Is a filum terminale with a normal appearance really normal?

INTRODUCTION. Tethered spinal cord is defined as a condition in which the conus medullaris ends at a level below the L1-2 intervertebral space. The spinal cord is considered to be tethered when there is a thick filum terminale or low-lying conus medullaris. It has also been reported that a normal level of the conus medullaris and normal thickness of the filum terminale do not mean that there is no cord tethering. MATERIALS AND METHODS. In this investigation, we examined 21 fila terminalia; 5 of them were taken from cadavers, and these were used as a control group (group 1; n/n), 8 from patients with a normal appearance of the filum terminale but with clinical symptoms (incontinence) and pathologic results of a urodynamic study (group 2; n/ab), and 8 from patients with an abnormal appearance of the filum terminale and with clinical symptoms (group 3; ab/ab). Interestingly, we found that while fila terminalia in the control group were made up mainly of collagen fibers, more connective tissue with dense collagen fibers, some hyalinization and dilated capillaries were noticed in the fila from group 2. RESULTS. Our results suggest that these histological features may reflect a decreased elasticity within the filum terminale, resulting in a tethering effect on the lower conus in otherwise normal physiological conditions. CONCLUSION. These findings lead us to reconsider sectioning of the filum terminale in incontinent patients with normal results in radiological studies, whose condition is called "nonneurogenic neurogenic bladder."     

Chilaiditi syndrome in a patient with urological problems: Incidental diagnosis on computed tomography

A rare syndrome, Chilaiditi’s syndrome is interposition of the colon only or with the small intestine in hepatodiaphragmatic area. It may be asymptomatic, but it may also present with symptoms, such as abdominal pain, nausea, vomiting, constipation and respiratory distress. We present a patient who was admitted with urological problems; he was incidentally diagnosed with Chilaiditi’s syndrome.     

Apoptosis seems to be the major process while surface and neural ectodermal layers detach during neurulation

Objective The aim of this study is to demonstrate the process of detaching neural and surface ectodermal layers soon after the neurulation completes. Materials and methods Specific pathogen-free chicken egg embryos were used to investigate the neurulation procedure. Ten eggs were saved as controls. The other ten eggs were opened at the 30th hour of embryo development and cultured with Z-VAD-FMK (peptide caspase inhibitor) to investigate the results of the apoptosis inhibition. Embryos were placed and developed up to 48 h in the culture medium. To detect apoptotic cells between neural and surface dermal layers, immunoreactivity of p53 and terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay were used. Results While the control group shows positive immunoreactivity of p53 and TUNEL-positive apoptotic cells at the site where the neural folds detach from the surface ectoderm, no TUNEL activity and no detachment were detected in the apoptosis-inhibited group. Conclusion As inhibition of apoptosis prevented the detachment of the neural and surface ectodermal layers from each other at the end of the neurulation, inhibition of apoptosis seemed to cause a considerable embryological error accounted for congenital dermal sinus tractus maldevelopment. This paper was presented at the 35th annual meeting of International Society of Paediatric Neurosurgery, 9–14 September 2007, Liverpool, England.     

Cardiac tamponade in an orthotopic liver recipient with pulmonary hypertension

OBJECTIVE: To describe the clinical, hemodynamic, and echocardiographic findings of cardiac tamponade in a patient with portopulmonary hypertension shortly after orthotropic liver transplantation. DESIGN: Case report. SETTING: Surgical intensive care unit of a university teaching hospital. PATIENT: One patient with portopulmonary hypertension deteriorated progressively after orthotropic liver transplantation and developed cardiogenic shock. INTERVENTION: Serial transthoracic echocardiography showed increased right ventricular pressures and pericardial effusion without evidence of cardiac tamponade. Since right ventricular diastolic collapse may not be present in the setting of pulmonary hypertension and her clinical scenario was consistent with tamponade, pericardiocentesis was performed. MEASUREMENTS AND MAIN RESULTS: There was dramatic improvement of the clinical, hemodynamic, and echocardiographic variables after pericardiocentesis CONCLUSION: Pulmonary hypertension may decrease the predictive accuracy of echocardiographic clues for cardiac tamponade. Pericardiocentesis should be considered with clinical suspicion of cardiac tamponade without classic echocardiographic evidence in portopulmonary hypertension.     

Plasma leptin levels in rats with pancreatitis

Diagnosis of pancreatitis is based on the determination of serum amylase and lipase levels. However, recent identification of specific leptin receptors in the pancreas suggests that this peptide may also play some roles in the modulation of pancreatic function. The objective of the present study was to investigate the relationship between serum leptin levels and pancreatitis. Thirty male Wistar rats were divided into 3 groups: the control group, acute pancreatitis group and chronic pancreatitis group. Pancreatitis was induced by injection of ethyl alcohol into the common biliary duct. A sham laparotomy was performed in the control group. Control and acute pancreatitis groups were sacrificed 24 hours later, and chronic pancreatitis group was sacrificed on postoperative day 7. Blood was taken by cardiac puncture for the determination of plasma leptin levels, and the pancreatic tissue was excised for histopathologic confirmation of pancreatitis. Plasma leptin rose significantly from the median of 0.78 +/- 0.12 ng/ml in the control group to 1.92 +/- 0.10 ng/ml and 1.86 +/- 0.13 ng/ml in acute and chronic pancreatitis groups, respectively (p < 0.001, for both). There was no significant difference in the plasma leptin levels between the acute pancreatitis group and the chronic pancreatitis group (p > 0.05). These findings confirm that leptin has a role in pancreas inflammation, and the inflamed tissue can be the source of local production of leptin.     

Relation of cortisol levels and bone mineral density among premenopausal women with major depression

We aimed to investigate the relationship between cortisol levels and bone mineral density (BMD) among premenopausal women with major depression. We compared BMD, plasma cortisol, osteocalcin and C-telopeptide (CTx) levels of 36 premenopausal women with major depression with 41 healthy women who were matched for age and body mass index. Osteocalcin and CTx were used for the evaluation of bone turnover. The clinical diagnosis of major depression was made by using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The 21-item Hamilton Rating Scale for Depression was used for the assessment of depressive symptoms. In comparison with the controls, the mean BMD of the depressed women was significantly lower at the lumbar spine and at all sites of the proximal femur (p = 0.02, 0.01). Plasma cortisol levels were significantly higher in depressive patients than in controls (p = 0.001). Osteocalcin was lower and CTx was higher in the patient group than in controls (p = 0.04, p = 0.008). Lumbar and femur BMD scores were negatively correlated with cortisol levels in the patient group. Major depression had important effects on BMD and bone turnover markers. Depression should be considered among risk factors for osteoporosis in premenopausal women.     

Hematoma progressivo na região anterior do pescoço após tratamento endovascular de aneurisma da artéria cerebral média

Background

Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm.