Urinary System Problems in al-Rãzî's Book, Man lã yaḥḍuruhu al-ṭabîb: Practical Advice for Those Who Cannot Access Physicians and Medical Recourses

OBJECTIVES

Abū Bakr Muḥammad ibn Zakariyyã al-Rãzî is a historical physician who made theoretical and practical contributions to medicine. The aim of al-Rãzî's book, Man lã yaḥḍuruhu al-ṭabîb, is to provide a valuable benefit to the general public. The book was written for people who do not have access to physicians, critical medical manuscripts, and medications. Our study aimed to add to the literature and discuss the issues concerning urinary tract problems in al-Rãzî's Man lã yaḥḍuruhu al-ṭabîb.

MATERIALS AND METHODS

The sections of al-Rãzî's Man lã yaḥḍuruhu al-ṭabîb dealing with the urinary system were discussed and translated from Arabic to English.

RESULTS

Urinary system problems are discussed in al-Rãzî's book under the headings of "Pains in the kidneys and bladder (nephritis and cystitis) and stones in the kidneys," "Hematuria," "Pyuria and painful micturition/dysuria," "Prescription for medicine on this subject," and "Drug for the difficulty of passing urine/strangury." The relevant sections mention drugs and approach to be used, particularly in the face of problems, rather than theoretical explanations. Changes in practice and treatment have been suggested in various symptomatic situations.

CONCLUSIONS

Rather than theoretical and etiological explanations for urinary problems, al-Rãzî provides accessible and applicable practical drugs and approaches for the general public, which can be considered suitable for the purpose mentioned in al-Rãzî's introduction to the book.

Two different approaches regarding hydrocephalus treatment in the Islamic World during the Middle Ages

AIM

This study aimed to present the sections allocated to hydrocephalus in the works of Ibn Hubal al-Baghdādī and Ibn al-Quff, to include them and determine their position in the history of medicine by discussing relevant literature.

MATERIAL AND METHODS

A printed copy and a manuscript in İstanbul Süleymaniye Manuscript Library, Fatih Collection, nr. 3632 of Ibn Hubal's Kitāb al-Mukhtārāt fī al-Ṭibb, and a facsimile of a printed copy and a manuscript in Istanbul University Rare Works Library, Arabic Manuscripts, A 4749 of Ibn al-Quff's Kitāb al-'Umda fī Ṣinā'a al-Jirāḥa, were used. The chapters on hydrocephalus in both works have been translated to English and obtained knowledge was determined based on relevant literature.

RESULTS

Hydrocephalus was discussed under the title "On swellings and water occurring outside the skull and on the 'uṭāsh of the child and on water collection in the skull" in the third volume of Ibn Hubal's work and "The sixth chapter on the treatment of water which collects in the heads of children" in the 19th article of Ibn al-Quff's work. Ibn Hubal's and Ibn al-Quff's knowledge and approach to hydrocephalus match the knowledge and approaches of their predecessors. Compared with Ibn Hubal, Ibn al-Quff provided more systematic and detailed information on hydrocephalus.

CONCLUSIONS

Like other writers of the Islamic world in the medieval times, Ibn Hubal and Ibn al-Quff accept definitions and classifications of hydrocephalus by Greco-Roman writers.

Ibn Zuhr (Avenzoar) on head wounds in his Kitāb al-Taysīr (Liber Teisir)

OBJECTIVE

This study aimed to present and evaluate the section concerning head wounds in Kitāb al-Taysīr (Liber Teisir) by Ibn Zuhr (Avenzoar).

METHODS

In this study, four different versions of Avenzoar's work were analyzed. The first two are in Arabic and titled Kitāb al-Taysīr fī al-Mudāwāt wa al-Tadbīr. Of which, one was edited by Michel Khouri and printed in Damascus in 1983, and the other was edited by Muḥammad b. 'Abd Allah al-Rūdānī and printed in Rabat in 1991. Third and fourth versions are in Latin; one was translated by Paravicius, edited by Hieronymus Surianus, and printed in Venice in 1530, whereas the other was a manuscript in Bibliothèque interuniversitaire de santé, MS 5119 in Paris and translated by John of Capua.

RESULTS

The titles of the sections are "Wounds due to iron objects" and "Wounds due to stones" in Arabic and "On head injuries from external factors such as blow" and "On head wounds from iron or stone or wood" in Latin. The chapter written by Avenzoar on head wounds is divided into two parts. First, he explained the treatment and subsequently described his views and related experiences.

CONCLUSION

The information provided by Avenzoar on head injuries technically reflects the medical and surgical comprehension of his era. In the section that is the focus of this study, he first provided technical information related to head injuries and then offered his opinions on the controversial and problematic issues in the treatment such as phlebotomy. This study revealed that Avenzoar approached the subject differently than his predecessors.

A Study on Head Wounds in Kitāb al-'Umda fī Ṣinā'a al-Jirāḥa by Ibn al-Quff

The aim of this study is to investigate the knowledge on head wounds contained in the Kitāb al-'Umda fī Ṣinā'a al-Jirāḥa, written by Ibn al-Quff in the thirteenth century. This study was based on a copy of the Kitāb al-'Umda fī Ṣinā'a al-Jirāḥa, printed in 2 volumes in Dā'ira al-Mā'ārif al-Uthmāniyya in Hyderabad in 1356/1937-38 and reprinted by the Institute for the History of Arabic-Islamic Science at the Johann Wolfgang Goethe University. This printed copy was compared with the manuscript of İstanbul University Rare Works Library, Arabic Manuscripts, A 4749. Relevant chapters were translated from Arabic to English, after which they were thoroughly examined. Obtained knowledge is presented in the Results section and is compared in the Discussion section with other reports of this subject. The first chapter classified head wounds into 6 types: the first 3 types are conservatively treated and the remaining 3 types are surgically treated. This chapter also presents information on how to proceed when there is a head wound-related hemorrhage, which medications should be used, and which are the adequate treatment protocols. The second chapter discusses the symptoms and signs that follow head blow and fall injuries. The characteristics and noteworthy circumstances of skull fractures as well as the surgical treatment methods are included in the fifteenth chapter, which is concluded with surgery-related complications. The present study shows that Ibn al-Quff benefited from his predecessors' knowledge and made some considerable contributions to this subject.

An Early Description of Using Oral Route for the Management of Cervical Vertebra Fracture by Ibn al-Quff in the Thirteenth Century

OBJECTIVE

This study presents information regarding the treatment of fractures and dislocations of the vertebrae, including the use of the oral route for upper cervical fractures, presented in certain chapters of the book titled Kitāb al-'Umda fī Ṣinā'a al-Jirāḥa (Ibn al-Quff, thirteenth century ad).

METHODS

A printed copy of the second volume of the book was studied. Chapters 22 ("On treatment of vertebral fractures") and 33 ("On treatment of vertebral dislocation") of the seventeenth treatise of this book were translated from Arabic into English. Each section is presented (in full text) in the Results section of this article. The findings were compared with the relevant literature and discussed to determine whether Ibn al-Quff presented novel information compared with that presented by his predecessors.

RESULTS

The writings of Ibn al-Quff regarding vertebral dislocations seem to summarize information derived from his predecessors. Moreover, he modified certain approaches, previously described for vertebral dislocations, and used them for correcting vertebral fractures. Ibn al-Quff introduced the most novel use of a bridlelike instrument for anterior cervical fracture through the oral route. By introducing the device in the mouth, he described a pushing maneuver to the cervical vertebrae from the ventral site and a simultaneous pulling maneuver by cupping on the neck from the dorsal site.

CONCLUSIONS

The use of the oral route introduced by Ibn al-Quff may be one of the earliest examples of novel, practical, and advanced treatment for cervical vertebral fracture.

On pains of the kidney and the bladder in Kitāb al-Tajārib by Rhazes

Abū Bakr Muḥammad ibn Zakariyyā al-Rāzī (865-925), known in the West as Rhazes, was one of the pioneer figures of the golden age of Islamic science and medicine during the middle ages. Kiṭab al-Ḥāwī fī al-Ṭibb (Liber Continens), Kitāb al-Ṭibb al-Manṣūrī (Liber Medicinalis ad Almansorem) and Kitāb al-Judarī wa al-Ḥaṣba (Liber de Pestilentia) are his very well-known works in medicine. One of his books Kitāb al-Tajārib (The Book of Experiences/The Casebook), was written in Arabic and one of its copies is Ahmed III, Nr. 1975 manuscript in Topkapı Palace Library in Istanbul. A physician, Ali Munshi of Bursa, translated Kitāb al-Tajārib into Turkish in the 18th century and Hamidiye, Nr. 1013; Veliyuddin Efendi, Nr. 2487 and orum, Nr. 2909 manuscripts are the copies of its Turkish translation in different libraries in Turkey. Both the book and its Turkish translation contain 31 chapters; 30 of them concerning diseases from head to heel and the last one on pharmaceutics. The 21st chapter, fī awjā' al-kulā wa al-mathāna wa al-bāh, of Kitāb al-Tajārib is on pains of the kidney, and the bladder, and coitus. Evaluation and presentation of the cases in this chapter regarding the kidney and the bladder are the aims of this report.

[Cranial surgery in XVIIth century Vienna: a case from Evliya Celebi's Book of Travel]

Book of Travel (Seyâhatnâme) of Evliya Celebi has always been an invaluable resource for history and ethnography researchers. And it is found out via our paper about "neurosurgical operation" that the above mentioned work can be studied for researches concerning the history of medicine. It is seen that Evliya Celebi reports a neurosurgical operation for curing a gunshot wound, and that he is very well aware of medical paradigm of his era. And he reports the situation without departing from the work and the dominant literary language of the work and without passing over the technical details, and he also does not get lost in the details. He also reports all the general stages of the operation by giving all the techniques and methods of his era. This work can also be considered as an evidence for the origins of western medicine and surgery in the east. Because it is observed that eastern scientists such as Ibn Sina and Zehravi have been referenced for the situation the surgeon took care of, the methods the surgeon used and the stages during the operation.

[A chapter about neurosurgery in Kânûnül- Cerrâhîn (The Law of Surgeons) of Sanîzâde Mehmed Ataullah Efendi: Cerâhâtü'r- Re's (Head Injuries). 1829]

In this article, it is intended to review the chapter which takes place in Kânûnü'l-Cerrâhîn (Cairo, 1829) (The Law of Surgeons) of Sanîzâde Mehmed Ataullah Efendi (1771-1826), one of those who pioneered in the foundation of modern medicine in the Ottoman Empire despite receiving classical medresseh education in the field of medicine and which reflects the neurosurgical implementations of his time regarding "Head Injuries" by transcribing it into present Turkish alphabet It is also intended to fill one of the gaps in the written History of Turkish Neurosurgery.

Spinal anatomy in an essential illustrated medical treatise of the late Ottoman era

OBJECTIVE

The aim of this article is to introduce a great physician of the late Ottoman period and his writings on spinal anatomy.

METHODS

The article presents chapters related to the anatomy of vertebra and the vertebral column in the book of Şanizade Ataullah Mehmed, Mir'āt al-Abdān fı Tashrıḥ-i A'ḍāi'l-Insān (Mirror of the Bodies in the Dissection of the Members of the Human Body).

RESULTS

Works of Şanizade are viewed as important landmarks in Turkish medical history. Anatomy education in Turkey can be divided into four historic periods and the second period is called the Şanizade Period (1816-1827). This period leads up to the opening of the first modern medical school in Turkey on March 14, 1827.

CONCLUSIONS

The most important characteristic of Şanizade's work is that it is the first illustrated anatomy book printed in the Ottoman Age, and the value of the work is shown by Şanizade being one of the originators of medical terms in Ottoman Medicine.

A randomised controlled trial of ribavirin in Crimean Congo haemorrhagic fever: ethical considerations

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, virological and ethical literature.

The Royal Book by Haly Abbas from the 10th century: one of the earliest illustrations of the surgical approach to skull fractures

Haly Abbas was one of the pioneering physicians and surgeons of the Eastern world in the 10th century who influenced the Western world by his monumental work, The Royal Book. The book was first partly translated into Latin by Constantinus Africanus in the 11th century without citing the author's name. Haly Abbas was recognized in Europe after full translation of The Royal Book by Stephen of Antioch in 1127. The Royal Book has been accepted as an early source of jerrah-names (surgical books) in the Eastern world. The chapters regarding cranial fractures in Haly Abbas' work include unique management strategies for his period with essential quotations from Paul of Aegina's work Epitome. Both authors preferred free bone flap craniotomy in cranial fractures. Although Paul of Aegina, a Byzantine physician and surgeon, was a connection between ancient traditions and Islamic interpretation, Haly Abbas seemed to play a bridging role between the Roman-Byzantine and the School of Salerno in Europe.

An evaluation regarding the current situation of stem cell studies in Turkey

Turkey is in a parallel state to that of other countries for developments in stem cell research and practices. Nevertheless, Turkish law has no regulations for stem cell practices. To define a legal framework for stem cell research, rules of general content should be used as the starting point. In 2005 and 2006, a general regulation and guidelines on stem cell research were published by Turkish Ministry of Health. Thus, the ministry, based on this first general regulation, stopped "Embryonic Stem Cell Research", while allowing "Adult Stem Cell Research" by a second general regulation. The method of such research was regulated with the addendum of 'Guidelines for Clinical Research on Non-embryonic stem Cell'. With the latest regulation, clinical stem cell research in Turkey has been based on 'Regulations for Clinical Research', which was legislated in 2009. However, the aforementioned regulations by the ministry are still legally binding. In addition, other regulations such as Medical Deontology Regulations of 1960 and Patients' Rights Regulations of 1998 are to be consulted for stem cell research in Turkey. While it is especially important that research that is still at experimental level not provide an opportunity for trade of hope in patients and their relatives, ethics discussions are enlightening in developing regulations and critical evaluation of current practices.

Circumferential total resection of cervical tumors: report of two consecutive cases and technical note

To date, few studies have addressed the subaxial vertebrectomy technique and related anatomical landmarks in this method. Total spondylectomy is performed via piecemeal resection or en bloc removal in a one-stage procedure associated with stabilizing the spine and preserving neurological status. In this presentation, a circumferential total cervical tumor resection for subaxial cervical spine lesions was described. Two cases of subaxial cervical malignancy, one with primary C3 chondrosarcoma and the other with C4 lung adenosarcoma metastasis, were both treated by the anterior-posterior approach. The lesions could be removed macroscopically totally in both cases. The patients did well after surgery with preserved neurological status and they survived a considerable period without tumor recurrence. Subaxial total tumor resection can be performed safely while preserving vertebral arteries with adequate anatomical knowledge and careful surgical planning, and circumferential vertebrectomy (even intralesional) can provide a long recurrence-free survival period for patients suffering from subaxial spine tumors.

Peripheral nerve disorders and treatment strategies according to Avicenna in his medical treatise, Canon of medicine

The written transmission of knowledge has played a great part in the advancement of medicine, and historical documents hold the key to a full exploration of the history of medicine. Some fields, including disciplines that deal with peripheral nerve disorders, have received little benefit from such valuable material. In particular, peripheral nerve surgery lacks perspectives from historical data. For many years, physicians have obtained positive results in the surgical treatment of peripheral nerve diseases. Relevant documents reveal that the first author who described the surgical repair of damaged peripheral nerves was Avicenna, a leading figure of the medieval era who lived in the Middle East. In his primary medical work, the Canon, he provides a description, albeit sketchy, of a suture procedure for peripheral nerve transection. This treatise influenced physicians for several centuries. In this presentation, we analyze excerpts from the Canon that concern peripheral nerve disorders and strategies for their management.

Hydrocephalus and its treatment according to Rhazes

The renowned medieval Persian physician Rhazes was an early proponent of experimental medicine. Rhazes made fundamental and enduring contributions to medicine and to other scientific fields. He wrote over 200 scientific books, more than half of which concerned medicine. He was well versed in Persian, Greek, and Indian medical knowledge, and made numerous contributions to the medical field through his own observations and discoveries. He was also a pioneer in the field of neurosurgery and, as he was predominantly a pediatrician, he dealt with the subject of hydrocephalus. A large part of his medical tome, al-Hawi, deals with head-related disorders including the hydrocephalus. Although he did not introduce novel concepts of hydrocephalus and its management, by combining the different approaches of experienced scholars he endeavored to improve treatment and knowledge of this problematic disease.

History of peripheral nerve repair: may the procedure have been practiced in Hippocratic School?

BACKGROUND

The literature regarding the history of the peripheral nerve repair is fairly scant. In the past, few physicians dealt with the topic and made prominent contributions. These works certainly eased the way to the modern concept of surgery of peripheral nerves. During the period between 7th and 17th centuries, Paulus Aeginatus, Avicenna, Roger of Salerno, Guglielmo da Saliceto, Guido Lanfranchi, and Gabriele Ferrara, who are universally accepted as the pioneers in this field, introduced the notion of nerve repair. The central predecessor of all these authors and as well as the founder of modern medicine, Hippocrates, also had reliable interest on peripheral nerve injuries; nevertheless, his written works do not include any section concerning peripheral nerve repair. An exciting document from Ottoman era challenges this issue by citing Hippocrates' nerve repair description. In this report, we present this account with a brief history of nerve repair.

METHODS

The relevant section of an early 16th century Ottoman surgical treatise was examined in detail.

RESULTS

The chapter regarding the treatments of acute wounds includes an anecdotal case report of nerve repair which is attributed to Hippocrates.

CONCLUSIONS

Although attainable works of Hippocrates do not contain nerve repair procedures this Ottoman era medical book suggest that Hippocrates or his pupils may have practiced surgical treatment of nerve injury.

Giant distal superior cerebellar artery aneurysm: case report and review of the literature

Aneurysms arising from the distal portion of superior cerebellar artery are infrequently seen. They are usually assumed to result from local arterial wall disruption like proximal supratentorial artery aneurysms. Depending on institutional facilities, these particular aneurysms can be treated either by a microsurgical procedure or interventional radiological technique. In general, surgical clipping has been recommended for these lesions. In this report we describe a 44-year old man who presented with a subarachnoid hemorrhage in the right cerebellopontine angle and was diagnosed with a giant aneurysm arising from the cisternal portion of the right superior cerebellar artery. The patient underwent surgery; microsurgical clipping of the aneurysm through subtemporal craniotomy was performed with no difficulty. We conclude that surgical therapy is suitable for the majority of aneurysms arising from the distal portion of the superior cerebellar artery.

A rare cause of "foot drop": spinal epidural brucella granuloma

Spinal epidural abscess is rare but serious medical condition which may cause permanent neurological deficits, or even death, if not treated. Staphylococcus aureus is the responsible microorganism in most spinal abscess cases. However, rarely other microorganisms like Brucella may be responsible. Brucellosis, a zoonotic infection endemic in the Mediterranean Region, Middle East; and South and Central America, most frequently involves the reticuloendothelial and musculoskeletal systems. Vertebral involvement is rarely seen; and its differential diagnosis is rather difficult. Spondylodiscitis and rarely spinal abscess or development of a granuloma are the main pathologies. Spinal epidural granulomas due to brucellosis may cause neurologic deficits. In this case presentation, a spinal epidural brucella granuloma causing foot drop is discussed taking other reports into account.

Lumbar radiculopathy due to unilateral facet hypertrophy following lumbar disc hernia operation: a case report

OBJECTIVE

To present a radiculopathy case due to unilateral facet hypertrophy developing three years after a lumbar disc hernia operation.

CASE REPORT

A fifty two-year-old female patient, who had been operated on for a left L5-S1 herniated lumbar disc three years ago, was hospitalized and re-operated with a diagnosis of unilateral facet hypertrophy. She had complaints of left leg pain and walking restrictions for the last six months. Left Straight Leg Raising test was positive at 40 degrees , left ankle dorsiflexion muscle strength was 4/5, left Extensor Hallucis Longus muscle strength was 3/5, and left Achilles reflex was hypoactive. Lumbar spinal Magnetic Resonance Imaging revealed left L5-S1 facet hypertrophy.

RESULTS AND CONCLUSIONS

Lumbar radiculopathy due to lumbar facet hypertrophy is a well-known neurological condition. Radicular pain develops during the late postoperative period following lumbar disc hernia operations that are often related to recurrent disc herniation or to formation of post-operative scar tissue. In addition, it can be speculated that unilateral facet hypertrophy, which may develop after a disc hernia operation, might also be one of the causes of radiculopathy.

The earliest document regarding the history of cranioplasty from the Ottoman era

Cranioplasty is one of the significant neurosurgical procedures in which the technical advances and also, by some means, drawbacks are still continuing. According to archeological findings and anthropological studies, the earliest procedures regarding cranioplasty date back to just about the same period claimed for trepanation. Ancient surgeons from different geographical sites and cultures performed both practices with remarkable survival rates. However, despite the length of the thriving past of cranioplasty, the first known written record on the topic dates back to late 16th century Europe. Further study of the Ottoman era documents revealed an intriguing text that was written about the repair of skull defects and that dates from early 16th century. This worthy discovery will add valuable contribution to the history of neurosurgery by drawing the written history of cranioplasty more than 60 years back and the use of organic grafts 160 years back. In the present study, this original text is discussed.

Hydrocephalus and its management in Avicenna's Canon of Medicine

Hydrocephalus and macrocrania in children have been regarded as amazing disorders throughout the history of medicine. Although the main underlying causes and pathophysiology of hydrocephalus were not understood until the middle of the 18th century, early physicians had made important contributions to this field with their careful observations, management protocols, and anatomical studies. Among these pioneering physicians was Avicenna, widely accepted as an influential and leading scientific figure of the medieval ages. Avicenna was interested in the study of hydrocephalus, and in his principal medical book, the Canon of Medicine, he devoted a large section to this topic. In this paper, a short excerpt concerning hydrocephalus is presented from Avicenna's Canon.

Ganglioglioma with lytic skull lesions: A case report

Gangliogliomas represent only 0.4% of central nervous system neoplasms and 1.3% of brain tumors. They are benign neoplasms with low morbidity and mortality and the patients usually present with seizures, but there has been no adult ganglioglioma with lytic skull lesion. A 49-year-old right handed woman suffering from generalized epileptic seizures was admitted to our hospital. She had also left hemiparesis with 4/5 motor strength. Magnetic resonance imaging and immunohistochemical studies revealed WHO Grade II ganglioglioma. Skull X-ray showed the lytic skull lesions. We have to consider gangliogliomas in the differential diagnosis of lytic skull lesions.

Primary spinal cord oligodendroglioma. Case illustration

Spinal cord oligodendrogliomas are rare pathologies of the spinal cord, and their location at conus and/or filum terminale is even rarer. There are only 7 spinal cord oligodendrogliomas reported in the literature. Our case is the eighth spinal cord oligodendrogliomas at this location.

A pioneer from the Islamic Golden Age: Haly Abbas and spinal traumas in his principal work, The Royal Book

Spinal diseases have attracted medical scientists throughout the history of medicine, probably because they are relatively easy to diagnose and fairly simple to treat. Physicians who made great progress in medicine during the glorious Islamic civilizations also enthusiastically dealt with spine-related problems. More than a thousand years ago Persia was a cradle of medical learning, and Islamic medicine and other sciences spread westward from that center. A leading figure during this period was Haly Abbas, who created an excellent and compact medical encyclopedia, The Royal Book. Sadly, this book has rarely been cited in the literature. The subject of the present vignette is Abbas' work regarding spinal trauma.

Management of spinal disorders and trauma in Avicenna's Canon of medicine

WE STUDY HISTORY in an attempt to achieve a wide perspective of life and reality. Spinal disorders, particularly spine traumas and their complications, have been one of the most challenging problems throughout the history of medicine and, indeed, throughout the history of humanity. The pioneers and founders of scientific medicine committed much of their lives to understanding these disorders. There is a paucity of historical documentation. From the extraordinary efforts of early practitioners, we may glean insight relevant to the more effective treatment of such debilitating disorders. Ibn Sina (Avicenna), who lived in the medieval period, was one such physician. His principal book of medicine, The Canon, played a fundamental role in the practice of medicine in the Eastern and Western worlds between the 11th and 17th centuries. In this book, published in the 11th century, he provided detailed accounts of spinal disorders and strategies for their management. Here, we provide a brief review of Avicenna's most significant points concerning spinal diseases and their treatment from the chapters of the Canon. Although, there are not basic differences from Hippocratic knowledge, this book contains some original contributions.

Solitary intraspinal lumbar vertebral osteochondroma: a case report

1-4% of osteochondromas involve the spine. They are commonly found in the posterior elements of the vertebra and can cause radicular symptoms. We report a 35 year-old man, suffering from right leg pain, which became worse over five years. His neurological examination revealed a positive right straight leg raising test and L4-L5 hypoesthesia. Lumbar computerised tomography (CT) and magnetic resonance imaging (MRI) studies revealed an exophytic, pedunculated bony projection. Osteochondroma should be considered while evaluating a patient with low back pain or radiculopathy without a CT or MRI appearance of a herniated lumbar disc.

MRI findings and encouraging fluconazole treatment results of intracranial Cladosporium trichoides infection

The authors report on a 31-year-old male patient harboring multiple intracranial mass lesions which proved histologically to be due to infection with Cladosporium trichoides upon removal of one of the lesions. Aggressive antifungal chemotherapy with fluconazole (400 mg/d for 3 months) in combination with surgery resulted in good clinical and radiologic outcome which prompted us to report this case.