Bacterial accumulation by the Demospongiae Hymeniacidon perlevis: a tool for the bioremediation of polluted seawater

Sponges can filter large amounts of water, which exerts an important grazing impact on free bacteria, an important component of the diet of sponges. We examined the accumulation of bacteria in the Demospongiae (Hymeniacidon perlevis). Analyses were performed on homogenates from unstarved and starved sponges in seawater from their sampling site (the Ionian Sea). Culturable heterotrophic bacteria (22 degrees C), total culturable bacteria (37 degrees C) and vibrios densities were measured on marine agar 2216, plate count agar and TCBS agar, respectively. Total and fecal coliforms, as well as fecal streptococci, were determined by the most probable number method (MPN). H. perlevis was able to accumulate all of the six microbiological groups. Bacterial groups differed in their resistance to digestion by H. perlevis. Our data suggest that H. perlevis may accumulate, remediate and metabolize bacteria and that they may be employed as a useful bioindicator and bioremediator.

Post-larval development of the commercial sponge Spongia officinalis L. (Porifera, Demospongiae)

This study investigated the development of the larvae of Spongia officinalis in experimental conditions, after settlement on plastic substrates, using electron and light microscopy. The released larvae show a dark pigmented ring distinguishes the posterior larval pole. The youngest larvae, covered with a flagellate epithelium, move onwards by rotating on their longitudinal axis. Over time a creeping-like motion prevails, probably linked to the need for settlement. After a free-swimming period of 24-48 h, larvae settle on the artificial substrate by the anterior pole. At settlement, the flagellate epithelium is substituted by flattened cells, which delimit the outermost surface. Post-larvae were reared to about three months. The early phase of post-larval differentiation shows a solid interior mainly consisting of granular cells varying in shape and size. They are included in a dense collagen matrix that contains a conspicuous amount of bacteria. Lacunae are already evident in the initial phase of metamorphosis. In several of them, cell debris and nucleate cells are visible. This feature is consistent with a progressive reduction of the cell mass (autolysis). Neither choanocyte chambers nor canals differentiate. The morphogenetic process leads to a metamorph only consisting of vacuolated cells and collagen fibrils included in a thin fibrous coat.

Paraspinal approach to the far lateral disc herniations: retrospective study on 42 cases

Forty-two patients underwent surgery for far-lateral disc herniations. Average patient age was 45.1 years, 28 patients were male and 14 female. The level concerned most was L4-5 disc (55%). A paramedian muscle-splitting intertransverse approach is described for this type of disc herniation. This method allows direct visualization of the disc and root involved and does not provide bone resection and important surgical manipulation. Ninety-one percent of the patients reported excellent or good results according to Macnab outcome criteria with an average follow-up of 32.5 months (range 1-5 years). Twelve patients (28.6%) developed postoperative transient radicular pain that disappeared in 15-21 days after analgesic therapy. There were no recurrences or spinal instability. The paramedian muscle-splitting intertransverse approach is a rational technique. Its advantages are that the spine is not opened and spinal stability is maintained. It requires minimal soft-tissue and bone resection and the herniated disc is directly visualized. Moreover, it contains minimal manipulation of the neuro-vascular structures and avoids significant muscle retraction. However, it requires an adequate learning curve and good familiarity with microsurgical techniques.

Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases

Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. Follow-up was performed at 1, 3 and 6 months and overall results were backed up by telephone questionnaire (Health Outcomes Carpal Tunnel Questionnaire, Health Outcomes, Bloomington, MN, USA). Results were favourable in 98% and 2% unfavorable for persistent pain. Rate of satisfaction of the patients was 90%. Average time of patient's return to work was 20 days. Eleven procedures (2.8%) were converted to open release. There was one case (0.2%) of incompleted section of the perineurium due to failure of endoscopic visualization of the ligament. In this case the procedure was converted to open and was completed with perineurium sutura. In six cases (1.5%) there were injury to superficial palmar arch. During the follow-up period there were no recurrences and no re-exploration. The mean preoperatively obtainable distal motor latency (DML) and sensory conduction velocity (SCV) values were 6.7 m/s and 29.2 m/s, respectively. The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.

Cervical neuroma presenting as a subarachnoid hemorrhage: case report

OBJECTIVE AND IMPORTANCE

The association of subarachnoid hemorrhage (SAH) with spinal lesions is well known, but hemorrhage from a cervical schwannoma is exceedingly rare. The histopathology and the mechanism of bleeding are discussed.

CLINICAL PRESENTATION

We report a healthy 37-year-old man presenting with SAH after intense physical stress caused by bleeding of a cervical neuroma.

INTERVENTION

A C6-T1 laminectomy disclosed an ovoid lesion, 4 cm in diameter; extremely dilated veins originated from the tumor. Removal of the spinal lesion resulted in immediate decongestion of the related venous network. The histopathological examination confirmed that the lesion was a telangiectatic schwannoma. The mechanism of bleeding of the intraforaminal cervical schwannoma is discussed.

CONCLUSION

Telangiectatic neuromas may be a cause of occult SAH. The importance of magnetic resonance imaging of the cervical spine is emphasized to explain SAH with negative findings on four-vessel angiography in patients whose SAH may have a surgically correctable cause distant from the intracranial compartment.

Giant aneurysm of the pericallosal artery

A rare case of a giant aneurysm of the pericallosal artery, evaluated by computed tomography, magnetic resonance imaging, and angiography, is reported, and the other 7 cases in the literature are reviewed. Giant aneurysms are exceptional in the distal segments of the anterior cerebral arteries, and may simulate a callosal tumor or hematoma on computed tomographic scan. The clinical, radiological, surgical, and pathological findings of giant aneurysms of this location are discussed and the other reported cases are analyzed. The role of magnetic resonance imaging in diagnosing and characterizing giant aneurysms is stressed.

CT indications for surgery and evaluation of prognosis in patients with spontaneous intracerebral haematomas

This study retrospectively analyzes the CT findings of 50 patients with spontaneous intracerebral haematomas and correlates them with the clinical condition at admission and the outcome. The volume of the haematoma was well correlated with the outcome and was a very useful indicator for surgery. In patients with haematoma volume lower than 25 ml and above 80 ml there was no indication for surgery; in patients with haematoma volume between 25 and 50 ml the operation does not significantly modify the survival rate, but favours a more rapid and complete recovery of the neurological deficits, whereas a haematoma volume between 50 and 80 ml favours the rate of survival.

Cerebellar metastasis from prostatic carcinoma simulating, on CT-scan, a cerebellopontine angle tumor. Case report

The authors report a rare case of cerebellar metastasis from prostatic carcinoma simulating on computerized tomography a cerebellopontine angle tumor. Solitary intracerebral metastases from prostatic cancer are infrequent, and their location in the posterior fossa with extension in the cerebellopontine angle is quite unusual. The differential CT findings from more common benign cerebellopontine angle tumors are briefly outlined.

Tumors of the neuron series presenting as cysts with mural nodules

Two cases of tumors of the neuron series presenting as cysts with mural tumor nodules are described. This radiographic and surgical aspect may be observed in astrocytomas, meningiomas or ependymomas, whereas it is more rare for neuroblastomas and ganglioneuromas. There are not CT features which allow to differentiate cystic tumors of the neuron series from the other cystic tumors. The finding of cyst with enhancing mural tumor nodule and unenhanced wall is more favorable from a surgical point of view; the complete removal of the nodule with preservation of the reactive cyst wall results in the cure of patients with ganglioneuroma and ganglioglioma and in good long-term survival in those with cerebral neuroblastomas.

Myxoma of the skull and orbit

An unusual case of myxoma of the skull extending into the orbital cavity is reported. Myxoma is a benign tumour of the soft tissues and maxillary bones, which often presents infiltrating growth and recurrences. Histologically it is characterized by abundant myxoid stroma and is often confused with other tumours which can present mucoid degeneration. Although diagnosis is impossible before histological examination, the possibility of a myxoma must be considered in the presence of extradural osteolytic poorly vascularized lesions.

Postoperative cervical pseudomeningocele

A case of postoperative cervical pseudomeningocele in a woman submitted to laminectomy for protruded disc is reported. The patient was investigated by myelography and metrizamide computed tomography and surgically treated with a good neurological result. The other eight reported cases of postoperative cervical pseudomeningocele are reviewed and the role of metrizamide CT scan in diagnosing this unusual complication of cervical laminectomies is emphasized.

Fibromuscular dysplasia of the carotid arteries. Clinical and radiological considerations

Seven patients with fibromuscular dysplasia of the carotid arteries are described. Three were asymptomatic and four had ischemic troubles. Angiographically, 3 had a fibromuscular dysplasia of type 1 and 4 of type 2; one patient also had an associated aneurysm of the cervical internal carotid artery. The neurological troubles and their pathogenesis, the angiographic findings and the differential diagnosis of this angiopathy are briefly discussed; the surgical procedures and their risks are also analyzed.

Cerebrospinal rhinorrhea in a patient with a posterior cranial fossa tumor

A rare case of a meningioma of the posterior margin of the petrous temporal bone associated with cerebrospinal fluid rhinorrhea is presented. After a careful review of the literature, the possible pathogenesis of the fistulous tract is discussed.

Primary lymphoma of the cranial vault

An exceptional case of a large intracranial extradural lymphoma arising from the skull and causing intracranial hypertension syndrome, in the absence of other localizations elsewhere in the body is described. Only another similar observation was reported in the literature. The diagnosis of this exceptional localization of lymphomas, which can mimic other intracranial tumors, is discussed on the basis of the computer-tomography findings and the usefulness of the radiotherapy is pointed out.

Lipoma of the ambient cistern causing obstructive hydrocephalus

A 62-year-old patient with lipoma of the ambient cistern and marked hydrocephalus is described. Intracranial lipomas are maldevelopmental lesions, which rarely produce neurological symptoms. The anatomopathological and clinical features of the lipomas of the ambient cistern are reviewed on the basis of the other reported cases. The importance of the computerized tomography and nuclear magnetic resonance for the diagnosis and the indications for the surgery are also discussed.

Craniopharyngioma of the cranial base and nasopharynx

A rare case of craniopharyngioma extending to the cranial base and nasopharynx is reported and eight other cases in the literature are reviewed. The embryology and the clinical features of these tumors are discussed. Tomograms of the skull and computed tomography are the most useful radiological tools of investigation. A nasoseptal or transpalatal approach to surgery, which has been performed in reported cases of cystic nasopharyngeal craniopharyngiomas, was not performed on our patient because of the hard consistency and the diffusely infiltrating aspect of the tumor.

Late neurological dysfunction in adult lumbosacral lipoma

The case of a 53-year-old woman with adult-onset neurological dysfunction secondary to spinal dysraphia and lumbosacral lipoma is presented. This condition not only affects children, but may produce neurological troubles also in adult age. This observation confirms that lumbosacral lipomas do not represent a static condition but carry the potential for late neurological dysfunction and therefore they should be treated in early life to prevent late complications. Besides the adult-onset urinary dysfunction and lumbosacral and sciatic pain should suggest the possibility of spinal dysraphia and lumbosacral lipoma.

Cystic lesions associated with meningiomas

Three cases of meningiomas associated with large cysts are reported, and 58 other cases from the literature are reviewed. The etiology of these cysts is analyzed on the basis of surgical and pathological findings. The preoperative diagnosis of large computed tomographic hypodensities associated with meningiomas and the differential features from other cystic tumors are discussed. The surgical aspect of the solid tumor and particularly the absence of a capsule separating the tumor from the cyst are usually decisive in confirming the intratumoral nature of the cyst. In questionable cases a histologic evaluation of the cyst walls may be necessary.

Lateral thoracic meningocele

A case of intrathoracic meningocele is reported, and 95 cases from the literature are reviewed. Thoracic meningoceles are usually associated with neurofibromatosis; nevertheless their etiology remains controversial. The authors postulate the role of spinal trauma in some patients and the origin of the meningocele from an abnormal prolongation of a nerve sleeve in nontraumatic cases. Thoracic meningoceles often are asymptomatic or produce radicular intercostal pain. Spinal computed tomography is the most useful investigation, particularly in the exploration of large meningoceles. Surgery is required in symptomatic cases and usually results in remission of the pain.

Anterior communicating artery aneurysm presenting with sudden paraplegia

A case of sudden paraplegia as the first symptom of a ruptured anterior communicating artery aneurysm is reported. The sudden appearance of paraparesis or paraplegia is an exceptional event in patients with intracranial aneurysms. The various pathogenetic mechanisms are briefly discussed. The insufficient blood perfusion of both paracentral areas was the cause of paraplegia in the reported case.

Giant spinal ependymoma. A case report

A case of a very extensive spinal ependymoma, treated by operation and irradiation with good outcome, is reported and the other cases in the literature are reviewed. In patients with giant spinal ependymomas, operation is always necessary, whatever the extent of the tumour, although the removal is often incomplete. Nevertheless, even partial removal sometimes brings about a neurological improvement, because of the favourable effect of the laminectomy. Postoperative irradiation is useful in cases with the histological appearance of malignancy.

Giant osteoma of the cranial vault with acromegaly and hydrocephalus. A case report

A case of acromegaly associated to a giant osteoma of the cranial vault and hydrocephalus in a young woman is reported. It can be suggested that acromegaly favoured the marked growth of the osteoma. Hydrocephalus resulted consequent to both the compression of the superior longitudinal sinus by the tumor and alteration of the CSF resorption. The rarity of giant osteomas of the cranial vault associated with intracranial hypertension is pointed out.

Subarachnoid hemorrhage due to a spinal neurinoma

A rare observation of spinal neurinoma associated with subarachnoid hemorrhage is reported and the other 12 cases in the literature are reviewed. The extramedullary location of the tumor and the feeble arachnoidal attachments to the spinal cord favor subarachnoidal bleeding in these cases. When the meningeal signs are evident and signs of spinal cord impairment are still unclear, an intracranial origin of the bleeding must be excluded. In doubtful cases, selective spinal angiography is useful in the differential diagnosis between a bleeding spinal tumor and an arteriovenous malformation of the spinal cord.

Postoperative lumbar arachnoidal diverticula

Five patients with arachnoidal diverticula after lumbar operations are reported. Myelography was performed in all cases, spinal computed tomography scanning in three; three patients underwent surgical treatment with good clinical results. Arachnoidal diverticula are a rare complication of operations on the lumbar spine. Spinal computed tomography scanning is very useful, especially in the investigation of large diverticula and in the radiologic visualization of the arachnoidal stalk. Surgical treatment, which is required in symptomatic cases, results in remission of pain and prevents neurological complications.

A case of pan-medullary astrocytoma in a child

The authors report a case of a Grade 2 astrocytoma with pan-medullary extension, from C1 to L2, in a little girl aged 12. It was successfully operated on. The clinical picture showed an initial acute paraplegia which suddenly turned into tetraplegia with respiratory insufficiency and second degree coma. Besides the rarity of the case, some atypical aspects are pointed out, such as the patient's youth and the partially aggressive character of the neoplasm. The surgical implications of such pan-medullary tumours are discussed, the authors emphasize the aspects that in their opinion indicate exploratory surgery and, when possible, total removal of the tumours.

[Neurinomas of the acoustic nerve and surgery with the suboccipital approach. A study of 70 cases]

The Authors report 70 cases of medium and large size acoustic neuromas, operated on using the suboccipital approach, the only one which allows their total extirpation. Total extirpation was performed in 77% of the patients. The Authors analyze the clinical picture, the neuroradiological diagnostic procedures and the surgical techniques used in the treatment of these lesions.