Isolated extraosseous epidural myeloma presenting with thoracic compressive myelopathy

Background contextMultiple myeloma is the commonest primary malignancy of the spine, but it rarely presents as an extraosseous epidural tumor with only five cases reported in literature so far.PurposeThe purpose of this study was to heighten awareness and treatment options of a rare case of extraosseous epidural myeloma.Study designThe study design comprises a case report and literature review.MethodsWe present a 60-year-old lady with progressive paraplegia (American Spinal Injury Association grade C) with sensory blunting below T8 level of 2 months’ duration. Magnetic resonance imaging showed an extradural tumor in the dorsal epidural space from T6 to T7 without local bony involvement. She underwent a T6 and T7 laminectomy, T5–T8 pedicle screw instrumentation, and gross total resection of tumor. Histopathological diagnosis was consistent with myeloma. After surgery, the patient underwent local irradiation and adjuvant chemotherapy.ResultsNeurological improvement of one grade (American Spinal Injury Association grade C to D) was observed at 3 weeks postoperatively.ConclusionsIsolated extraosseous epidural myeloma without destruction or collapse of vertebral bodies should be included in the differential diagnosis of epidural mass lesions causing spinal cord compression. The overall prognosis in terms of survival is poor, but early decompression can prevent neurological deterioration and improve quality of life.     

In vitro Comparison of Adipogenic Differentiation in Human Adipose-Derived Stem Cells Cultured with Collagen Gel and Platelet-Rich Fibrin

Background: Adipose-derived stem cells (ADSCs) are the most preferred cell type, based on their phenotypic characteristics, plasticity, and favorable immunological properties for applications in soft-tissue augmentation. Hence, the present in vitro study was aimed to evaluate the adipogenic differentiation potential of human ADSCs upon culturing individually with collagen gel and platelet-rich fibrin (PRF). Materials and methods: The collected lipoaspirate was used for establishing ADSCs using enzymatic digestion method. Then, the cells were analyzed for their morphology, viability, proliferation rate, population doubling time (PDT), colony-forming ability, cell surface markers expression, and osteogenic differentiation as biological properties. Further, ADSCs were evaluated for their adipogenicity using induction media alone, and by culturing with collagen gel and PRF individually for prospective tissue augmentation. Results: ADSCs were successfully established in vitro and exhibited a fibroblast-like morphology throughout the culture period. Cells had higher viability, proliferation potential and showed their ability to form colonies. The positive expression of cell surface markers and osteogenic ability confirmed the potency of ADSCs. The ADSCs cultured on collagen gel and PRF, individually, showed higher number of differentiated adipocytes than ADSCs grown with adipogenic induction medium alone. Conclusion: The extent of lipid accumulation by ADSCs was slightly higher when cultured on collagen gel than on PRF. Additional experiments are required to confirm better suitability of scaffold materials for soft-tissue regeneration.     

Evaluation of blood glucose levels after hepatitis B immune globulin administration utilizing two different blood glucose monitoring systems

Background

Hepatitis B Immune Globulin (HBIG) is used post liver transplantation (OLT) in hepatitis B surface antigen-positive recipients to prevent recurrence of hepatitis B. One formulation of HBIG, HepaGam B, contains the disaccharide maltose, which can potentially falsely elevate glucose readings when glucose nonspecific point of care (GNSPOC) testing is used, such as a glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ)-based method. This can result in inappropriate administration of antidiabetic agents and resultant episodes of clinically significant hypoglycemia. Glucose specific point of care (GSPOC) testing, such as a glucose oxidase-based method, however, is not affected by the presence of maltose. The purpose of this study was to determine if there was a significant difference in glucose readings using GSPOC and GNSPOC monitoring devices after HBIG administration.

Methods

This is a nonrandomized, prospective study evaluating patients receiving maintenance HBIG therapy over 3 months post liver transplantation. Blood glucose levels in each subject were analyzed by GSPOC and GNSPOC devices at specific times around HBIG administration.

Results

Five adult OLT recipients receiving maintenance HBIG therapy were administered HepaGam B during the regularly scheduled outpatient visits. The median difference (GNSPOC minus GSPOC) predose as well as immediately, 60 minutes, and 120 minutes postdose were: −2, 11, 6, and 0 mg/dL, respectively. A random intercept model was used to fit the five subjects' glucose reading data over time. The Meter by Time interaction effect was not significant (P = .59) and the Meter effect was not significant (P = .46), which demonstrated no statistical difference between GNS and GS readings following HBIG administration.

Conclusions

Based on these results, there is not a significant difference between GSPOC and GNSPOC readings after administration of this HBIG formulation.     

Predictors of poor dental arch relationship in young children with unilateral cleft lip and palate

The aim of this cross-sectional outcome study using retrospective data capture of treatment histories was to examine the characteristics of young children with unilateral cleft lip and palate who had poor dental arch relationship (i.e., Goslon 5). The study sample comprised 120 children born with nonsyndromic complete unilateral cleft lip and palate between 1995 and 2003, and were aged between 5.0 and 7.0 years (mean age, 5.1 years) at the time of data collection. The dental arch relationship was assessed using the Goslon yardstick from intraoral dental photographs. An independent investigator recorded treatment histories from the clinical notes. The inter- and intraexaminer agreements evaluated by weighted kappa statistics were high. There was no association between dental arch relationship and the type of presurgical orthopedics or pharyngeal flap. Dental arch relationship was associated with the initial cleft size (odds ratio, OR = 1.3; 95% confidence interval, CI = 1.1-1.5, p < 0.01), surgeon grade for palate repair (OR = 5.0, 95% CI = 1.2-19.9, p < 0.05), and primary gingivoperiosteoplasty (OR = 2.8, 95% CI = 1.0-8.1, p = 0.05). These data suggest that intraoral dental photographs provide a reliable method for rating dental arch relationship. Wide initial cleft, high-volume surgeon, and primary gingivoperiosteoplasty are predictors of poor dental arch relationship outcome in young children with unilateral cleft lip and palate. These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.     

Clinical, anatomic, and electrophysiologic evaluation following intravitreal bevacizumab for macular edema in retinal vein occlusion

PURPOSE: To investigate clinical, anatomic, and electrophysiologic response after single intravitreal injection of bevacizumab for macular edema attributable to retinal vein occlusion. DESIGN: Prospective nonrandomized, interventional case series. METHODS: Twenty-one patients with macular edema attributable to vein occlusion received intravitreal injection of bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion (CRVO), and 12 patients had branch retinal vein occlusion (BRVO). Complete ophthalmic examination including optical coherence tomography (OCT) was done at baseline and follow-up visits. Fifteen patients underwent fluorescein angiography at baseline. Selected patients underwent electroretinography (ERG) and visual evoked potential (VEP) at baseline and follow-up. Follow-up was for 12 weeks. RESULTS: At baseline, mean visual acuity was 20/381 (median, 20/400) and showed improvement to mean 20/135 (median, 20/60) after one month, (P = .001). At 12 weeks, mean visual acuity was 20/178 (median, 20/80) (P = .001). The mean central retinal thickness (CRT) was 647.81 microm (median, 609.00 microm) at baseline and decreased to mean 293.43 microm (median, 222.00 microm) at one month (P = .001). At 12 weeks, mean CRT was 320.90 mum (median, 280.00 microm) (P = .001). ERG and VEP showed no worsening of the waveforms. There was no significant difference in the visual outcome between the BRVO and CRVO groups. CONCLUSION: Intravitreal injection of bevacizumab appears to result in significant short-term improvement of visual acuity and macular edema secondary to vein occlusion. The present report confirms the previous studies. No ocular toxicity or adverse effects were observed. However, prospective, randomized, controlled long-term studies are required with an adequate number of patients.     

Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation?

The optimal surgical management for failed conservative measures in epistaxis remains unclear. Given the growing enthusiasm for endoscopic transnasal sphenopalatine artery ligation, it is prudent and timely to evaluate the evidence base for this technique. This study aims to analyse the current evidence for transnasal endoscopic sphenopalatine artery ligation by reviewing the literature and also by comparing the results with other approaches to the management of epistaxis. A detailed literature search identified 11 publications relating to endoscopic sphenopalatine artery ligation. The total number of patients in the pooled series was 127, of which 98% had control of epistaxis following surgery. These results compared favourably to the results of most other techniques used in the modern treatment of epistaxis. Nonetheless, the total number of patients in the 11 case series is small. It is therefore recommended that all units using this technique audit their results to see if the high success rates achieved in the literature are reproducible. If this is the case, then endoscopic sphenopalatine artery ligation may indeed be the surgical answer to intractable posterior epistaxis.     

Serpiginous choroiditis-like picture due to ocular toxoplasmosis

PURPOSE: To report an atypical presentation of ocular toxoplasmosis in the form of serpiginous choroiditis-like picture in an immunocompetent individual. METHODS: Case report: A 32-year-old man with blurred vision in the left eye showed serpiginous choroiditis-like appearance. Fundus fluorescein angiography and relevant laboratory tests including anti-toxoplasma serology and polymerase chain reaction (PCR) in aqueous humor were performed. RESULTS: The serology in blood and PCR in aqueous humor were positive for Toxoplasma gondii infection. The patient was treated with anti-toxoplasma antimicrobials and systemic steroids. At the end of six weeks of treatment the fundus lesions had healed well, with good visual recovery. CONCLUSIONS: Serpiginous choroiditis-like picture can be an atypical manifestation of ocular Toxoplasma gondii infection.     

Repeated infusions of identical doses of norepinephrine show potentiation of metabolic responses in human subjects

Thermogenic responses to similar doses of norepinephrine appear to be different when repeatedly administered. This hypothesis was tested by three consecutive 30-minute infusions of a fixed dose of norepinephrine separated by a rest period of one hour between infusions. There was a significant increase or potentiation of the metabolic response as measured by oxygen consumption to the third dose of norepinephrine, while the cardiovascular responses showed no change. It is therefore important to make allowances for this phenomenon when assessing intergroup differences in regulatory thermogenesis using dose-response protocols for norepinephrine administration.