, and C6-C7) and quantified using signal to noise ratio (SNR) and contrast to noise ratio (CNR). Qualitative and quantitative evaluation of the color images shows consistent improvement across all the healthy and SCI subjects over conventional gray-scale T2-weighted gradient echo (GRE) images. Inter-observer reliability test showed moderate to strong intra-class correlation (ICC) coefficients in the proposed techniques (ICC?>?0.73). The results suggest that the color images could be used for quantification and enhanced visualization of the spinal cord structures in addition to the conventional gray-scale images. This would immensely help towards improved delineation of the gray/white and CSF structures and further aid towards accurate manual or automatic drawings of region of interests (ROIs).     

Spinal osteoblastic meningioma with hematopoiesis: radiologic-pathologic correlation and review of the literature

Spinal meningiomas associated with bone formation and hematopoiesis are rare tumors with only 3 prior case reports in the literature. We describe a case report of a woman who presented with back pain and an isolated event of urinary incontinence. A calcified spinal canal mass at T8 was identified on computed tomographic and magnetic resonance imaging. A gross total resection of the tumor was performed and pathologic examination showed a meningioma, World Health Organization grade 1, containing bone and bone marrow elements. A review of previously reported cases and a discussion of possible mechanisms of bone and hematopoiesis development in meningioma are presented.     

Toward development of a Taenia solium paramyosin-based vaccine against porcine cysticercosis

Taenia solium paramyosin (TPmy) is a prominent 100 kDa antigen in human and porcine cysticercosis. TPmy is an alpha-helical coiled coil protein present in muscle and tegumentary structures of T. solium cysticerci. TPmy has the property of binding C1q resulting in inhibition of the complement cascade. TPmy probably binds C1q through its collagen-like domains and could be involved in a parasite strategy to modulate host immune response. Humoral immune response against TPmy is prefrentially directed against carboxyl terminal end in humans and mice, whereas amino terminal end of TPmy preferentially induces a Th1-related cellular immune response. Protection studies in murine model of cysticercosis showed that the amino terminal end fragment of TPmy induces approximately 60% protection against an i.p. challenge with Taenia crassiceps cysts when mice are immunized with recombinant fragments of TPmy. Initial protection studies using genetic immunization showed that amino terminal end fragment of TPmy cloned into a plasmid expression vector with a cytomegalovirus promoter, together with IL-12-expressing plasmids induced 79% protection, suggesting that this kind of TPmy-immunization might result in development of a cost-effective vaccine against cysticercosis.     

Increased Resistance to Taenia crassiceps Murine Cysticercosis in Qa-2 Transgenic Mice

We previously reported important differences in resistance to Taenia crassiceps murine cysticercosis between BALB/c substrains. It was suggested that resistance might correlate with expression of the nonclassic class I major histocompatibility complex (MHC) Qa-2 antigen; BALB/cAnN is Qa-2 negative and highly susceptible to T. crassiceps, whereas BALB/cJ expresses Qa-2 and is highly resistant. In this study, we investigated the role of Qa-2 in mediating resistance to cysticercosis by linkage analysis and infection of Qa-2 transgenic mice. In BALB/cAnN × (C57BL/6J × BALB/cAnN)F₁ and BALB/cAnN × (BALB/cJ × BALB/cAnN)F₁ backcrosses, the expression of Qa-2 antigen correlated with resistance to cysticercosis. Significantly fewer parasites were recovered from infected Qa-2 transgenic male and female mice than from nontransgenic mice of similar genetic background. These results clearly demonstrate that the Qa-2 MHC antigen is involved in resistance to T. crassiceps cysticercosis.

Taenia solium cysticercosis is a parasitic disease that seriously affects human health (24) and causes important economic losses in pig farming of developing countries (1) where conditions that favor parasite transmission persist. The essential role of pigs as an obligatory intermediate host in the parasite life cycle offers the opportunity to interfere with transmission by inducing acquired immunity through vaccination (10, 13, 18), by decreasing susceptibility through genetic manipulation (14), or both. Systematic exploration of the role of genetic factors in cysticercosis and the identification of protective immunogens are hampered by the high costs and slow data retrieval involved in studies with pigs. However, another cestode, Taenia crassiceps, that naturally infects rodents (3) is highly suitable for experimentation. It shows extensive antigenic cross-reactivity and cross-protective immunity with T. solium (7, 21); the antigenic similarity is such that T. crassiceps antigens can be used for immunodiagnosis of human cysticercosis (9). Furthermore, T. crassiceps and T. solium both have a typical two-host taeniid life cycle and morphologically and structurally related larval stages. Since T. crassiceps can reproduce asexually, experimental infection is readily attained by injecting the cysticerci in the peritoneal cavity of the mouse (3). Thus, T. crassiceps murine cysticercosis has been shown to be a useful experimental model of metacestode infection in the study of genetic factors involved in host resistance (2, 20) and underlying immunological mechanisms (19, 23, 25).Initial findings showed that genes linked to H-2 affect T. crassiceps growth in mice (20). Thus, significant differences in the extent of the parasitosis were found between mice carrying the H-2^d (BALB/cAnN and DBA/2) haplotype, which were the most susceptible, and mice with H-2^b (BALB/B, C57BL/6J, and C57BL/10J) or H-2^k (BALB/K, C3H/HeJ, and C3H/FeJ) haplotype, which were comparatively resistant. Further studies (2) showed low susceptibility of congenic and recombinant B10 mice, regardless of H-2 haplotype, indicating that genes in C57BL background confer resistance to the parasitosis such that they override the effect of H-2. The effect of genes outside H-2 on the control of parasite growth was also revealed by the differential susceptibility of three H-2^d BALB/c substrains, of which BALB/cAnN was highly susceptible, whereas BALB/cJ was highly resistant and BALB/cByJ displayed and intermediate degree of susceptibility (2). BALB/cAnN and BALB/cJ, which are genetically quite similar strains, differ in several phenotypes, including the expression of the Qa-2 antigen (11, 16). This antigen is a nonclassical class I major histocompatibility complex (MHC) molecule encoded by four genes (Q6 to Q9) located telomeric to the H-2D loci (11, 22). BALB/cJ (Qa-2^low), a Qa-2 expressor substrain, has only active Q6 and Q7 genes because Q8 and Q9 have fused, resulting in an inactive Q8/Q9^d gene (11, 15). In BALB/cAnN (Qa-2^null), an additional deletion of genomic DNA has occurred between the Q6 and Q7 genes, leading to their inactivation and accounting for the Qa-2 null expression (11). We proposed previously that differences in susceptibility to T. crassiceps observed between BALB/cJ and BALB/cAnN might be related to Qa-2 antigen expression (2). Here we describe that results of genetic linkage studies are entirely consistent with this hypothesis. Furthermore, a role of Qa-2 in mediating resistance to T. crassiceps was directly established by the diminution of parasite loads in infected Qa-2 transgenic mice.     

颈椎脊神经沟及其沟内段脊神经形态学观察

目的　探讨脊神经沟与沟内段脊神经受嵌压的关系。方法　取 6 0具成尸 (男 2 8,女 32 ) 12 0侧颈椎 ,对脊神经沟外口宽度、深度及其沟内段脊神经前支横径进行观察 ,并统计脊神经前支横径与脊神经沟外口宽度之比。结果　①脊神经沟外口宽度、深度自颈 3至颈 6均逐渐增大 ,其平均值分别为 4 5± 1 2mm和4 3± 1 2mm ;② 3到 7颈神经前支横径逐渐增大 ,平均值为 2 9± 1 0mm ;③颈神经前支横径与脊神经沟外口宽度之比 ,颈 5最小 (1∶1 5 4 ) ,颈 4次之 (1∶1 6 7) ,颈 3最大 (1∶1 75 )。结论　脊神经沟与沟内段脊神经受累关系密切 ,下颈段 (5、6 )颈神经受累机率可能大于上颈段 (3、4 )。     

Spinal pleomorphic xanthoastrocytoma companied with periventricular tumor

Pleomorphic xanthoastrocytoma (PXA) is a low grade tumor that occurs in supratentorial area of children and young adult. In the previous reports, PXA of spinal cord or multicentre was extremely rare. A 60-year-old patient of spinal PXA and periventricular tumor presented with waist pain and weakness of double legs for one month. Neuroimaging showed that a lesion at the level of L2-L3 and periventricular tumor. Postoperative microscopy indicated that WHO grade II PXA. Photomicrograph of the lesion showed spindle cells, marked nuclear and cytoplasmic pleomorphism, with foamy cytoplasm. Immunohistochemical staining showed that GFAP and S-100 were positive. This is a rare case of synchronous multicentric PXA. Physicians should be realized multicentric dissemination by meninges or cerebrospinal fluid in PXA patients. It is important to describe the particular case in order to better understanding of clinical features.     

Spinal cord stimulation modulates intraspinal colorectal visceroreceptive transmission in rats

Previous studies have shown that spinal cord stimulation (SCS) of upper lumbar segments decreases visceromotor responses to mechanical stimuli in a sensitized rat colon and reduces symptoms of irritable bowel syndrome in patients. SCS applied to the upper cervical spinal dorsal column reduces pain of chronic refractory angina. Further, chemical stimulation of C1-C2 propriospinal neurons in rats modulates the responses of lumbosacral spinal neurons to colorectal distension. The present study was designed to compare the effects of upper cervical and lumbar SCS on activity of lumbosacral neurons receiving noxious colorectal input. Extracellular potentials of L6-S2 spinal neurons were recorded in pentobarbital anesthetized, paralyzed and ventilated male rats. SCS (50 Hz, 0.2 ms) at low intensity (90% of motor threshold) was applied to the dorsal column of upper cervical (C1-C2) or upper lumbar (L2-L3) ipsilateral spinal segments. Colorectal distension (CRD, 20 mmHg, 40 mmHg, 60 mmHg, 20s) was produced by air inflation of a latex balloon. Results showed that SCS applied to L2-L3 and C1-C2 segments significantly reduced the excitatory responses to noxious CRD from 417.6+/-68.0 to 296.3+/-53.6 imp (P<0.05, n=24) and from 336.2+/-64.5 to 225.0+/-73.3 imp (P<0.05, n=18), respectively. Effects of L2-L3 and C1-C2 SCS lasted 10.2+/-1.9 and 8.0+/-0.9 min after offset of CRD. Effects of SCS were observed on spinal neurons with either high or low-threshold excitatory responses to CRD. However, L2-L3 or C1-C2 SCS did not significantly affect inhibitory neuronal responses to CRD. C1-C2 SCS-induced effects were abolished by cutting the C7-C8 dorsal column but not by spinal transection at cervicomedullary junction. These data demonstrated that upper cervical or lumbar SCS modulated responses of lumbosacral spinal neurons to noxious mechanical stimulation of the colon, thereby, proved two loci for a potential therapeutic effect of SCS in patients with irritable bowel syndrome and other colonic disorders.     

Spinal cord involvement in the nonhuman primate model of Lyme disease

Lyme borreliosis is a multisystemic disease caused by infection with various genospecies of the spirochete Borrelia burgdorferi. The organs most often affected are the skin, joints, the heart, and the central and peripheral nervous systems. Multiple neurological complications can occur, including aseptic meningitis, encephalopathy, facial nerve palsy, radiculitis, myelitis, and peripheral neuropathy. To investigate spinal cord involvement in the nonhuman primate (NHP) model of Lyme borreliosis, we inoculated 25 adult Macaca mulatta with B. burgdorferi sensu strictu strains N40 by needle (N=9) or by tick (N=4) or 297 by needle (N=2), or with B. burgdorferi genospecies garinii strains Pbi (N=4), 793 (N=2), or Pli (N=4) by needle. Immunosuppression either transiently (TISP) or permanently (IS) was used to facilitate establishment of infection. Tissues and fluids were collected at necropsy 7-24 weeks later. Hematoxylin and eosin staining was used to study inflammation, and immunohistochemistry and digital image analysis to measure inflammation and localize spirochetes. The spirochetal load and C1q expression were measured by TaqMan RT-PCR. The results showed meningoradiculitis developed in only one of the 25 NHP's examined, TISP NHP 321 inoculated with B. garinii strain Pbi. Inflammation was localized to nerve roots, dorsal root ganglia, and leptomeninges but rarely to the spinal cord parenchyma itself. T cells and plasma cells were the predominant inflammatory cells. Significantly increased amounts of IgG, IgM, and C1q were found in inflamed spinal cord. Taqman RT-PCR found spirochetes in the spinal cord only in IS-NHP's, mostly in nerve roots and ganglia rather than in the cord parenchyma. C1q mRNA expression was significantly increased in inflamed spinal cord. This is the first comprehensive study of spinal cord involvement in Lyme borreliosis.