Intraspinal epidermoid cyst

An intraspinal epidermoid cyst occurring in the lumbo-sacral region of a 38-year old man with congenital spina bifida occulta is described. Relevant literature on the subject is reviewed.     

Human os penis

We report a case of human penile ossification with roentgenologic and histologic confirmation. The English literature is reviewed, and the pathogenesis of such a rare lesion is presented. Penile ossification appears to be an acquired metaplastic process occurring in an area of fibrosis.     

Scrotal calcinosis: calcification of epidermal cysts

The so-called idiopathic scrotal calcinosis does not appear to be idiopathic, but rather a process of dystrophic calcification of epidermal cysts. We report a case that would be otherwise called "idiopathic" where we found squamous epithelial lining around the calcified masses. Literature is reviewed in support of the view that the calcified scrotal nodules are related to epidermal cysts.     

Primary and revision lumbar discectomy: A three-year review from one center

Background:

Despite variations in technique, the results of primary and revision lumbar discectomy have been good. The aim of this study was to retrospectively review cases of primary and revision lumbar discectomy performed in our institute over a three-year period.

Materials and Methods:

The case records of 273 patients who underwent lumbar discectomy between January 2001-2004 and fulfilled our inclusion and exclusion criteria were reviewed. Of these, 259 were primary discectomies and 14 were revision surgeries. Recurrence was defined as ipsilateral disc herniation at the previously operated level. Demographic parameters, magnetic resonance imaging of the disc, patient satisfaction and rate of recurrence were analyzed.

Results:

The primary surgery group had 52 (20.08%) contained and 207 (79.92%) extruded or sequestered discs, while the numbers in the revision group were three (21.43%) and 11 (78.57%) respectively. “Satisfactory” outcome was noted in 96.5% of the primary surgeries, with a recurrence rate of 3.5%. In the revision group 78.6% had “satisfactory” outcome. In 9.4% of the primary group we encountered complications, while it was 21.43% in the revision group.

Conclusions:

Lumbar discectomy is a safe, simple and effective procedure with satisfactory outcome in 96.5% of primary disc surgery and 78.6% of revision disc surgery.     

Impact of chronic undernutrition on higher mental functions in Indian boys aged 10–12 years

Undernourished rural children 10–12 years of age demonstrated the following, when compared to normal nourished children: (i) a relative deficit of memory quotients assessed by the Wechsler memory scale; (ii) lower scores for abilities related to personal and current information, orientation, mental control, logical memory, digit span, visual reproduction and associative learning; (iii) impaired set formation and flexibility in attention as assessed by the card sorting test; and (iv) impairment in conditional learning on maze and conditional associative learning tests. The performance on the finger dexterity test for fine motor coordination was not affected in undernourished children.     

Small-cell carcinoma of prostate

Small-cell carcinoma of the prostate is rare, but lethal. We report on 2 cases and review another 6 cases reported in the English literature. Microscopically the tumor may be pure small-cell carcinoma like that seen in the lung or may have a mixed pattern of adenocarcinoma with small-cell carcinoma. This tumor most probably arises from the basal or reserve cells of the prostatic acini. The totipotential basal cells have dual capacity for differentiation into adenocarcinoma and small-cell carcinoma.     

ATRIAL FIBRILLATION IN THE ELDERLY: PHYSICIANS' ATTITUDES TO ANTICOAGULATION

SUMMARY The use of warfarin and aspirin for the primary prevention of stroke in elderly patients with atrial fibrillation (AF) is controversial. To establish current practice we circulated a questionnaire to 300 geriatricians (G) and 300 cardiologists (C). The response rates were 47% G and 51% C. Most physicians prescribed warfarin in AF associated with mitral stenosis (G vs C, 86% vs 89%, NS). Cardiologists were more likely to prescribe warfarin in AF associated with dilated cardiomyopathy (G vs C, 52% vs 86%, P<0.01). A minority would prescribe warfarin in aortic valve disease and AF (G vs C, 37% vs 24%, P<0.05) and lone AF (G vs C, 10% vs 26%, P<0.01). Aspirin was favoured in aortic valve disease and lone AF. The cardiologists were less reluctant to use warfarin in the young and more likely to electrically cardiovert the young with chronic AF.     

MRI Detection of Early Bone Metastases in B16 Mouse Melanoma Models

Bone metastasis causes significant morbidity in cancer patients, including bone pain, pathologic fractures, nerve compression syndrome, and hypercalcemia. Animal models are utilized to study the pathogenesis of skeletal metastases and to evaluate potential therapeutic agents. Previously published methods for imaging bone metastasis in rodent models have focused on identifying advanced stage metastasis using simple X-rays. Here we report MRI as a method for detecting early bone metastases in mouse models in vivo. B16 mouse melanoma cells were injected into the left cardiac ventricle of C57BL/6 mice and magnetic resonance (MR) images were obtained of the left leg following the development of metastatic disease, when tumor associated bone destruction was histologically present but not visible by X-ray. T1 and T2 relaxation times of bone marrow were measured in healthy control mice and B16 melanoma tumor-bearing mice. Mean T2 values for normal marrow were 28 ms (SD 5) and for diseased bone marrow were 41 ms (SD 3). T2 relaxation time of diseased bone marrow is significantly longer than that of normal bone marrow (P < 0.0001) and can be used as a marker of early bone metastases. These studies demonstrate that MR imaging can detect bone marrow metastases in small animals prior to development of cortical bone loss identified by X-ray.     

Recombinant ADAMTS13 normalizes von Willebrand factor‐cleaving activity in plasma of acquired TTP patients by overriding inhibitory antibodies

Summary. Background: Severe deficiency of the von Willebrand factor (VWF)‐cleaving protease ADAMTS13 as observed in acquired thrombotic thrombocytopenic purpura (TTP) is caused by inhibitory and non‐inhibitory autoantibodies directed against the protease. Current treatment with plasma exchange is considered to remove circulating antibodies and to concurrently replenish the deficient enzyme. Objectives: To explore the use of recombinant ADAMTS13 (rADAMTS13) as a potential therapeutic agent in acquired TTP, we investigated its efficacy in normalizing VWF‐cleaving activity in the presence of ADAMTS13 inhibitors. Methods: Thirty‐six plasma samples from TTP patients were adjusted to predefined inhibitor titers, and recovery of ADAMTS13 activity was analyzed following supplementation with rADAMTS13. Results: We showed a linear relation between the inhibitor titer measured and effective rADAMTS13 concentration necessary for reconstitution of VWF‐cleaving activity in the presence of neutralizing autoantibodies. Conclusions: Our results support the further investigation of the potential therapeutic applicability of rADAMTS13 as an adjunctive therapy in acquired TTP.