An extradural cyst in a French Bulldog

CASE HISTORY

A 7-year-old, male neutered French Bulldog was referred to a specialist veterinary hospital for evaluation of progressive paraparesis of 6-months' duration. The owners reported both faecal and urinary incontinence at home.

CLINICAL FINDINGS

The dog presented with ambulatory paraparesis and pelvic limb ataxia that was more pronounced in the right pelvic limb. The pelvic limb withdrawal response and sciatic myotatic response were reduced bilaterally. Postural reaction responses were delayed in both pelvic limbs, and this was more obvious in the right pelvic limb. The anal tone and perineal sensation were normal at the time of examination.An L4-S3 myelopathy was suspected. CT of the spine revealed a compressive, bilobed, extramedullary, cyst-like structure within the vertebral canal, between L7 and S3. Surgical removal of the cyst via a L7-S1 dorsal laminectomy was performed. Histopathological examination and additional immunohistochemistry of the excised structure indicated a probable ependymal cyst with a ciliated lining. The dog recovered well post-operatively, and at follow-up 3 weeks later had some improvement of his neurological signs. The paraparesis and pelvic limb ataxia had improved; however, the remaining neurological examination was similar to the pre-surgical examination.

DIAGNOSIS

Extradural cyst.

CLINICAL RELEVANCE

Spinal cysts can contribute to clinical signs that resemble other common chronic spinal cord diseases, such as intervertebral disc disease. Therefore, this disease should be considered as a differential when dealing with cases of progressive paraparesis and pelvic limb ataxia. This case report may potentially provide opportunities in the future for further understanding of the pathogenesis, behaviour, outcomes and subclassification of spinal cysts in dogs.

Clinical and imaging experience with yttrium-90 microspheres in the management of unresectable liver tumours

INTRODUCTION

Selective internal radiation therapy (SIRT) is emerging as a new therapeutic modality in recent years for management of non-resectable hepatic malignancies. Our experience in clinical application of this treatment is reported here.

MATERIAL AND METHODS

From June 2004, patients whose liver tumours were no longer amenable for any conventional treatment with either chemotherapy or surgery were considered for yttrium-90 microspheres treatment after discussion at our multidisciplinary meeting. A pre-treatment planning was carried out with visceral angiography and technetium-99m macroaggregated albumin (MAA) for assessment of both tumour volume and extrahepatic shunting in addition to a baseline PET and CT scans, respectively. Two weeks later, a second visceral angiogram was performed to deliver the calculated dosage of microspheres into the arterial system supplying the tumour. Patients were then followed up with tumour markers, repeat PET and CT scans of abdomen at 6 weeks and 3 monthly thereafter.

RESULT

Twenty-one patients (F=11, M=10; age range 40-75 years, mean=58 years) received yttrium-90 microspheres consisting of liver metastases from colorectal primary (n=10) and non-colorectal primaries (n=8), and primary liver tumours (n=3). One patient received 2 treatments. The mean administered activity of microspheres delivered was 1.9 GBq (range 1.2-2.5 GBq). Injection of microspheres had no immediate effect on either clinical haematology or liver function tests. At follow-up, 86% of patients showed decreased activity on PET scan at 6 weeks (p=0.01). The mean pre-treatment SUV was 12.2+/-3.7 and the mean post-treatment SUV was 9.3+/-3.7, indicating a significant improvement measured with PET activity. Only 13% showed a reduction in the size of tumour on CT scan. For patients with colorectal liver metastases, there was no significant reduction in CEA level (127+/-115 vs 75+/-72 micro/l, p=0.39). Complications were seen in 4 patients (19%) including radiation hepatitis (n=2), cholecystitis (n=1) and duodenal ulceration (n=1). All resolved without surgical intervention. Seven patients died at follow-up from progressive extrahepatic disease (33%).

CONCLUSION

SIRT should be considered for patients with advanced liver cancer. It has a significant effect on liver disease in the absence of extrahepatic disease. PET imaging has an integral role in the assessment of patients treated with yttrium-90 SIR-Spheres.

Modified de Gramont with oxaliplatin in the first-line treatment of advanced colorectal cancer

We previously reported high activity for oxaliplatin and a modified de Gramont regimen (OxMdG) in a single centre study of patients with metastatic colorectal cancer. We now report results with a further 56 patients treated at 14 centres. Low rates of grade 3 and 4 toxicity were seen, with no toxic deaths. Objective response rates were CR/PR=53%; NC=34.7%; PD=12.2%. Median time to progression was 8.3 months and overall survival was 14.5 months. This regimen is more convenient than those based around the conventional de Gramont regimen but is highly active and well tolerated; it forms part of a current UK MRC phase 3 trial.

A quantitative autoradiographic comparison of binding to glutamate receptor sub-types in hippocampus and forebrain regions of a food-storing and a non-food-storing bird

In two species of birds, food-storing marsh tits, P. palustris, and non-storing blue tits, P. caeruleus, quantitative receptor autoradiography was used to localize NMDA (N-methyl-D-aspartate)-sensitive [3H]glutamate, [3H]MK801, and [3H]AMPA binding sites, in six regions of the forebrain: hippocampus and parahippocampus, hyperstriatum accessorium (vision) and ventrale (sensory integration), neostriatum (auditory), and lobus parolfactorius (basal ganglia). In both species high levels of labelling to both NMDA and AMPA receptors were observed throughout the forebrain. However, a marked difference in receptor labelling was apparent between the two species, with levels of binding to NMDA ion channel sites being significantly lower (20%) in both the hippocampus and parahippocampus, in food storers compared to non-food storers. The levels of binding to other forebrain regions were remarkably similar in the two species. No differences were seen in the binding to AMPA receptors in forebrain regions of either species.

[Marshall syndrome--case report]

A girl, 15, with Marshall syndrome, was hospitalized for retinal tear and detachment of the left eye. The results of ophthalmological examination and applied eye surgery have been described. The authors confirm the essential phenotypical overlap of Marshall and Stickler syndromes. This suggest that they are caused by variable expression of a differently mutated gene, probably the type II procollagen gene (COL2A1), known to play a part in the etiology of Stickler syndrome. This justifies the usage, by some authors, of the common name of Marshall-Stickler syndrome.

The accumulation of fluoroquinolones in Staphylococcus aureus during the postantibiotic effect

The accumulation of radiolabelled pefloxacin, norfloxacin, and lomefloxacin was determined in Staphylococcus aureus during log phase growth, the postantibiotic effect (PAE), and at 1, 4 and 6 h post PAE. Uptake in actively growing cells was consistent with a non-saturable passive diffusion process. The addition of metabolic inhibitors significantly increased accumulation consistent with the presence of an energy dependent efflux system. Accumulation of all three fluoroquinolones in PAE phase cells was significantly increased compared to that which occurred in actively growing cells. In contrast to cells in the log phase, addition of metabolic inhibitors to PAE phase cells did not result in a significant increase in drug accumulation. Uptake kinetics 1 h and 4 h post PAE were similar to those found during the PAE phase. Organisms required 6 h after the end of the PAE phase before normal uptake kinetics of fluoroquinolones resumed.

[Traumatic avulsion of the optic nerve in the chiasm region]

Avulsion of the optic nerve in the chiasmal region is a very rare injury. The authors presented a case of such avulsion with concomitant temporal visual field defect in the other eye. The pathomechanism of this type of optic nerve injuries is discussed.