Diabetes insipidus secondary to penetrating spinal cord trauma: case report and literature review

STUDY DESIGN

Case report.

OBJECTIVE

To present a case of central diabetes insipidus (CDI) that developed after a gunshot injury to the thorax and thoracic spinal cord and to discuss the disease process in light of the relevant literature.

SUMMARY OF BACKGROUND DATA

Antidiuretic hormone (ADH) abnormalities may develop after spinal trauma and/or surgery. Although there are published reports of inappropriate ADH syndrome arising in this clinical picture, CDI is rare.

METHODS

A 33-year-old woman with hemopneumothorax and a gunshot wound to her thoracic spine was treated with chest tube drainage. No surgery was performed for the spinal injury. The patient was paraplegic on admission and rapidly developed excessive urine output. Testing revealed that her serum ADH level was low, consistent with CDI. Desmopressin acetate nasal spray was the prescribed treatment.

RESULTS

The patient responded well to the desmopressin acetate spray.

CONCLUSIONS

CDI is a complicated hormonal disorder characterized by excessive urine output. It is typically linked to an abnormality in the hypothalamohypophyseal axis that markedly reduces ADH production. The most common inciting causes are craniocerebral trauma, brain tumor and/or surgery, and central nervous system infection. Although uncommon, CDI should be considered when a spinal trauma patient develops excessive urine output.

Monitoring the chemotherapeutic response in primary lung cancer using 99mTc-MIBI SPET

Prediction and evaluation of the response to chemotherapy (CTx) are important for the correct and cost-effective treatment of patients with primary lung cancer. Although fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is accepted as the most useful and accurate nuclear medicine technique for this purpose, its expense and limited availability restrict its use. Compared with PET agents, technetium-99m methoxyisobutylisonitrile (MIBI), which is used in nuclear oncology, is cheaper and available in any nuclear medicine clinic. With this in mind, in this study we aimed to evaluate the role of 99mTc-MIBI in monitoring the chemotherapeutic response in primary lung cancer. Twenty patients with primary lung cancer underwent 99mTc-MIBI single-photon emission tomography (SPET) at 15 min (early) and 3-4 h (delayed) after injection of the tracer. All patients underwent 99mTc-MIBI SPET study twice: before and after the 3rd cycle of CTx. Patients were divided into two groups, responders [R(+), n=10] and nonresponders [R(-), n=10], according to the change in tumour size on CT scan taken 2 weeks after the last cycle of the CTx. From the SPET images early and delayed tumour/lung ratios (ER and DR) were obtained before and after CTx. In the R(+) group, ER and DR decreased significantly after CTx, from 3.28+/-1.55 to 1.78+/-0.72 (P<0.04) and from 3.23+/-1.55 to 2.0+/-0.88 (P<0.05), respectively. However, in the R(-) group, while ER showed a slight and statistically insignificant increase after CTx (from 2.51+/-1.23 to 2.65+/-1.86), DR increased significantly, from 2.74+/-1.37 to 3.27+/-2.31 (P<0.03). The percentage decreases in ER and DR in the R(+) group after CTx was significantly higher than that in the R(-) group: 34.36%+/-26.7% vs -13.78%+/-27.58% (P<0.0002) and 29.45%+/-25.23% vs -18.58%+/-20.51% (P<0.0005), respectively. Using a decrease of > or =10% as a threshold for monitoring the chemotherapeutic response, 99mTc-MIBI had a sensitivity of 90% and a specificity of 100%. We found a positive correlation in 14 patients between ER and DR and survival: r=0.6754 and P=0.008, and r=0.5755 and P=0.031, respectively. Our results suggest that 99mTc-MIBI might be used in routine practice to monitor the chemotherapeutic response in patients with primary lung cancer, especially when PET is not available.

Arginase and ornithine, as markers in human non-small cell lung carcinoma

The arginase activity and ornithine level were determined in tissue obtained from patients with non-small cell lung carcinoma (NSLC). The arginase activity and ornithine level in tumor tissues were 1.89 +/- 1.28 U/mg protein and 42.32 +/- 25.82 nmol/mg protein, respectively versus 0.67 +/- 0.19 U/mg protein and 10.12 +/- 3.69 nmol/mg protein for normal tissues (p < 0.01).

Effect of collateral circulation on healing of small intestinal anastomosis in rabbits

BACKGROUND/AIMS

In patients who have acute superior mesenteric artery occlusion and clearly gangrenous intestines, resection and anastomosis have been advised as the only surgical procedure. Distal and proximal bowel segments adjacent to this necrotic part have collateral blood supply although they have normal macroscopic appearance. After resection of necrotic segment, there will be a low flow at the anastomosis due to collateral circulation and the healing may therefore be impaired.

METHODOLOGY

This situation was investigated in rabbits creating unilateral collateral circulation at the small bowel anastomosis. Bursting pressure, tissue hydroxyproline concentration and bursting sites were determined on days 4, 8, and 12. Findings were compared with the those of normal anastomosis.

RESULTS

There was significantly decreased mean bursting pressure(106 +/- 40.3 mmHg) in unilateral collateral circulation group as compared with the that of control group (158 +/- 26.6 mmHg) on day 8 (p < 0.05). On the same day mean hydroxyproline concentration of this group was also lower(7.06 +/- 0.5 mg/g tissue) than the value of control group(7.69 +/- 0.4 mg/g tissue), with the statistical significance on the border line(p = 0.05). The low values of these two parameters reached normal levels on day 12. Bursting sites were mostly on the anastomotic line in unilateral collateral circulation group, while they were mostly on the bowel wall in the control group on day 8.

CONCLUSION

These findings suggest an insufficient healing process in the bowel anastomosis with unilateral collateral circulation on day 8 in rabbits.

Epidermoid tumor of the interhemispheric fissure

In this report, we present a case of an interhemispheric epidermoid presenting with generalized seizure. The tumor was demonstrated radiologically and discussed with the pertinent literature.

Primary Ewing's sarcoma of the temporal bone with intracranial, extracranial and intraorbital extension. Case report

Primary cranial Ewing's sarcoma is a very rare malignant tumor. Primary temporal bone Ewing's sarcoma with intraorbital extension is also a very rare condition. In this article we describe a case of primary Ewing's sarcoma of the temporal bone which extended into intracranial, extracranial and intraorbital compartments; manifesting with a swelling in the zygomatic fossa and proptosis of the right eye. The tumor was excised partially, and the patient underwent radiochemotherapy. The patient died 6 months after the therapy, with lung metastasis. The case is discussed with the pertinent literature.

Epidermoid tumor of the occipital bone

Intradiploic epidermoid tumor of the occipital bone was presented. There were neither intracranial extensions nor neurologic deficits. The lesion started as a painless mass under the scalp. The total removal of the tumor was associated with a good prognosis.

Epidermoid cyst of the brain stem. Case report

Brain stem epidermoid cysts are extremely rare lesions. Only nine cases have been reported. Management of the epidermoid cyst is decompression of cyst contents and removal of cyst capsule. But in some cases resection of the cyst may result in a poor outcome because of cyst wall adhesion into the brain stem.