Lateral intra-extraspinal cervical schwannomas: Partial versus total resection

The study involved 27 lateral cervical schwannomas surgically treated in the last 40 years utilizing either partial or total resection. The study aims to compare the results of total and partial resection of spinal lateral schwannoma and to assess the values of partial resection of large lateral cervical schwannomas. We performed a retrospective analysis of 27 patients operated for lateral cervical schwannomas in the period 1971–2010, out of which 11 had partial resection. The average follow-up of the patients was 136.4 months, comparing pre- and postoperative clinical picture, time to relapse, dynamics of yearly growth of schwannomas, and the need for re-resection. The average period of preoperative complaint in lateral cervical schwannomas was 19.6 months. Unilateral cervicobrachialgia as a manifestation of radiculopathy was observed in 85% of LCSs, and, was, as a rule the first symptom of the disease. Surgical treatment of 27 patients with LCSs resulted in recovery or improvement of complaints in 80% of cases. The treatment effect did not depend on the degree of resection. Reoperation was done, on average, 16.3 years after partial resection. The residues of lateral cervical schwannomas stopped growing 15 years after partial resection and underwent cystic degeneration. Partial resection of lateral cervical schwannomas is an excellent alternative to total resection, not only for the elderly or in cases of increased surgical risk, but also as a method of choice since it is more readily available to a larger number of surgeons and associated with low percentages of surgically relevant relapses and high percentages of improvement.     

Exercise Intolerance in Patients with Chronic Iliocaval Venous Occlusion: Initial Experience with Noninvasive Exercise Testing before and after Intervention

Patients with chronic iliocaval occlusions after thrombosis often present with exercise intolerance, which improves after venous reconstruction. Three male patients with chronic iliocaval occlusions underwent a cardiorespiratory fitness test before and 2.5–11 months after venous reconstruction using stents. After the intervention, average absolute oxygen consumption increased by 29.5%, maximal oxygen consumption relative to body weight increased by 38.7%, total work at maximum exercise increased by 74.4%, and exercise time increased by 18.7%. The cardiorespiratory fitness test may be a useful noninvasive tool to objectively evaluate exercise intolerance due to chronic venous occlusions and response to therapy.     

Multiple sclerosis and oxidative stress—a clinical perspective

Multiple Sclerosis (MS) has been traditionally considered to be a chronic inflammatory disease of central nervous system (CNS), resulting in demyelization and clinical presentation of physical disability. Such understanding of MS was solely related to neuroinflammation and its harmful effects; however, count-less data suggest the importance of neurodegenerative mechanisms that are evident in chronic demyelization plaques, and believed to be initiated by oxidative stress. CNS is particularly sensitive to oxidative attack due to the high level of oxygen utilization, relatively small amounts of conventional antioxidants and antioxidative enzymes, and large amounts of polyunsaturated lipids, biomolecules highly susceptible to oxidation. The role and significance of reactive oxygen species (ROS) in MS development has not been fully understood yet, it is believed that ROS formation is primarily orchestrated by immunoinflammatory mechanisms, but there are also data suggesting that certain inflammation independent mechanisms can result in neuronal degeneration and demyelization. They are mainly related to abnormal mitochondria functioning, glutamate excitotoxicity and the disruption of redox active metal homeostasis. Today, there is still a debate whether MS is an immunoinflammatory or neurodegenerative disorder; is it a cause or a consequence of oxidative stress, although clinical trials show encouraging results of antioxidant therapy usage in the disease management.