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Masuda S, Fukasawa T, Takeuchi M, Arai K, Fujibayashi S, Otsuki B, Murata K, Shimizu T, Matsuda S, Kawakami K. Are Dental Procedures Associated With Pyogenic Vertebral Osteomyelitis? Clin Orthop Relat Res 2024; 482:716-723. [PMID: 37768869 PMCID: PMC10936976 DOI: 10.1097/corr.0000000000002871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Dental procedures can lead to bacteremia and have been considered a potential risk factor for pyogenic vertebral osteomyelitis (PVO). However, data on the association between dental procedures and PVO are limited. QUESTIONS/PURPOSES (1) After controlling for relevant confounding variables, are dental procedures associated with an increased risk of PVO? (2) Does antibiotic prophylaxis before dental procedures effectively decrease the risk of PVO? METHODS A case-crossover study was conducted to investigate the association between dental procedures and PVO using a Japanese claims database. The advantage of this study design is that confounding factors that do not vary over time are automatically adjusted for, because cases act as their own controls. From April 2014 to September 2021, the database included 8414 patients who were hospitalized for PVO. Of these, 50% (4182 of 8414) were excluded because they had not undergone any dental procedures before the index date, a further 0.1% (10 of 8414) were excluded because they were younger than 18 years at the index date, and a further 7% (623 of 8414) were excluded because they did not have at least 20 weeks of continuous enrollment before the index date, leaving 43% (3599 of 8414) eligible for analysis here. The mean age was 77 ± 11 years, and 55% (1985 of 3599) were men. Sixty-five percent (2356 of 3599) of patients had a diagnosis of diabetes mellitus, and 42% (1519 of 3599) of patients had a diagnosis of osteoporosis. We compared the frequency of dental procedures between a 4-week hazard period before the admission date for PVO and two control periods, 9 to 12 weeks and 17 to 20 weeks before the admission date for PVO, within individuals. We calculated odds ratios and 95% confidence intervals using conditional logistic regression analysis. RESULTS Comparing the hazard and matched control periods within individuals demonstrated that dental procedures were not associated with an increased risk of PVO (OR 0.81 [95% CI 0.72 to 0.92]; p < 0.001). Additional analysis stratified by antibiotic prophylaxis use showed that antibiotic prophylaxis was not associated with a lower OR of developing PVO after dental procedures (with antibiotic prophylaxis: OR 1.11 [95% CI 0.93 to 1.32]; p < 0.26, without antibiotic prophylaxis: OR 0.72 [95% CI 0.63 to 0.83]; p < 0.001). Our sensitivity analyses, in which the exposure assessment interval was extended from 4 to 8 or 12 weeks and exposure was stratified by whether the dental procedure was invasive, demonstrated results that were consistent with our main analysis. CONCLUSION Dental procedures were not associated with an increased risk of subsequent PVO in this case-crossover study. The effectiveness of antibiotic prophylaxis was not demonstrated in the additional analysis that categorized exposure according to the use of antibiotic prophylaxis. Our results suggest that the association between dental procedures and PVO may have been overestimated. Maintaining good oral hygiene may be important in preventing the development of PVO. The indications for antibiotic prophylaxis before dental procedures should be reconsidered in view of the potential risk of adverse drug reactions to antibiotic prophylaxis and the emergence of drug-resistant pathogens. Larger randomized controlled trials are needed to confirm these findings and assess the role of antibiotic prophylaxis. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Korenori Arai
- Department of Oral Implantology, Osaka Dental University, Hirakata, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Yang F, Liu Z, Li P, Zhu Q, He Q, Liang Y, Zhang B. Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case-Control Study. Orthop Surg 2023; 15:3209-3222. [PMID: 37880194 PMCID: PMC10694026 DOI: 10.1111/os.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Pulmonary embolism, cardiac embolism, and even cerebral embolism due to paraspinal vein leakage (PVL) are increasingly reported, and their risk factors need to be adequately investigated for prevention. To this end, this study investigated the correlation of the distribution and morphological characteristics of fracture lines with the occurrence of PVL after percutaneous vertebroplasty (PVP), which has not been previously reported. METHODS Patients with acute single-segment thoracolumbar osteoporotic vertebral compression fractures (OVCFs) treated with PVP at our institution from January 2019 to July 2022 were selected for a matched case-control study. The case and control groups included those with and without PVL, respectively, matched at a 1:1 ratio based on general clinical characteristics. Additionally, fracture map and heatmap analysis was performed in both groups. In addition to the general clinical characteristics, the vertebral height ratio, puncture angle, delivery rate, and indexes were assessed via the three-dimensional CT reconstruction fracture line mapping technique, namely, the distribution of fracture lines, fracture line length, main fracture line shape, location of fracture line involvement, and number of fracture line branches, were compared between the two groups. The Wilcoxon rank-sum test, t tests, analysis of variance, and conditional logistic regression were used for statistical analysis. RESULTS Among 658 patients with OVCFs, 54 who did and 54 who did not develop PVL were included in this study. Significant differences in the puncture angle, fracture line distribution (MR-1, ML-2, MM-2, MR-2, ML-3, MM-3, LL-1, LM-1, LL-2, LM-2), fracture line involvement of the posterior wall, total fracture line length, and main fracture line length were found between the two groups (p < 0.05). Logistic univariate analysis showed significant differences in the puncture angle, fracture line distribution (MR-1, ML-2, MM-2, MR-2, ML-3, MM-3, LL-1, LL-2, LM-2, LL-3), total fracture line length, main fracture line length, and fracture line involvement of the posterior wall between the two groups (p < 0.05). Logistic multifactorial analysis showed that the fracture line distribution (UR-3, ML-3, LM-2, LR-2) and main fracture line length were independent risk factors for the development of PVL in both groups. In addition, the fracture maps and heatmaps showed a greater degree of fracture line encapsulation and more extensive involvement in the middle and lower regions of the vertebral body in the PVL group than in the control group. CONCLUSIONS Through a three-dimensional computed tomography reconstruction-based fracture line mapping technique, this study revealed for the first time that the distribution of fracture lines (UR-3, ML-3, LM-2, LR-2) and main fracture line length were independent risk factors for PVL after PVP in patients with acute single-segment thoracolumbar OVCFs. In addition, we hypothesized that the fracture line-vein traffic branch that may appear within 2 weeks after injury in acute OVCF patients may be one of the mechanisms influencing the above potential independent risk factors associated with PVL.
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Affiliation(s)
- Fan Yang
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Zhengang Liu
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Pengfu Li
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Qingsan Zhu
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | | | | | - Boyin Zhang
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunChina
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Paxson AI, Chang LH, Gard JMC, Harryman WL, Nelson CS, Salmon SB, Marr KD, Wachsmuth LM, Ramanathan A, Ran J, Kapoor A, Marugan JJ, Henderson MJ, Sanchez TW, Cress AE. Phenotype plasticity and altered sensitivity to chemotherapeutic agents in aggressive prostate cancer cells. Front Cell Dev Biol 2023; 11:1285372. [PMID: 38046670 PMCID: PMC10690371 DOI: 10.3389/fcell.2023.1285372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
In 2023, approximately 288,300 new diagnoses of prostate cancer will occur, with 34,700 disease-related deaths. Death from prostate cancer is associated with metastasis, enabled by progression of tumor phenotypes and successful extracapsular extension to reach Batson's venous plexus, a specific route to the spine and brain. Using a mouse-human tumor xenograft model, we isolated an aggressive muscle invasive cell population of prostate cancer, called DU145J7 with a distinct biophysical phenotype, elevated histone H3K27, and increased matrix metalloproteinase 14 expression as compared to the non-aggressive parent cell population called DU145WT. Our goal was to determine the sensitivities to known chemotherapeutic agents of the aggressive cells as compared to the parent population. High-throughput screening was performed with 5,578 compounds, comprising of approved and investigational drugs for oncology. Eleven compounds were selected for additional testing, which revealed that vorinostat, 5-azacitidine, and fimepinostat (epigenetic inhibitors) showed 2.6-to-7.5-fold increases in lethality for the aggressive prostate cancer cell population as compared to the parent, as judged by the concentration of drug to inhibit 50% cell growth (IC50). On the other hand, the DU145J7 cells were 2.2-to-4.0-fold resistant to mitoxantrone, daunorubicin, and gimatecan (topoisomerase inhibitors) as compared to DU145WT. No differences in sensitivities between cell populations were found for docetaxel or pirarubicin. The increased sensitivity of DU145J7 prostate cancer cells to chromatin modifying agents suggests a therapeutic vulnerability occurs after tumor cells invade into and through muscle. Future work will determine which epigenetic modifiers and what combinations will be most effective to eradicate early aggressive tumor populations.
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Affiliation(s)
- Allan I. Paxson
- Partnership for Native American Cancer Prevention, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Loren H. Chang
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Jaime M. C. Gard
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - William L. Harryman
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Colin S. Nelson
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Stella B. Salmon
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Kendra D. Marr
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
- Medical Scientist Training MD/PhD Program, College of Medicine Tucson, University of Arizona, Tucson, AZ, United States
| | - Leah M. Wachsmuth
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Anita Ramanathan
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Jing Ran
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Abhijeet Kapoor
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Juan J. Marugan
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Mark J. Henderson
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Tino W. Sanchez
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, United States
| | - Anne E. Cress
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, United States
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Yang H, Wei XS, Gong J, Du XM, Feng HB, Su C, Gilmore C, Yue C, Yu SB, Li C, Sui HJ. The relationship between myodural bridge, atrophy and hyperplasia of the suboccipital musculature, and cerebrospinal fluid dynamics. Sci Rep 2023; 13:18882. [PMID: 37919345 PMCID: PMC10622500 DOI: 10.1038/s41598-023-45820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
The Myodural Bridge (MDB) is a physiological structure that is highly conserved in mammals and many of other tetrapods. It connects the suboccipital muscles to the cervical spinal dura mater (SDM) and transmits the tensile forces generated by the suboccipital muscles to the SDM. Consequently, the MDB has broader physiological potentials than just fixing the SDM. It has been proposed that MDB significantly contributes to the dynamics of cerebrospinal fluid (CSF) movements. Animal models of suboccipital muscle atrophy and hyperplasia were established utilizing local injection of BTX-A and ACE-031. In contrast, animal models with surgical severance of suboccipital muscles, and without any surgical operation were set as two types of negative control groups. CSF secretion and reabsorption rates were then measured for subsequent analysis. Our findings demonstrated a significant increase in CSF secretion rate in rats with the hyperplasia model, while there was a significant decrease in rats with the atrophy and severance groups. We observed an increase in CSF reabsorption rate in both the atrophy and hyperplasia groups, but no significant change was observed in the severance group. Additionally, our immunohistochemistry results revealed no significant change in the protein level of six selected choroid plexus-CSF-related proteins among all these groups. Therefore, it was indicated that alteration of MDB-transmitted tensile force resulted in changes of CSF secretion and reabsorption rates, suggesting the potential role that MDB may play during CSF circulation. This provides a unique research insight into CSF dynamics.
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Affiliation(s)
- Heng Yang
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Xiao-Song Wei
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Jin Gong
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Xue-Mei Du
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hong-Bo Feng
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chang Su
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | | | - Chen Yue
- Department of Gynecology ands Obstetrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Sheng-Bo Yu
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Chan Li
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China.
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China.
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Jiang T, Aji T, Ran B, Guo Q, Zhang R, Ahan A, Abulizi A, Tuergan T, Shao Y, Wen H. Collateral circulation caused by end-stage hepatic alveolar echinococcosis. BMC Infect Dis 2023; 23:322. [PMID: 37189056 DOI: 10.1186/s12879-022-07970-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (HAE), as a benign parasitic disease with malignant infiltrative activity, grows slowly in the liver, allowing sufficient time for collateral vessels to emerge in the process of vascular occlusion. METHODS The portal vein (PV), hepatic vein and hepatic artery were observed by enhanced CT and the inferior vena cava (IVC) by angiography, respectively. Analysis of the anatomical characteristics of the collateral vessels helped to look into the pattern and characteristics of vascular collateralization caused by this specific etiology. RESULTS 33, 5, 12 and 1 patients were included in the formation of collateral vessels in PV, hepatic vein, IVC and hepatic artery, respectively. PV collateral vessels were divided into two categories according to different pathways: type I: portal -portal venous pathway (13 cases) and type II: type I incorporates a portal-systemic circulation pathway (20 cases). Hepatic vein (HV) collateral vessels fell into short hepatic veins. The patients with IVC collateral presented with both vertebral and lumbar venous varices. Hepatic artery collateral vessels emanating from the celiac trunk maintains blood supply to the healthy side of the liver. CONCLUSIONS Due to its special biological nature, HAE exhibited unique collateral vessels that were rarely seen in other diseases. An in-depth study would be of great help to improve our understanding related to the process of collateral vessel formation due to intrahepatic lesions and its comorbidity, in addition to providing new ideas for the surgical treatment of end-stage HAE.
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Affiliation(s)
- Tiemin Jiang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
- The First Clinical Medical College of Xinjiang Medical University, Urumqi, 830054, China
| | - Tuerganaili Aji
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Bo Ran
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Guo
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Ruiqing Zhang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ayifuhan Ahan
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Abuduaini Abulizi
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Talaiti Tuergan
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Yingmei Shao
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China.
- Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China.
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.
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Zhang XH, Gong J, Song Y, Hack GD, Jiang SM, Yu SB, Song X, Zhang J, Yang H, Cheng J, Sui HJ, Zheng N. An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex. Clin Anat 2023. [PMID: 37096831 DOI: 10.1002/ca.24048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/11/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
The suboccipital cavernous sinus (SCS) and the myodural bridge complex (MDBC) are both located in the suboccipital region. The SCS is regarded as a route for venous intracranial outflow and is often encountered during surgery. The MDBC consists of the suboccipital muscles, nuchal ligament, and myodural bridge and could be a power source for cerebrospinal fluid circulation. Intracranial pressure depends on intracranial blood volume and the cerebrospinal fluid. Since the SCS and MDBC have similar anatomical locations and functions, the aim of the present study was to reveal the relationships between them and the detailed anatomical characteristics of the SCS. The study involved gross dissection, histological staining, P45 plastination, and three-dimensional visualization techniques. The SCS consists of many small venous sinuses enclosed within a thin fibrous membrane that is strengthened by a fibrous arch closing the vertebral artery groove. The venous vessels are more abundant in the lateral and medial portions of the SCS than the middle portion. The middle and medial portions of the SCS are covered by the MDBC. Type I collagen fibers arranged in parallel and originating from the MDBC terminate on the SCS either directly or indirectly via the fibrous arch. The morphological features of SCS revealed in this research could serve as an anatomical basis for upper neck surgical procedures. There are parallel arrangements of type I collagen fibers between the MDBC and the SCS. The MDBC could change the blood volume in the SCS by pulling its wall during the head movement.
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Affiliation(s)
- Xu-Hui Zhang
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Jin Gong
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Yang Song
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Gary D Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of dentistry, Baltimore, USA
| | - Si-Meng Jiang
- Postgraduate Training Base, The 967 Hospital of the Joint Logistics Support Force, Jinzhou Medical University, Dalian, China
| | - Sheng-Bo Yu
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Xue Song
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Jing Zhang
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Heng Yang
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Jing Cheng
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, China
- Dalian Hoffen Preservation Technique Institution, Dalian, China
| | - Nan Zheng
- Department of Anatomy, Dalian Medical University, Dalian, China
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Fiorenza V, Ascanio F, Brunasso L, Lo Duca B, Fimognari AM, Grippi L, Giovannini EA, Maugeri R, Iacopino DG. Nuance in Craniovertebral Junction Surgical Approach for Posterior C1-C2 Harms Stabilization: "Window Transposition" of the External Vertebral Venous Plexus for Bloodless C1 Lateral Mass Screw Insertion: Anatomical Aspects and Technical Notes. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:307-313. [PMID: 38153486 DOI: 10.1007/978-3-031-36084-8_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Atlas and axis instrumentation may be necessary in cases of several craniocervical junction pathologies. According to the Harms technique, C1-C2 polyaxial screws are inserted respectively in the C1 lateral masses and in C2 pedicles. C1 lateral mass screw insertion requires the careful subperiosteal dissection of the posterior elements of C1, the identification of the screw entry point by the downward distraction of C2 nerve root, and the cautious sparing of the overlying posterior external vertebral venous plexus (peVVP), whose bleeding, obstructing the surgical field, is sometimes barely controlled by hemostatic agents and swabbing. The authors describe in detail the anatomical aspects of an alternative surgical technique developed for the microsurgical transposition of the C1-C2 interposed external vertebral venous plexus in the case of Harms C1-C2 screw stabilization. The longitudinal median incision of the atlantoaxial membrane, followed by bilateral subperiosteal dissection and microsurgical section respectively at the inferior borders of the C1 laminae and at the superior borders of the C2 laminae, allows, as a "window opening," the symmetrical mediolateral transposition of the peVVP. This procedure provides a faster and cleaner anatomical exposition of the posterior surface of the C1 lateral mass and the C2 isthmus, preventing troublesome intraoperative venous bleeding that hinders C1 lateral mass screw insertion.
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Affiliation(s)
- Vito Fiorenza
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Francesco Ascanio
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Lara Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
| | - Benedetto Lo Duca
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Anna Maria Fimognari
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Luisa Grippi
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Evier Andrea Giovannini
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
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Li H, Zhang W, Xia M. Pancreatic carcinoma with pelvic metastasis: A case report. Asian J Surg 2023; 46:661-662. [PMID: 35918223 DOI: 10.1016/j.asjsur.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Hui Li
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, 214023, China
| | - Wenjia Zhang
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, 214023, China
| | - Min Xia
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, 214023, China.
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9
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Bone Metastasis in Bladder Cancer. J Pers Med 2022; 13:jpm13010054. [PMID: 36675715 PMCID: PMC9864951 DOI: 10.3390/jpm13010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Bladder cancer (BCa) is the 10th most common and 13th most deadly malignancy worldwide. About 5% of BCa patients present initially with metastatic disease, with bone being the most diagnosed site for distant metastasis. The overall one-year survival of patients with BCa is 84%, whereas it is only 21% in patients with bone metastasis (BM). Metastasis of BCa cells to bone occurs by epithelial-to-mesenchymal transition, angiogenesis, intravasation, extravasation, and interactions with the bone microenvironment. However, the mechanism of BCa metastasis to the bone is not completely understood; it needs a further preclinical model to completely explain the process. As different imaging mechanisms, PET-CT cannot replace a radionuclide bone scan or an MRI for diagnosing BM. The management of BCa patients with BM includes chemotherapy, immunotherapy, targeted therapy, antibody-drug conjugates, bisphosphonates, denosumab, radioisotopes, and surgery. The objective of these treatments is to inhibit disease progression, improve overall survival, reduce skeletal-related events, relieve pain, and improve the quality of life of patients.
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10
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Passerini M, Maamari J, Nayfeh T, Hassett LC, Tande AJ, Murad MH, Temesgen Z, Berbari EF. Early switch to oral antibiotic therapy for the treatment of patients with bacterial native vertebral osteomyelitis: a quaternary center experience, systematic review, and meta-analysis. J Bone Jt Infect 2022; 7:249-257. [DOI: 10.5194/jbji-7-249-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract. Recent data suggest that oral therapy can be effective for bone infections.
We aim to assess the efficacy of an early switch to oral therapy (<2 weeks) compared to a non-early switch in bacterial native vertebral
osteomyelitis. We conducted a cohort study at Mayo Clinic, Rochester (MN),
between 2019–2021 combined with a systematic review, which queried multiple
databases. Data were analyzed using a random-effects model. The cohort study
included 139 patients: two received an early switch. Of 3708 citations, 13
studies were included in the final analysis. Meta-analysis demonstrated no
difference in treatment failure (odds ratio = 1.073, 95 % confidence
interval 0.370–3.116), but many studies presented high risk of bias. Current
evidence is insufficient to conclude the proportion of patients with failure
or relapse is different in the two groups. High-quality studies are
warranted before early switch can be routinely recommended.
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11
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Muacevic A, Adler JR, Pikoulis E, Tomos P, Nastos C. Synchronous Sternal Metastasectomy and Total Thyroidectomy for Differentiated Thyroid Cancer: A Rare Case Report. Cureus 2022; 14:e31294. [PMID: 36514611 PMCID: PMC9733711 DOI: 10.7759/cureus.31294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
Bone metastases from thyroid cancer are mainly rare, while sternal metastases are extremely uncommon. Bone metastases might be either synchronous or metachronous to primary thyroid cancer. A 60-year-old male patient presented to our department with a painful, fixed and firm sternal mass. Preoperative imaging studies, such as neck ultrasound (US) and computed tomography (CT) of the chest, revealed a 6.5 cm nodule of the right thyroid lobe with high-risk malignancy characteristics and a massive metastatic mass of the anterior mediastinal, which was extended from the sternal notch to the third intercostal space. The diagnosis of papillary thyroid carcinoma with sternal metastatic lesions was established. After meticulous discussion in the multidisciplinary board of our hospital, a total thyroidectomy plus en-bloc resection of this massive sternal metastasis and adjuvant radioiodine therapy were decided. Eight months postoperatively, no recurrence has occurred in this patient. R0 resection of isolated bone metastasis of thyroid origin is still an optimal therapeutic decision for these patients. In cases of sternal metastasis, radical surgical resection with negative margins, including both resection of the lesion and reconstruction of the chest wall, in order to successfully maintain the chest wall's stability, is recommended.
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12
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Jiang W, Tan XY, Li JA, Dong M. Spontaneous Spinal Epidural Hematoma Complicated by Pulmonary Embolism During Pregnancy: A Case Report. Front Med (Lausanne) 2022; 9:832693. [PMID: 35402434 PMCID: PMC8990125 DOI: 10.3389/fmed.2022.832693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Spontaneous spinal epidural hematoma, without discernable underlying conditions, is considered a neurological emergency, and is rare during pregnancy. Case Presentation We report the case of a 24-year-old patient at 37 weeks of gestation. She had back pain that progressed to paraplegia of both lower limbs within 2 days. Thoracic magnetic resonance imaging revealed a lesion behind the spinal cord at the T5–T6 level, suggestive of spontaneous spinal epidural hematoma. Due to the rapid recovery of muscle strength in her lower limbs after an emergency cesarean section, we used methylprednisolone therapy to reduce spinal edema rather than decompression of the spinal canal. We incidentally found that the patient’s left pulmonary artery was occluded. In consideration of spontaneous spinal epidural hematoma as relative contraindication to anticoagulation, and in the absence of pulmonary embolism symptoms, including good partial oxygen pressure, we did not administer anticoagulant therapy. The patient’s condition improved rapidly in the following week. Conclusion Spontaneous spinal epidural hematoma concomitant with pulmonary artery embolism is an extremely rare manifestation during pregnancy. As exemplified by our case, desirable treatment outcomes are possible under such cases.
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Affiliation(s)
- Wei Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xuan-Yu Tan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jia-Ai Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Ming Dong
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Ming Dong,
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13
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Spinal vascular lesions: anatomy, imaging techniques and treatment. Eur J Radiol Open 2021; 8:100369. [PMID: 34307789 PMCID: PMC8283341 DOI: 10.1016/j.ejro.2021.100369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Vascular myelopathies include different aetiology and mechanism of damage. The level of the lesion and the localization within the SC correlates with the clinical symptoms. CT, MRI and angiography are essential for diagnosis and treatment playing a complementary role. MRI is the gold standard for the evaluation of spinal cord lesions. Spinal angiography is the gold standard for evaluation of spinal cord vasculature and vascular malformations.
Background Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage. Purpose The aim is to provide a comprehensive review on the radiological features of the most common vascular myelopathies, passing through the knowledge of the vascular spinal anatomy and the clinical aspects of the different aetiologies, which is crucial to promptly address the diagnosis and the radiological assessment.
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14
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MacPhee R, Del Pino SH, Kramarz A, Forasiepi AM, Bond M, Sulser RB. Cranial Morphology and Phylogenetic Relationships of Trigonostylops wortmani, an Eocene South American Native Ungulate. BULLETIN OF THE AMERICAN MUSEUM OF NATURAL HISTORY 2021. [DOI: 10.1206/0003-0090.449.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R.D.E. MacPhee
- Department of Mammalogy/Vertebrate Zoology and Richard Gilder Graduate School, American Museum of Natural History
| | | | - Alejandro Kramarz
- Sección Paleontología de Vertebrados, Museo Argentino de Ciencias Naturales Bernardino Rivadavia, CONICET, Buenos Aires, Argentina
| | | | - Mariano Bond
- Departamento Científico de Paleontología Vertebrados, Museo de La Plata, Paseo del Bosque s/n, 1900 La Plata, Argentina
| | - R. Benjamin Sulser
- Department of Mammalogy/Vertebrate Zoology and Richard Gilder Graduate School, American Museum of Natural History
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15
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Mohammadyari P, Gadda G, Taibi A. Modelling physiology of haemodynamic adaptation in short-term microgravity exposure and orthostatic stress on Earth. Sci Rep 2021; 11:4672. [PMID: 33633331 PMCID: PMC7907254 DOI: 10.1038/s41598-021-84197-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular haemodynamics alters during posture changes and exposure to microgravity. Vascular auto-remodelling observed in subjects living in space environment causes them orthostatic intolerance when they return on Earth. In this study we modelled the human haemodynamics with focus on head and neck exposed to different hydrostatic pressures in supine, upright (head-up tilt), head-down tilt position, and microgravity environment by using a well-developed 1D-0D haemodynamic model. The model consists of two parts that simulates the arterial (1D) and brain-venous (0D) vascular tree. The cardiovascular system is built as a network of hydraulic resistances and capacitances to properly model physiological parameters like total peripheral resistance, and to calculate vascular pressure and the related flow rate at any branch of the tree. The model calculated 30.0 mmHg (30%), 7.1 mmHg (78%), 1.7 mmHg (38%) reduction in mean blood pressure, intracranial pressure and central venous pressure after posture change from supine to upright, respectively. The modelled brain drainage outflow percentage from internal jugular veins is 67% and 26% for supine and upright posture, while for head-down tilt and microgravity is 65% and 72%, respectively. The model confirmed the role of peripheral veins in regional blood redistribution during posture change from supine to upright and microgravity environment as hypothesized in literature. The model is able to reproduce the known haemodynamic effects of hydraulic pressure change and weightlessness. It also provides a virtual laboratory to examine the consequence of a wide range of orthostatic stresses on human haemodynamics.
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Affiliation(s)
- Parvin Mohammadyari
- Department of Physics and Earth Sciences, University of Ferrara, 44122, Ferrara, Italy
| | - Giacomo Gadda
- National Institute for Nuclear Physics (INFN), Section of Ferrara, 44122, Ferrara, Italy.
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, 44122, Ferrara, Italy
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16
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Cazzato F, D'Ercole A, De Luca G, Aiello FB, Croce A. Neck subcutaneous nodule as first metastasis from broad ligament leiomyosarcoma: a case report and review of literature. BMC Surg 2020; 20:297. [PMID: 33238975 PMCID: PMC7687730 DOI: 10.1186/s12893-020-00951-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Leiomyosarcoma usually develops in the myometrium and is characterized by a high recurrence rate, frequent hematogenous dissemination, and poor prognosis. Metastasis is usually to lungs, liver, and bone, and occasionally to the brain, but seldom to the head and neck region. Primary leiomyosarcoma very rarely arises in the broad ligament. Case presentation A 54-year old woman presented to the otolaryngology department with a mass in the right posterior region of the neck 4 years after surgery for a primary leiomyosarcoma of the right broad ligament. The neck mass was removed and found to be a metastatic leiomyosarcoma. Leiomyosarcoma localizations in lungs and liver were absent. Morphological examination showed both the primary and the secondary leiomyosarcomas to have features of low-grade tumors. One year after excision of the neck mass, the patient presented with tachycardia. Echocardiography detected two intracardiac nodules suggestive of metastatic tumors. Chemotherapy was administered; the disease has been stable since then. Conclusions We report the first case of broad ligament leiomyosarcoma with the neck subcutaneous region being the first site of secondary involvement. We speculate that the Batson venous plexus might have been the pathway of dissemination.
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Affiliation(s)
- Fiorella Cazzato
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Angela D'Ercole
- Surgical Pathology Unit, Santissima Annunziata Hospital, Chieti, Italy
| | - Graziano De Luca
- Clinical Pathology Unit, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Francesca B Aiello
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Adelchi Croce
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy.
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17
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Kosugi K, Yamada Y, Yamada M, Yokoyama Y, Fujiwara H, Yoshida K, Yoshida K, Toda M, Jinzaki M. Posture-induced changes in the vessels of the head and neck: evaluation using conventional supine CT and upright CT. Sci Rep 2020; 10:16623. [PMID: 33024196 PMCID: PMC7538893 DOI: 10.1038/s41598-020-73658-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022] Open
Abstract
Since the venous system is affected by gravity, upright computed tomography (CT) in addition to conventional supine CT has great potential for evaluating postural changes in the venous system. We evaluated the morphological differences in the head and neck vessels by performing a contrast CT study in both the supine and the sitting positions. In this study, the 20 included participants (10 men and 10 women) were healthy adults aged 30 to 55 years. The cross-sectional area of the cervical vessels, craniocervical junction veins, and intracranial vessels were obtained quantitatively. Venous sinuses and venous plexuses that were difficult to measure were evaluated qualitatively. The average change in areas from a supine to an upright posture was - 77.87 ± 15.99% (P < 0.0001) in the right internal jugular vein (IJV), - 69.42 ± 23.15% (P < 0.0001) in the left IJV, - 61.52 ± 12.81% (P < 0.0001) in the right external jugular vein (EJV), and - 58.91 ± 17.37% (P < 0.0001) in the left EJV. In contrast, the change in the anterior condylar vein (ACV) from a supine to an upright posture was approximately + 144% (P < 0.005) on the right side and + 110% (P < 0.05) on the left side. In addition, according to the qualitative analysis, the posterior venous structures including the anterior condylar confluence (ACC) of the craniocervical junction became more prominent in an upright posture. Despite these changes, the intracranial vessels showed almost no change between postures. From a supine to an upright position, the IJVs and EJVs above the heart collapsed, and venous channels including the ACCs and ACVs opened, switching the main cerebral venous drainage from the IJVs to the vertebral venous system. Upright head CT angiography can be useful for investigating physiological and pathophysiological hemodynamics of the venous system accompanying postural changes.
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Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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18
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Al-Sharydah AM, Al-Suhibani SS, Al-Muhanna AF, Al-Abdulwahhab AH. Spinal anastomosed remnant imprints of vertebral veins linking the transverse foramina: a case report of a novel anatomic variant of the cervical venous plexus. Surg Radiol Anat 2020; 43:109-115. [PMID: 32914224 DOI: 10.1007/s00276-020-02565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite various postulated classifications attempting to simplify the complex angioarchitecture of the cervical spine, the nomenclature of spinal variants and lesions remains inconsistent. Knowledge of variations in the anatomy of the vertebral veins will assist in avoiding complications during neck surgery and procedures such as vertebroplasty. In addition, venous variants may act as a route for the spread of infection, emboli, or metastases. Therefore, we report a novel variant encountered at our institution in this case report. METHODS We coincidentally discovered an original anatomical variant of the cervical venous plexus linking the transverse foramina in a Saudi man. RESULTS We termed the variant "spinal anastomosed remnant imprints" (SARI), guided by the second edition of Terminologia Embryologica, a project of the Federative International Programme for Anatomical Terminology. This variant anastomoses with the vertebral veins at the same level, forming segmented osseous impressions. It shares a topographical relationship with the embryonic anterior cardinal veins, which normally regress in the prenatal period. We hypothesize that these intersegmental anastomosing veins do not always regress and may persist into adulthood, with individualized variations of the venous circulation. CONCLUSION This report highlights an important finding of interpersonal anatomical variation of veins in the cervical spine, discovered with the aid of advanced imaging to distinguish it from pathological conditions. This will be of assistance to radiologists, anatomists, and clinicians in decision-making and to surgeons in planning for neck surgery.
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Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, P.O. Box: 31952, AlKhobar City, Eastern Province, Saudi Arabia
| | - Sari Saleh Al-Suhibani
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, P.O. Box: 31952, AlKhobar City, Eastern Province, Saudi Arabia
| | - Asma Fahd Al-Muhanna
- Anatomy and Embryology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City, Eastern Province, Saudi Arabia
| | - Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, P.O. Box: 31952, AlKhobar City, Eastern Province, Saudi Arabia.
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19
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Sharfman ZT, Gelfand Y, Shah P, Holtzman AJ, Mendelis JR, Kinon MD, Krystal JD, Brook A, Yassari R, Kramer DC. Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implications. Asian Spine J 2020; 14:742-759. [PMID: 32718133 PMCID: PMC7595828 DOI: 10.31616/asj.2019.0369] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Spinal epidural abscess (SEA) is a rare condition associated with significant morbidity and mortality. Despite advances in diagnostic medicine, early recognition of SEAs remains elusive. The vague presentation of the disease, coupled with its numerous risk factors, the diagnostic requirement for obtaining advanced imaging, and the necessity of specialized care constitute extraordinary challenges to both diagnosis and treatment of SEA. Once diagnosed, SEAs require urgent or emergent medical and/or surgical management. As SEAs are a relatively rare pathology, high-quality data are limited and there is no consensus on their optimal management. This paper focuses on presenting the treatment modalities that have been successful in the management of SEAs and providing a critical assessment of how specific SEA characteristics may render one infection more amenable to primary surgical or medical interventions. This paper reviews the relevant history, epidemiology, clinical presentation, radiology, microbiology, and treatment of SEAs and concludes by addressing the medicolegal implications of delayed treatment of the disease.
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Affiliation(s)
- Zachary Tuvya Sharfman
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pryiam Shah
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ari Jacob Holtzman
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joseph Roy Mendelis
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merritt Drew Kinon
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan David Krystal
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Allan Brook
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Claude Kramer
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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20
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D'Abadie P, Ghaye B, Jamar F. Vertebral uptake of 99mTc-macroaggregated albumin during lung perfusion scanning. World J Nucl Med 2020; 19:271-272. [PMID: 33354184 PMCID: PMC7745876 DOI: 10.4103/wjnm.wjnm_44_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/23/2019] [Indexed: 11/08/2022] Open
Abstract
A 53-year-old female underwent a lung ventilation/perfusion scintigraphy (V/Q scan) in the workup of extensive thrombosis of the left subclavian and internal jugular veins. The perfusion lung scan visualized an atypical uptake in the thoracic vertebrae. A chest Computed Tomography (CT) scan demonstrated unusual tortuous and opacified thoracic superficial veins, collaterals of the lateral thoracic vein. Many venous collateral pathways can be developed in the case of superior vena cava syndrome. 99mTc-macroaggregated albumin particles may pass through the lateral thoracic vein and eventually through the vertebral venous plexus before being finally trapped by the vertebral capillaries. Besides right-to-left shunting, extrapulmonary uptake in the lung perfusion scintigraphy is very rare and may be used by collateral venous pathways.
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Affiliation(s)
- Philippe D'Abadie
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium
| | - Benoit Ghaye
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium
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21
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Abstract
STUDY DESIGN Case control series. OBJECTIVE The aim of this study was to evaluate and compare the effectiveness of methods to decrease surgical site infections (SSIs) following spine tumor surgery. SUMMARY OF BACKGROUND DATA With the aging population of the United States, the prevalence of cancer and associated metastatic spine disease is increasing. The most common complication of spine tumor surgery is SSI. METHODS This a single-institution case-control series of patients undergoing spine tumor surgery from June 2003 to October 2018. Patients were grouped into the following groups: Betadine irrigation and intrawound vancomycin powder (BIVP), intrawound vancomycin powder only (IVP), and patients receiving neither (NONE). The primary outcome was SSIs/wound complications. RESULTS One hundred fifty-one spine tumor patients undergoing 174 procedures meeting our inclusion criteria were identified. The BIVP group had 60 patients (73 procedures); the IVP group had 46 patients (47 procedures); and the NONE group had 45 patients (54 procedures). The overall infection rate was 8.6% of all procedures (15/174) and 9.9% (15/151) of all patients. Bivariate analysis comparing patients with and without infections noted the patients with SSIs had significantly higher rates of preoperative radiation treatment (53.3% in infection group vs. 25.5% in noninfection group), P = 0.02. Patients undergoing procedures in the BIVP group had a significantly lower rate of infections (2.7%) than the patients in the IVP (12.8%) and NONE (13%) groups, P = 0.04. Stepwise regression analysis was used to evaluate further factors associated with SSIs. Elevated BMI was significantly associated with SSIs in the model [P = 0.02, odds ratio (OR) 1.14]. BIVP was also protective against infections as compared to the IVP and NONE groups, P = 0.02, OR 0.02. CONCLUSION BIVP led to a significant decrease in SSI rates following spine tumor surgery. Administration of BIVP is not time consuming and decreased SSI rates. LEVEL OF EVIDENCE 3.
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22
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Freeman CW, Lazor JW, Loevner LA, Nabavizadeh SA. Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings. J Neuroimaging 2019; 29:673-688. [DOI: 10.1111/jon.12664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Colbey W. Freeman
- Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Jillian W. Lazor
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Laurie A. Loevner
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
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Unnithan AKA. A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0046-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Forasiepi AM, Macphee RD, Pino SHD. Caudal Cranium of Thylacosmilus atrox (Mammalia, Metatheria, Sparassodonta), a South American Predaceous Sabertooth. BULLETIN OF THE AMERICAN MUSEUM OF NATURAL HISTORY 2019. [DOI: 10.1206/0003-0090.433.1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Ross D.E. Macphee
- Department of Mammalogy, American Museum of Natural History, New York
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Depauw PRAM, Groen RJM, Van Loon J, Peul WC, Malbrain MLNG, De Waele JJ. The significance of intra-abdominal pressure in neurosurgery and neurological diseases: a narrative review and a conceptual proposal. Acta Neurochir (Wien) 2019; 161:855-864. [PMID: 30911831 PMCID: PMC6483957 DOI: 10.1007/s00701-019-03868-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/03/2019] [Indexed: 11/24/2022]
Abstract
Intra-abdominal pressure (IAP) is a physiological parameter that has gained considerable attention during the last few decades. The incidence of complications arising from increased IAP, known as intra-abdominal hypertension (IAH) or abdominal compartment syndrome in critically ill patients, is high and its impact is significant. The effects of IAP in neurological conditions and during surgical procedures are largely unexplored. IAP also appears to be relevant during neurosurgical procedures (spine and brain) in the prone position, and in selected cases, IAH may affect cerebrospinal fluid drainage after a ventriculoperitoneal shunt operation. Furthermore, raised IAP is one of the contributors to intracranial hypertension in patients with morbid obesity. In traumatic brain injury, case reports described how abdominal decompression lowers intracerebral pressure. The anatomical substrate for transmission of the IAP to the brain and venous system of the spine is the extradural neural axis compartment; the first reports of this phenomenon can be found in anatomical studies of the sixteenth century. In this review, we summarize the available knowledge on how IAP impacts the cerebrospinal venous system and the jugular venous system via two pathways, and we discuss the implications for neurosurgical procedures as well as the relevance of IAH in neurological disorders.
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Affiliation(s)
- Paul R A M Depauw
- Department of Neurosurgery, Elisabeth Tweesteden Hospital (ETZ), Tilburg, The Netherlands.
- Elisabeth Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes Van Loon
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center (LUMC) and The Hague Medical Center (HMC+), Leiden, The Netherlands
| | - Manu L N G Malbrain
- Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
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Ventilatory Strategies in the Brain-injured Patient. Int Anesthesiol Clin 2019; 56:131-146. [PMID: 29227316 DOI: 10.1097/aia.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Noh T, Zervos TM, Chen A, Chedid M. Treatment of a Staphylococcus lugdunensis cervical epidural abscess. BMJ Case Rep 2019; 12:12/3/e227449. [PMID: 30898958 DOI: 10.1136/bcr-2018-227449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
First reported in 1988, Staphylococcus lugdunensis is a virulent coagulase-negative Staphylococcus species often associated with endocarditis. This is the first case report describing this infection in the cervical spine. A 58-year-old, left-handed Caucasian woman with no significant medical history presented with neck and left arm pain. Neurological examination revealed mild left deltoid 4/5 weakness and myelopathy. She was found to have an epidural cervical spinal cord mass that was causing severe cord compression and underwent partial anterior cervical decompression of the mass. On entering what was believed to be the mass, yellow-tinged fluid was encountered. An abscess was immediately suspected, so the dura was not entered. The specimen sent for culture was identified a day later as S. lugdunensis A two-dimensional echocardiogram was negative for vegetations. A peripherally inserted central catheter line was placed and the patient discharged on 6 weeks of physical therapy and 6-8 weeks of intravenous cefazolin.
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Affiliation(s)
- Thomas Noh
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Anne Chen
- Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mokbel Chedid
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Recent Increase in the Rate of Spinal Infections May be Related to Growing Substance-use Disorder in the State of Washington: Wide Population-based Analysis of the Comprehensive Hospital Abstract Reporting System (CHARS) Database. Spine (Phila Pa 1976) 2019; 44:291-297. [PMID: 30059485 DOI: 10.1097/brs.0000000000002819] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Epidemiological study. OBJECTIVE The aim of this study was to evaluate trends in the incidence of spinal infections (SI) and the possible role of substance use disorder (SUD) as a key associated factor. SUMMARY OF BACKGROUND DATA SI pose major diagnostic and therapeutic challenge in developed countries, resulting in substantial morbidity and mortality. With an estimated incidence of up to 1:20,000, recent clinical experiences suggest that this rate may be rising. METHODS To evaluate a possible change in trend in the proportion of SI, we searched the Washington state Comprehensive Hospital Abstract Reporting System (CHARS) data during a period of 15 years. We retrieved ICD-9 and 10 codes, searching for all conditions that are regarded as SI (discitis, osteomyelitis, and intraspinal abscess), as well as major known SI-related risk factors. RESULTS We found that the proportion of SI among discharged patients had increased by around 40% during the past 6 years, starting at 2012 and increasing steadily thereafter. Analysis of SI-related risk factors within the group of SI revealed that proportion of SUD and malnutrition had undergone the most substantial change, with the former increasing >3-fold during the same period. CONCLUSION Growing rates of drug abuse, drug dependence, and malnutrition throughout the State of Washington may trigger a substantial increase in the incidence of spinal infections in discharged patients. These findings may provide important insights in planning prevention strategies on a broader level. LEVEL OF EVIDENCE 4.
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Bonsib SM. Urologic Diseases Germane to the Medical Renal Biopsy: Review of a Large Diagnostic Experience in the Context of the Renal Architecture and Its Environs. Adv Anat Pathol 2018; 25:333-352. [PMID: 30036201 PMCID: PMC6086223 DOI: 10.1097/pap.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The kidney is one of the most complicated organs in development and is susceptible to more types of diseases than other organs. The disease spectrum includes developmental and cystic diseases, involvement by systemic diseases, iatrogenic complications, ascending infections and urinary tract obstruction, and neoplastic diseases. The diagnosis of kidney disease is unique involving 2 subspecialties, urologic pathology and renal pathology. Both renal and urologic pathologists employ the renal biopsy as a diagnostic modality. However, urologic pathologists commonly have a generous specimen in the form of a nephrectomy or partial nephrectomy while a renal pathologist requires ancillary modalities of immunofluorescence and electron microscopy. The 2 subspecialties differ in the disease spectrum they diagnose. This separation is not absolute as diseases of one subspecialty not infrequently appear in the diagnostic materials of the other. The presence of medical renal diseases in a nephrectomy specimen is well described and recommendations for reporting these findings have been formalized. However, urologic diseases appearing in a medical renal biopsy have received less attention. This review attempts to fill that gap by first reviewing the perirenal anatomy to illustrate why inadvertent biopsy of adjacent organs occurs and determine its incidence in renal biopsies followed by a discussion of gross anatomic features relevant to the microscopic domain of the medical renal biopsy. Unsuspected neoplasms and renal cysts and cystic kidney diseases will then be discussed as they create a diagnostic challenge for the renal pathologist who often has limited training and experience in these diseases.
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Ignatowski TA, Spengler RN. Targeting tumor necrosis factor in the brain relieves neuropathic pain. World J Anesthesiol 2018; 7:10-19. [DOI: 10.5313/wja.v7.i2.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain is a chronic syndrome caused by direct damage to or disease of the somatosensory nervous system. The lack of safe, adequate and sustained pain relief offered by present analgesic treatments is most alarming. While many treatment options are available to manage chronic pain, such as antidepressants, non-steroidal anti-inflammatory agents, opioids, and anticonvulsants, chronic neuropathic pain remains largely unmanaged. Compounding the dilemma of ineffective chronic pain treatments is the need to provide relief from suffering and yet not contribute to the scourge of drug abuse. A recent epidemic of addiction and accidental drug prescription overdoses parallel the increased use of opioid treatment, even though opioids are rarely an effective treatment of relieving chronic pain. To make matters worse, opioids may contribute to exacerbating pain, and side-effects such as cognitive impairment, nausea, constipation, development of tolerance, as well as their potential for addiction and overdose deaths exist. Clearly, there is an urgent need for alternative, non-opiate treatment of chronic pain. Innovative discoveries of pertinent brain mechanisms and functions are key to developing effective, safe treatments. Pioneering work has revealed the essential effects of the pleiotropic mediator tumor necrosis factor (TNF) on brain functioning. These studies establish that TNF inhibits norepinephrine release from hippocampal neurons, and show that excess TNF production within the hippocampus occurs during neuropathic pain, which mobilizes additional mechanisms that further inhibit norepinephrine release. Significantly, it has been verified that elevated levels of TNF in the brain are actually required for neuropathic pain development. Since TNF decreases norepinephrine release in the brain, enhanced TNF levels would prevent engagement of the norepinephrine descending inhibitory neuronal pain pathways. Increased levels of TNF in the brain are therefore critical to the development of neuropathic pain. Therefore, strategies that decrease this enhanced TNF expression in the brain will have superior analgesic efficacy. We propose this novel approach of targeting the pathologically high levels of brain TNF as an effective strategy in the treatment of the devastating syndrome of chronic pain.
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Affiliation(s)
- Tracey A Ignatowski
- Department of Pathology and Anatomical Sciences and Program for Neuroscience, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, United States
- NanoAxis, LLC, Clarence, NY 14031, United States
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Malignant invasion of the central nervous system: the hidden face of a poorly understood outcome of prostate cancer. World J Urol 2018; 36:2009-2019. [PMID: 29980839 DOI: 10.1007/s00345-018-2392-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 12/25/2022] Open
Abstract
Malignancies of the central nervous system include primary brain tumors and brain metastases, the latter being the major cause of intracranial neoplasms in adults. Although prostate cancer (PCa) brain metastases are not the most common source, recent data show that the relevance of prostate cancer brain metastases (PCBM) cannot be neglected. In this review, we focus on the molecular repertory as well as on the phenotypical similarities between PCBM and primary PCa, such as the cellular evolution and the maintenance of androgen-receptor expression. Moreover, the simultaneous occurrence of PCBM with other PCa metastatic sites and the significance of the clinical heterogeneity of the disease are also discussed. In addition, a potential relationship between the heterogeneous behavior exhibited by PCBM and the co-occurrence of malignant cell clusters with distinct genetic profiles is also hypothesized, as well as the prominent role of astrocytes in the establishment of PCBM.
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AlTahan HA, Amer RR, Madani AA, Bakhsh EA. An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:694-698. [PMID: 29904039 PMCID: PMC6034556 DOI: 10.12659/ajcr.908793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Epidural venous plexus (EVP) engorgement occurs due to many conditions, so it can be easily misdiagnosed. This becomes problematic when the diagnosis requires prompt treatment for a good outcome, especially when it results in cauda equina syndrome (CES). We report a case of extensive iliocaval thrombosis leading to epidural venous plexus and ascending lumbar vein engorgement as an outcome of deep venous thrombosis (DVT) due to probable adverse effects of oral combined contraceptive pills (OCCP). CASE REPORT A 42-year-old woman presented to a rural medical facility with bilateral lower-limb swelling and skin darkening for 2 days. She was transferred to a tertiary medical facility where her condition deteriorated to severe CES. A lower-limbs ultrasonography confirmed the presence of extensive DVT extending to the lower segment of the inferior vena cava. Spine magnetic resonance imaging showed abnormal enhancement of the conus medullaris with thick enhanced cauda equina nerve roots, consistent with a possible case of Guillain-Barré syndrome. However, there was engorgement of the EVP extending to the ascending lumbar, azygos, and hemiazygos veins, which was misdiagnosed. The patient was managed immediately with low-molecular-weight heparin and steroids. She died 4 weeks after admission due to hospital-acquired pneumonia and acute respiratory distress syndrome, probably due to the high dose of steroids. CONCLUSIONS Acute CES has a wide differential diagnosis. This report describes an unusual cause of CES and emphasizes the importance of early recognition to avoid misdiagnosis and management delay. Early identification of this clinical entity markedly decreases morbidity and mortality and thus improves the prognosis. Likewise, underlying causing factors such as venous congestion due to OCCP-related DVT should be considered in the diagnosis.
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Affiliation(s)
- Husam A. AlTahan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Roaa R. Amer
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Areej A. Madani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman A. Bakhsh
- Department of Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
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Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery. Asian Spine J 2018; 12:459-465. [PMID: 29879773 PMCID: PMC6002161 DOI: 10.4184/asj.2018.12.3.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/14/2017] [Accepted: 11/01/2017] [Indexed: 11/17/2022] Open
Abstract
Study Design Randomized clinical trial. Purpose In this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding. Overview of Literature Bleeding is the most significant complication in patients undergoing spinal surgery. Methods We randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively. Results T-tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed (p =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group (p =0.056). Diabetic females had the highest bleeding amount between the groups (p =0.03). Bleeding was higher in patients with higher BMI (p =0.02) and was related to operative time (p =0.001) in both the groups. Conclusions Preoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose.
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Hibi A, Kasugai T, Kamiya K, Kamiya K, Kominato S, Ito C, Miura T, Koyama K. Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1357-1364. [PMID: 29259148 PMCID: PMC5745891 DOI: 10.12659/ajcr.905953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Spontaneous spinal epidural hematoma Symptoms: Abdominal pain • chest pain • complete paraplegia Medication: — Clinical Procedure: Conservative management Specialty: Nephrology
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Takahisa Kasugai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Satoru Kominato
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichii, Japan
| | - Chiharu Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Toshiyuki Miura
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Katsushi Koyama
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan
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Operative vectors, anatomic distortion, fluid dynamics and the inherent effects of pneumatic insufflation encountered during transanal total mesorectal excision. Tech Coloproctol 2017; 21:783-794. [PMID: 28993914 DOI: 10.1007/s10151-017-1693-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Transanal total mesorectal excision (taTME) is an altogether different approach to rectal cancer surgery, and the effects of carbon dioxide (CO2) on this dissection remain poorly described. METHODS This article critically examines the effect of carbon dioxide insufflation and the workspace it creates during the process of taTME. The unique aspects of insulation with this approach are governed by the laws of physics, especially the principles of fluid dynamics, an area that remains poorly described for laparoscopy and not at all described for taTME. RESULTS A summary of established factors which affect the operative field of the taTME surgeon is delineated and further explored. In addition, new concepts regarding gas delivery, such as insufflation vectors, anatomic distortion, hyper-dissection, and workspace volume rate of change as a function of taTME dissection time, are addressed. Collectively, these factors pose important challenges which increase case complexity and are thus essential for taTME trainers and trainees alike to understand. CONCLUSIONS Although an invisible gas, CO2 insufflation with taTME produces markedly visible effects which are imposed upon the operative field. This can result in anatomic distortion and misperception of operative planes. Thus, practicing taTME surgeons should be cognizant of these effects.
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Abstract
BACKGROUND Spondylodiscitis in children is rare. The condition has an incidence of 2 to 4 % of all infectious skeletal diseases in children. AIM Aim of the article is the presentation of epidemiology, the clinical signs, radiological findings as well the treatment options of non-specific and specific spondylodiscitis in children. METHODS The available literature was reviewed. RESULTS Non-specific spondylodiscitis in children is caused by haematogenous spread of pathogens. Staphylococcus aureus is the most frequently detected bacterium. The clinical signs are unspecific and an Magnetic Resonance Imaging of the spine is the standard radiological procedure to detect spondylodiscitis. In general, the treatment is conservative and includes an antibiotic therapy as well an immobilization of the spine. In endemic areas of the world, specific spondylodiscitis is more common and is caused by Mycobacterium tuberculosis or Brucellae. The treatment is also conservative. For all entities of spondylodiscitis in children, a surgical intervention is only necessary in the case of severe deformities due to the infection or in the case of neurological symptoms. CONCLUSION Elevated infectious laboratory values and back pain or other unspecific symptoms can indicate spondylodiscitis in children. MRI of the spine is necessary to rule out spondylodiscitis.
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Affiliation(s)
- A Völker
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Schubert
- Klinik für Gastroenterologie und Rheumatologie, Fachbereich Infektions- und Tropenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - C-E Heyde
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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Intraoperative Navigation Is Associated with Reduced Blood Loss During C1-C2 Posterior Cervical Fixation. World Neurosurg 2017; 107:574-578. [PMID: 28842229 DOI: 10.1016/j.wneu.2017.08.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Traumatic injuries, degenerative/rheumatologic conditions, tumors, or infections of the upper cervical spine may in certain circumstances require surgical stabilization. C1 lateral mass screws (Harms technique) in combination with C2 instrumentation (pars, pedicle, translaminar screws) have become a mainstay of surgical treatment. The surgical anatomy of the C1 lateral mass can be challenging especially with the robust venous plexus that often causes significant bleeding with exposure of the C1-C2 articular complex. The purpose of this study was to examine whether the use of navigation reduced intraoperative blood loss during atlantoaxial fixation. METHODS We reviewed our institutional experience with atlantoaxial instrumentation with and without navigation from 2007 to 2016. We limited our cases to those requiring C1-C2 stabilization in traumatic and degenerative cases and not as part of more extensive surgical stabilizations. We identified 45 consecutive patients and compared intraoperative blood loss, need for transfusion, and time of procedure with and without the use of navigation. RESULTS There was a significant reduction in the amount of intraoperative blood loss in the navigated (n = 20) versus non-navigated cases (n = 25). In addition, although the navigated cases initially were longer, currently there is no significant difference in the length of the cases. CONCLUSIONS In our series, surgical navigation significantly reduced blood loss compared with non-navigated cases without increasing surgical time or risk of complication. Furthermore, navigation has the potential to reduce operative times due to a reduction in blood loss.
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Li CC, Li CZ, Wu ST, Cha TL, Tang SH. Spondylodiscitis with Epidural and Psoas Muscle Abscesses as Complications After Transrectal Ultrasound-guided Prostate Biopsy: Report of a Rare Case. Eur J Case Rep Intern Med 2017; 4:000694. [PMID: 30755964 PMCID: PMC6346856 DOI: 10.12890/2017_000694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 11/17/2022] Open
Abstract
A 71-year-old man presented with spondylodiscitis with epidural and psoas muscle abscesses following transrectal ultrasound (TRUS)-guided prostate biopsy. These rare complications were detected by computed tomography of the abdomen and magnetic resonance imaging of the lumbar spine. The patient was successfully treated with antibiotics and underwent neurosurgery. Awareness of presentations such as backache and weakness of the lower limbs after prostate biopsy is important as these symptoms are usually mistaken for bone or muscle problems and often not recognized as being related to infection.
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Affiliation(s)
- Chiao-Ching Li
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chiao-Zhu Li
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shou-Hung Tang
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Rossini Z, Pessina F. Perineural Spread or Neural Tropism? Discussion of a Paper and Description of an Unusual Case of Cervical Intradural Extramedullary Dumbbell Metastasis from Renal Cell Carcinoma. World Neurosurg 2017; 100:696-698. [PMID: 28437878 DOI: 10.1016/j.wneu.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Zefferino Rossini
- Division of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Milan, Italy; Division of Neurosurgery, Università degli Studi di Milano, Milan, Italy.
| | - Federico Pessina
- Division of Neurosurgery, Università degli Studi di Milano, Milan, Italy
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Tubbs RS, Demerdash A, Loukas M, Curé J, Oskouian RJ, Ansari S, Cohen-Gadol AA. Intracranial Connections of the Vertebral Venous Plexus: Anatomical Study with Application to Neurosurgical and Endovascular Procedures at the Craniocervical Junction. Oper Neurosurg (Hagerstown) 2017; 14:51-57. [DOI: 10.1093/ons/opx080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/15/2017] [Indexed: 01/30/2023] Open
Abstract
Abstract
BACKGROUND
Descriptions of intracranial extensions of vertebral venous plexuses are lacking.
OBJECTIVE
To identify vertebral venous plexuses at the craniocervical junction in cadavers and describe them.
METHODS
The authors dissected 15 ink-injected, formalin-fixed, adult cadaveric heads and measured cranial extensions of the spinal venous plexuses.
RESULTS
All specimens had vertebral venous plexuses at the craniocervical junction composed of multiple interwoven vessels concentrated anteriorly (anterior vertebral plexuses), posteriorly (posterior vertebral venous plexuses), and laterally (lateral vertebral venous plexuses). Veins making up the plexus tended to be largest for the anterior internal vertebral venous plexus. On 33%, a previously unnamed lateral internal vertebral venous plexus was identified that connected to the lateral marginal sinus. The anterior external vertebral venous plexus connected to the basilar venous plexus via transclival emissary veins in 13%; remaining veins connected either intracranially via small perforating branches through the anterior atlanto-occipital membrane (33%) or had no direct gross connections inside the cranium (53%). The anterior internal vertebral plexus, which traveled between layers of the posterior longitudinal ligament, connected to the anterior half of the marginal sinus in 33% and anterolateral parts of the marginal sinus in 20%. The posterior internal venous plexus connected to the posterior aspect of the marginal sinus on 80% and into the occipital sinus in 13.3%. The posterior external venous plexus connected to veins of the hypoglossal canal in 20% and into the posterior aspect of the marginal sinus in 13.3%.
CONCLUSION
Knowledge of these connections is useful to neurosurgeons and interventional radiologists.
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Affiliation(s)
| | - Amin Demerdash
- Pediatric Neurosurgery, Children's of Alabama, Birmingham, Al-abama
| | - Marios Loukas
- Department of Anatomical Sci-ences, St. George's University, Grand Anse, Grenada
| | - Joel Curé
- Department of Neuro-radiology, University of Alabama, Birm-ingham, Alabama
| | | | - Shaheryar Ansari
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
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42
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Osorio M, Moubayed SP, Su H, Urken ML. Systematic review of site distribution of bone metastases in differentiated thyroid cancer. Head Neck 2017; 39:812-818. [DOI: 10.1002/hed.24655] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marcela Osorio
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Sami P. Moubayed
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
| | - Henry Su
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Mark L. Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
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43
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The periprostatic venous plexus: an unusual source of fatal pulmonary embolism during corporoplasty. Int J Legal Med 2016; 131:713-717. [PMID: 28004195 DOI: 10.1007/s00414-016-1519-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
When a sudden death occurs during a minor surgical intervention, it may require a careful and extensive postmortem investigation. One such case concerns a 61-year-old male patient affected by Peyronie's disease, who died suddenly during a corporoplasty procedure. Autopsy and histologic examinations showed a massive bilateral pulmonary micro-embolism brought on by periprostatic venous plexus thrombosis. The cause of death was attributed to intraoperative fatal pulmonary micro-embolism. Pulmonary thromboembolism is a major cause of death and is known to be a possible complication of surgery. Nevertheless, the periprostatic venous plexus is an unusual site of thrombosis, as it has been demonstrated that the majority of emboli originate in the legs. In this case, the embolism was massive and fatal and occurred during a minor surgical procedure, even though the patient was not at risk for venous thromboembolism, nor did he have a significant past medical history.
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Sindelar B, Bailes J, Sherman S, Finan J, Stone J, Lee J, Ahmadian S, Zhou Y, Patel V, Smith D. Effect of Internal Jugular Vein Compression on Intracranial Hemorrhage in a Porcine Controlled Cortical Impact Model. J Neurotrauma 2016; 34:1703-1709. [PMID: 27573472 DOI: 10.1089/neu.2016.4648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Internal jugular vein (IJV) compression has been shown to reduce axonal injury in pre-clinical traumatic brain injury (TBI) models and clinical concussion studies. However, this novel approach to prophylactically mitigating TBI through venous congestion raises concerns of increasing the propensity for hemorrhage and hemorrhagic propagation. This study aims to test the safety of IJV compression in a large animal controlled cortical impact (CCI) injury model and the resultant effects on hemorrhage. Twelve swine were randomized to placement of a bilateral IJV compression collar (CCI+collar) or control/no collar (CCI) prior to CCI injury. A histological grading of the extent of hemorrhage, both subarachnoid (SAH) and intraparenchymal (IPH), was conducted in a blinded manner by two neuropathologists. Other various measures of TBI histology were also analyzed including: β-amyloid precursor protein (β-APP) expression, presence of degenerating neurons, extent of cerebral edema, and inflammatory infiltrates. Euthanized 5 h after injury, the CCI+collar animals exhibited a significant reduction in total SAH (p = 0.024-0.026) and IPH scores (p = 0.03-0.05) compared with the CCI animals. There was no statistically significant difference in scoring for the other markers of TBI (β-APP, neuronal degeneration, cerebral edema, or inflammatory infiltration). In conclusion, IJV compression was shown to reduce hemorrhage (SAH and IPH) in the porcine CCI model when applied prior to injury. These results suggest the role of IJV compression for mitigation of not only axonal, but also hemorrhagic injury following TBI.
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Affiliation(s)
- Brian Sindelar
- 1 Department of Neurosurgery, NorthShore University HealthSystem , Evanston, Illinois.,2 Department of Neurosurgery, University of Florida , Gainesville, Florida
| | - Julian Bailes
- 1 Department of Neurosurgery, NorthShore University HealthSystem , Evanston, Illinois
| | - Sydney Sherman
- 1 Department of Neurosurgery, NorthShore University HealthSystem , Evanston, Illinois
| | - John Finan
- 1 Department of Neurosurgery, NorthShore University HealthSystem , Evanston, Illinois
| | - James Stone
- 1 Department of Neurosurgery, NorthShore University HealthSystem , Evanston, Illinois
| | - John Lee
- 3 Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem , Evanston, Illinois
| | - Saman Ahmadian
- 3 Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem , Evanston, Illinois
| | - Ying Zhou
- 4 Department of Research Institute, NorthShore University HealthSystem , Evanston, Illinois
| | - Vimal Patel
- 1 Department of Neurosurgery, NorthShore University HealthSystem , Evanston, Illinois
| | - David Smith
- 5 Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
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45
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Paulino E, Neves PLA, Rocha LOS. Periprostatic venous thrombosis. AUTOPSY AND CASE REPORTS 2016; 6:3-5. [PMID: 27818952 PMCID: PMC5087977 DOI: 10.4322/acr.2016.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/15/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eduardo Paulino
- Pathology and Forensic Department - Faculty of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte/MG - Brazil
| | - Pedro Lobo Alcântara Neves
- Pathology and Forensic Department - Faculty of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte/MG - Brazil
| | - Luiz Otávio Savassi Rocha
- Internal Medicine Department - Faculty of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte/MG - Brazil
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46
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Tuan AS, Nabavizadeh SA, Pukenas B, Mohan S, Learned KO. Reversible dilatation of lumbar epidural venous plexus secondary to pelvic venous compression: mimicker of pathology. BJR Case Rep 2016; 3:20150287. [PMID: 30363285 PMCID: PMC6159269 DOI: 10.1259/bjrcr.20150287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/01/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
Radiculopathy from dilated epidural varices is a rarely recognized phenomenon, and engorged varices may mimic a disc herniation, fistula or mass. We report a case of a distended bladder causing reversible pelvic venous congestion and resultant epidural venous plexus engorgement. We show marked engorgement of the epidural venous plexus and crowding of the cauda equina from a markedly distended bladder with resolution of these findings following bladder decompression. Familiarity with this clinical entity is crucial to avoid misdiagnosis and to prevent potential unnecessary surgical intervention.
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Affiliation(s)
- August S Tuan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - S Ali Nabavizadeh
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Bryan Pukenas
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kim O Learned
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Perispinal injection is a novel emerging method of drug delivery to the central nervous system (CNS). Physiological barriers prevent macromolecules from efficiently penetrating into the CNS after systemic administration. Perispinal injection is designed to use the cerebrospinal venous system (CSVS) to enhance delivery of drugs to the CNS. It delivers a substance into the anatomic area posterior to the ligamentum flavum, an anatomic region drained by the external vertebral venous plexus (EVVP), a division of the CSVS. Blood within the EVVP communicates with the deeper venous plexuses of the CSVS. The anatomical basis for this method originates in the detailed studies of the CSVS published in 1819 by the French anatomist Gilbert Breschet. By the turn of the century, Breschet's findings were nearly forgotten, until rediscovered by American anatomist Oscar Batson in 1940. Batson confirmed the unique, linear, bidirectional and retrograde flow of blood between the spinal and cerebral divisions of the CSVS, made possible by the absence of venous valves. Recently, additional supporting evidence was discovered in the publications of American neurologist Corning. Analysis suggests that Corning's famous first use of cocaine for spinal anesthesia in 1885 was in fact based on Breschet's anatomical findings, and accomplished by perispinal injection. The therapeutic potential of perispinal injection for CNS disorders is highlighted by the rapid neurological improvement in patients with otherwise intractable neuroinflammatory disorders that may ensue following perispinal etanercept administration. Perispinal delivery merits intense investigation as a new method of enhanced delivery of macromolecules to the CNS and related structures.
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Affiliation(s)
- Edward Lewis Tobinick
- Institute of Neurological Recovery, 2300 Glades Road, Suite 305E, Boca Raton, FL, 33431, USA.
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48
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Gas Embolic Stroke Secondary to Bowel Infarction. J Stroke Cerebrovasc Dis 2015; 25:e1-3. [PMID: 26599977 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/22/2015] [Indexed: 10/22/2022] Open
Abstract
A 69-year-old gentleman with metastatic esophageal adenocarcinoma presented with acute abdominal pain to the emergency medicine department and subsequently developed an acute left hemiplegia while in the resuscitation unit. An unenhanced computed tomography (CT) scan of the head showed right frontal cerebral gas emboli while an unenhanced CT scan of the abdomen and pelvis showed extensive portal venous gas and pneumatosis intestinalis, presumed secondary to bowel infarction.
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Bludau F, Reis T, Schneider F, Clausen S, Wenz F, Obertacke U. [Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT). Alternative therapy for patients with oligometastatic spinal metastases]. Radiologe 2015; 55:859-67. [PMID: 26420600 DOI: 10.1007/s00117-015-0018-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients. METHOD AND RESULTS Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated. CONCLUSION The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.
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Affiliation(s)
- F Bludau
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland.
| | - T Reis
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - F Schneider
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - S Clausen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - F Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - U Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
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50
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Mattei TA, Rehman AA, Dinh DH. Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion. Global Spine J 2015; 5:e52-8. [PMID: 26430602 PMCID: PMC4577316 DOI: 10.1055/s-0035-1544155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/08/2014] [Indexed: 12/28/2022] Open
Abstract
Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a subdural hematoma after a percutaneous vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of venous congestion caused by cement obstruction. Results Because the subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the vertebroplasty, we discuss the possible role of venous congestion as the main etiologic factor leading to rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of spinal subdural hematoma in which venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous hypertension may shed new light into the pathophysiology of spinal subdural hematomas.
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Affiliation(s)
- Tobias A. Mattei
- Department of Neurosurgery, Brain and Spine Institute, Buffalo, New York, United States,Address for correspondence Tobias A. Mattei, MD Brain and Spine Institute400 International Drive, Buffalo, NY 14221United States
| | - Azeem A. Rehman
- Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
| | - Dzung H. Dinh
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
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