Giant calcified thoracic disk herniations: ossification of PLL or autonomous entity?

BACKGROUND

Giant calcified thoracic disk herniation (GCTD) is an uncommon event, which requires surgical treatment in less than 1% of patients. GCDTs are a specific subgroup of herniated thoracic disks occupying more than 40% of the spinal canal showing calcifications associated with a certain degree of ossification. In this paper, we are reporting our whole experience in the surgical management of GCTDs through anterior approaches. We believe that they present characteristics that associate them to the circumscribed type of ossified posterior longitudinal ligament (OPLL) with a possible common pathophysiology consisting in the dural violation.

METHODS

Twenty-three consecutive patients with GCDTs were managed through anterior approaches during the period 1996-2019 at the Niguarda Hospital, Milan, Italy. Clinical data, radiological features, surgical reports, histological findings, and outcomes were reviewed.

RESULTS

There was no mortality, whereas permanent morbidity consisted of 1 case of worsened paraparesis due to accidental spinal cord contusion. One patient required reoperation to repair a postoperative cerebrospinal fluid (CSF) leakage. All patients underwent postoperative MRI which showed excellent decompression of cord and dural sac in all cases. Histological study of en-bloc removed GCTD showed typical calcification patterns of the PLL.

CONCLUSIONS

GCDTs may be assimilated to the so-called "circumscribed type" of OPLL. The GCDTs may show the same radiological CT and MRI pattern of OPLL. The anterior accesses now represent the standard of care for GCTDs. The use of operative microscope and intraoperative monitoring is mandatory. The risk of CSF leakage can be markedly reduced by meticulous reconstruction of the dura and the placement of spinal drainage. Adequate exposition may sometimes require one or two levels of corpectomy with consequent vertebral body reconstruction and fixation of anterior column of the spine.

Early percutaneous treatment of an aggressive vertebral hemangioma: A case report with a 5-year follow-up

Vertebral hemangiomas (VHs) are very common radiological findings, and the majority of them are completely asymptomatic and harmless. However, although rarely, they can present as locally aggressive, symptomatic lesions, and requiring surgery. In these cases, early diagnosis and treatment are mandatory to avoid serious complications and invasive surgery; however, there is no consensus about the best therapeutic option. Minimally-invasive percutaneous techniques have recently gained interests as a therapeutic option. A case of a 58-year-old male with a symptomatic aggressive VH of L5 presenting with untractable low back and radicular pain without neurological deficits is reported. An early percutaneous procedure with selective embolization combined with biportal kyphoplasty of L5 was performed. No complications and a very low-intraoperative bleeding were reported. The patient has been monitored for the following 5 years with a good outcome and with no signs of recurrence. This case report highlights the importance of making the right diagnosis and the advantages of an early percutaneous treatment with selective embolization and augmentation to avoid major open surgery with high risks.

Spinal epidural abscess in COVID-19 patients

Objective

To report the peculiarity of spinal epidural abscess in COVID-19 patients, as we have observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2.

Methods

We reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we surgically managed over a 2-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess.

Results

The abscesses were primary in all cases indicating that no evident infective source was found. A primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spread from adjacent infective sites, such as spondylodiscitis, generally occurring in patients with diabetes, obesity, cancer, or other chronic diseases.

In all cases, there was mild lymphopenia but the spinal abscess occurred regardless of the severity of the viral disease, immunologic state, or presence of bacteremia. Obesity was the only risk factor and was reported in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas classic abscess generally occur at the lumbar level. No patient had a history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases.

Conclusion

We wonder about the concentration of this uncommon disease in such a short period. To our knowledge, cases of spinal epidural abscess in COVID-19 patients have not been reported to date. We hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion to the correspondent spinal epidural space.

Furthermore, spinal epidural abscess carries a significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but should be kept in mind as early diagnosis and treatment are crucial.

Application of absolute qPCR as a screening method to detect illicit 17β-oestradiol administration in male cattle

It has been previously demonstrated that the progesterone receptor gene is up-regulated in the sex accessory glands of pre-pubertal and adult male bovines after 17β-oestradiol treatment. In the present study, a qualitative screening method was optimised to detect 17β-oestradiol treatment using absolute quantification by qPCR of the progesterone receptor gene to determine the amount of gene expression in bulbo-urethral glands. An external standard curve was generated and developed with TaqMan® technology. Based on two in vivo experiments, the decision limit CCα, sensitivity and specificity of this screening method were established. Trial 1 consisted of 32 Friesian veal calves divided into two groups: group A (n = 12), consisting of animals treated with four doses of 17β-oestradiol (5 mg week(-1) per animal); and group B (n = 20), consisting of control animals. Trial 2 was performed on 26 Charolaise beef cattle that either received five doses of 17β-oestradiol (group C; 20 mg week(-1) per animal; n = 6) or remained untreated (group D; n = 20). Further, progesterone receptor gene expression was evaluated in beef and veal calves for human consumption. A specific CCα on 20 Piedmontese control beef cattle was calculated to include these animals in a field investigation. Five out of 190 beef cattle and 26 out of 177 calves tested expressed the progesterone receptor gene above their respective CCα and they were classified as being suspected of 17β-oestradiol treatment. Additionally, 58% of veal calves that tested suspect via qPCR exhibited histological lesions of the bulbo-urethral gland tissue, which are typical of oestrogen administration and are consistent with hyperplasia and metaplasia of the glandular epithelium.

Italian multicentre open trial on DDAVP spray in nocturnal enuresis

OBJECTIVE

The aim of the study was to compare the efficacy and safety of different doses of DDAVP spray treatment (20 to 40 mcg/day) in patients with primary monosymptomatic nocturnal enuresis (defined as three or more wet nights per week).

MATERIAL AND METHODS

237 patients (152 males, 75 females; age range 5-17 years), with no infections or organic abnormalities of the urinary apparatus and no neurological disorders, were admitted into the trial. The experimental design was planned as an "open study" with five different treatments schedules (5 groups). The daily doses of DDAVP at bedtime in groups 1 and 2 were 20 and 30 mcg, respectively, for 6 weeks. In groups 3 and 4 the daily doses for the first 2 weeks were 20 and 30 mcg, respectively, and then, after a washout period of 2 weeks, the daily doses for the two groups were 30 and 20 mcg, respectively. A dose-response study (20 to 40 mcg/day) was carried out in group 5.

RESULTS

DDAVP spray therapy in primary monosymptomatic nocturnal enuresis was found to be resolutive in 70-75% of treated patients. No difference in response was found between the patients treated with the daily dose of 20 and those on 30 mcg. No important reactions were observed in patients treated with DDAVP spray at the different daily dose (20 to 40 mcg) or for different periods of time (up to 6 weeks).

CONCLUSIONS

DDAVP spray therapy at a dose of 20 mcg/day was effective in 70-75% of primary monosymptomatic nocturnal enuretics. In non-responders the daily dose of DDAVP should be increased to 30 to 40 mcg.

A possible correlation between the blood leukocyte formula and the use of glucocorticoids as growth promoters in beef cattle

Clinical analyses designed to set welfare parameters were performed on blood drawn from the caudal vein of 14 groups of cattle (young bulls and heifers) (n = 10) from 480 to 550 kg b.w., each group representative of a different farm. The leukocyte formula exhibited a lymphocytopenia in four groups compared with the values from a control group (n = 50). This finding was related to the possible illicit use of corticoids as growth promoters in meat production. The individual plasmas tested negative by two different ELISA kits for corticosteroids, but chemical analyses by LC-MS/APCI (detection limit 0.5 ng/ml) on the pooled plasma of each of the 14 groups revealed the presence of beclomethasone and fluocinolone acetonide in 3 of the 4 suspect farms. These corticosteroids are not always efficiently screened by commercially available immunoassays. The epidemiological reliability of blood analysis as a screening test for such drugs is discussed in the light of the need for quality certification of the whole meat production processes 'from farm to fork', and for enhanced animal welfare.

Child with oral, facial, digital, and skeletal anomalies and psychomotor delay: a new OFDS form?

We report on a male infant with oral, facial, digital, and skeletal anomalies in association with severe psychomotor delay. This may represent a new oral-facial-digital syndrome.

Stratton-Parker syndrome: confirmation of a new entity

Recently, Stratton and Parker [Am J Med Genet 32:169-173, 1989] reported on a child with a previously undescribed combination of growth hormone deficiency, wormian bones, dextrocardia, brachycamptodactyly, and other midline defects. We report on another patient with similar clinical signs.

Use of a novel non-steroidal anti-inflammatory drug, nimesulide, in the treatment of abacterial prostatovesiculitis

Nimesulide, a novel non-steroidal anti-inflammatory drug, was used in cases of abacterial prostato-vesiculitis. Thirty patients with a mean age of 33.7 years (range 18-58) were studied. Nimesulide was administered orally 100 mg b.i.d. for three cycles of 10 d each. Dysuric symptoms, semen analysis, and transrectal ultrasound were examined during the study. The concentration-time curves of nimesulide (NIM) and its metabolite, hydroxynimesulide (OH-NIM) in seminal fluid were also evaluated after single oral administration (100 mg) using an HPLC technique. Following administration of the drug, the Cmax was reached in seminal fluid at the second hour for NIM (with a mean value +/- SD of 0.58 +/- 0.13 micrograms ml-1) and at the fourth hour for OH-NIM (2.98 +/- 0.38 micrograms ml-1). Maximal seminal fluid concentrations compared to blood plasma levels were observed at the fourth hour for both substances (31.73 +/- 2.34% for NIM; 31.87 +/- 8.66% for OH-NIM. Dysuric symptoms were relieved in 20 (66%) patients. A clear amelioration of inflammatory signs were observed at transrectal ultrasound evaluation in 16 (54%) patients. No statistically significant changes of sperm count and motility in the whole sample were observed, while a significant reduction in the number of abnormal forms occurred. From these results, nimesulide appears to be an effective anti-inflammatory drug with a good diffusion into the genital apparatus and low side-effects.

MRI appearances in amoebic granulomatous hepatitis: a case report

Amoebiasis is a common cause of liver disease usually presenting as single large or multiple smaller abscesses. Cases with granulomatous hepatitis have rarely been described. We report the case of a 7-year-old girl with amoebic granulomatous hepatitis in which multiple liver abscesses were demonstrated by MRI. A total of 14 abscesses were identified, ranging from 5 mm to 3 cm in diameter. The largest lesions appeared to T2-weighted images as heterogeneous, low-intensity areas surrounded by a double-layered wall, the inner layer of which was hyperintense and the outer layer hypointense. These signs, which have never been described in classic amoebic abscess, represent, we believe, a pattern of hepatic granulomatous amoebiasis lesions. We suggest that MRI should always be performed in cases of amoebic infection.

Intestinal lymphangiectasia, lymphedema, mental retardation, and typical face: confirmation of the Hennekam syndrome

We report on a male with intestinal lymphangiectasia, mild mental retardation, seizures, and a typical face; the syndrome was first delineated by Hennekam et al., Am. J. Med. Genet. 34:593-600 [1989]. His parents are consanguineous. This case seems to confirm the existence of the Hennekam syndrome.

[Peripheral nerve block during ambulatory surgery of varicose veins]

This retrospective study of the 46 operations, carried out over a one year period for lower limb varicose veins using peripheral nerve blocks, included 45 patients (35 women and 10 men, mean age 49.3 years), all ASA 1 or 2, except for 4 elderly patients with a varicose ulcer (ASA 2 or 3). In 40 procedures, a sciatic nerve block combined with a "3 in 1" lumbar plexus block at the level of the groin (as described by Winnie) were used. In the remaining six, either a sciatic nerve block (short saphenous vein crossectomy; n = 3), or a "3 in 1" lumbar plexus block alone (short stripping of the long saphenous vein; n = 3) were required. A peripheral nerve stimulator to locate accurately each nerve was used. For each nerve block, the anaesthetic mixture consisted of 20 ml lidocaine 1.5% with 1:200,000 adrenaline, and 10 ml of bupivacaine 0.375% with 1:200,000 adrenaline. Surgery was only performed on one limb at a time, as the required dose of local anaesthetic was too high to safely carry out bilateral nerve blocks. In 71.7% of patients surgery was made on an day-case basis. Of those patients who had to remain in hospital overnight or longer, the peripheral nerve block was never responsible for this. During the same period, nine similar procedures were carried out under general anaesthesia, and two under epidural anaesthesia. They included seven bilateral varicose veins, three patient refusals for peripheral nerve blocks, and one allergy to lidocaine. Already used for some procedures in orthopaedic and casualty surgery, peripheral nerve blocks seem to be well suited for surgery of unilateral varicose veins.

Characterization of deletions in the dystrophin gene giving mild phenotypes

We have characterized deletions of the dystrophin gene in patients suffering from relatively mild muscular dystrophy. Our data show that most of the Becker muscular dystrophy (BMD) patients have intragenic deletions which leave the protein reading frame in phase. Remarkably, large deletions of the region corresponding to the central triple helical repeats in the protein can result in an exceptionally mild phenotype. Three brothers suffering from BMD, glycerol kinase deficiency, and adrenal hypoplasia possess a deletion at the 3' end of the gene. They also display developmental delay. Thus the 3' processing of the gene must be necessary for the correct function of the dystrophin molecule.

Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells

The oligosaccharide content of breast-milk and urine from ten nursing mothers and their babies, collected 30 days after delivery, was analysed by thin-layer and high-performance liquid chromatography. Each woman's milk and urinary oligosaccharide profiles were very similar, and the pattern of oligosaccharides excreted by her infant was also strongly correlated with that of her milk. The babies excreted 300-500 mg/day oligosaccharides and the mothers 500-800 mg/day. The effect of oligosaccharide fractions from a 500 ml pool of colostrum on bacterial adhesion to uroepithelial cells was tested on a strain of Escherichia coli isolated from an infant with urinary tract infection. The high-molecular-weight sialylated oligosaccharides had no effect but neutral oligosaccharides caused inhibition of bacterial adhesion which rose as the size of the oligosaccharides decreased. These findings suggest that breastfeeding may have a preventive effect on urinary tract infection in both mother and infant.

Tryptophan availability and fetal behavioral states

Behavioral state instability in growth-retarded fetuses might be related to a decrease in serotonine production. Tryptophan maternal and cord blood values after elective cesarean section have been investigated by means of high performance liquid chromatography in 20 growth-retarded fetuses due to pregnancy-induced hypertension (PIH) and 20 normal pregnancies as control group. The feto-maternal ratio of tryptophan is significantly higher in normal fetuses than in PIH growth-retarded fetuses (p less than 0.001). Behavioral states have been determined 1 week and just before cesarean section. Values of 1F, 2F, 3F and 4F differ in the 2 groups (p less than 0.001). A higher percentage of non-coincidences (p less than 0.001) and state interruptions (p less than 0.001) is found in PIH fetuses. A significant correlation is demonstrated between the increase of non-coincidences and decrease in the feto-maternal Trp ratio (p less than 0.001).

Changes of membrane fluidity in erythrocytes of obese children: a spin label study

Red blood cells depend on circulating lipoproteins for the turnover of membrane phospholipids. Thus abnormalities in lipid and lipoprotein metabolism are frequently associated with changes in composition and fluidity of erythrocyte membranes. Using the electron spin resonance technique we studied the physical state of erythrocyte membranes from 15 obese children with a body mass index ranging from 22.8 to 34 kg . m-2 and slight alterations of plasma lipids. The spin labels used, 5-doxylstearate and 16-doxylstearate, have shown an increase of the order parameter and of the correlation time, respectively. These observations indicate a decrease of fluidity at the surface and in the hydrophobic core of erythrocyte membranes from obese subjects. The results are statistically significant and they are discussed in relation to clinical aspects of childhood obesity. Studies on erythrocyte membrane molecular organization could represent a sensitive way to find out small metabolic alterations hardly detectable with compositional studies.