Hodgkin's disease of the thoracic vertebrae

Background contextHodgkin's disease rarely occurs in the spine, which is usually a setting for the advanced form of the disease.PurposeTo describe an unusual case of isolated, primary spinal Hodgkin's disease and to draw attention to this disease as a possible diagnosis in patients with mixed inflammatory cell infiltrate lesions located in the thoracic spine.Study design/settingA case report of a 28-year-old woman who presented with back pain and progressive weakness in the lower extremities as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae.MethodsWe report a new case of spinal cord compression resulting from Hodgkin's disease of the thoracic vertebrae. Decompression surgery was performed in the patient, followed by antibiotic treatment.ResultsAntibiotic therapy temporarily improved inflammation and fever. However, magnetic resonance imaging (MRI) evaluation showed that the inflammatory reaction in the lesion was not completely resolved. The disease progressed and later investigations revealed Hodgkin's disease, which improved with a course of chemotherapy and radiation.ConclusionsHodgkin's disease should be considered in the differential diagnosis of spinal neoplastic lesions with clinical features similar to spondylitis. Because MRI evaluation showed that the vertebral disc was maintained in this case, the presence of a tumor rather than inflammation should have been suspected.     

Using intraoperative radiography to detect incomplete seating of Trident acetabular system ceramic liners

Purpose

There have been some reports of incomplete seating of the ceramic liner in the Stryker Trident acetabular system. We sought to prevent incomplete seating through the use of intraoperative radiography.

Method

We retrospectively reviewed 21 hips in 18 patients who had undergone total hip arthroplasty using a posterolateral approach with a Stryker Trident ceramic liner. All procedures included an intraoperative anteroposterior view radiograph to evaluate liner seating. If incomplete seating was recognized we reinserted the liner. We investigated whether this technique made it possible to detect and correct incomplete seating.

Results

Six of the 21 hips evidenced incomplete seating. In four of these hips, the incomplete seating was revealed on the intraoperative radiograph: two were reinserted properly, one was replaced with a polyethylene liner, and in the last one the incomplete seating was missed despite the radiographical evidence. The location of the gap between the socket and liner caused by the incomplete seating was inferior in all these cases. Intraoperative radiography did not indicate incomplete seating in two hips in which the location of the gap was anterior; the problem was revealed by postoperative lateral view radiography.

Conclusion

With a posterolateral approach in a lateral decubitus position, the use of intraoperative radiography was effective when the gaps were superior or inferior. However, this approach made it easy to miss anterior gaps and intraoperative radiography did not reveal them.     

A case of mesenteric cystic lymphangioma in an adult which caused duodenal stenosis after resection

INTRODUCTIONWe present a rare case of mesenteric lymphangioma in a middle-aged female.PRESENTATION OF CASEA 56-year-old female was admitted to the hospital with upper abdominal pain. Abdominal computed tomography revealed a multicystic mass surrounding the mesentery. We made the decision to resect the mass, suspecting that was a mesenteric lymphangioma based on additional imaging studies. The tumor adhered strongly to parts of the duodenum and the upper jejunum. In order to preserve the jejunum, we dissected its serosa away from the tumor. Approximately 1 week after surgery the patient experienced a constriction of the third portion of the duodenum. Her symptoms were improved with conservative therapy, and she was discharged from the hospital 62 days after surgery.DISCUSSIONLymphangioma originating from the mesentery may have cause adhesions due to exfoliated tumor cells; it is necessary to be concerned about postoperative obstruction.CONCLUSIONThe preoperative diagnosis of lymphangioma is based on various imaging modalities.     

Reproducibility of three-dimensional coordinate systems based on craniofacial landmarks

Abstract Objectives: To propose a method for evaluating the reproducibility of anatomical coordinate systems based on craniofacial skeletal landmarks and to tentatively evaluate four systems created on preoperative cone-beam computed tomography (CBCT) data obtained from mandibular prognathism patients in order to confirm the utility for actual patients' data. Materials and Methods: In three-dimensional images of 10 patients obtained by a CBCT with a large field of view, six dentists set four coordinate systems that were created in different ways, twice by plotting some landmarks situated in the superior portion of the maxillofacial skeletons. The 95% confidence ellipse of six objective landmarks related to the jaw and teeth (upper incisor, left upper first molar, lower incisor, left lower first molar, menton, and left gonion) were three-dimensionally drawn for each coordinate system. The ellipsoid volume was calculated to evaluate the reproducibility of the coordinate systems. Results: The reproducibility could be evaluated for each coordinate system using the method proposed. The coordinate systems that were created by landmarks situated at greater distances from each other showed relatively small ellipsoid volume in comparison to those with shorter distances between landmarks. Conclusion: Anatomical coordinate systems with larger distances between the landmarks used were stable when landmarks related to the jaw and teeth were assigned as objective landmarks. The method proposed here was effective in terms of the reproducibility evaluation of a coordinate system.     

Stimulus duration and pain in nerve conduction studies

Introduction: It is generally believed that a shorter stimulus duration is less painful in nerve conduction studies (NCS). We investigated whether a shorter duration stimulus is actually less painful when the same physiological effect, such as supramaximal stimulation, is achieved in motor NCS. Methods: The tibial nerve was stimulated at the ankle in 14 control subjects and the median nerve at the wrist in 20 subjects. Two stimulations of different durations were given blindly, and each subject was asked to report which was more painful. Results: A 0.2‐ms‐duration stimulus was significantly less painful than those with longer or shorter durations for the tibial nerve. For the median nerve, the 0.05‐ and 0.2‐ms durations were equally less painful than a 1‐ms‐duration stimulus. Conclusions: As a common duration for motor NCS, 0.2 ms seems appropriate, because the tibial nerve stimulation was more painful than the median nerve stimulation. Muscle Nerve, 2013     

Coagulofibrinolytic changes in patients with disseminated intravascular coagulation associated with post-cardiac arrest syndrome― Fibrinolytic shutdown and insufficient activation of fibrinolysis lead to organ dysfunction

Introduction

Post-cardiac arrest syndrome (PCAS) is often associated with disseminated intravascular coagulation (DIC), thus leading to the development of multiple organ dysfunction syndrome (MODS). The aim of this study was to examine the pathophysiological relationships between coagulation, fibrinolysis and fibrinolytic shutdown by evaluating the levels of coagulofibrinolytic markers, including soluble fibrin, thrombin-activatable fibrinolysis inhibitor (TAFI), tissue plasminogen activator-plasminogen activator inhibitor-1 complex (tPAIC), plasmin-alpha2 plasmin inhibitor complex (PPIC), neutrophil elastase and fibrin degradation product by neutrophil elastase (EXDP).

Materials and Methods

Fifty-two resuscitated patients were divided into two groups: 22 DIC and 30 non-DIC patients.

Results

The levels of soluble fibrin, PPIC, tPAIC, EXDP and neutrophil elastase in the DIC patients with PCAS were significantly higher than those observed in the non-DIC patients. The values of the tPAIC and JAAM DIC scores were found to be independent predictors of increased SOFA scores in the DIC patients. The MODS patients demonstrated significantly higher levels of soluble fibrin and tPAIC; however, the levels of TAFI and EXDP were identical between the patients with and without MODS. In addition, positive correlations were observed between the levels of tPAIC and EXDP in the patients with non-MODS; however, no correlations were observed between these markers in the MODS patients.

Conclusions

Thrombin activation and fibrinolytic shutdown play important roles in the development of organ dysfunction in PCAS patients. Neutrophil elastase-mediated fibrinolysis cannot overcome the fibrinolytic shutdown that occurs in DIC patients with PCAS, thus resulting in the development of MODS.     

Effect of stimulation of the dorsal aspect of the cervical spinal cord on ’Iocal cerebral blood flow and EEG in the cat

Abstract

Currently there is considerable interest in electrical stimulation of the dorsal aspect of the cervical spinal cord as a potentially effective therapy for persistent vegetative patients. The authors assessed change in the local cerebral blood flow (LCBF) and electroencephalogram (EEe) in the cat following spinal cord stimulation (SCS). In 31 adult cats under isoflurane anesthesia, an electrode for SCS was introduced epidurally to the midline of the C2-C3 segment. Stimulation was performed at 25 Hz and 0.7 msec for30 min. These animals were divided into five groups by the voltage: (1) 2V (n = 7), (2) 4V (n = 7), (3) 6V (n = 7), (4) 4V with intravenous injection of muscarinic cholinergic agents - atropine sulfate (n =5), and (5) sham-operated control (n = 5) without stimulation. LCBF was measured by laser Doppler flowmetry through bilateral small burr holes at the parietal area during and 60 min after stimulation. At 2~ LCBF increased only during SCSI then returned to the pre-stimulated level, while the increase continued until the end of the experiment at 4Vand 6V. The increase in LCBF was not affected by atropine sulfate. EEe showed spike and wave or polyspikes after SCS in two animals of the 6V group, but not in the 2V and 4V groups, and moreover a moderate increase ofthe background activity at only 4V. The present data suggested that SCS at 4Vcan provide the appropriate microcirculatory enhancement with less harmful influence which continues to increase 30 min after SCSI although the exact mechanism should be elucidated continuously. Within the limitation of animal experiments, this study could provide the logical basis for determining the condition of SCS. [Neural Res 2000; 22: 386-392]     

Endothelium-dependent relaxation and vasospasm in the single-hemorrhage canine model

Abstract

We have investigated the relationship between angiographic vasospasm and the ability of spastic vessels to relax in response to agents which promote release of endothelium derived relaxing factor. Vasospasm was induced in dogs by the 'single hemorrhage' technique. Animals received a single intracisternal injection of blood, blood activated with thromboplastin or collagen, or inert material, and angiograms were obtained day 0 and day 7. Vasospasm was estimated by measuring the ratio of the diameter of the vessel before and after treatment. Rings of cerebral artery obtained from these animals were suspended in a standard organ- bath arrangement, contracted with prostaglandin F2(X and then treated with increasing doses of adenosine triphosphate or bradykinin, both of which cause relaxation by an endothelium-dependent process. The arteries from animals with moderate to severe vasospasm showed a response to bradykinin and adenosine- triphosphate which was reduced, absent or converted to a contraction, when compared with normal vessels. Vessels in which vasospasm was mild or absent relaxed as expected to these agents. The reduction in vessel diameter showed a highly significant correlation with the reduction in relaxation to bradykinin or adenosine-triphosphate. These results have demonstrated that impairment of endothelium-dependent vasorelaxation correlates with the existence of vasospasm. [Neurol Res 1996; 18: 553-558]     

Recognition of Facial Expressions and Prosodic Cues with Graded Emotional Intensities in Adults with Asperger Syndrome

This study investigated the ability of adults with Asperger syndrome to recognize emotional categories of facial expressions and emotional prosodies with graded emotional intensities. The individuals with Asperger syndrome showed poorer recognition performance for angry and sad expressions from both facial and vocal information. The group difference in facial expression recognition was prominent for stimuli with low or intermediate emotional intensities. In contrast to this, the individuals with Asperger syndrome exhibited lower recognition accuracy than typically-developed controls mainly for emotional prosody with high emotional intensity. In facial expression recognition, Asperger and control groups showed an inversion effect for all categories. The magnitude of this effect was less in the Asperger group for angry and sad expressions, presumably attributable to reduced recruitment of the configural mode of face processing. The individuals with Asperger syndrome outperformed the control participants in recognizing inverted sad expressions, indicating enhanced processing of local facial information representing sad emotion. These results suggest that the adults with Asperger syndrome rely on modality-specific strategies in emotion recognition from facial expression and prosodic information.