Spinal arachnoiditis mimicking a spinal cord tumor: a case report and review of the literature.

We report on an unusual case of idiopathic arachnoiditis mimicking a spinal cord tumor in a 50-year-old man with progressive paraparesis. The medical imaging work-up showed an enlarged terminal cone with adjacent cysts. Although there was no enhancement of the terminal cone or the surrounding structures, the diagnosis of spinal cord tumor was maintained and surgery was carried out. Exploration of the cauda equina and the tissue surrounding the terminal cone did not reveal a tumor. The patient improved dramatically after surgery but the symptoms recurred 1 year later. We review arachnoiditis, its pathology, and its treatment with special attention drawn to the primary form of spinal arachnoiditis.     

Thrombolytic Evacuation of Intracerebral and Intraventricular Hemorrhage

Intracranial hemorrhage (ICH) accounts for 10-15?% of all strokes, however it causes 30-50?% of stroke related mortality, disability and cost. The prevalence increases with age with only two cases/100,000/year for age less than 40?years to almost 350 cases/100,000/year for age more than 80?years. Several trials of open surgical evacuation of ICH have failed to show clear benefit over medical management. However, some small trials of minimal invasive hematoma evacuation in combination with thrombolytics have shown encouraging results. Based on these findings larger clinical trials are being undertaken to optimize and define therapeutic benefit of minimally invasive surgery in combination with thrombolytic clearance of hematoma. In this article we will review some of the background of minimally invasive surgery and the use of thrombolytics in the setting of ICH and intraventricular hemorrhage (IVH) and will highlight the early findings of MISTIE and CLEAR trials for these two entities respectively.     

Identification of N-Terminally Truncated Derivatives of Insulin Analogs Formed in Pharmaceutical Formulations

Purpose

Isolation and identification of unknown impurities of recombinant insulin lispro (produced at IBA) formed during accelerated stability testing of pharmaceutical solutions. For comparative purposes also commercially available formulations of recombinant human insulin (Humulin S®; Lilly), recombinant insulin lispro (Humalog®; Lilly), recombinant insulin aspart (NovoRapid® Penfill®; Novo Nordisk), recombinant insulin detemir (Levemir®; Novo Nordisk) and recombinant insulin glargine (Lantus®; Sanofi-Aventis) were analyzed.

Methods

The impurities of insulin analogs were isolated by RP-HPLC and identified with peptide mass fingerprinting using MALDI-TOF/TOF mass spectrometry.

Results

The identified derivatives were N-terminally truncated insulin analog impurities of decreased molecular mass of 119, 147 and 377 Da related to the original protein. The modifications resulting in a mass decrease were detected at the N-terminus of B chains of insulin lispro, insulin aspart, human insulin, insulin glargine, insulin detemir in all tested formulations. To our knowledge it is the first time that these impurities are reported.

Conclusions

The following derivatives formed by truncation of the B chain in insulin analogs were identified in pharmaceutical formulations: desPhe^B1-N-formyl-Val^B2 derivative, desPhe^B1 derivative, pyroGlu^B4 derivative.

     

Survival of patients after combined treatment for rectal cancer]

The analysis of end results of treatment of rectal cancer showed combined therapy to assure long survival in the whole group of radically operated cases, viz. two-third of them survived 10 years. Conversely, mean survival of non-operated or surgically palliated patients was as low as 10.1 and 26.7 months, respectively. Survival of radically operated cases was found to be related to various clinico-anatomic factors, the most close relationship being observed for extent, histology and growth pattern of tumor and regional nodal status. The influence of site and surgical procedure on patient survival proved far less significant.     

Inflammatory and degenerative phases resulting from anterior cruciate rupture in a non‐invasive murine model of post‐traumatic osteoarthritis

Joint injury is the predominant risk factor for post‐traumatic osteoarthritis development (PTOA). Several non‐invasive mouse models mimicking human PTOA investigate molecular mechanisms of disease development; none have characterized the inflammatory response to this acute traumatic injury. Our aim was to characterize the early inflammatory phase and later degenerative component in our in vivo non‐invasive murine model of PTOA induced by anterior cruciate ligament (ACL) rupture. Right knees of 12‐week‐old C57Bl6 mice were placed in flexion at a 30° offset position and subjected to a single compressive load (12N, 1.4 mm/s) to induce ACL rupture with no obvious damage to surrounding tissues. Tissue was harvested 4 h post‐injury and on days 3, 14, and 21; contralateral left knees served as controls. Histological, immunohistochemical, and gene analyzes were performed to evaluate inflammatory and degenerative changes. Immunohistochemistry revealed time‐dependent expression of mature (F4/80 positive) and inflammatory (CD11b positive) macrophage populations within the sub‐synovial infiltrate, developing osteophytes, and inflammation surrounding the ACL in response to injury. Up‐regulation of genes encoding acute pro‐inflammatory markers, inducible nitric oxide synthase, interleukin‐6 and interleukin‐17, and the matrix degrading enzymes, ADAMTS‐4 and MMP3 was detected in femoral cartilage, concomitant with extensive cartilage damage and bone remodelling over 21‐days post‐injury. Our non‐invasive model describes pathologically distinct phases of the disease, increasing our understanding of inflammatory episodes, the tissues/cells producing inflammatory mediators and the early molecular changes in the joint, thereby defining the early phenotype of PTOA. This knowledge will guide appropriate interventions to delay or arrest disease progression following joint injury. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2118–2127, 2018.     

CT and MR findings in ruptured dermoid cyst in the right parasellar cistern: report of a case.

A case of ruptured dermoid cyst in the right parasellar cistern imaged by MRI and CT is reported. The disseminated lipid droplets were found scattered throughout the subarachnoid spaces including the prepontine cisterns, in front of the right petrous apex as well as bilaterally in the frontal horns. The density of the lipid droplets was comprised between -80 and -100 HU. The lesions were hyperintense on T1-weighted images and hypointense on T2-weighted images.