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1

Rehabilitation in spinal infection diseases  

PubMed Central

Spinal cord infections were the diseases defined by Hypocrite yet the absence of modern medicine and there was not a real protocol in rehabilitation although there were many aspects in surgical treatment options. The patients whether surgically or conservatively treated had a lot of neurological, motor, and sensory disturbances. Our clinic has quite experience from our previous researchs. Unfortunately, serious spinal cord infections are still present in our region. In these patients the basic rehabilitation approaches during early, pre-operation, post-operation period and in the home environment will provide significant contributions to improve the patients’ sensory and motor skills, develop the balance and proriocaption, increase the independence of patients in daily living activities and minimize the assistance of other people. There is limited information in the literature related with the nature of the rehabilitation programmes to be applied for patients with spinal infections. The aim of this review is to share our clinic experience and summarise the publications about spinal infection rehabilitation. There are very few studies about the rehabilitation of spinal infections. There are still not enough studies about planning and performing rehabilitation programs in these patients. Therefore, a comprehensive rehabilitation programme during the hospitalisation and home periods is emphasised in order to provide optimal management and prevent further disability. PMID:25621205

Nas, Kemal; Karakoç, Mehmet; Ayd?n, Abdulkadir; Öne?, Kadriye

2015-01-01

2

Rehabilitation in spinal infection diseases.  

PubMed

Spinal cord infections were the diseases defined by Hypocrite yet the absence of modern medicine and there was not a real protocol in rehabilitation although there were many aspects in surgical treatment options. The patients whether surgically or conservatively treated had a lot of neurological, motor, and sensory disturbances. Our clinic has quite experience from our previous researchs. Unfortunately, serious spinal cord infections are still present in our region. In these patients the basic rehabilitation approaches during early, pre-operation, post-operation period and in the home environment will provide significant contributions to improve the patients' sensory and motor skills, develop the balance and proriocaption, increase the independence of patients in daily living activities and minimize the assistance of other people. There is limited information in the literature related with the nature of the rehabilitation programmes to be applied for patients with spinal infections. The aim of this review is to share our clinic experience and summarise the publications about spinal infection rehabilitation. There are very few studies about the rehabilitation of spinal infections. There are still not enough studies about planning and performing rehabilitation programs in these patients. Therefore, a comprehensive rehabilitation programme during the hospitalisation and home periods is emphasised in order to provide optimal management and prevent further disability. PMID:25621205

Nas, Kemal; Karakoç, Mehmet; Ayd?n, Abdulkadir; Öne?, Kadriye

2015-01-18

3

Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management  

PubMed Central

Background: Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Every occurrence produces patient morbidity, which may adversely affect long-term outcome and increases health care costs. Methods: A comprehensive review of the literature from 1990 to 2012 was performed utilizing PubMed and several key words: Infection, spine, instrumentation, implant, management, and biofilms. Articles that provided a current review of the pathogenesis, diagnosis, prevention, and management of instrumented spinal infections over the years were reviewed. Results: There are multiple risk factors for postoperative spinal infections. Infections in the setting of instrumentation are more difficult to diagnose and treat due to biofilm. Infections may be early or delayed. C Reactive Protein (CRP) and Magnetic Resonance Imaging (MRI) are important diagnostic tools. Optimal results are obtained with surgical debridement followed by parenteral antibiotics. Removal or replacement of hardware should be considered in delayed infections. Conclusions: An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight in the pathogenesis and management of infected spinal implants. This literature review highlights the mechanism, pathogenesis, prevention, and management of infection after spinal instrumentation. It is important to accurately identify and treat postoperative spinal infections. The treatment is often multimodal and prolonged. PMID:24340238

Kasliwal, Manish K.; Tan, Lee A.; Traynelis, Vincent C.

2013-01-01

4

A Comparison of Antibiotic Susceptibility Patterns of Klebsiella Associated Urinary Tract Infection in Spinal Cord Injured Patients with Nosocomial Infection  

Microsoft Academic Search

Just regarding different risk factors for antibiotic resistant uropathogenes, it seems justice to improve diagnostic power for drug resistant uropathogenes and well appropriate empirical therapy. 300 and 145 cases of clinicopathologically diagnosed nosocomial and spinal cord injured (SCI) asso- ciated urinary tract infection (UTI), respectively, were considered as our samples included in our 24 months study (2005 and 2006). 50

Farzin Khorvash; Kamyar Mostafavizadeh; Sina Mobasherizadeh; Mohaddeseh Behjati

5

Spinal infections in the immunocompromised host.  

PubMed

There is an increasing population of immunocompromised patients with HIV, IV drug abuse, organ transplantation, and long-term steroid treatment developing spinal infections. Delayed diagnosis because of blunted host immune response and lack of outward signs and symptoms places the treating physician at a disadvantage in the treatment of this type of disease, which presents at a later stage of development. Immunocompromised patients are infected by a different group of pathogens than their healthier cohorts (e.g., Pseudomonas, gram-negative bacteria and fungal infections) because their host defenses are diminished. Osteomyelitis with or with out pyomyositis and epidural abscess may occur. The overriding symptom is back pain. Radiculopathy, myelopathy, and sensory loss may accompany local pain and tenderness. Plain film radiography, CT scan, MR image, and bone scan is invaluable in the diagnosis of these infections. The cornerstone of treatment is identification of the responsible pathogen, appropriate medical therapy, immobilization of the affected segment of the spine, and physical therapy to combat physical deconditioning. Psoas abscesses may require surgical debridement if they cannot be adequately drained by CT-guided percutaneous catheterization. Epidural abscesses with neurologic compromise require surgical drainage. Impingement of the spinal cord or cauda equina by collapsed osteomyelitic vertebral bodies requires surgical debridement by anterior vertebrectomy, with an autologous tricortical iliac crest strut and immobilization of the spine using external bracing or posterior instrumentation as dictated by the disease. PMID:8539051

Broner, F A; Garland, D E; Zigler, J E

1996-01-01

6

Preoperative, intraoperative, and postoperative measures to further reduce spinal infections  

PubMed Central

Background: The rate of postoperative spinal infections varies from 0.4% to 3.5%. Although the introduction of additional preoperative, intraoperative, and postoperative methods of prophylaxis should further reduce spinal infection rates, these measures will not succeed unless surgeons are well informed of their availability, utility, and efficacy. This study provides a review of several preoperative, intraoperative, and postoperative methods of prophylaxis that could minimize the risk of postoperative spinal infections. Various preoperative, intraoperative, and postoperative measures could further reduce the risk of spinal infections. Preoperative prophylaxis against methicillin-resistant Staphylococcus aureus could utilize (1) nasal cultures and Bactroban ointment (mupirocin), and (2) multiple prophylactic preoperative applications of chlorhexidine gluconate (CHG) 4% to the skin. Intraoperative prophylactic measures should not only include the routine use of an antibiotic administered within 60 min of the incision, but should also include copious intraoperative irrigation [normal saline (NS) and/or NS with an antibiotic]. Intraoperatively, instrumentation coated with antibiotics, and/or the topical application of antibiotics may further reduce the infection risk. Whether postoperative infections are reduced with the continued use of antibiotic prophylaxis remains controversial. Other postoperative measures may include utilization of a silver (AgNO3)-impregnated dressing (Silverlon dressing) and the continued use of bed baths with CHG 4%. The introduction of multiple preoperative, intraoperative, and postoperative modalities in addition to standardized prophylaxis may further contribute to reducing postoperative spinal infections. PMID:21427784

Epstein, Nancy E.

2011-01-01

7

Postoperative spinal infection mimicking systemic vasculitis with titanium-spinal implants  

PubMed Central

Background Secondary systemic vasculitis after posterior spinal fusion surgery is rare. It is usually related to over-reaction of immune-system, to genetic factors, toxicity, infection or metal allergies. Case Description A 14 year-old girl with a history of extended posterior spinal fusion due to idiopathic scoliosis presented to our department with diffuse erythema and nephritis (macroscopic hemuresis and proteinuria) 5 months post surgery. The surgical trauma had no signs of inflammation or infection. The blood markers ESR and CRP were increased. Skin tests were positive for nickel allergy, which is a content of titanium alloy. The patient received corticosteroids systematically (hydrocortisone 10 mg) for 6 months, leading to total recess of skin and systemic reaction. However, a palpable mass close to the surgical wound raised the suspicion of a late infection. The patient had a second surgery consisting of surgical debridement and one stage revision of posterior spinal instrumentation. Intraoperative cultures were positive to Staphylococcus aureus. Intravenous antibiotics were administered. The patient is now free of symptoms 24 months post revision surgery without any signs of recurrence of either vasculitis or infection. Literature Review Systemic vasculitis after spinal surgery is exceptionally rare. Causative factors are broad and sometimes controversial. In general, it is associated with allergy to metal ions. This is usually addressed with metal on metal total hip bearings. In spinal surgery, titanium implants are considered to be inert and only few reports have presented cases with systemic vasculitides. Therefore, other etiologies of immune over-reaction should always be considered, such as drug toxicity, infection, or genetic predisposition. Purposes and Clinical Relevance Our purpose was to highlight the difficulties during the diagnostic work-up for systemic vasculitis and management in cases of posterior spinal surgery. PMID:21914179

2011-01-01

8

Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population.  

PubMed

As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status. PMID:25348798

Shacham, Enbal; Onen, Nur F; Donovan, Michael F; Rosenburg, Neal; Overton, E Turner

2014-10-27

9

[Corynebacterium pseudodiphtheriticum pneumonia in a patient diagnosed with HIV infection].  

PubMed

Corynebacterium pseudodiphteriticum is a diphteromorphic bacterium, previously described as pathogenic in very few cases. We present the case of a patient diagnosed of infection by the human immunodeficiency virus (HIV), who developed pneumonia probably caused by Corynebacterium pseudodiphtheriticum and who had a good response to the initial empirical therapy with cephotaxime. We reviewed the literature on patients with diagnosis of HIV infection, acquired immunodeficiency syndrome (AIDS) and AIDS-related complex and we found just one case of this corynebacterium acting as pathogenic and causing a pulmonary abscess. PMID:8136430

Roig, P; López, M M; Arriero, J M; Cuadrado, J M; Martín, C

1993-10-01

10

[Cutaneous botryomycosis. A rarely diagnosed bacterial infection of the skin].  

PubMed

Botryomycosis is a rare chronic bacterial infection, which can involve the skin as well as internal organs. Clinically and histologically it resembles actinomycosis and deep fungal infections. The most common causative organisms described are Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa, but the pathogenesis of botryomycosis is still poorly understood. A 16-year-old girl presented with multiple erythematous solid and partly purulent nodules which were extremely resistant to therapy. In this case we could diagnose a botryomycosis caused by Staphylococcus aureus. PMID:17565479

Meissner, M; Spieth, K; Wolter, M; Gille, J; Boehncke, W-H; Thaci, D; Kaufmann, R

2007-11-01

11

Urinary tract infection in individuals with spinal cord lesion.  

PubMed

Urinary tract infection is the most frequently reported secondary impairment in individuals with spinal cord lesion. The most prevalent risk indicator is an indwelling catheter. Hydrophilic catheters for clean intermittent catheterization may induce lower rates of bacteriuria and long-term urethral complications. Due to chronic bacterial infection within biofilms, an antibacterial treatment based on a urinary culture of bacteria in the urine and its antimicrobial susceptibility may fail to eradicate catheter-associated urinary tract infection. No commercially available drugs are sufficiently active against the bacteria in a mature biofilm. Biomaterials may be modified to decrease the formation of a biofilm. Silver alloy catheters are effective in preventing urinary tract infection when indwelling urinary catheterization is necessary. The risk of systemic argyria in long-term use needs to be evaluated. Suprapubic cystostomy drainage in patients with neurogenic bladder is preferred to an indwelling urethral catheter. In cases of recurring urinary tract infection in patients with a permanent urinary catheter, it may be beneficial to change the catheter every 1 or 2 weeks. There is some evidence that cranberry products may prevent urinary tract infection. In the future, bacterial interference and vaccination may be a possibility for prevention of urinary tract infection. PMID:11753133

Biering-Sørensen, Fin

2002-01-01

12

Spinal Epidural Abscess Associated With Moxibustion-Related Infection of the Finger  

PubMed Central

Objective: To describe a spinal epidural abscess that originated from cellulitis after moxibustion. Methods: Case report. Findings: A 78-year-old woman with diabetes mellitus was diagnosed with tetraplegia due to a cervical spinal epidural abscess extending to the thoracic spinal epidural space. The abscess was caused by osteomyelitis and cellulitis of the right third finger, which had been cauterized repeatedly with moxa. After surgical decompression and drainage of the spinal epidural abscess and comprehensive rehabilitation, motor strength and functional level improved. Conclusions: This case illustrates the risk of spinal epidural abscess in persons with diabetes mellitus who present with focal cellulitis and osteomyelitis. PMID:18795486

Lee, Kyung Whan; Han, Soo Jeong; Kim, Dong Jun; Lee, Mee Jin

2008-01-01

13

Dual diagnoses: the person with a spinal cord injury and a concomitant brain injury.  

PubMed

Spinal cord injury (SCI) alone is a devastating event that often results in physical disability. When the SCI is combined with a brain injury, the degree of disability can be magnified and the patient's rehabilitation becomes further complicated. It is not unusual for the head injury to be overlooked or undetected during the emergent and acute phases of treatment. The brain injury may first appear when the client demonstrates an inability or resistance to carry out functional activities appropriate to his/her level of injury. Cognitive deficits can limit or complicate the client's ability to adapt to his/her physical limitations, learn compensatory skills, and achieve the maximal level of independence. These patients require a wide base of physical, psychological, educational, and medical support. Because they are at a high risk for developing complications, they will require lifelong interventions and involvement from an interdisciplinary team to provide a safety net. The following article examines the patient with dual diagnoses of SCI and brain injury. A comprehensive review of commonly encountered problematic scenarios and interventions is presented. PMID:14626031

Arzaga, Deborah; Shaw, Vance; Vasile, Ann T

2003-01-01

14

Short communication: acute phase proteins in Holstein cows diagnosed with uterine infection.  

PubMed

The aim of this work was to monitor the pattern of serum acute phase proteins [paraoxonase (PON), haptoglobin (Hp) and albumin] during the peripartum period of normal healthy cows (n=16) compared to that in cows diagnosed with uterine infection (n=15). Albumin concentrations were lower at 21 days before expected calving in cows subsequently diagnosed with uterine infection and predicted the occurrence of uterine infection with an accuracy of 79.3%. Cows diagnosed with uterine infection had a postpartum reduction in serum PON activity and the concentration of Hp increased at 7 DIM for multiparous uterine infected cows. In conclusion, cows diagnosed with uterine infection had reduced serum albumin concentration 21 days before calving, lower PON activity at 7 days after calving, and increased Hp in multiparous cows at 7 DIM compared to healthy cows. PMID:23540606

Schneider, A; Corrêa, M N; Butler, W R

2013-08-01

15

SETX gene mutation in a family diagnosed autosomal dominant proximal spinal muscular atrophy  

Microsoft Academic Search

Autosomal dominant proximal spinal muscular atrophy (ADSMA) is a rare disorder with unknown gene defects in the majority of families. Here we describe a family where the diagnosis of juvenile and adult onset ADSMA was made in three individuals. Because of retained tendon reflexes an atypical course of juvenile amyotrophic lateral sclerosis (ALS4) was considered. SETX gene sequencing revealed the

Sabine Rudnik-Schöneborn; Larissa Arning; Jörg T. Epplen; Klaus Zerres

16

Wound management with vacuum-assisted closure in postoperative infections after surgery for spinal stenosis  

PubMed Central

Objective To evaluate the results of negative-pressure wound therapy (NPWT) in the treatment of surgical spinal site infections. Materials and methods The use of NPWT in postoperative infections after dorsal spinal surgery (transforaminal lumbar interbody fusion plus posterior instrumentation) was studied retrospectively. From February 2011 to January 2012, six patients (females) out of 317 (209 females; 108 males) were readmitted to our clinic with surgical site infections on postoperative day 14 (range 9–19) and were treated with debridement, NPWT, and antibiotics. We evaluated the clinical and laboratory data, including the ability to retain the spinal hardware and recurrent infections. Results The incidence of deep postoperative surgical site infection was six (1.89%) patients (females) out of 317 patients (209 females; 108 males) at 1 year. All patients completed their wound NPWT regimen successfully. An average of 5.1 (range 3–8) irrigation and debridement sessions was performed before definitive wound closure. The mean follow-up period was 13 (range 12–16) months. No patient had a persistent infection requiring partial or total hardware removal. The hospital stay infection parameters normalized within an average of 4.6 weeks. Conclusion The study illustrates the usefulness of NPWT as an effective adjuvant treatment option for managing complicated deep spinal surgical wound infections.

Karaaslan, Fatih; Erdem, ?evki; Mermerkaya, Musa U?ur

2015-01-01

17

Risk factors for surgical site infections diagnosed after hospital discharge  

Microsoft Academic Search

A prospective cohort study on 1103 consecutive patients undergoing general surgery with a follow-up of up to 30 days was undertaken to analyse the risk factors for surgical-site infection (SSI). Relative risks (RRs), crude and multiple-risk factors adjusted for by logistic regression analysis, and their 95% confidence intervals were calculated. One hundred and four patients (9·4%) developed infection, 81 in

M. Lecuona; À. Torres-Lana; M. Delgado-Rodríguez; J. Llorca; A. Sierra

1998-01-01

18

Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge  

Microsoft Academic Search

Although surgical site infections (SSIs) are known to cause substantial illness and costs during the index hospitalization, lit- tle information exists about the impact of infections diagnosed after discharge, which constitute the majority of SSIs. In this study, using patient questionnaire and administrative data- bases, we assessed the clinical outcomes and resource utiliza- tion in the 8-week postoperative period associated

Eli N. Perencevich; Kenneth E. Sands; Sara E. Cosgrove; Edward Guadagnoli; Ellen Meara; Richard Platt

2003-01-01

19

Cytomegalovirus DNA detection in Guthrie cards: a powerful tool for diagnosing congenital infection  

Microsoft Academic Search

Background: A simple and reliable diagnosis of congenital cytomegalovirus infection is necessary both for clinical and epidemiological purposes. This could be accomplished through the demonstration of cytomegalovirus (CMV) DNA in blood spots (DBS) on Guthrie cards. Objectives: (1) To assess the sensitivity and specificity of the method (DBS test) in diagnosing congenital CMV infection compared with viral isolation and (2)

Maria Barbi; Sandro Binda; Valeria Primache; Simona Caroppo; Patrizia Didò; Paola Guidotti; Carlo Corbetta; Davide Melotti

2000-01-01

20

Difficulties in Diagnosing Group O Human Immunodeficiency Virus Type 1 Acute Primary Infection ?  

PubMed Central

We report a rare case of acute human immunodeficiency virus (HIV) type 1 group O infection in a French Caucasian woman. Her sexual partner was secondarily diagnosed with HIV infection, and transmission was confirmed by phylogenetic analysis. The unequal performance of many of the serologic and molecular assays commercially available leads to delays in diagnosis and affects patient management. PMID:18480223

Henquell, Cécile; Jacomet, Christine; Antoniotti, Odile; Chaib, Abdelhak; Regagnon, Christel; Brunet, Sylvie; Peigue-Lafeuille, Hélène; Barin, Francis

2008-01-01

21

Difficulties in diagnosing group o human immunodeficiency virus type 1 acute primary infection.  

PubMed

We report a rare case of acute human immunodeficiency virus (HIV) type 1 group O infection in a French Caucasian woman. Her sexual partner was secondarily diagnosed with HIV infection, and transmission was confirmed by phylogenetic analysis. The unequal performance of many of the serologic and molecular assays commercially available leads to delays in diagnosis and affects patient management. PMID:18480223

Henquell, Cécile; Jacomet, Christine; Antoniotti, Odile; Chaib, Abdelhak; Regagnon, Christel; Brunet, Sylvie; Peigue-Lafeuille, Hélène; Barin, Francis

2008-07-01

22

SETX gene mutation in a family diagnosed autosomal dominant proximal spinal muscular atrophy.  

PubMed

Autosomal dominant proximal spinal muscular atrophy (ADSMA) is a rare disorder with unknown gene defects in the majority of families. Here we describe a family where the diagnosis of juvenile and adult onset ADSMA was made in three individuals. Because of retained tendon reflexes an atypical course of juvenile amyotrophic lateral sclerosis (ALS4) was considered. SETX gene sequencing revealed the previously reported heterozygous missense mutation c.1166T

Rudnik-Schöneborn, Sabine; Arning, Larissa; Epplen, Jörg T; Zerres, Klaus

2012-03-01

23

Louping ill virus genome sequence derived from the spinal cord of an infected lamb.  

PubMed

Louping ill virus (LIV) is a zoonotic virus causing fatal encephalitis in young sheep and grouse. We have recovered the complete genome sequence from a spinal cord sample prepared from a lamb that was naturally infected with LIV. This is only the second LIV genome sequence reported and the first prepared from a clinical sample. PMID:23868122

Marston, Denise A; Mansfield, Karen L; Mearns, Rebecca; Ellis, Richard J; Fooks, Anthony R; Johnson, Nicholas

2013-01-01

24

Behçet's disease diagnosed after acute HIV infection: viral replication activating underlying autoimmunity?  

PubMed

Behçet's disease is an autoimmune systemic vasculitis that can occur after exposure to infectious agents. Behçet's disease also has been associated with HIV infection, including de novo development of this condition during chronic HIV infection and resolution of Behçet's disease symptoms following initiation of antiretroviral therapy. We describe a patient who presented with systemic vasculitis with skin and mucous membrane ulcerations in the setting of acute HIV infection, who was eventually diagnosed with Behçet's disease, demonstrating a possible link between acute HIV infection, immune activation and development of autoimmunity. PMID:24912539

Roscoe, Clay; Kinney, Rebecca; Gilles, Ryan; Blue, Sky

2014-06-01

25

Spinal and paraspinal infections associated with contaminated methylprednisolone acetate injections - Michigan, 2012-2013.  

PubMed

As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without meningitis associated with the 2012-2013 fungal meningitis outbreak nationally. Although the index patient had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold found on plants and in soil. Exposures have occurred through epidural, paraspinal, peripheral nerve, and intra-articular injection with MPA from contaminated lots compounded by the New England Compounding Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to determine factors that might have contributed to the high percentage of spinal and paraspinal infections reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12-121 days) were observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI) finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients who received injections with contaminated MPA but have not developed infection. PMID:23677044

2013-05-17

26

New diagnoses of HTLV infection in England and Wales: 2002-2004.  

PubMed

Human T cell lymphotropic viruses (HTLV) are retroviruses transmitted through breastfeeding, sexual contact, blood transfusion and injecting drug use. HTLV is endemic in the Caribbean, and parts of Africa, Japan and South America, with isolated foci in other areas. Infection is life long. Fewer than 5% of those infected progress to one of the HTLV-related diseases, but these are debilitating and often fatal. In England and Wales, laboratory and clinical reports of new HTLV diagnoses are routinely collected, including infections identified by the blood service since the introduction of anti-HTLV testing in August 2002. Between 2002 and 2004, 273 individuals were diagnosed with HTLV: 102 (37%) were male and 169 female (sex was not reported for two). Median ages at diagnosis were 54 and 50 years respectively. Clinical reports were received for 78% (212/273) individuals. Where reported, 58% (116/199) of individuals were of black Caribbean ethnicity and 29% (57/199) white; 87% (128/147) were probably infected heterosexually or through mother-to-child transmission; 45% (66/146) were probably infected in the Caribbean and 40% (59/146) in the United Kingdom. An appreciable number of HTLV infections continue to be diagnosed within England and Wales, with increases in 2002-2003 because of anti-HTLV testing of blood donations. While most infections diagnosed are directly associated with the Caribbean, transmission of HTLV infection is occurring within England and Wales. Specialist care services for HTLV-infected individuals and their families have improved in recent years, but prevention remains limited. PMID:16282645

Dougan, S; Smith, Alan; Tosswill, J C; Davison, K; Zuckerman, M; Taylor, G P

2005-10-01

27

Nondisclosure of HIV Status in a Clinical Trial Setting: Antiretroviral Drug Screening Can Help Distinguish Between Newly Diagnosed and Previously Diagnosed HIV Infection  

PubMed Central

In The HIV Prevention Trials Network 061 study, 155 human immunodeficiency virus (HIV)–infected men reported no prior HIV diagnosis; 83 of those men had HIV RNA levels of <1000 copies/mL at enrollment. Antiretroviral drug testing revealed that 65 of the 83 (78.3%) men were on antiretroviral treatment. Antiretroviral drug testing can help distinguish between newly diagnosed and previously diagnosed HIV infection. PMID:24092804

Marzinke, Mark A.; Clarke, William; Wang, Lei; Cummings, Vanessa; Liu, Ting-Yuan; Piwowar-Manning, Estelle; Breaud, Autumn; Griffith, Sam; Buchbinder, Susan; Shoptaw, Steven; del Rio, Carlos; Magnus, Manya; Mannheimer, Sharon; Fields, Sheldon D.; Mayer, Kenneth H.; Wheeler, Darrell P.; Koblin, Beryl A.; Eshleman, Susan H.; Fogel, Jessica M.

2014-01-01

28

Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder  

Microsoft Academic Search

Study Design:Randomized, double blind, placebo-controlled trial with a crossover design.Objective:To evaluate cranberry tablets for the prevention of urinary tract infection (UTI) in spinal cord injured (SCI) patients.Setting:Spinal Cord Injury Unit of a Veterans Administration Hospital, MA, USA.Methods:Subjects with spinal cord injury and documentation of neurogenic bladder were randomized to receive 6 months of cranberry extract tablet or placebo, followed by

M J Hess; P E Hess; M R Sullivan; M Nee; S V Yalla

2008-01-01

29

FDG-PET Imaging Can Diagnose Periprosthetic Infection of the Hip  

PubMed Central

A battery of diagnostic tests is often required to differentiate aseptic loosening from periprosthetic infection since the gold standard remains elusive. We designed a prospective study to determine the accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in diagnosing periprosthetic infection in a large multicenter setting. One hundred and thirteen patients with 127 painful hip prostheses were evaluated by FDG-PET. Images were considered positive for infection if PET demonstrated increased FDG activity at the bone-prosthesis interface of the femoral component. A combination of preoperative tests, intraoperative findings, histopathology, and clinical followup constituted the gold standard for diagnosing infection. Among the 35 positive PET scans, 28 hips were confirmed infected according to our criteria for diagnosing periprosthetic infection. Of the 92 hip prostheses with negative FDG-PET findings, 87 were considered aseptic. The sensitivity, specificity, positive and negative predictive values for FDG-PET were 0.85 (28 of 33), 0.93 (87 of 94), 0.80 (28 of 35), and 0.95 (87 of 92), respectively. The overall accuracy of this novel noninvasive imaging modality reached 0.91 (115 of 127). Based on our results, FDG-PET appears a promising and accurate diagnostic tool for distinguishing septic from aseptic painful hip prostheses. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:18421537

Chryssikos, Timothy; Ghanem, Elie; Newberg, Andrew; Zhuang, Hongming; Alavi, Abass

2008-01-01

30

Abdominal hollow viscus injuries are associated with spine and neurologic infections after penetrating spinal cord injuries.  

PubMed

Penetrating spinal cord injuries are rare but potentially devastating injuries that are associated with significant morbidity. The objective of this study was to assess the impact of abdominal hollow viscus injuries (HVIs) on neurologic and spinal infectious complications in patients sustaining penetrating spinal cord injuries. We performed a 13-year retrospective review of a Level I trauma center database. Variables analyzed included demographics, injury patterns and severity, spine operations, and outcomes. Spine and neurologic infections (SNIs) were defined as paraspinal or spinal abscess, osteomyelitis, and meningitis. Multivariate analysis was performed to identify factors associated with SNI. Of 137 patients, there were 126 males (92%) with a mean age of 27 ± 10 years. Eight patients (6%) underwent operative stabilization of their spine. Fifteen patients (11%) developed SNI. There was a higher incidence of SNI among patients with abdominal HVI compared with those without (eight [26%] vs six [6%], P < 0.001). On multivariate analysis, after controlling for injury severity, solid abdominal injury and HVI, vascular injury, and spine operation, abdominal HVIs were independently associated with an increased risk for SNI (odds ratio, 6.88; 95% confidence interval, 2.14 to 22.09; P = 0.001). Further studies are required to determine the optimal management strategy to prevent and successfully treat these infections. PMID:25264640

Schwed, Alexander C; Plurad, David S; Bricker, Scott; Neville, Angela; Bongard, Fred; Putnam, Brant; Kim, Dennis Y

2014-10-01

31

Projections of diagnosed HIV infection in children and adolescents in New York State.  

PubMed

Decreasing mother-to-child transmission is changing the population of children and adolescents with HIV. This project used recent epidemiological data to develop short-term projections of children and adolescents living with diagnosed HIV infection in New York State. A population simulation model was created to project prevalence of diagnosed HIV cases aged 0-19 years by age, sex, race/ethnicity and risk for years 2007-2014. Using 2006 data as the baseline population and 2001-2006 diagnosis and death data, annual diagnoses and deaths were calculated for each age/sex/race/risk category and known cases were 'aged' into the next year. The model produced annual estimates until 2014. The model predicts a decline in the number of persons aged 0-19 years living with diagnosed HIV in New York from 2810 in 2006 to 1431 in 2014, a net decrease of 49%. Living cases with paediatric risk continue to decrease. Cases aged 13-19 with non-paediatric risk increase slowly, leading to a shift in the risk composition of the population. The dominant effect seen in the model is the ageing out of perinatally infected children born before measures to prevent mother-to-child transmission were broadly implemented in the mid- to late 1990s. Changing trends in the young HIV-infected population should be considered in developing public health programmes for HIV prevention and care in New York State for the coming years. PMID:22324499

Gordon, Daniel E; Ghazaryan, Lusine R; Maslak, Julia; Anderson, Bridget J; Brousseau, Kathleen S; Carrascal, Alvaro F; Smith, Lou C

2012-03-01

32

Diagnosing infections: a qualitative view on prescription decisions in general practice over time  

Microsoft Academic Search

Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resulting in unnecessary antimicrobial\\u000a resistance. Our aim is to map general practitioners’ (GPs’) decision-making for common infections, exploring their diagnostic\\u000a basis for antibiotic prescriptions. Setting General practice in Iceland. Method Ten in-depth qualitative interviews with, and three observations of, GPs in 1995. Diagnostic issues extracted and analysed.

Ingunn BjornsdottirKarl; Karl G. Kristinsson; Ebba Holme Hansen

2010-01-01

33

Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients  

Microsoft Academic Search

Highly active antiretroviral therapy (HAART) has dramatically decreased opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected patients. However, gastrointestinal disease continues to account for a high proportion of presenting symptoms in these patients. Gastrointestinal symptoms in treated patients who respond to therapy are more likely to the result of drug-induced complications than OI. Endoscopic evaluation of the gastrointestinal tract remains

Ana Luiza Werneck-Silva; Ivete Bedin Prado

2009-01-01

34

Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers  

PubMed Central

AIM: Helicobacter pylori (H pylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma. Conventional invasive tests are less sensitive than non-invasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers. METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test, histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of H pylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2), iceA1, iceA2 and cag A. RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%) and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity, positive predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79% and 81%) than in patients with non-bleeding peptic ulcers (99%, 99% and 98%) (P<0.001, P<0.01 and P<0.001 respectively). The sensitivity, negative predictive value and diagnostic accuracy of mucosal polymerase reaction for H pylori were significantly lower in patients with bleeding peptic ulcers (84%, 83% and 81%) than in patients with chronic gastritis (100%, 100% and 100%) (P = 0.02, P = 0.02 and P = 0.001). CONCLUSION: Mucosal polymerase chain reaction for detecting H pylori infection is not reliable in patients with bleeding peptic ulcers. PMID:15637749

Lin, Hwai-Jeng; Lo, Wen-Ching; Perng, Chin-Lin; Tseng, Guan-Ying; Li, Anna Fen-Yau; Ou, Yueh-Hsing

2005-01-01

35

Limited cross-border infections in patients newly diagnosed with HIV in Europe  

PubMed Central

Background International travel plays a role in the spread of HIV-1 across Europe. It is, however, not known whether international travel is more important for spread of the epidemic as compared to endogenous infections within single countries. In this study, phylogenetic associations among HIV of newly diagnosed patients were determined across Europe. Results Data came from the SPREAD programme which collects samples of newly diagnosed patients that are representative for national HIV epidemics. 4260 pol sequences from 25 European countries and Israel collected in 2002–2007 were included. We identified 457 clusters including 1330 persons (31.2% of all patients). The cluster size ranged between 2 and 28. A number of 987 patients (74.2%) were part of a cluster that consisted only of patients originating from the same country. In addition, 135 patients (10.2%) were in a cluster including only individuals from neighboring countries. Finally, 208 patients (15.6%) clustered with individuals from countries without a common border. Clustering with patients from the same country was less prevalent in patients being infected with B subtype (P-value <0.0001), in men who have sex with men (P-value <0.0001), and in recently infected patients (P-value =0.045). Conclusions Our findings indicate that the transmission of HIV-1 in Europe is predominantly occurring between patients from the same country. This could have implications for HIV-1 transmission prevention programmes. Because infections through travelling between countries is not frequently observed it is important to have good surveillance of the national HIV-1 epidemics. PMID:23551870

2013-01-01

36

Severity and outcomes of Pneumocystis pneumonia in patients newly diagnosed with HIV infection: an observational cohort study  

PubMed Central

It is unclear whether patients who are unaware of their HIV infection have different severity or outcomes of Pneumocystis pneumonia (PCP) compared to patients who have been previously diagnosed with HIV. In this retrospective observational cohort study of consecutive HIV-infected patients with microscopically diagnosed PCP at San Francisco General Hospital between 1997 and 2006, 121 of 522 patients (23%) were unaware of their HIV infection prior to their diagnosis of PCP. The proportion of patients with concurrently diagnosed HIV and PCP each year remained unchanged during the study period. Patients with newly diagnosed HIV had a significantly higher alveolar-arterial oxygen gradient at presentation (median 51 versus 45 mm Hg, p=0.03), but there were no differences in mortality, frequency of mechanical ventilation, or admission to intensive care compared to patients with previously diagnosed HIV infection. In multivariate analysis, patients who reported a sexual risk factor for HIV infection were more likely to be newly diagnosed with HIV than patients who reported injection drug use as their only HIV risk factor (odds ratio = 3.14, 95% confidence interval 1.59–6.18, p = 0.001). This study demonstrates a continued need for HIV education and earlier HIV testing, particularly in patients with high-risk sexual behavior. PMID:19521925

Fei, Matthew W.; Sant, Catherine A.; Kim, Eunice J.; Swartzman, Alexandra; Davis, J. Lucian; Jarlsberg, Leah G.; Huang, Laurence

2009-01-01

37

Analysis of the Host Transcriptome from Demyelinating Spinal Cord of Murine Coronavirus-Infected Mice  

PubMed Central

Persistent infection of the mouse central nervous system (CNS) with mouse hepatitis virus (MHV) induces a demyelinating disease pathologically similar to multiple sclerosis and is therefore used as a model system. There is little information regarding the host factors that correlate with and contribute to MHV-induced demyelination. Here, we detail the genes and pathways associated with MHV-induced demyelinating disease in the spinal cord. High-throughput sequencing of the host transcriptome revealed that demyelination is accompanied by numerous transcriptional changes indicative of immune infiltration as well as changes in the cytokine milieu and lipid metabolism. We found evidence that a Th1-biased cytokine/chemokine response and eicosanoid-derived inflammation accompany persistent MHV infection and that antigen presentation is ongoing. Interestingly, increased expression of genes involved in lipid transport, processing, and catabolism, including some with known roles in neurodegenerative diseases, coincided with demyelination. Lastly, expression of several genes involved in osteoclast or bone-resident macrophage function, most notably TREM2 and DAP12, was upregulated in persistently infected mouse spinal cord. This study highlights the complexity of the host antiviral response, which accompany MHV-induced demyelination, and further supports previous findings that MHV-induced demyelination is immune-mediated. Interestingly, these data suggest a parallel between bone reabsorption by osteoclasts and myelin debris clearance by microglia in the bone and the CNS, respectively. To our knowledge, this is the first report of using an RNA-seq approach to study the host CNS response to persistent viral infection. PMID:24058676

Elliott, Ruth; Li, Fan; Dragomir, Isabelle; Chua, Ming Ming W.; Gregory, Brian D.; Weiss, Susan R.

2013-01-01

38

Spinal Infections  

MedlinePLUS

... count, c-reactive protein (CRP) and an erythrocyte sedimentation rate (ESR). These values may be slightly elevated ... with your C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) as markers of the response to ...

39

Recently diagnosed sexually HIV-infected patients: seroconversion interval, partner notification period and a high yield of HIV diagnoses among partners.  

PubMed

We collected data on the outcome of partner notification (PN) for 356 index patients (iPs) newly diagnosed with HIV, all sexually infected, in six European countries, 1995-96. The PN period (the period during which exposed partners should be notified about their risk of being HIV infected) could be defined on the basis of last negative HIV test in 170/356 (48%), from other key dates for 12, and for 14 more on the sole basis of known HIV exposure (total 196/356, 55%). However, of the 170 iPs with a last negative HIV test date, PN period was not defined in 52 (31%), even though 28/52 were recent seroconverters (negative HIV test within 24 months of HIV diagnosis). Discrepancies in PN period evaluation were common: of the 85 iPs for whom PN period was reportedly defined as '3 months before last HIV-negative date', the period actually used was equal to this in only 12. A user-friendly worksheet would simplify the task of eliciting and using key dates to define the PN period. Forms on PN outcome were received for 166/200 (83%) reported current partners, but only 124/508 (24%) ex-partners. Fifty-two of 290 (18%) notified partners already knew they were HIV-positive, and 38/130 (29%) notified partners for whom pre-PN status was negative or unknown were HIV-positive on post-PN testing. Results of HIV tests (if any) after PN were unknown for 37/133 (28%) current partners not already known to be HIV-positive, and for 71/105 (68%) ex-partners-a doubling of the information loss rate. Notification of 133 current and 105 ex-partners not previously identified as HIV-positive thus produced 28 (21%) and 10 (10%) new HIV diagnoses, respectively. The total yield of HIV diagnoses was 38/100 (38%) partners of recent seroconverters (22 already known plus 16 PN-diagnosed), compared with 52/190 (27%) partners of other iPs (30 already known plus 22 PN-diagnosed). We propose prioritization for PN of partners of recent seroconverters, augmented surveillance for HIV diagnoses and recurrence in PN networks of at-risk, non-notified partners, and new measures that preserve anonymity to alert potential and past sexual contacts of HIV-diagnosed individuals who are unable or unwilling to assist in PN. PMID:11435634

2001-07-01

40

THE EFFECT OF INTRAWOUND VANCOMYCIN POWDER ON SURGICAL SITE INFECTIONS IN POSTERIOR INSTRUMENTED SPINAL ARTHRODESES  

E-print Network

.279 Cardiovascular Disease² 17.5 13.3 p=0.123 Respiratory Disease² 17.5 14.5 p=0.272 Hypertension² 56.7 41.9 p=0.0001 Mean ASA Grade (SD)³ 2.6 (0.6) 2.5 (0.6) p=0.067 History of Surgical Site Infection (%)? 1.8 3.9 p=0.098 Current Cigarette Use at Time of Surgery... factors for SSI can be classified as preoperative factors, operative factors, and postoperative factors. Preoperative risk factors for SSI after spinal surgery include history of inflammatory arthritis15, diabetes15,16, past SSIs15, cigarette smoking17...

Heller, Aaron

2012-08-31

41

Evidence-based management of deep wound infection after spinal instrumentation.  

PubMed

In this study, evidence-based medicine is used to assess optimal surgical and medical management of patients with post-operative deep wound infection following spinal instrumentation. A computerized literature search of the PubMed database was performed. Twenty pertinent studies were identified. Studies were separated into publications addressing instrumentation retention versus removal and publications addressing antibiotic therapy regimen. The findings were classified based on level of evidence (I-III) and findings were summarized into evidentiary tables. No level I or II evidence was identified. With regards to surgical management, five studies support instrumentation retention in the setting of early deep infection. In contrast, for delayed infection, the evidence favors removal of instrumentation at the time of initial debridement. Surgeons should be aware that for deformity patients, even if solid fusion is observed, removal of instrumentation may be associated with significant loss of correction. A course of intravenous antibiotics followed by long-term oral suppressive therapy should be pursued if instrumentation is retained. A shorter treatment course may be appropriate if hardware is removed. PMID:25308619

Lall, Rishi R; Wong, Albert P; Lall, Rohan R; Lawton, Cort D; Smith, Zachary A; Dahdaleh, Nader S

2014-10-01

42

Diagnosing Sporadic Creutzfeldt-Jakob Disease: Accuracy of CSF 14-3-3 Protein Test of the Spinal Fluid  

MedlinePLUS

... thought that a type of protein called a “prion protein” (PrP) causes the disease. The PrP typically ... the PrP changes shape suddenly, it becomes a prion. This is an infectious protein that can infect ...

43

Development and validation of an algorithm to identify patients newly diagnosed with HIV infection from electronic health records.  

PubMed

An algorithm was developed that identifies patients with new diagnoses of HIV infection by the use of electronic health records. It was based on the sequence of HIV diagnostic tests, entry of ICD-9-CM diagnostic codes, and measurement of HIV-1 plasma RNA levels in persons undergoing HIV testing from 2006 to 2012 at four large urban Veterans Health Administration (VHA) facilities. Source data were obtained from the VHA National Corporate Data Warehouse. Chart review was done by a single trained abstractor to validate site-level data regarding new diagnoses. We identified 1,153 patients as having a positive HIV diagnostic test within the VHA. Of these, 57% were determined to have prior knowledge of their HIV status from testing at non-VHA facilities. An algorithm based on the sequence and results of available laboratory tests and ICD-9-CM entries identified new HIV diagnoses with a sensitivity of 83%, specificity of 86%, positive predictive value of 85%, and negative predictive value of 90%. There were no meaningful demographic or clinical differences between newly diagnosed patients who were correctly or incorrectly classified by the algorithm. We have validated a method to identify cases of new diagnosis of HIV infection in large administrative datasets. This method, which has a sensitivity of 83%, specificity of 86%, positive predictive value of 85%, and negative predictive value of 90% can be used in analyses of the epidemiology of newly diagnosed HIV infection. PMID:24564256

Goetz, Matthew Bidwell; Hoang, Tuyen; Kan, Virginia L; Rimland, David; Rodriguez-Barradas, Maria

2014-07-01

44

Magnetic resonance imaging findings of spinal intramedullary spirocercosis.  

PubMed

Spirocerca lupi is a nematode infecting dogs in tropical and subtropical areas. Aberrant S. lupi migration to different body organs, including the spinal cord, has been documented. To date, the diagnosis of aberrant spinal cord migration was made at post-mortem examination or as an incidental finding, during spinal surgery. We describe two dogs with acute asymmetric paraparesis that were subsequently diagnosed with spinal cord spirocercosis. In magnetic resonance (MR) images of the spine, T2 hyperintense lesions were seen in the spinal cord of both dogs. The lesions appeared isointense on T1-weighted images and focal enhancement was detected after gadolinium administration. The MR imaging findings were compatible with focal inflammation, presumably along the parasite migration tract. Gross and microscopic pathologic findings confirmed the diagnosis of aberrant spinal intramedullary migration of S. lupi in one dog, and in the other dog, the clinical and imaging findings were supportive of this diagnosis. PMID:18833954

Chai, Orit; Shelef, Ilan; Brenner, Ori; Dogadkin, Osnat; Aroch, Itamar; Shamir, Merav H

2008-01-01

45

Cerebral vasculitis and encephalitis due to Epstein-Barr virus in a patient with newly diagnosed HIV infection.  

PubMed

Epstein-Barr virus (EBV) is a common infection which usually produces mild or no symptoms in immunocompetent individuals. In human immunodeficiency virus (HIV) associated immunosuppression it is most commonly associated with malignancy which usually occurs at very low CD4+ cell counts. We describe a newly diagnosed HIV-positive patient who presented with headaches and cerebellar signs. She was incorrectly diagnosed with cerebral tuberculosis (TB) infection based on the histology report from a cerebellar biopsy specimen. After extensive investigation including cerebrospinal fluid sampling and reanalysis of the brain biopsy specimens she was found to have EBV-associated cerebral vasculitis and encephalitis and was successfully treated with valganciclovir and steroids. Whilst there are a few reports of EBV-associated encephalitis, cerebral vasculitis secondary to EBV in the context of HIV infection has not previously been described in the literature. PMID:24568965

Raman, Lavanya; Nelson, Mark

2014-04-01

46

Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes  

PubMed Central

We report two unusual cases of a 17-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an intradural dermoid cyst and holocord edema or syrinx, presenting with paraparesis and sphincter dysfunction secondary to an intramedullary abscess and a 26-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an infected dermoid cyst and intramedullary abscess, presenting with recurrent episodes of meningitis and hydrocephalus. Pre-operative magnetic resonance imaging (MRI) studies in these patients were initially confused for an intramedullary spinal cord tumor; however, the presence of an associated dermal sinus tract made this diagnosis of neoplasm less likely. Total excision of the dermal sinus tract, debulking of the dermoid cyst and drainage of the intramedullary abscess through an L1-L5 osteoplastic laminoplasty and midline myelotomy, followed by long-term antibiotic therapy resulted in a good functional recovery. Post-operative MRI of the spine showed removal of the dermoid cyst, decreased inflammatory granulation tissue and resolution of the holocord edema or syrinx. We also performed a literature review to determine the cumulative experience of management of intramedullary abscess in this rare clinical setting. PMID:24891897

Vadivelu, Sudhakar; Desai, Sohum K.; Illner, Anna; Luerssen, Thomas G.; Jea, Andrew

2014-01-01

47

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice  

PubMed Central

Objectives To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review. Methods A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature review Results Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers. Conclusion Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed. PMID:21528621

Pannek, Juergen

2011-01-01

48

Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses  

PubMed Central

Background Given the growing interest in the cancer burden in persons living with HIV/AIDS, we examined the validity of data sources for cancer diagnoses (cancer registry versus International Classification of Diseases, Ninth Revision [ICD-9 codes]) and compared the association between HIV status and cancer risk using each data source in the Veterans Aging Cohort Study (VACS), a prospective cohort of HIV-infected and uninfected veterans from 1996 to 2008. Methods We reviewed charts to confirm potential incident cancers at four VACS sites. In the entire cohort, we calculated cancer-type-specific age-, sex-, race/ethnicity-, and calendar-period-standardized incidence rates and incidence rate ratios (IRR) (HIV-infected versus uninfected). We calculated standardized incidence ratios (SIR) to compare VACS and Surveillance, Epidemiology, and End Results rates. Results Compared to chart review, both Veterans Affairs Central Cancer Registry (VACCR) and ICD-9 diagnoses had approximately 90% sensitivity; however, VACCR had higher positive predictive value (96% versus 63%). There were 6,010 VACCR and 13,386 ICD-9 incident cancers among 116,072 veterans. Although ICD-9 rates tended to be double VACCR rates, most IRRs were in the same direction and of similar magnitude, regardless of data source. Using either source, all cancers combined, most viral-infection-related cancers, lung cancer, melanoma, and leukemia had significantly elevated IRRs. Using ICD-9, eight additional IRRs were significantly elevated, most likely due to false positive diagnoses. Most ICD-9 SIRs were significantly elevated and all were higher than the corresponding VACCR SIR. Conclusions ICD-9 may be used with caution for estimating IRRs, but should be avoided when estimating incidence or SIRs. Elevated cancer risk based on VACCR diagnoses among HIV-infected veterans was consistent with other studies.

Park, Lesley S; Tate, Janet P; Rodriguez-Barradas, Maria C; Rimland, David; Goetz, Matthew Bidwell; Gibert, Cynthia; Brown, Sheldon T; Kelley, Michael J; Justice, Amy C; Dubrow, Robert

2014-01-01

49

Urinary tract infections in patients with spinal cord lesions: treatment and prevention.  

PubMed

Even though the mortality due to urinary tract complications has decreased dramatically during the last decades in individuals with spinal cord lesions (SCL), urinary tract infections (UTI) still cause significant morbidity in this population. Complicated UTI are caused by a much wider variety of organisms in individuals with SCL than in the general population and are often polymicrobial. Escherichia coli, Pseudomonas spp., Klebsiella spp., Proteus spp., Serratia spp., Providencia spp., enterococci, and staphylococci are the most frequently isolated bacteria in urine specimens taken from individuals with SCL. There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterisation during the rehabilitation phase has been shown to lower the rate of UTI, and virtually eliminate many of the complications associated with indwelling catheters. Persons with SCL should only be treated for bacteriuria if they have symptoms. Generally, it is advisable to use antibacterial agents with little or no impact on the normal flora. Single agent therapy - in accordance with antimicrobial susceptibility test - is preferred. We advise extending treatment to at least 5 days, and in those with reinfection or relapsing UTI, at least 7 to 14 days, depending on the severity of the infection. The diagnosis of structural and/or functional risk factors is essential in order to plan an optimal treatment for UTI in individuals with SCL, which should include treatment of simultaneously occurring predisposing factors. The treatment of structural risk factors follows general urological principles, aiming for sufficient outlet from the bladder with minimal residual urine and low pressure voiding. For prevention of UTI, general cleanliness and local hygiene should be encouraged. If the patient has a reinfection or relapsing symptomatic UTI, it is important to check for inadequately treated infection and complications, which need special attention, in particular residual urine and urinary stones. No reliable evidence exists of the effectiveness of cranberry juice and other cranberry products. Prophylactic antibacterials should only be used in patients with recurrent UTI where no underlying cause can be found and managed, and in particular if the upper urinary tract is dilated. Antibacterials should not be used for the prevention of UTI in individuals with SCL and indwelling catheters. However, the use of prophylactic antibacterials for individuals with SCL using intermittent catheterisation or other methods of bladder emptying is controversial. PMID:11511022

Biering-Sørensen, F; Bagi, P; Høiby, N

2001-01-01

50

Diagnosing and Managing Diabetes in HIV-Infected Patients: Current Concepts.  

PubMed

Diabetes mellitus (DM) is a common condition with significant associated morbidity and mortality. DM diagnosis and management among human immunodeficiency virus (HIV)-infected patients is a particularly relevant topic as the HIV-infected population ages and more HIV-infected individuals live with chronic medical comorbidities. Although there is mixed evidence regarding HIV as an independent risk factor for DM, multiple factors related to HIV and its treatment are associated with DM. This review covers the epidemiology of DM in HIV-infected patients, and diagnosis, management, and treatment goals for DM in HIV-infected patients. We highlight the most recent DM treatment guidelines from the American Diabetes Association and the European Association for the Study of Diabetes, emphasizing individualization of DM medication therapy and treatment goals. Finally, we review a comprehensive approach to cardiovascular disease risk reduction in HIV-infected patients with DM and measures to prevent other complications of DM. PMID:25313249

Monroe, Anne K; Glesby, Marshall J; Brown, Todd T

2015-02-01

51

Cryptosporidium hominis Infection Diagnosed by Real-Time PCR-RFLP  

PubMed Central

There are approximately 20 known species of the genus Cryptosporidium, and among these, 8 infect immunocompetent or immunocompromised humans. C. hominis and C. parvum most commonly infect humans. Differentiating between them is important for evaluating potential sources of infection. We report here the development of a simple and accurate real-time PCR-based restriction fragment length polymorphism (RFLP) method to distinguish between C. parvum and C. hominis. Using the CP2 gene as the target, we found that both Cryptosporidium species yielded 224 bp products. In the subsequent RFLP method using TaqI, 2 bands (99 and 125 bp) specific to C. hominis were detected. Using this method, we detected C. hominis infection in 1 of 21 patients with diarrhea, suggesting that this method could facilitate the detection of C. hominis infections. PMID:23864748

Cheun, Hyeng-Il; Kim, Kyungjin; Yoon, Sejoung; Lee, Won-Ja; Park, Woo-Yoon; Sim, Seobo

2013-01-01

52

[A case of previous infection with schistosomiasis japonica diagnosed holistically on the basis of various clinical examination findings].  

PubMed

A 66-year-old male was referred to our hospital because of a high CRP level. CT and MRI revealed cord-like contrast effects along the periphery of the liver, and peripheral portal vein occlusion was suspected. Histopathological analysis revealed fibrotic occlusion and eosinophil and histiocytic infiltration of the portal vein. Taking into account various clinical imaging tests, blood tests, and histopathological tests and of his current clinical history, he was diagnosed with previous infection of schistosomiasis japonica. We believe that this case illustrates the importance of a comprehensive diagnosis; in addition, we implemented real-time virtual sonography and EOB-MRI that provided useful visual information. PMID:24806239

Iwata, Tomoaki; Kondo, Yasuteru; Kimura, Osamu; Fujishima, Fumiyoshi; Morosawa, Tatsuki; Ninomiya, Masashi; Kakazu, Eiji; Kogure, Takayuki; Iwasaki, Takao; Shimosegawa, Tooru

2014-05-01

53

"Get them while they're young": reflections of young gay men newly diagnosed with HIV infection.  

PubMed

Thirty years into the epidemic, young men who have sex with men (YMSM) continue to be the largest at-risk group for HIV infection in the United States. In this qualitative study, face-to-face confidential interviews were conducted with 10 recently diagnosed YMSM. The purpose of the study was to explore the factors that may have contributed to each young man's recent HIV diagnosis and to solicit his perspectives on the design and efficacy of existing HIV prevention programs. Content analysis of the interview data revealed four major themes: personal risks, lack of relevant education, accessing the Internet, and the need for mentors. The informants in this study recommended the formulation of age-specific education interventions and the development of HIV prevention interventions that match the sophistication level and needs of today's gay youth to reduce the number of new HIV infections in YMSM. PMID:21459623

Flores, D Dennis; Blake, Barbara J; Sowell, Richard L

2011-01-01

54

Possible Strongyloides stercoralis infection diagnosed by videocapsule endoscopy in an immunocompetent patient with devastating diarrhea  

PubMed Central

Strongyloides stercoralis is an endemic parasitic infection of tropical areas, but it is rare in Europe. Most infected immunocompetent patients are asymptomatic, but may present with abdominal pain and diarrhea even several years after acquiring the infection. However, in immunocompromized patients, hyperinfection syndrome has a high mortality rate. Risk factors for the hyperinfection syndrome are corticosteroids and infection with human T lymphotropic virus type 1. Diagnosis of strongyloidiasis is usually made by identifying the larvae in the stool or in duodenal biopsies. There are only four published cases of strongyloidiasis in Greek patients, three of them were immunocompromized. In our patient videocapsule endoscopy identified rhabditiform larvae suggestive of strongyloidiasis. This case report illustrates the difficulty in establishing a diagnosis of the disease in immunocompetent patients. PMID:24713813

Xouris, Dimitrios; Vafiadis-Zoumbulis, Irene; Papaxoinis, Kostis; Bamias, Giorgos; Karamanolis, George; Vlachogiannakos, Janis; Ladas, Spiros D.

2012-01-01

55

Schistosomiasis japonicum diagnosed on liver biopsy in a patient with hepatitis B co-infection: a case report  

PubMed Central

Introduction Chronic hepatitis B virus and schistosomiasis are independently associated with significant mortality and morbidity worldwide. Despite much geographic overlap between these conditions and no reason why co-infection should not exist, we present what is, to the best of our knowledge, the first published report of a proven histological diagnosis of hepatic Schistosomiasis japonicum and chronic hepatitis B co-infection. A single case of hepatitis B and hepatic Schistosomiasis mansoni diagnosed by liver biopsy has previously been reported in the literature. Case presentation A 38-year-old Chinese man with known chronic hepatitis B virus infection presented with malaise, nausea and headache. Blood tests revealed increased transaminases and serology in keeping with hepatitis B virus e-antigen seroconversion. A liver biopsy was performed because some investigations, particularly transient elastography, suggested cirrhosis. Two schistosome ova were seen on liver histology, identified as S. japonicum, probably acquired in China as a youth. His peripheral eosinophil count was normal, schistosomal serology and stool microscopy for ova, cysts and parasites were negative. Conclusion Hepatic schistosomiasis co-infection should be considered in patients with hepatitis B virus infection who are from countries endemic for schistosomiasis. Screening for schistosomiasis using a peripheral eosinophil count, schistosomal serology and stool microscopy may be negative despite infection, therefore presumptive treatment could be considered. Transient elastography should not be used to assess liver fibrosis during acute flares of viral hepatitis because readings are falsely elevated. The impact of hepatic schistosomiasis on the sensitivity and specificity of transient elastography measurement for the assessment of hepatitis B is as yet unknown. PMID:24521427

2014-01-01

56

18F-Fluorodeoxyglucose Positron Emission Tomography/CT Scanning in Diagnosing Vascular Prosthetic Graft Infection  

PubMed Central

Vascular prosthetic graft infection (VPGI) is a severe complication after vascular surgery. CT-scan is considered the diagnostic tool of choice in advanced VPGI. The incidence of a false-negative result using CT is relatively high, especially in the presence of low-grade infections. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scanning has been suggested as an alternative for the diagnosis and assessment of infectious processes. Hybrid 18F-FDG PET/CT has established the role of 18F-FDG PET for the assessment of suspected VPGI, providing accurate anatomic localization of the site of infection. However, there are no clear guidelines for the interpretation of the uptake patterns of 18F-FDG as clinical tool for VPGI. Based on the available literature it is suggested that a linear, diffuse, and homogeneous uptake should not be regarded as an infection whereas focal or heterogeneous uptake with a projection over the vessel on CT is highly suggestive of infection. Nevertheless, 18F-FDG PET and 18F-FDG PET/CT can play an important role in the detection of VPGI and monitoring response to treatment. However an accurate uptake and pattern recognition is warranted and cut-off uptake values and patterns need to be standardized before considering the technique to be the new standard. PMID:25210712

Saleem, Ben R.; Pol, Robert A.; Slart, Riemer H. J. A.; Reijnen, Michel M. P. J.; Zeebregts, Clark J.

2014-01-01

57

Use of an Electronic Nose To Diagnose Mycobacterium bovis Infection in Badgers and Cattle  

Microsoft Academic Search

It is estimated that more than 50 million cattle are infected with Mycobacterium bovis worldwide, resulting in severe economic losses. Current diagnosis of tuberculosis (TB) in cattle relies on tuberculin skin testing, and when combined with the slaughter of test-positive animals, it has significantly reduced the incidence of bovine TB. The failure to eradicate bovine TB in Great Britain has

R. Fend; R. Geddes; S. Lesellier; H.-M. Vordermeier; L. A. L. Corner; E. Gormley; E. Costello; R. G. Hewinson; D. J. Marlin; A. C. Woodman; M. A. Chambers

2005-01-01

58

Low Prevalence of Transmitted Drug Resistance in Patients Newly Diagnosed with HIV-1 Infection in Sweden 2003–2010  

PubMed Central

Transmitted drug resistance (TDR) is a clinical and epidemiological problem because it may contribute to failure of antiretroviral treatment. The prevalence of TDR varies geographically, and its prevalence in Sweden during the last decade has not been reported. Plasma samples from 1,463 patients newly diagnosed with HIV-1 infection between 2003 and 2010, representing 44% of all patients diagnosed in Sweden during this period, were analyzed using the WHO 2009 list of mutations for surveillance of TDR. Maximum likelihood phylogenetic analyses were used to determine genetic subtype and to investigate the relatedness of the sequences. Eighty-two patients showed evidence of TDR, representing a prevalence of 5.6% (95% CI: 4.5%–6.9%) without any significant time trends or differences between patients infected in Sweden or abroad. Multivariable logistic regression showed that TDR was positively associated with men who have sex with men (MSM) and subtype B infection and negatively associated with CD4 cell counts. Among patients with TDR, 54 (68%) had single resistance mutations, whereas five patients had multi-drug resistant HIV-1. Phylogenetic analyses identified nine significantly supported clusters involving 29 of the patients with TDR, including 23 of 42 (55%) of the patients with TDR acquired in Sweden. One cluster contained 18 viruses with a M41L resistance mutation, which had spread among MSM in Stockholm over a period of at least 16 years (1994–2010). Another cluster, which contained the five multidrug resistant viruses, also involved MSM from Stockholm. The prevalence of TDR in Sweden 2003–2010 was lower than in many other European countries. TDR was concentrated among MSM, where clustering of TDR strains was observed, which highlights the need for continued and improved measures for targeted interventions. PMID:22448246

Karlsson, Annika; Björkman, Per; Bratt, Göran; Ekvall, Håkan; Gisslén, Magnus; Sönnerborg, Anders; Mild, Mattias; Albert, Jan

2012-01-01

59

Evaluation of a new fluorescence quantitative PCR test for diagnosing Helicobacter pylori infection in children  

PubMed Central

Background Numerous diagnostic tests are available to detect Helicobactor pylori (H. pylori). There has been no single test available to detect H. pylori infection reliably. We evaluated the accuracy of a new fluorescence quantitative PCR (fqPCR) for H. pylori detection in children. Methods Gastric biopsy specimens from 138 children with gastritis were sent for routine histology exam, rapid urease test (RUT) and fqPCR. 13C-urea breath test (13C-UBT) was carried out prior to endoscopic procedure. Gastric fluids and dental plaques were also collected for fqPCR analysis. Results 38 children (27.5%) were considered positive for H. pylori infection by gold standard (concordant positive results on 2 or more tests). The remaining 100 children (72.5%) were considered negative for H. pylori. Gastric mucosa fqPCR not only detected all 38 H. pylori positive patients but also detected 8 (8%) of the 100 gold standard-negative children or 11 (10.7%) of the 103 routine histology-negative samples. Therefore, gastric mucosa fqPCR identified 46 children (33.3%) with H. pylori infection, significantly higher than gold standard or routine histology (P<0.01). Both gastric fluid and dental plaque fqPCR only detected 32 (23.2%) and 30 (21.7%) children with H. pylori infection respectively and was significantly less sensitive than mucosa fqPCR (P<0.05) but was as sensitive as non-invasive UBT. Conclusions Gastric mucosa fqPCR was more sensitive than routine histology, RUT, 13C-UBT alone or in combination to detect H. pylori infection in children with chronic gastritis. Either gastric fluid or dental plaque PCR is as reliable as 13C-UBT for H. pylori detection. PMID:23311469

2013-01-01

60

How to use: bacterial cultures in diagnosing lower respiratory tract infections in cystic fibrosis.  

PubMed

Respiratory infections are the leading cause of morbidity and mortality in cystic fibrosis. Certain bacteria, such as Pseudomonas aeruginosa, are associated with a worse clinical outcome than others, but can be completely eradicated if identified and treated early. The diagnosis of lower respiratory tract infections can be challenging in the non-expectorating patient, in whom upper airway samples, such as cough swabs, are a surrogate for lower airway sampling. However, the results of these often do not fit with the clinical picture, presenting a management dilemma. Frequently, clinicians are faced with a negative culture result in a progressively symptomatic patient and vice versa. When judging the clinical significance of a positive upper airway culture result in an asymptomatic patient, it is important to consider the prognostic significance of the organism cultured. Given that the reported sensitivity of upper airway swabs (which includes throat swabs) is variable, ranging from 35.7% to 71% for Pseudomonas aeruginosa, 50% to 86% for Staphylococcus aureus and 11% to 92% for Haemophilus influenza, upper airway samples may fail to identify lower airway infections. Therefore, in symptomatic children, a repeatedly negative upper airway swab should not be considered as reassuring, and alternative sampling methods, such as induced sputum or bronchoalveolar lavage, should be considered. Here we use some examples of common scenarios to illustrate how best to use bacterial cultures to aid management decisions in cystic fibrosis. PMID:24334311

Ahmed, Bushra; Bush, Andrew; Davies, Jane C

2014-10-01

61

Evaluation of recombinant antigens of Trypanosoma cruzi to diagnose infection in naturally infected dogs from Chaco region, Argentina.  

PubMed

Dogs are considered the main mammal reservoir of Trypanosoma cruzi in domiciliary environments. Consequently, accurate detection of T. cruzi infection in canine populations is epidemiologically relevant. Here, we analysed the utility of the T. cruzi recombinant antigens FRA, SAPA, CP1, Ag1 and a SAPA/TSSA VI mixture, in an ELISA format. We used a positive control group of sera obtained from 38 dogs from the Chaco region in Argentina with positive homogenate-ELISA reaction, all of them also positive by xenodiagnosis and/or PCR. The negative group included 19 dogs from a nonendemic area. Sensitivity, specificity, area under the curve (AUC) of the receiver operating charactheristic (ROC) curve and Kappa index were obtained to compare the diagnostic efficiency of the tests. The SAPA/TSSA VI had the highest performance, with a sensitivity of 94.7% and an AUC ROC of 0.99 that indicates high accuracy. Among individual antigens, SAPA-ELISA yielded the highest sensitivity (86.8%) and AUC ROC (0.96), whereas FRA-ELISA was the least efficient test (sensitivity = 36.8%; AUC ROC = 0.53). Our results showed that the use of SAPA/TSSA VI in ELISAs could be a useful tool to study dogs naturally infected with T. cruzi in endemic areas. PMID:25201522

Floridia-Yapur, N; Vega-Benedetti, A F; Rumi, M Monje; Ragone, P; Lauthier, J J; Tomasini, N; d'Amato, A M Alberti; Lopez-Quiroga, I; Diosque, P; Marcipar, I; Nasser, J R; Cimino, R O

2014-12-01

62

Clinical and Radiographic Factors Do Not Accurately Diagnose Smear-Negative Tuberculosis in HIV-infected Inpatients in Uganda: A Cross-Sectional Study  

Microsoft Academic Search

BackgroundAlthough World Health Organization guidelines recommend clinical judgment and chest radiography for diagnosing tuberculosis in HIV-infected adults with unexplained cough and negative sputum smears for acid-fast bacilli, the diagnostic performance of this approach is unknown. Therefore, we sought to assess the accuracy of symptoms, physical signs, and radiographic findings for diagnosing tuberculosis in this population in a low-income country with

J. Lucian Davis; William Worodria; Harriet Kisembo; John Z. Metcalfe; Adithya Cattamanchi; Michael Kawooya; Rachel Kyeyune; Saskia den Boon; Krista Powell; Richard Okello; Samuel Yoo; Laurence Huang

2010-01-01

63

Associations between availability and coverage of HIV-prevention measures and subsequent incidence of diagnosed HIV infection among injection drug users.  

PubMed

HIV-prevention measures specific to injection drug users (IDUs), such as opioid substitution treatment and needle-and-syringe programs, are not provided in many countries where injection drug use is endemic. We describe the incidence of diagnosed HIV infection in IDUs and the availability and coverage of opioid substitution and needle-and-syringe programs in the European Union and 5 middle- and high-income countries. Countries with greater provision of both prevention measures in 2000 to 2004 had lower incidence of diagnosed HIV infection in 2005 and 2006. PMID:19372511

Wiessing, Lucas; Likatavicius, Giedrius; Klempová, Danica; Hedrich, Dagmar; Nardone, Anthony; Griffiths, Paul

2009-06-01

64

Diagnoses of Human Immunodeficiency Virus (HIV) Infection Among Foreign-Born Persons Living in the District of Columbia.  

PubMed

This study characterizes available surveillance data for HIV infected foreign-born residents in the District of Columbia (DC) to inform local HIV prevention and care efforts. HIV surveillance data were reviewed for adults and adolescents (ages ?13 years) living with HIV in 2008. Variables analyzed included demographics, region of origin (for persons born outside of the U.S.), insurance coverage, linkage to and continuous HIV care. Of the 16,513 DC residents living with HIV diagnoses, 1,391 (8.4 %) were foreign-born. Of foreign-born infected, 71.9 % were male; 33.3 % were from Africa and 20.8 % from Central America; 80.6 % were exposed through sex; 36.3 % had health coverage at diagnosis. While 100 % of foreign-born persons had documented linkage to HIV care, only 18.0 % had documentation of continued HIV care. These data suggest that strengthening continuous HIV care support after successful care linkage is warranted for foreign-born persons living with HIV in DC. PMID:23897303

Willis, Leigh A; Opoku, Jenevieve; Murray, Ashley; West, Tiffany; Johnson, Anna Satcher; Pappas, Gregory; Sutton, Madeline Y

2015-02-01

65

The use of gas-sensor arrays to diagnose urinary tract infections.  

PubMed

Sensorial analysis based on the utilisation of human senses, is one of the most important and straightforward investigation methods in food and chemical analysis. An electronic nose has been used to detect in vivo Urinary Tract Infections from 45 suspected cases that were sent for analysis in a UK Health Laboratory environment. These samples were analysed by incubation in a volatile generation test tube system for 4-5 h. The volatile production patterns were then analysed using an electronic nose system with 14 conducting polymer sensors. An intelligent model consisting of an odour generation mechanism, rapid volatile delivery and recovery system, and a classifier system based on learning techniques has been considered. The implementation of an Extended Normalised Radial Basis Function network with advanced features for determining its size and parameters and the concept of fusion of multiple classifiers dedicated to specific feature parameters has been also adopted in this study. The proposed scheme achieved a very high classification rate of the testing dataset, demonstrating in this way the efficiency of the proposed scheme compared with other approaches. This study has shown the potential for early detection of microbial contaminants in urine samples using electronic nose technology. PMID:16278941

Kodogiannis, Vassilis; Wadge, Edmund

2005-10-01

66

Hepatitis C Core Antigen Testing: A Reliable, Quick, and Potentially Cost-effective Alternative to Hepatitis C Polymerase Chain Reaction in Diagnosing Acute Hepatitis C Virus Infection.  

PubMed

Hepatitis C virus (HCV) is increasingly common among human immunodeficiency virus (HIV)-infected men who have sex with men. We evaluated the efficacy of HCV core antigen in diagnosing acute HCV in an HIV-infected cohort. Compared with HCV polymerase chain reaction, core antigen proved sensitive (100%) and specific (97.9%). As a quick, simple, and cost-effective test, it has considerable utility in screening for acute HCV. PMID:25301216

Cresswell, Fiona V; Fisher, Martin; Hughes, Daniel J; Shaw, Simon G; Homer, Gary; Hassan-Ibrahim, Mohammed O

2015-01-15

67

Spinal stenosis  

MedlinePLUS

... spinal stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain - spinal stenosis ... help your pain during flare-ups. Treatments for back pain caused by spinal stenosis include: Medicines that may ...

68

Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS)  

MedlinePLUS

... CDC.gov . Hantavirus Share Compartir Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS) Diagnosing HPS Diagnosing HPS in ... is no specific treatment, cure, or vaccine for hantavirus infection. However, we do know that if infected ...

69

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections  

PubMed Central

Objective Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Methods Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Results Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00–0.35) to 0.65 (0.45–0.82). Inter-specialty agreement varied from 0.04 (0.00–0.62) in to 0.55 (0.37–0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14–0.42) and good for ICPs (0.41, 0.28–0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00–0.10) to 0.50 (0.45–0.55) and was not improved by reading SSI definition. Conclusion Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries. PMID:23874690

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

70

[A case of pulmonary Mycobacterium gordonae infection diagnosed by gastric juice culture and successfully treated with multidrug chemotherapy].  

PubMed

In September 2008, a 60-year-old woman presented to our hospital with a complaint of bloody sputum; she was healthy until this event. Chest computed tomography scan revealed a cavity, nodular shadows, and bronchiectasis in the left upper lobe and in the left and right middle lobes. Acid-fast bacilli were detected 2 times on gastric juice culture and Mycobacterium gordonae was identified on biochemical study. No active chemotherapy was administered because the discharge of this strain was considered casual and clinically nonsignificant. However, her radiological findings worsened in the following 1 year and 3 months, and M. gordonae was detected 2 more times on gastric juice culture. Subsequently, she was diagnosed with pulmonary mycobacteriosis caused by M. gordonae and was treated with clarithromycin, rifampicin, and levofloxacin. After 1 month, her gastric juice culture yielded negative results for M. gordonae, and after a year and a half, her radiological findings improved. In this case, gastric juice culture was as useful as sputum examination for diagnosis and evaluation of the disease. Although M. gordonae is usually considered nonpathogenic, our study shows that it can be pathogenic, and M. gordonae infection may require treatment with chemotherapy. PMID:23367832

Nakazawa, Atsuhito; Hagiwara, Eri; Ikeda, Satoshi; Oda, Tsuneyuki; Komatsu, Shigeru; Ogura, Takashi

2012-11-01

71

Complications in the management of metastatic spinal disease  

PubMed Central

Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial spinal pain. No treatment has been proven to increase the life expectancy of patients with spinal metastasis. The goals of therapy are pain control and functional preservation. The most important prognostic indicator for spinal metastases is the initial functional score. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues; neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy is the most commonly used treatment modality for those patients presenting with spinal pain, causative by tumours which are not impinging on neural elements. Operative intervention has, until recently been advocated for establishing a tissue diagnosis, mechanical stabilization and for reduction of tumor burden but not for a curative approach. It is treatment of choice patients with diseaseadvancement despite radiotherapy and in those with known radiotherapy-resistant tumors. Vertebral resection and anterior stabilization with methacrylate or hardware (e.g., cages) has been advocated.Surgical decompression and stabilization, however, along with radiotherapy, may provide the most promising treatment. It stabilizes the metastatic deposited areaand allows ambulation with pain relief. In general, patients who are nonambulatory at diagnosis do poorly, as do patients in whom more than one vertebra is involved. Surgical intervention is indicated in patients with radiation-resistant tumors, spinal instability, spinal compression with bone or disk fragments, progressive neurologic deterioration, previous radiation exposure, and uncertain diagnosis that requires tissue diagnosis. The main goal in the management of spinal metastatic deposits is always palliative rather than curative, with the primary aim being pain relief and improved mobility. This however, does not come without complications, regardless of the surgical intervention technique used. These complication range from the general surgical complications of bleeding, infection, damage to surrounding structures and post operative DT/PE to spinal specific complications of persistent neurologic deficit and paralysis. PMID:22919567

Dunning, Eilis Catherine; Butler, Joseph Simon; Morris, Seamus

2012-01-01

72

Spinal fusion  

MedlinePLUS

... Anterior spinal fusion; Spine surgery - spinal fusion; Low back pain - fusion; Herniated disk - fusion ... If you had chronic back pain before surgery, you will likely still have some pain afterward. Spinal fusion is unlikely to take away all your pain ...

73

Medical ICU Admission Diagnoses and Outcomes in Human Immunodeficiency Virus–Infected and Virus–Uninfected Veterans in the Combination Antiretroviral Era  

PubMed Central

Objectives Human immunodeficiency virus (HIV)–infected (HIV+) patients on combination antiretroviral therapy are living longer but have increased risk for aging-associated disease which may lead to increasing critical care requirements. We compare medical ICU admission characteristics and outcomes among HIV infected and demographically similar uninfected patients (uninfected) and considered whether an index which combines routine clinical biomarkers (the Veterans Aging Cohort Study Index) predicts 30-day medical ICU mortality. Design Observational data analyses (Veterans Aging Cohort Study). Setting Eight Veterans Affairs medical centers nationwide. Patients HIV infected and uninfected with a medical ICU admission between 2002 and 2010. Intervention None. Measurements and Main Results Medical ICU admission was determined using bedsection (Veterans Affairs) and revenue center codes (Medicare). For Veterans Affairs admissions, we used clinical data to calculate Veterans Aging Cohort Study Index scores and multivariable logistic regression to determine factors associated with 30-day mortality. Overall, 539 of 3,620 (15%) HIV infected and 375 of 3,639 (10%) uninfected had a medical ICU admission; 72% and 78%, respectively, were Veterans Affairs based. HIV+ patients were younger at admission (p < 0.0001). Although most HIV+ patients were on antiretroviral therapy (71%) with undetectable HIV-1 RNA (54%), compared with uninfected they were more commonly admitted with respiratory diagnoses or infections (21% vs. 12%), were more likely to require mechanical ventilation (17% vs. 9%; p = 0.001), and had a higher mortality rate (18.6% vs. 11.2%, p = 0.003). Cardiovascular diagnoses were less common among HIV infected (18% vs. 29%; p < 0.0001). In logistic regression (c-statistic 0.87), a 5-point increment in Veterans Aging Cohort Study Index was associated with an odds ratio of death of 1.22 (95% confidence interval 1.14–1.30) among HIV infected and of 1.50 (95% confidence interval 1.29–1.76) among uninfected; infection/sepsis and respiratory diagnoses were also associated with mortality. Conclusions Medical ICU admission was frequent, 30-day mortality higher, and mechanical ventilation more common in HIV infected compared with uninfected. The Veterans Aging Cohort Study Index calculated at medical ICU admission predicted 30-day mortality for HIV infected and uninfected. As more individuals age with HIV, their requirements for medical ICU care may be greater than demographically similar uninfected individuals. PMID:23507717

Akgün, Kathleen M.; Tate, Janet P.; Pisani, Margaret; Fried, Terri; Butt, Adeel A.; Gibert, Cynthia L.; Huang, Laurence; Rodriguez-Barradas, Maria C.; Rimland, David; Justice, Amy C.; Crothers, Kristina

2014-01-01

74

Prevention of urinary tract infections in palliative radiation for vertebral metastasis and spinal compression: A pilot study in 71 patients  

SciTech Connect

Purpose: To assess the impact of bladder instillations of hyaluronic acid (HA) on the prevalence of urinary tract infection (UTI) in patients receiving emergency radiotherapy for metastatic spinal cord compression. Methods and Materials: Patients were recruited consecutively at one center and assigned to usual care (UC) (n = 34, mean age 62.2 years) or UC with once-weekly HA instillation (UC + HA) (Cystistat: 40 mg in 50 mL phosphate-buffered saline) (n = 37; mean age, 63.1 years). All patients had an indwelling catheter and received radiotherapy. UTI status was assessed at baseline and during hospitalization. Results: At baseline, patient groups were comparable, except for the prevalence of UTI at baseline, which was 11.8% and 0% in the UC and UC + HA patients, respectively (p = 0.0477). During hospitalization, 76.5% (vs. 11.8% at baseline, p < 0.0001) of the UC patients had a UTI compared with 13.5% (vs. 0% at baseline, p = 0.0541) of the UC + HA patients (p < 0.0001). Both groups were hospitalized for similar periods (19.8 days [UC] vs. 18.5 days, p = 0.4769) and received equivalent radiotherapy sessions (4.6 [UC] vs. 5.8 sessions, p = 0.2368). Conclusions: Patients receiving UC + HA had a 5.7-fold decrease in UTI prevalence over the hospitalization period compared to UC patients, suggesting that bladder instillations of HA effectively prevent UTI in patients with indwelling catheters receiving radiotherapy for nerve compression.

Manas, Ana [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain)]. E-mail: amanas.hdoc@salud.madrid.org; Glaria, Luis [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain); Pena, Carmen [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain); Sotoca, Amalia [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain); Lanzos, Eduardo [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain); Fernandez, Castalia [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain); Riviere, Marc [Bioniche Life Sciences Inc., Montreal, Quebec (Canada)

2006-03-01

75

HIV non-B subtype distribution: emerging trends and risk factors for imported and local infections newly diagnosed in South Australia.  

PubMed

Monitoring HIV subtype distribution is important for understanding transmission dynamics. Subtype B has historically been dominant in Australia, but in recent years new clades have appeared. Since 2000, clade data have been collected as part of HIV surveillance in South Australia. The aim of this study was to evaluate the prevalence of and risk factors for HIV-1 non-B subtypes. The study population was composed of newly diagnosed, genotyped HIV subjects in South Australia between 2000 and 2010. We analyzed time trends and subtype patterns in this cohort; notification data were aggregated into three time periods (2000-2003, 2004-2006, and 2007-2010). Main outcome measures were number of new non-B infections by year, exposure route, and other demographic characteristics. There were 513 new HIV diagnoses; 425 had information on subtype. The majority (262/425) were in men who have sex with men (MSM), predominantly subtype B and acquired in Australia. Infections acquired in Australia decreased from 77% (2000-2003) to 64% (2007-2010) (p=0.007) and correspondingly the proportion of subtype B declined from 85% to 68% (p=0.002). Non-B infections were predominantly (83%) heterosexual contacts, mostly acquired overseas (74%). The majority (68%) of non-B patients were born outside of Australia. There was a nonsignificant increase from 1.6% to 4.2% in the proportion of locally transmitted non-B cases (p=0.3). Three non-B subtypes and two circulating recombinant forms (CRFs) were identified: CRF_AE (n=41), C (n=36), CRF_AG (n=13), A (n=9), and D (n=2). There has been a substantial increase over the past decade in diagnosed non-B infections, primarily through cases acquired overseas. PMID:23098890

Hawke, Karen G; Waddell, Russell G; Gordon, David L; Ratcliff, Rodney M; Ward, Paul R; Kaldor, John M

2013-02-01

76

Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study  

PubMed Central

Background: ageing is frequently accompanied by a higher incidence of infections and an increase in disability in activities of daily living (ADL). Objective: this study examines whether clinical infections [urinary tract infections (UTI) and lower respiratory tract infections (LRTI)] predict an increase in ADL disability, stratified for the presence of ADL disability at baseline (age 86 years). Design: the Leiden 85-plus Study. A population-based prospective follow-up study. Setting: general population. Participants: a total of 154 men and 319 women aged 86 years. Methods: information on clinical infections was obtained from the medical records. ADL disability was determined at baseline and annually thereafter during 4 years of follow-up, using the 9 ADL items of the Groningen Activity Restriction Scale. Results: in 86-year-old participants with ADL disability, there were no differences in ADL increase between participants with and without an infection (?0.32 points extra per year; P = 0.230). However, participants without ADL disability at age 86 years (n = 194; 41%) had an accelerated increase in ADL disability of 1.07 point extra per year (P < 0.001). For UTIs, this was 1.25 points per year (P < 0.001) and for LRTIs 0.70 points per year (P = 0.041). In this group, an infection between age 85 and 86 years was associated with a higher risk to develop ADL disability from age 86 onwards [HR: 1.63 (95% CI: 1.04–2.55)]. Conclusions: among the oldest-old in the general population, clinically diagnosed infections are predictive for the development of ADL disability in persons without ADL disability. No such association was found for persons with ADL disability. PMID:23482352

Caljouw, Monique A. A.; Kruijdenberg, Saskia J. M.; de Craen, Anton J. M.; Cools, Herman J. M.; den Elzen, Wendy P. J.; Gussekloo, Jacobijn

2013-01-01

77

Selective testing strategies for diagnosing group A streptococcal infection in children with pharyngitis: a systematic review and prospective multicentre external validation study  

PubMed Central

Background: Several clinical prediction rules for diagnosing group A streptococcal infection in children with pharyngitis are available. We aimed to compare the diagnostic accuracy of rules-based selective testing strategies in a prospective cohort of children with pharyngitis. Methods: We identified clinical prediction rules through a systematic search of MEDLINE and Embase (1975–2014), which we then validated in a prospective cohort involving French children who presented with pharyngitis during a 1-year period (2010–2011). We diagnosed infection with group A streptococcus using two throat swabs: one obtained for a rapid antigen detection test (StreptAtest, Dectrapharm) and one obtained for culture (reference standard). We validated rules-based selective testing strategies as follows: low risk of group A streptococcal infection, no further testing or antibiotic therapy needed; intermediate risk of infection, rapid antigen detection for all patients and antibiotic therapy for those with a positive test result; and high risk of infection, empiric antibiotic treatment. Results: We identified 8 clinical prediction rules, 6 of which could be prospectively validated. Sensitivity and specificity of rules-based selective testing strategies ranged from 66% (95% confidence interval [CI] 61–72) to 94% (95% CI 92–97) and from 40% (95% CI 35–45) to 88% (95% CI 85–91), respectively. Use of rapid antigen detection testing following the clinical prediction rule ranged from 24% (95% CI 21–27) to 86% (95% CI 84–89). None of the rules-based selective testing strategies achieved our diagnostic accuracy target (sensitivity and specificity > 85%). Interpretation: Rules-based selective testing strategies did not show sufficient diagnostic accuracy in this study population. The relevance of clinical prediction rules for determining which children with pharyngitis should undergo a rapid antigen detection test remains questionable. PMID:25487666

Cohen, Jérémie F.; Cohen, Robert; Levy, Corinne; Thollot, Franck; Benani, Mohamed; Bidet, Philippe; Chalumeau, Martin

2015-01-01

78

Comparison of Serological and Nucleic Acid Based Assays Used to Diagnose Hepatitis C Virus (HCV) Infection in Acute and Chronic Liver Diseases  

PubMed Central

Background: This study reports a comparative diagnostic potential of three different assay systems used to detect HCV infection in acute and chronic liver diseases. Methods: A total number of 364 patients with various types of liver diseases were analyzed for hepatitis C virus (HCV) core antigen using Enzyme Immuno Assay (EIA), HCV-RNA by RT-PCR and anti-HCV antibodies by third generation EIA system. Simultaneously these patients were also tested for markers of other hepatitis viruses, notably, hepatitis A, B, C, D and E. In some cases, even transfusion transmitted virus (TTV) was tested using TTV-DNA as the marker of TTV infection. Results: Analysis of results demonstrated the presence of hepatitis B, C and E in different proportions of patients belonging to these liver diseases. Hepatitis A and D infections could not be detected in these cases TTV infection was prevalent in different liver diseases in different proportions. Though none of control sera demonstrated hepatitis A-E infection, however, TTV infection was noted in control group also. When we analysed all the sera for HCV infection using these different assay systems, we found HCV core, HCV-RNA and anti-HCV antibodies in 18.3%, 18.3% and 5.83% cases of acute viral hepatitis (AVH), 13.3 %, 13.3% and 46.6% cases of chronic viral hepatitis (CVH), 23.8%, 23.8% and 23.8% cases with cirrhosis of liver and 20%, 17.5% and 10% cases respectively, of fulminant hepatic failure (FHF) patients. Whereas HCV core and HCV-RNA assays were comparable and predominantly positive in acute cases (AVH and FHF), anti-HCV antibodies were detected in high proportions in chronic liver diseases. Cirrhosis patients showed all the markers in equal proportions. This pattern of HCV markers remains unaffected by co-infection of HCV with other hepatitis viral infections. Conclusion: In conclusion, where HCV core and HCV-RNA are best diagnostic markers in acute liver diseases, anti-HCV diagnoses high proportion of HCV cases in chronic liver diseases. This diagnostic pattern is not changed on co-infection of HCV with other viral infections. PMID:21475446

Irshad, M.; Dhar, I.; Khushboo; Singh, Shiwani; Kapoor, S.

2007-01-01

79

Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders  

Microsoft Academic Search

This paper examines factors associated with adherence to antiretroviral medications (ARVs) in an HIV-infected population at high risk for non-adherence: individuals living with psychiatric and substance abuse disorders. Data were examined from baseline interviews of a multisite cohort intervention study of 1138 HIV-infected adults with both a psychiatric and substance abuse disorder (based on a structured psychiatric research interview using

Claude Ann Mellins; Jennifer F. Havens; Cheryl McDonnell; Carolyn Lichtenstein; Karina Uldall; Margaret Chesney; E. Karina Santamaria; James Bell

2009-01-01

80

Immunohistological characterization of spinal TB granulomas from HIV-negative and -positive patients.  

PubMed

Tuberculosis (TB) is mainly a disease of the lungs, but Mycobacterium tuberculosis (Mtb) can establish infection in virtually any organ in the body. Rising rates of extrapulmonary (EP) TB have been largely associated with the HIV epidemic, as patients co-infected with HIV show a four-fold higher risk of EPTB. Spinal TB (Pott's Disease), one of the most debilitating extrapulmonary forms of disease, is difficult to diagnose and can cause deformity and/or neurological deficits. This study examined the histopathology and distribution of immune cells within spinal TB lesions and the impact of HIV on pathogenesis. The overall structure of the spinal granulomas resembled that seen in lung lesions from patients with pulmonary TB. Evidence of efficient macrophage activation and differentiation were detectable within organized structures in the spinal tissue, irrespective of HIV status. Interestingly, the granulomatous architecture and macroscopic features were similar in all samples examined, despite a reversal in the ratio of infiltrating CD4 to CD8 T cells in the lesions from HIV-infected patients. This study provides a foundation to understand the mechanism of tissue destruction and disease progression in Spinal TB, enabling the future development of novel therapeutic strategies and diagnostic approaches for this devastating disease. PMID:23541388

Danaviah, S; Sacks, J A; Kumar, K P S; Taylor, L M; Fallows, D A; Naicker, T; Ndung'u, T; Govender, S; Kaplan, G

2013-07-01

81

Frequency and Determinants of Preventive Care Counseling by HIV Medical Care Providers during Encounters with Newly Diagnosed and Established HIV-Infected Patients.  

PubMed

This study evaluates the frequency and determinants of preventive care counseling by HIV medical care providers (HMCPs) during encounters with newly diagnosed and established HIV-infected patients. Data used were from a probability sample of HMCPs in Houston/Harris County, Texas, surveyed in 2009. Overall, HMCPs offered more preventive care counseling to newly diagnosed than the established patients (adjusted odds ratio [AOR] = 7.28; 95% confidence interval [CI] = 2.86-16.80). They were more likely to counsel newly diagnosed patients than the established ones on medication and adherence (AOR = 14.70; 95% CI = 1.24-24.94), HIV risk reduction (AOR = 5.91; 95% CI = 0.48-7.13), and disease screening (AOR = 7.20; 95% CI = 0.72-11.81). HIV medical care providers who were less than 45 years of age, infectious disease specialists, and had less than 30 minutes of encounter time were less likely to counsel patients regardless of the status. Our findings suggest the need for HMCPs to improve their preventive care counseling efforts, in order to help patients build skills for adopting and maintaining safe behavior that could assist in reducing the risk of HIV transmission. PMID:25361557

Mgbere, Osaro; Rodriguez-Barradas, Maria C; Bell, Tanvir K; Khuwaja, Salma; Arafat, Raouf; Essien, Ekere J; Singh, Mamta; Simmons, Paul; Aguilar, Jonathan

2014-10-31

82

Surgical correction of spinal deformities following spinal cord injury occurring in childhood.  

PubMed

This article reports on the surgical treatment of 14 consecutive patients with paralytic spinal deformities secondary to spinal cord injury occurring in childhood. Eleven patients underwent a posterior spinal fusion and three patients underwent a combined anterior and posterior spinal arthrodesis. Luque rods were used in all but one patient. The spinal fusion extended to the sacrum in 10 patients. No patient developed postoperative wound infections or medical complications. Four patients (28.6%) who underwent initially a posterior spinal arthrodesis developed pseudarthrosis. This was treated successfully by a combined anterior and posterior spinal fusion in two patients. The remaining patients underwent a revision posterior spinal fusion with recurrence of the nonunion in one patient. A combined anterior and posterior spinal arthrodesis could be considered the treatment of choice for patients with severe deformities who can tolerate anterior surgery. If pseudarthrosis develops following posterior spinal fusion, this can be best treated by a combined anterior and posterior revision procedure with instrumentation. PMID:18053399

Tsirikos, Athanasios I; Markham, Philip; McMaster, Michael J

2007-01-01

83

Diagnostic accuracy of a point-of-care urine test for tuberculosis screening among newly-diagnosed hiv-infected adults: a prospective, clinic-based study  

PubMed Central

Background A rapid diagnostic test for active tuberculosis (TB) at the clinical point-of-care could expedite case detection and accelerate TB treatment initiation. We assessed the diagnostic accuracy of a rapid urine lipoarabinomannan (LAM) test for TB screening among HIV-infected adults in a TB-endemic setting. Methods We prospectively enrolled newly-diagnosed HIV-infected adults (?18 years) at 4 outpatient clinics in Durban from Oct 2011-May 2012, excluding those on TB therapy. A physician evaluated all participants and offered CD4 cell count testing. Trained study nurses collected a sputum sample for acid-fast bacilli smear microscopy (AFB) and mycobacterial culture, and performed urine LAM testing using Determine™ TB LAM in the clinic. The presence of a band regardless of intensity on the urine LAM test was considered positive. We defined as the gold standard for active pulmonary TB a positive sputum culture for Mycobacterium tuberculosis. Diagnostic accuracy of urine LAM was assessed, alone and in combination with smear microscopy, and stratified by CD4 cell count. Results Among 342 newly-diagnosed HIV-infected participants, 190 (56%) were male, mean age was 35.6 years, and median CD4 was 182/mm3. Sixty participants had culture-positive pulmonary TB, resulting in an estimated prevalence of 17.5% (95% CI 13.7-22.0%). Forty-five (13.2%) participants were urine LAM positive. Mean time from urine specimen collection to LAM test result was 40 minutes (95% CI 34–46 minutes). Urine LAM test sensitivity was 28.3% (95% CI 17.5-41.4) overall, and 37.5% (95% CI 21.1-56.3) for those with CD4 count <100/mm3, while specificity was 90.1% (95% CI 86.0-93.3) overall, and 86.9% (95% CI 75.8-94.2) for those with CD4?diagnosed HIV-infected adults, but improved sensitivity when combined with sputum smear microscopy. PMID:24571362

2014-01-01

84

Prevalent and Incident HIV Diagnoses among Entamoeba histolytica-Infected Adult Males: A Changing Epidemiology Associated with Sexual Transmission — Taiwan, 2006–2013  

PubMed Central

Background Sexually transmitted Entamoeba histolytica infection (EHI) has been increasingly recognized among men who have sex with men (MSM). We used the National Disease Surveillance Systems (NDSS) to identify prevalent and incident HIV diagnoses among adults with EHI and to determine the associated factors. Methodology The NDSS collect demographic, clinical, and behavioral characteristics of case patients through physician reports and public health interviews. EHI was confirmed by polymerase-chain-reaction assays, histopathology, or serology with documented liver abscess. We linked NDSS databases to identify prevalent and incident HIV diagnoses among noninstitutionalized Taiwanese adults with confirmed EHI during 2006–2013. Cox proportional-hazards analysis was used to determine associated factors. Principal findings Of noninstitutionalized adults with EHI, we identified prevalent HIV diagnosis in 210 (40%) of 524 males and one (1.7%) of 59 females, and incident HIV diagnosis in 71 (23%) of 314 males. MSM accounted for 183 (87%) and 64 (90%) of prevalent and incident HIV diagnoses in males, respectively. From 2006–2009 to 2010–2013, the prevalence of HIV diagnosis increased from 32% to 45% (P?=?0.001) while the incidence of HIV diagnosis increased from 5.4 to 11.3 per 100 person-years (P?=?0.001) among males with EHI. Incident HIV diagnosis was independently associated with a younger age, residing in metropolitan areas, hospitalization, previous syphilis, and engagement in oral, anal, or oral–anal sex before illness onset. Conclusions/significance Prevalent and incident HIV diagnoses were increasingly identified among adult males in Taiwan, preferentially affecting younger urban MSM. Surveillance and risk-reduction interventions are recommended against the interplay of HIV epidemic and sexually transmitted EHI. PMID:25299178

Lo, Yi-Chun; Ji, Dar-Der; Hung, Chien-Ching

2014-01-01

85

A comparison of psychiatric diagnoses among HIV-infected prisoners receiving combination antiretroviral therapy and transitioning to the community  

PubMed Central

Background The criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors. Methods A retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record. Results Findings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment. Conclusions Additional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned. PMID:25606368

Di Paola, Angela; Altice, Frederick L; Powell, Mary Lindsay; Trestman, Robert L; Springer, Sandra A

2014-01-01

86

Viral respiratory infections diagnosed by multiplex PCR after allogeneic hematopoietic stem cell transplantation: long-term incidence and outcome.  

PubMed

Viral respiratory infections (VRIs) are frequent after hematopoietic stem cell transplantation and constitute a potential cause of mortality. We analyzed the incidence, risk factors, and prognosis of VRIs in a cohort of transplanted patients. More frequent viruses were human coronavirus and human rhinovirus followed by flu-like viruses and adenovirus. Risk factors for death were lymphocytopenia and high steroid dosage. PMID:24732781

Wolfromm, Alice; Porcher, Raphael; Legoff, Jérome; Peffault de Latour, Régis; Xhaard, Aliénor; de Fontbrune, Flore Sicre; Ribaud, Patricia; Bergeron, Anne; Socié, Gérard; Robin, Marie

2014-08-01

87

Enhanced U.S. Army HIV diagnostic algorithm used to diagnose acute HIV infection in a deployed soldier.  

PubMed

Antibody screening alone may fail to detect human immunodeficiency virus (HIV) in recently infected individuals. By U.S. Army regulation, HIV-infected soldiers are not permitted to deploy to areas of conflict, including Iraq and Afghanistan. We report here the first case of acute HIV infection (AHI) in a soldier in a combat area of operation detected by an enhanced U.S. Army HIV testing algorithm and discuss features of the tests which aided in clinical diagnosis. We tested the sample from the AHI case with a third generation HIV-1/HIV-2 plus O enzyme immunoassay, HIV-1 Western Blot, and a qualitative HIV-1 ribonucleic acid molecular diagnostic assay. Risk factors for HIV acquisition were elicited in an epidemiologic interview. Evaluation of the blood sample for AHI indicated an inconclusive serologic profile and a reactive HIV-1 ribonucleic acid result. The main risk factor for acquisition reported was unprotected sexual intercourse with casual strangers in the U.S. while on leave during deployment. The clinical diagnosis of AHI in a combat area of operation is important. Diagnosis of HIV is key to preventing adverse effects to the infected soldier from deployment stressors of deployment and further transmission via parenteral or sexual exposures. PMID:22645891

Hakre, Shilpa; Paris, Robert M; Brian, Julie E; Malia, Jennifer; Sanders-Buell, Eric E; Tovanabutra, Sodsai; Sleigh, Bryan C; Cook, James E; Michael, Nelson L; Scott, Paul T; Deuter, Dan R; Cersovsky, Steven B; Peel, Sheila A

2012-05-01

88

An intradural extramedullary tuberculoma of the spinal cord in a non-HIV-infected patient: case report and review of the literature.  

PubMed

Spinal tuberculomas are extrapulmonary manifestations of tuberculosis involving the central nervous system. They are characterized as extradural, intradural extramedullary, or intradural, according to their location. Intradural extramedullary tuberculomas are extremely rare. There have been only 24 case reports found in English language literature. Our case is the only documented intradural extramedullary tuberculoma in a non-HIV-infected patient in North America. A literature review using a Medline search from 1966 to the present is performed to characterize the clinical spectrum of the three types of tuberculomas and review the diagnosis and management of this potentially curable disease. An analysis of the cases of intradural extramedullary tuberculomas published since 1984 is performed to highlight the unique characteristics of this rare disease. PMID:16902844

Luo, Lan; Pino, Joseph

2006-01-01

89

How Is Spinal Cord Injury (SCI) Diagnosed?  

MedlinePLUS

... they are not strong enough to move against gravity). D: The impairment is incomplete. Motor function is ... i.e., the joints can be moved against gravity). E: The patient's functions are normal. All motor ...

90

Unique Antimicrobial Effects of Platelet-Rich Plasma and Its Efficacy as a Prophylaxis to Prevent Implant-Associated Spinal Infection  

PubMed Central

Platelet-rich-plasma (PRP) has attracted great attention and has been increasingly used for a variety of clinical applications including orthopaedic surgeries, periodontal and oral surgeries, maxillofacial surgeries, plastic surgeries, and sports medicine. However, very little is known about the antimicrobial activities of PRP. In this study, PRP is found to have antimicrobial properties both in vitro and in vivo. In vitro, the antimicrobial properties of PRP have been found to be bacterial strain specific and time specific: PRP has significantly (80–100 fold reduction in colony forming units) inhibited the growth of methicillin sensitive and methicillin resistant Staphylococcus aureus, Group A streptococcus, and Neisseria gonorrhoeae within the first few hours but it has no significant antimicrobial properties against E. coli and Pseudomonas. The antimicrobial properties of PRP also depend on the concentration of thrombin. In vivo, an implant-associated spinal infection rabbit model has been established and used to evaluate the antimicrobial and wound healing properties of PRP. Compared to the infection controls, PRP treatment has resulted in significant reduction in bacterial colonies in bone samples at all time points studied (i.e. 1, 2, and 3 weeks) and significant increase in mineralized tissues (thereby better bone healing) at post-operative weeks 2 and 3. PRP therefore may be a useful adjunct strategy against post-operative implant-associated infections. PMID:23447088

Li, Hongshuai; Hamza, Therwa; Tidwell, John E.; Clovis, Nina

2013-01-01

91

Spinal epidural lipomatosis: a case study.  

PubMed

Spinal epidural lipomatosis (SEDL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. A patient with a primary malignant brain tumor on chronic corticosteroids presented with a clinical picture of cord compression and was diagnosed with SEDL. PMID:15366546

Clancey, Jeanne K

2004-08-01

92

Trends of human immunodeficiency virus type-1 infection in female prostitutes and males diagnosed with a sexually transmitted disease in Djibouti, east Africa.  

PubMed

A cross-sectional serosurvey for human immunodeficiency virus type 1 (HIV-1) was conducted during the first quarter of 1991 among high risk groups in Djibouti, East Africa, and compared with previous surveys in 1987, 1988, and 1990. The survey demonstrated evidence of HIV-1 infection in 36.0% (n = 292) of street prostitutes, 15.3% (n = 360) of prostitutes working as bar hostesses, and 10.4% (n = 193) of males diagnosed with a sexually transmitted disease. By multivariate modeling, HIV-1 seropositivity in prostitutes was associated with Ethiopian nationality, working as a street prostitute, and residing in Djibouti for two years or less. We suggest that prostitution, particularly street prostitution, is a major route of HIV-1 transmission in Djibouti. PMID:8517486

Rodier, G R; Couzineau, B; Gray, G C; Omar, C S; Fox, E; Bouloumie, J; Watts, D

1993-05-01

93

Frequency of primary resistance to antiretroviral drugs and genetic variability of HIV-1 among infected pregnant women recently diagnosed in Luanda-Angola.  

PubMed

The determination of the prevalence of primary resistance to antiretroviral therapy in different places of the world is of extreme importance in molecular epidemiology monitoring, and it can guide the initial patient therapy in a given geographical area. The frequency of drug resistance mutations (DRM) and the genetic variability of HIV-1 isolates from newly diagnosed HIV-infected pregnant women attending the antenatal clinics of the Lucrecia Paim and Augusto N'Gangula maternities, Luanda-Angola, were determined. Thirty five out of 57 samples (61.4%) were sequenced and one mutation associated with resistance to nucleoside reverse transcriptase inhibitors was detected. Additionally, two mutations associated with resistance to non-nucleoside reverse transcriptase inhibitors were also detected. No primary mutations associated with protease inhibitors (PI) were found. Subtypes A1, C, D, F1, G, H, CRF 13, CRF 37, and other mosaics were detected. PMID:20929349

Castelbranco, Emingarda Patrícia André Félix; da Silva Souza, Edvaldo; Cavalcanti, Ana Maria Salustiano; Martins, Angélica Nascimento; de Alencar, Luiz Claúdio Arraes; Tanuri, Amilcar

2010-12-01

94

Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection.  

PubMed

Various bacterial, fungal, parasitic, and viral pathogens can cause folliculitis, which is often mistakenly treated with antibiotics for months or even years. A laboratory diagnosis is required before therapy can be planned. Here, we describe the prevalence and risk factors, as well as the clinical, cytological, and mycological characteristics, of patients with Malassezia folliculitis (MF) in Adana, Turkey. We also report the treatment responses of the MF patients and describe the Malassezia spp. using culture-based molecular methods. Cytological examinations were performed in 264 folliculitis patients, 49 of whom (18.5%) were diagnosed with MF. The positivity of the May-Grünwald-Giemsa (MGG) smear was higher (100%) than that of the potassium hydroxide test (81.6%). Using Wood's light, yellow-green fluorescence was observed in 66.7% of the MF patients. Identification using the rDNA internal transcribed spacer region revealed that Malassezia globosa was the most common species, followed by Malassezia sympodialis, Malassezia restricta, and Malassezia furfur. The MF patients were treated with itraconazole capsules (200 mg/d) for 2 weeks. Complete recovery was observed in 79.6% of the patients. These novel findings help improve our current understanding of the epidemiological characteristics of MF and establish MGG as a practical tool for the diagnosis of MF. PMID:23706503

Durdu, Murat; Güran, Mümtaz; Ilkit, Macit

2013-08-01

95

Diagnosing ALS  

MedlinePLUS

... About ALS Share Print Diagnosing ALS En español ALS is a very difficult disease to diagnose. To date, there is no one ... series of diagnostic tests, often ruling out other diseases that mimic ALS, that a diagnosis can be established. A comprehensive ...

96

Temporal trend and characteristics of recent HIV-1 infections: application of an algorithm for the identification of recently acquired HIV-1 infections among newly diagnosed individuals over a 10-year period.  

PubMed

Identification of recent infections (RI) may contribute to improve the quality of human immunodeficiency virus (HIV) surveillance, monitoring ongoing transmission and planning and evaluating prevention programs. Our study applied an algorithm combining clinical and serological information to identify RI in individuals newly diagnosed with HIV in Rome, during the years 1999-2008, in order to describe the trend and characteristics of recently infected individuals. RI were documented seroconverters, or people with an HIV avidity index (AI)<0.80. Individuals with advanced infection (CD4 count <200 cells/?L or AIDS-defining illness) or with AI ?0.80 were considered long-standing infections. Overall, we observed 2,563 new HIV diagnoses. The algorithm was applied in 2124/2563 (82.9%). Of these, 355 were RI (16.7%). RI was found independently associated with calendar year (adjusted odds ratio [aOR]= 1.06, 95% confidence intervals [CI]=[CI 1.02-1.11], for every year of increase), HIV-risk category (men having sex with men: aOR=1.44, [CI 1.04-1.98]; injecting drug users: aOR=1.58, [CI 1.03-2.42] vs. heterosexuals), country of origin (foreign-born: vs Italians: aOR=0.46, [CI 0.33-0.62]), and recruitment site (inpatient vs outpatient clinic: aOR=0.49, [CI 0.37-0.66]). By the application of our algorithm we could characterize the pattern of ongoing HIV transmission, identifying groups needing more urgent prevention programs. PMID:24177297

Orchi, Nicoletta; Sias, Catia; Vlassi, Chrysoula; Navarra, Assunta; Angeletti, Claudio; Puro, Vincenzo; Sciarrone, Maria R; Capobianchi, Maria R; Girardi, Enrico

2013-10-01

97

Incremental cost per newly diagnosed HIV infection (NDHI): routine (RTS), targeted (TTS), and current clinical practice testing strategies (CPTS)  

PubMed Central

Introduction Although RTS as HIV Diagnosis was considered cost effectiveness [1], overall budget may be unaffordable for some countries. We explore Incremental cost per NDHI associated with different TS. Materials and Methods From a health care perspective, using direct costs and Euros currency, we calculated budget and cost per NDHI of RTS (all patients were tested), TTS (Universal risk practices and clinical conditions-RP&CC - only positive were tested), and CPTS (Only patients physicians considered were tested). We considered DRIVE (Spanish acronym of HIV infection Rapid Diagnosis) study and clinical Practice outcomes. Population between 18–60 years, attending to a Hospital Emergency Room or to a Primary Care Center performed an HIV RP&CC questionnaire (Q) and an HIV rapid test (HIV RT). Unitary costs considered were: HIV RT, nurse, registry, transport and HIV confirmation when necessary, imputed to all population in RTS and CPTS and only in HIV RP&CC-Q positive in TTS analysis, while HIV RP&CC-Q costs were added to all population in TTS. Sensitivity analyses were performed with varying rates of NDHI and of positive HIV RP&CC-Q population, and different RP&CC Q sensitivity (SE) to predict HIV infection. Results 5,329 HIV RP&CC-Q and HIV RT were performed to 49.64% women, median age 37 years old, 74.9% Spaniards. In DRIVE and CP, NDHI were 4.1‰, and 1.6‰, while HIV RP&CC-Q was positive in 51.2%. HIV RP&CC-Q SE was 100%. Overall budget employed in HIV testing was in RTS 43,503€, in TTS 24,472€ and in CPTS 5,032€. Cost per 1 NDHI was 1,977€, 1,112€ and 5,032€, respectively. A reduction in cost of 865€, favouring TTS vs. RTS, while an increased cost of 824€ in CPTS vs. RTS was obtained. Considering NDHI rate of 2.6‰ saving costs increased to 1379€ in TTS, while were reduced to 576€ if NDHI rate increases 6.2‰. Effect of RP&CC-Q positivity rate was similar, if 25% saving costs were 1368€, while if 75% were reduced to 399€. Varying SE of RP&CC-Q to 95%, 91% and 50% cost saving was 810€, 754€, and 208€, and number of MHI one, two and 11. Conclusions In DRIVE study Targeted TS with universal screening of RP&CC before an HIV rapid test is cost saving, without missing NDHI, with respect to Routine TS. Lower rates of HIV infection and RP&CC in the population, increase costs savings. PMID:25394110

Gomez-Ayerbe, Cristina; Jesús Pérez Elías, María; Muriel, Alfonso; Pérez Elías, Pilar; Cano, Agustina; Diaz, Alberto; Moreno, Ana; Luis Casado, Jose; Santos, Cristina; Martinez-Colubi, María; Uranga, Almudena; Dronda, Fernando; Moreno, Santiago

2014-01-01

98

Human Immunodeficiency Virus (HIV) Antibody Avidity Testing To Identify Recent Infection in Newly Diagnosed HIV Type 1 (HIV1)Seropositive Persons Infected with Diverse HIV1 Subtypes  

Microsoft Academic Search

A guanidine-based antibody avidity assay for the identification of recently acquired human immunodefi- ciency virus type 1 (HIV-1) infection was evaluated. The kinetics of maturation of antibody avidity were determined prospectively in 23 persons undergoing acute seroconversion followed for up to 1,075 days. Avidity indices (AI) of <0.75 and <0.80 reproducibly identified seroconversion within the previous 125 (95% confi- dence

A. Chawla; G. Murphy; C. Donnelly; C. L. Booth; M. Johnson; J. V. Parry; A. Phillips; A. M. Geretti

2007-01-01

99

Associations of medically documented psychiatric diagnoses and risky health behaviors in highly active antiretroviral therapy-experienced perinatally HIV-infected youth.  

PubMed

The Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) study is a prospective, multisite, longitudinal cohort of U.S. HIV-infected youth. This analysis was limited to perinatally HIV-infected youth (n=197), 13 years and older, with selected variables completely abstracted from HIV diagnosis through 2006. We evaluated relationships between ever having one or more nonsubstance related medically documented psychiatric diagnoses and three risky health behaviors (substance abuse, preadult sexual activity, and treatment adherence problems) recorded between 2001 and 2006. Logistic regression was used for all binary outcomes and participant age was included as a covariate when possible. All 197 participants included in the analysis were prescribed antiretroviral therapy during the study period; 110 (56%) were female, 100 (51%) were black non-Hispanic, and 86 (44%) were Hispanic; mean age at the last visit was 16.8 years, ranging from 13 to 24 years. One hundred forty-six (74%) participants had a history of at least one risky health behavior. There were 108 (55%) participants with at least one medically documented psychiatric diagnosis, 17 (9%) with at least one record of substance abuse, 12 (6%) with documented preadult sexual activity, and 142 (72%) participants with reported adherence problems. In the final model, a history of at least one psychiatric diagnosis was associated with having at least one of the three risky behaviors (odds ratio [OR]=2.33, p=0.015). There is a need for a continued close partnership between HIV specialty care providers and mental health services treating perinatally HIV-infected youth with an added focus on improving treatment adherence. PMID:21745118

Kapetanovic, Suad; Wiegand, Ryan E; Dominguez, Ken; Blumberg, Dean; Bohannon, Beverly; Wheeling, John; Rutstein, Richard

2011-08-01

100

Spinal Stenosis  

MedlinePLUS

... more quickly when walking up or down a hill, a ramp or steps. Usually, it is relieved by sitting down or leaning over. However, not all patients with spinal narrowing develop symptoms—and we still don't understand why. Because of this, the term "spinal ...

101

Newly Diagnosed?  

MedlinePLUS

... Suggestions Examine Your Skin Newly Diagnosed? Understanding Your Pathology Biopsy: The First Step Sentinel Node Biopsy Finding ... start this journey: Get a copy of your pathology report. We can help you understand the report ...

102

Latent class analysis of the diagnostic characteristics of PCR and conventional bacteriological culture in diagnosing intramammary infections caused by Staphylococcus aureus in dairy cows at dry off  

PubMed Central

Background Staphylococcus aureus is one of the most common causes of intramammary infections in dairy cows at dry off. Reliable identification is important for disease management on herd level and for antimicrobial treatment of infected animals. Our objective was to evaluate the test characteristics of PathoProof ™ Mastitis PCR Assay and bacteriological culture (BC) in diagnosing bovine intramammary infections caused by S. aureus at dry off at different PCR cycle threshold (Ct)-value cut-offs. Methods Sterile quarter samples and non-sterile composite samples from 140 animals in seven herds were collected in connection with the dairy herd improvement (DHI) milk recording. All quarter samples were analyzed using BC whereas all composite samples were analyzed with PathoProof ™ Mastitis PCR Assay. Latent class analysis was used to estimate test properties for PCR and BC in the absence of a perfect reference test. The population was divided into two geographically divided subpopulations and the Hui-Walter 2-test 2-populations model applied to estimate Se, Sp for the two tests, and prevalence for the two subpopulations. Results The Se for PCR increased with increasing Ct-value cut-off, accompanied by a small decrease in Sp. For BC the Se decreased and Sp increased with increasing Ct-value cut-off. Most optimal test estimates for the real-time PCR assay were at a Ct-value cut-off of 37; 0.93 [95% posterior probability interval (PPI) 0.60-0.99] for Se and 0.95 [95% PPI 0.95-0.99] for Sp. At the same Ct-value cut-off, Se and Sp for BC were 0.83 [95% PPI 0.66-0.99] and 0.97 [95% PPI 0.91-0.99] respectively. Depending on the chosen PCR Ct-value cut-off, the prevalence in the subpopulations varied; the prevalence increased with increasing PCR Ct-value cut-offs. Conclusion Neither BC nor real-time PCR is a perfect test in detecting IMI in dairy cows at dry off. The changes in sensitivity and prevalence at different Ct-value cut-offs for both PCR and BC may indicate a change in the underlying disease definition. At low PCR Ct-value cut-offs the underlying disease definition may be a truly/heavily infected cow, whereas at higher PCR Ct-value cut-offs the disease definition may be a S. aureus positive cow. PMID:23164432

2012-01-01

103

Spinal Stenosis  

MedlinePLUS

... For example: Continued followup of participants in the SPORT trial will assess long-term outcomes and the cost effectiveness of surgical or nonsurgical management of spinal stenosis and other back problems. SPORT ...

104

Spinal Tap  

MedlinePLUS

... the area. The sample is sent to a lab for analysis and testing. Your doctor might ask you to lie on your back for a few hours after the procedure. Safety A spinal tap is considered a safe procedure ...

105

Best practices for the treatment and prevention of urinary tract infection in the spinal cord injured population: The Alberta context  

PubMed Central

The purpose of this review of clinical guidelines and best practices literature is to suggest prevention options and a treatment approach for intermittent catheter users that will minimize urinary tract infections (UTI). Recommendations are based both on evidence in the literature and an understanding of what is currently attainable within the Alberta context. This is done through collaboration between both major tertiary care centres (Edmonton and Calgary) and between various professionals who regularly encounter these patients, including nurses, physiatrists and urologists. PMID:23671527

Hill, Timothy C.; Baverstock, Richard; Carlson, Kevin V.; Estey, Eric P.; Gray, Gary J.; Hill, Denise C.; Ho, Chester; McGinnis, Rosemary H.; Moore, Katherine; Parmar, Raj

2013-01-01

106

Dermatological problems following spinal cord injury in Korean patients.  

PubMed

Objective To identify dermatological conditions following spinal cord injury (SCI) and analyze these conditions in relation to various characteristics of SCI. Design Retrospective chart review. Setting National Health Insurance Corporation Ilsan Hospital of Korea, Rehabilitation Center, Spinal Cord Unit. Participants Patients treated for SCI who were referred to dermatology for dermatological problems, 2000-2012. Results Of the 1408 SCI patients treated at the spinal cord unit, 253 patients with SCI were identified to have been referred to dermatology for skin problems and a total of 335 dermatological conditions were diagnosed. The most common dermatological finding was infectious (n = 123, 36.7%) followed by eczematous lesions (n = 109, 32.5%). Among the infectious lesions, fungal infection (n = 76, 61.8%) was the most common, followed by bacterial (n = 27, 21.9%) lesions. Seborrheic dermatitis (n = 59, 64.1%) was the most frequent eczematous lesion. Ingrown toenail occurred more frequently in tetraplegics whereas vascular skin lesions occurred more commonly in patients with paraplegia (P < 0.05). Xerotic dermatitis showed a higher occurrence within 12 months of injury rather than thereafter (P < 0.05). Of these, 72.4% of the infectious and 94.7% of the fungal skin lesions manifested below the neurological level of injury (NLI; P < 0.001) and 61.5% of the eczematous lesions and 94.9% of seborrheic dermatitis cases occurred above the NLI (P < 0.001). There was no significant difference in dermatological diagnoses between patients with neurologically complete and incomplete SCI. Conclusion The most common dermatological condition in patients with SCI among those referred to dermatology was fungal infection, followed by seborrheic dermatitis. Although dermatological problems after SCI are not critical in SCI outcome, they negatively affect the quality of life. Patients and caregivers should be educated about appropriate skin care and routine dermatological examinations. PMID:24090454

Han, Zee-A; Choi, Ja Young; Ko, Young Jin

2013-10-24

107

Patterns of drug resistance among newly diagnosed HIV-1 infected patients in Greece during the last decade: the crucial role of transmission networks  

PubMed Central

Introduction The prevalence of drug resistance is approximately 10% in Europe and North America among newly infected patients. We aim to investigate the temporal patterns of resistance among drug naive HIV-infected individuals in Greece and also to determine transmission networking among those with resistant strains. Materials and Methods Protease (PR) and partial reverse transcriptase (RT) sequences were determined from 2499 newly diagnosed HIV-1 patients, in Greece, during 2003–2013. Genotypic drug resistance was estimated using the HIVdb: Genotypic Resistance Interpretation Algorithm. We identified transmission clusters of resistant strains on the basis of a large collection of HIV-1 sequences from 4024 seropositives in Greece. Phylodynamic analysis was performed using a Bayesian method. Results We estimated drug resistance levels among naïve patients on the basis of all resistance mutations in PR and partial RT. The overall prevalence of resistance was 19.6% (490/2499). Resistance to NNRTIs was the most common (397/2499, 15.9%) followed by PIs (116/2499, 4.6%) and NRTIs (79/2499, 3.2%). We found a significant trend for decreasing resistance to NRTIs over time (6.7%–1.6%). There was no time trend for the overall PI and NNRTI resistance. The most frequently observed major resistant sites in PR were V82 (2.0%) and L90 (1.8%). In RT, we found E138 (58.6%), K103 (13.1%), V179 (8.4%) and T215 (7.1%), M41 (4.7%) associated with resistance to NNRTIs and NRTIs, respectively. The prevalence of K103N and E138Q were significantly increased during 2003–2013. Crucially, we found that both K103N, E138Q are associated with transmission networking within men having sex with men (MSM) and intravenous drug user (IDU) local networks. The K103N network included seropositives across Greece, while the latter only from the recent IDU outbreak in Athens metropolitan area (1). Phylodynamic analyses revealed that the exponential growth for K103N network started in 2009 (Figure 1) and for the E138Q in 2010. Conclusions The overall resistance has been stable in Greece over time; however, specific NNRTI resistance patterns are increasing. Notably, they are associated with local transmission networking, thus suggesting that this is the cause for the increased patterns of NNRTI resistance and not multiple transmissions of resistant strains from different sources among treated individuals. Our study highlights the advance of molecular epidemiology for understanding the dynamics of resistance. PMID:25397487

Paraskevis, Dimitrios; Zavitsanou, Assimina; Magiorkinis, Emmanouil; Gargalianos, Panagiotis; Xylomenos, Georgios; Lazanas, Marios; Chini, Maria; Skoutelis, Athanasios; Papastamopoulos, Vasileios; Antoniadou, Anastasia; Papadopoulos, Antonios; Psichogiou, Mina; Daikos, Georgios; Vassilakis, Alexis; Chrysos, Georgios; Paparizos, Vasilis; Kourkounti, Sofia; Sambatakou, Helen; Kordossis, Theodoros; Koratzanis, Georgios; Panagopoulos, Periklis; Maltezos, Evangelos; Drimis, Stylianos; Hatzakis, Angelos

2014-01-01

108

A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas  

PubMed Central

Background HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population. Methods Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract–level social determinants of health variables for 21,948 black MSM and non-MSM aged ?15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling. Results Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased. Conclusions This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income. PMID:25268831

Gant, Zanetta; Gant, Larry; Song, Ruiguang; Willis, Leigh; Johnson, Anna Satcher

2014-01-01

109

Solitary spinal dural syphilis granuloma mimicking a spinal meningioma.  

PubMed

Dural granuloma is extremely rare. To our knowledge, there has no case reported solitary spinal dural syphilis granuloma worldwide so far. Here we report our findings in a 49-year-old woman, who presented with 10-year progressive left lower-limb numbness and two weeks of right lower-limb numbness. Magnetic resonance imaging (MRI) suggested a homogeneous enhanced spindle-shaped lesion, 2.9 × 1.5 cm in size, occupying the spinal intradural extramedullary space, at the level of Thoracic (T)-2/3, which mimicked the appearance of spinal meningioma. The Treponema pallidum particle agglutination (TPPA) test titer of 1:8, and the venereal diseases research laboratory of cerebral spinal fluid (VDRL-CSF) was reactive, so confirmed neurosyphilis was considered. After formal anti-syphilis treatment, posterior laminectomy surgery was performed, and the lesion was completely separated and extirpated. Final histopathologic diagnosis of the lesion was confirmed as chronic granulomatous inflammation, combined with the neurosyphilis history, spinal dural syphilis granuloma was finally diagnosed. Postoperatively, the patient recovered without any further treatment. PMID:24831378

Zhou, Heng-Jun; Zhan, Ren-Ya; Chen, Man-Tao; Cao, Fei; Zheng, Xiu-Jue

2014-01-01

110

Spinal Bracing  

NASA Technical Reports Server (NTRS)

Dr. Arthur Copes of the Copes Foundation, Baton Rouge, LA, says that 35 percent of the 50 technical reports he received from the NASA/Southern University Industrial Applications Center in Baton Rouge and the Central Industrial Applications Center, Durant, OK, were vital to the development of his Copes Scoliosis Braces, which are custom designed and feature a novel pneumatic bladder that exerts constant corrective pressure to the torso to slowly reduce or eliminate the spinal curve.

1991-01-01

111

Spinal Infarcts  

Microsoft Academic Search

In the last decade typical signs of spinal cord ischemia have been reported. Confirming and supporting signs of acute ischemic\\u000a myelomalacia are vertebral body infarction and the pathognomonic contrast enhancement of the cauda equina in the course of\\u000a the disease. Moreover, bone infarction strongly indicates the proximal occlusion and the level of the affected segmental artery.\\u000a Cartilaginous disc embolism, embolism

Michael Mull; Armin Thron

112

Spinal Metastases  

Microsoft Academic Search

Spinal cord metastases are a common complication of systemic malignancy, most commonly from lung, breast, and prostate cancer.\\u000a Patients may present with a variety of symptoms, most notably pain and weakness. The ultimate goals in managing these patients\\u000a include maximizing neurologic function, length of survival, and quality of life. These goals can best be reached via early,\\u000a accurate diagnosis followed

Jonathan H. Sherman; Dawit G. Aregawi; Mark E. Shaffrey; David Schiff

113

Spinal deformity.  

PubMed

Early results of scoliosis screening programs have demonstrated that mild spinal deformity is common, usually nonprogressive, and often requires no specific treatment. The role of the primary care physician is an important one in identifying the rare case, which is secondary to some underlying disorder which itself requires treatment, and the progressive curves, which should be managed by bracing. The informed physician can make this separation efficiently with minimum cost to the family and minimum radiation exposure to the patient. PMID:7373257

Staheli, L T

1980-06-01

114

A glimmer of hope? Evaluation of time for non-genitourinary medicine physicians to diagnose HIV infection in patients presenting with HIV-related illness.  

PubMed

A study conducted in 2002-2003 at three UK south coast hospitals measuring the length of time for non-genitourinary medicine physicians to diagnose HIV when patients presented with an HIV-related illness, found a median time to diagnosis of four days with 70% of diagnoses being made within seven days. This retrospective cohort study of all patients newly diagnosed with HIV between 1 January 2010 and 31 December 2011 was conducted at the same three hospitals. Thirty-seven patients were newly diagnosed with HIV in non-genitourinary (GU) medicine inpatient and outpatient settings (24 men, 13 women), with a mean age of 43 years. The median time to diagnosis was one day (interquartile range of 0-4 days), with 81% of diagnoses made within seven days of first presentation. Late diagnosis of HIV remains a significant challenge, but delayed diagnosis in a patient admitted with an HIV-related illness is reducing in this setting. PMID:23970573

Clarke, E; Drew, O; Sundaram, S; Baker, A; Whale, J; Rowen, D; Patel, R

2013-08-01

115

Spinal cord contusion  

PubMed Central

Spinal cord injury is a major cause of disability with devastating neurological outcomes and limited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result. PMID:25206890

Ju, Gong; Wang, Jian; Wang, Yazhou; Zhao, Xianghui

2014-01-01

116

Infections  

MedlinePLUS

... Ear (Otitis Externa) Syphilis Tetanus Tonsillitis Toxic Shock Syndrome Toxic Synovitis Tuberculosis Urinary Tract Infections Vaginal Yeast Infections Warts West Nile Virus What Is "PANS"? Whooping Cough (Pertussis) ...

117

Spinal subdural abscess following epidural steroid injection.  

PubMed

The authors report the case of a 58-year-old man who presented with a cervicothoracolumbosacral spinal subdural abscess about a month after receiving an epidural steroid injection for management of low-back pain due to L5-S1 disc herniation. Although he presented with symptoms concerning for a spinal etiology, the subdural empyema was not evident on the initial MRI study and was observed on imaging 5 days later. This patient was successfully managed with surgical intervention and antibiotic treatment, and he is doing well more than 21 months after the operation. It is possible that a prior history of disc herniation or other spinal abnormality may increase a patient's risk of developing spinal subdural empyema. This case illustrates the risk of infection following spinal epidural steroid injections and the importance of early recognition and intervention to successfully treat an extensive subdural abscess. PMID:25343407

Kraeutler, Matthew J; Bozzay, Joseph D; Walker, Matthew P; John, Kuruvilla

2015-01-01

118

Factors Associated With Severity of Depression and High-Risk Sexual Behavior Among Persons Diagnosed With Human Immunodeficiency Virus (HIV) Infection  

Microsoft Academic Search

Whereas some people appear to cope after learning that they have human immunodeficiency virus (HIV) infection, others experience depression and suicidal ideation. In this study, 142 persons with HIV infection were administered the Center for Epidemiological Studies Depression Scale (CES–D). High levels of depression were predicted by lower perceived social support, attributions that health was influenced more by chance, high-risk

Jeffrey A. Kelly; Debra A. Murphy; G. Richard Bahr; Jeffrey J. Koob; Michael G. Morgan; Seth C. Kalichman; L. Yvonne Stevenson; Ted L. Brasfield; Barry M. Bernstein; Janet S. St. Lawrence

1993-01-01

119

SHORT REPORT: PROSPECTIVE EVALUATION OF A MULTI-TEST STRIP FOR THE DIAGNOSES OF SCRUB AND MURINE TYPHUS, LEPTOSPIROSIS, DENGUE FEVER, AND SALMONELLA TYPHI INFECTION  

Microsoft Academic Search

A multi-test strip dotblot immunoassay for the diagnosis of typhoid fever, scrub typhus, murine typhus, dengue virus infection and leptospirosis was evaluated in Thai adults presenting to hospital with acute, undifferentiated fever. The kit gave multiple positive test results in 33 of 36 patients with defined infections and was therefore not a useful admission diagnostic tool. can coexist in the

GEORGE WATT; KRISADA JONGSAKUL; RONNATRAI RUANGVIRAYUTH; PACHAREE KANTIPONG; KHACHORNSAKDI SILPAPOJAKUL

2005-01-01

120

Intracranial metastasis from primary spinal primitive neuroectodermal tumor  

PubMed Central

Primary spinal primitive neuroectodermal tumors (PNET) are rare tumors, with only 94 cases reported till date. Metastasis to brain from a spinal PNET is even rarer. In the present report, we evaluate the pathology and treatment of solitary intracranial metastasis from spinal PNET in a 22-year-old female who presented with headache and left hemiparesis and was diagnosed to have right parietal parasagittal tumor. She has been previously diagnosed to have cervicothoracic primary spinal PNET, and was treated by surgery, radiotherapy, and chemotherapy seven years back. The intracranial tumor has been removed and pathological examination confirmed as PNET. She received radiotherapy and chemotherapy with ifosfamide and etoposide, following surgery for the right parietal PNET. At 20 months follow-up, patient is stable and has no recurrence of the disease. Critical review of reported cases of primary spinal PNET metastsising to brain was done. PMID:23741262

Ghanta, Rajesh Kumar; Koti, Kalyan; Ghanta, Venkata Sateesh K.; Teegala, Ramesh

2013-01-01

121

Characteristics of patients recently infected with HIV-1 non-B subtypes in France: a nested study within the mandatory notification system for new HIV diagnoses.  

PubMed

The presence of HIV-1 non-B subtypes in Western Europe is commonly attributed to migration of individuals from non-European countries, but the possible role of domestic infections with non-B subtypes is not well investigated. The French mandatory anonymous reporting system for HIV is linked to a virological surveillance using assays for recent infection (<6 months) and serotyping. During the first semester of years 2007 to 2010, any sample corresponding to a non-B recent infection was analyzed by sequencing a 415-bp env region, followed by phylogenetic analysis and search for transmission clusters. Two hundred thirty-three recent HIV-1 infections with non-B variants were identified. They involved 5 subtypes and 7 circulating recombinant forms (CRFs). Ninety-two cases (39.5%) were due to heterosexual transmissions, of which 39 occurred in patients born in France. Eighty-five cases (36.5%) were identified in men having sex with men (MSM). Forty-three recent non-B infections (18.5%) segregated into 14 clusters, MSM being involved in 11 of them. Clustered transmission events included 2 to 7 cases per cluster. The largest cluster involved MSM infected by a CRF02_AG variant. In conclusion, we found that the spread of non-B subtypes in France occurs in individuals of French origin and that MSM are particularly involved in this dynamic. PMID:25232163

Brand, Denys; Moreau, Alain; Cazein, Françoise; Lot, Florence; Pillonel, Josiane; Brunet, Sylvie; Thierry, Damien; Le Vu, Stéphane; Plantier, Jean-Christophe; Semaille, Caroline; Barin, Francis

2014-11-01

122

Primary extramedullary spinal melanoma mimicking spinal meningioma: A case report and literature review  

PubMed Central

Primary spinal melanoma is a rare lesion, which occurs throughout the cranial and spinal regions, however, is primarily observed in the middle or lower thoracic spine. The clinical features of primary spinal melanoma are complex and unspecific, resulting in a high misdiagnosis rate. In the present case report, a rare case of spinal melanoma exhibiting the dural tail sign and mimicking spinal meningioma is reported. The initial diagnosis, using magnetic resonance imaging (MRI), was unclear. Thus, melanin-containing tumors and spinal meningioma should have been considered in the differential diagnosis. The tumor was completely resected using a standard posterior midline approach, which was followed by chemotherapy. Subsequent to the surgery, the patient was discharged with improved motor capacity and a follow-up MRI scan showed no recurrence after six months. The present study demonstrates that it is critical for neurosurgeons to focus on increasing the accuracy of initial diagnoses in order to make informed decisions regarding the requirement for surgical resection. The present case report presents the clinical, radiological and pathological features of primary extramedullary spinal melanoma mimicking spinal meningioma to emphasize the importance of early identification and diagnosis. PMID:24959273

LI, YU-PING; ZHANG, HENG-ZHU; SHE, LEI; WANG, XIAO-DONG; DONG, LUN; XU, ENXI; WANG, XING-DONG

2014-01-01

123

Spinal disease in neurologically symptomatic HIV-positive patients  

Microsoft Academic Search

We review the MRI findings of human immunodeficiency virus (HIV)-positive patients with “spinal” symptoms and review the\\u000a literature. In 23 consecutive HIV-positive patients presenting with acute neurologic complaints thought to be referable to\\u000a the spine, we reviewed spinal MRI, medical charts, and laboratory, pathologic, and autopsy data. In the early stages of HIV\\u000a infection, the common causes of spinal complaints

K. H. Taber; L. A. Hayman; W. X. Shandera; P. J. Díaz-Marchan; T. Omessi

1999-01-01

124

How Is Asthma Diagnosed?  

MedlinePLUS

... page from the NHLBI on Twitter. How Is Asthma Diagnosed? Your primary care doctor will diagnose asthma ... other disease may be causing your symptoms. Diagnosing Asthma in Young Children Most children who have asthma ...

125

Surveillance of Physician-Diagnosed Skin and Soft Tissue Infections Consistent With Methicillin-Resistant "Staphylococcus aureus" (MRSA) among Nebraska High School Athletes, 2008-2012  

ERIC Educational Resources Information Center

Though historically confined to hospital settings, methicillin-resistant Staphylococcus aureus (MRSA) has received increasing attention in the wider community, particularly among athletes. A 2007-2008 investigation in Nebraska concluded that MRSA skin infections were an emerging problem among the state's student athletes. Statewide…

Buss, Bryan F.; Connolly, Susan

2014-01-01

126

Human Cryptosporidiosis Diagnosed in Western Australia: a Mixed Infection with Cryptosporidium meleagridis, the Cryptosporidium Mink Genotype, and an Unknown Cryptosporidium Species  

PubMed Central

This report describes a case of cryptosporidiosis from an immunocompetent patient from Perth, Western Australia, suffering from diarrhea and a spectrum of other symptoms. Molecular identification revealed that this patient was infected with three Cryptosporidium species—Cryptosporidium meleagridis, the Cryptosporidium mink genotype, and an unknown Cryptosporidium species. PMID:23637295

Combs, Barry; MacKenzie, Brian; Ryan, Una

2013-01-01

127

Diagnosing Aleutian mink disease infection by a new fully automated ELISA or by counter current immunoelectrophoresis: a comparison of sensitivity and specificity.  

PubMed

Aleutian disease (AD) is a severe disease characterized by hypergammaglobulinemia causing multiple symptoms such as acute renal failure, arteritis, reduced reproductive performance and pneumonia in mink. AD is caused by the parvovirus Aleutian mink disease virus (ADV) and diagnosed primarily based on ADV serology sometimes supplemented by organ PCR analysis. In Denmark, approximately 3.5-4 million serum samples are tested every year for the presence of anti ADV antibodies as part of a national eradication program. The present study compares the diagnostic performance of the two most commonly used assays for serological screening for Aleutian disease: counter current immunoelectrophoresis (CIEP) and ELISA. In total, 3810 mink were sampled in doublets and analyzed by CIEP and a newly developed fully automated ELISA. The results show that the two assays have a comparable diagnostic performance with the ELISA having a higher sensitivity but lower specificity than the CIEP assay. The ELISA has been approved by the Danish authorities for diagnosing Aleutian disease in mink. PMID:24462658

Dam-Tuxen, Rebekka; Dahl, Jan; Jensen, Trine Hammer; Dam-Tuxen, Thomas; Struve, Tina; Bruun, Leif

2014-04-01

128

Chronic spinal subdural abscess mimicking an intradural-extramedullary tumor.  

PubMed

Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. But they are not sensitive indicators of SSA, especially chronic abscesses patient tend to have a less specific characteristic. We report the case of a healthy man with chronic subdural abscess referred to our hospital as an intradural-extramedullary (IDEM) tumor. The patient presented with voiding difficulty and pain in the back and left leg. In a contrast MRI scan, a rim-enhanced mass-like lesion was seen at the L5/S1 level. But adjacent ill-defined epidural fat enhancement that are unusual imaging manifestation for IDEM tumors was seen. He had no fever and normal WBC, ESR, and CRP. In addition, the patient had no previous infection history or other disease, but he did have an epidural block for back pain at another hospital 2 years previously. So, we repeated the MRI with a high-resolution 3-T scanner. The newly taken MR images in our hospital revealed a clear enlargement of lesion size compared to the previous MRI taken 1 week before in other hospital. We suspected a chronic spinal subdural abscess with recent aggravation and immediately performed surgical evacuation. In the surgical field, tensed dura was observed and pus was identified after opening the abscess capsule. Because chronic spinal subdural abscesses are difficult to diagnose, we could differentiate with IDEM tumor exactly and an exact history taking, contrast MRI are required. PMID:23397217

Lim, Hyo-Yeol; Choi, Hong-Jun; Kim, Sungjun; Kuh, Sung-Uk

2013-05-01

129

Failure of Urological Implants in Spinal Cord Injury Patients due to Infection, Malfunction, and Implants Becoming Obsolete due to Medical Progress and Age-Related Changes in Human Body Making Implant Futile: Report of Three Cases  

PubMed Central

Any new clinical data, whether positive or negative, generated about a medical device should be published because health professionals should know which devices do not work, as well as those which do. We report three spinal cord injury patients in whom urological implants failed to work. In the first, paraplegic, patient, a sacral anterior root stimulator failed to produce erection, and a drug delivery system for intracavernosal administration of vasoactive drugs was therefore implanted; however, this implant never functioned (and, furthermore, such penile drug delivery systems to produce erection had effectively become obsolete following the advent of phosphodiesterase type 5 inhibitors). Subsequently, the sacral anterior root stimulator developed a malfunction and the patient therefore learned to perform self-catheterisation. In the second patient, also paraplegic, an artificial urinary sphincter was implanted but the patient developed a postoperative sacral pressure sore. Eight months later, a suprapubic cystostomy was performed as urethral catheterisation was very difficult. The pressure sore had not healed completely even after five years. In the third case, a sacral anterior root stimulator was implanted in a tetraplegic patient in whom, after five years, a penile sheath could not be fitted because of penile retraction. This patient was therefore established on urethral catheter drainage. Later, infection with Staphylococcus aureus around the receiver block necessitated its removal. In conclusion, spinal cord injury patients are at risk of developing pressure sores, wound infections, malfunction of implants, and the inability to use implants because of age-related changes, as well as running the risk of their implants becoming obsolete due to advances in medicine. Some surgical procedures such as dorsal rhizotomy are irreversible. Alternative treatments such as intermittent catheterisations may be less damaging than bladder stimulator in the long term. PMID:23864980

Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter; Selmi, Fahed

2013-01-01

130

Overview of Spinal Cord Disorders  

MedlinePLUS

... or anterior root) contains nerve fibers that carry impulses (signals) from the spinal cord to muscles to ... Down the Spinal Cord Spinal nerves carry nerve impulses to and from the spinal cord through two ...

131

Spinal Paraganglioma Adherent to the Cauda Equina  

PubMed Central

Paragangliomas are rare among intradural spinal tumors. Most of them are benign, but aggressive behavior and local recurrence can occur. Cases of paraganglioma are, difficult to diagnose radiologically; hence, diagnosis is confirmed histopathologically. Radiologically, paragangliomas are similar to ependymomas, and, histopathologically, they are similar to neuroendocrine tumors. We evaluated the case of a 76-year-old woman with a spinal paraganglioma that was associated with back pain and radiating pain in both the lower extremities. She underwent an operation, and her symptoms were relieved. Here, we describe a rare case of paraganglioma that was adherent to the cauda equina.

Oh, Han San; Park, Kwan Ho

2014-01-01

132

Cardiac myxosarcoma with thoracic spinal metastasis.  

PubMed

Echocardiography revealed a left atrial tumor in a 59-year-old man with back pain that concurrently worsened with left foot drop and loss of the left ankle reflex soon after admission to our hospital. Magnetic resonance imaging of the spine revealed an epidural tumor extending from Th5 with spinal cord compression. The patient was immediately treated by emergency Th4-5 laminectomy and epidural decompression. One month later, a cardiac tumor excised via the left atrial approach was histopathologically diagnosed as myxosarcoma, and the Th5 tumor was consistent with this finding. This is the first report to describe spinal metastasis of cardiac myxosarcoma. PMID:23677508

Kimura, Mitsuhiro; Kikuchi, Chizuo; Takahashi, Yoshiki; Kanazawa, Hiroshi; Nakazawa, Satoshi

2014-07-01

133

Scientific Rationale for Study Design of Community-based Simplified Antibiotic Therapy Trials in Newborns and Young Infants With Clinically Diagnosed Severe Infections or Fast Breathing in South Asia and sub-Saharan Africa  

PubMed Central

Background: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0–59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted. Methods: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are in settings of high neonatal mortality, where hospitalization is not feasible or frequently refused. All use procaine penicillin and gentamicin intramuscular injections for 7 days as reference therapy and compare this to various experimental arms utilizing comparatively simpler combination regimens with fewer injections and oral amoxicillin. Conclusion: The results of these trials will inform World Health Organization policy regarding community case management of young infants with clinical severe infections or with fast breathing. PMID:23945577

2013-01-01

134

MRI and FDG PET/CT findings in 3 cases of spinal infectious arachnoiditis.  

PubMed

Spinal arachnoiditis is a disease characterized by inflammation and scarring of the arachnoid membrane of the spinal cord. FDG PET/CT findings of spinal arachnoiditis have been rarely reported. We present 3 cases of spinal infectious arachnoiditis (1 pyogenic and 2 tuberculous). MRI was performed in these 3 cases showing thickened spinal meninges with marked enhancement. FDG PET/CT was performed in 2 cases showing intense linear FDG uptake along the spinal canal. The combination of MRI and FDG PET/CT may be helpful in identifying the infectious sites and evaluating the activity of the infection. PMID:24321827

Dong, Aisheng; Zuo, Changjing; Zhang, Ping; Lu, Jianping; Bai, Yushu

2014-10-01

135

Spinal Muscular Atrophy  

MedlinePLUS

NINDS Spinal Muscular Atrophy Information Page Synonym(s): Werdnig-Hoffman Disease, Kugelberg-Welander Disease Condensed from Spinal Muscular ... of symptoms. Type I (also known as Werdnig-Hoffman disease, or infantile-onset SMA) is evident at ...

136

Microbiology and Epidemiology of Infectious Spinal Disease  

PubMed Central

Objective Infectious spinal disease is regarded as an infection by a specific organism that affects the vertebral body, intervertebral disc and adjacent perivertebral soft tissue. Its incidence seems to be increasing as a result of larger proportion of the older patients with chronic debilitating disease, the rise of intravenous drug abuser, and the increase in spinal procedure and surgery. In Korea, studies assessing infectious spinal disease are rare and have not been addressed in recent times. The objectives of this study are to describe the epidemiology of all kind of spinal infectious disease and their clinical and microbiological characteristics as well as to assess the diagnostic methodology and the parameters related to the outcomes. Methods A retrospective study was performed in all infectious spinal disease cases presenting from January 2005 to April 2010 to three tertiary teaching hospitals within a city of 1.5 million in Korea. Patient demographics, risk factors, clinical features, and outcomes were assessed. Risk factors entailed the presence of diabetes, chronic renal failure, liver cirrhosis, immunosuppressants, remote infection, underlying malignancy and previous spinal surgery or procedure. We comparatively analyzed the results between the groups of pyogenic and tuberculous spinal infection. SPSS version 14 statistical software was used to perform the analyses of the data. The threshold for statistical significance was established at p<0.05. Results Ninety-two cases fulfilled the inclusion criteria and were reviewed. Overall, patients of tuberculous spinal infection (TSI) and pyogenic spinal infection (PSI) entailed 20 (21.7%) and 72 (78.3%) cases, respectively. A previous spinal surgery or procedure was the most commonly noted risk factor (39.1%), followed by diabetes (15.2%). The occurrence of both pyogenic and tuberculous spondylitis was predominant in the lumbar spine. Discs are more easily invaded in PSI. At initial presentation, white cell blood count and C-reactive protein levels were higher in PSI compared to TSI (p<0.05). Etiological agents were identified in 53.3%, and the most effective method for identification of etiological agents was tissue culture (50.0%). Staphyococcus aureus was the most commonly isolated infective agent associated with pyogenic spondylitis, followed by E. coli. Surgical treatment was performed in 31.5% of pyogenic spondylitis and in 35.0% of tuberculous spondylitis cases. Conclusion Many previous studies in Korea usually reported that tuberculous spondylitis is the predominant infection. However, in our study, the number of pyogenic infection was 3 times greater than that of tuberculous spinal disease. Etiological agents were identified in a half of all infectious spinal disease. For better outcomes, we should try to identify the causative microorganism before antibiotic therapy and make every effort to improve the result of culture and biopsy. PMID:25289121

Jeong, Se-Jin; Youm, Jin-Young; Kim, Hyun-Woo; Ha, Ho-Gyun; Yi, Jin-Seok

2014-01-01

137

An Unusual Cervical Spinal Meningioma in a Child  

PubMed Central

The incidence of spinal meningioma is very rare in children. A 14-year-old girl presented with right arm weakness, gait disturbance, and urinary incontinence. Cervical magnetic resonance imaging revealed an intradural extramedullary tumor dorsal to the spinal cord in the level of C1. The tumor was totally removed despite the severe cord compression. Meningotheliomatous meningioma was diagnosed after histological examination. PMID:23560181

Lee, Jong-Koo; Paik, Ae-Lan; Jang, Woo-Young

2013-01-01

138

A computer vision system for diagnosing scoliosis using moiré images  

Microsoft Academic Search

For young people, scoliosis deformities are an evolving process which must be detected and treated as early as possible. The moiré technique is simple, inexpensive, not aggressive and especially convenient for detecting spinal deformations. Doctors make their diagnosis by analysing the symmetry of fringes obtained by such techniques. In this paper, we present a computer vision system for help diagnosing

M. Batouche; R. Benlamri; M. K. Kholladi

1996-01-01

139

Primary spinal cord melanoma in thoracic spine with leptomeningeal dissemination and presenting hydrocephalus.  

PubMed

Primary spinal cord melanoma is a rare central nervous system malignant tumor. Usually it resembles an intradural extramedullary (IDEM) nerve sheath tumor or melanoma. We experienced a patient with upper thoracic primary IDEM spinal cord melanoma who was diagnosed to be with hydrocephalus and without intracranial lesions. Initial symptoms of the patient were related to the hydrocephalus and the primary spinal cord melanoma was diagnosed eight months later. At the first operation, complete resection was impossible and the patient refused additional radiotherapy or chemotherapy. At 22 months after surgery, the patient revisited our institution with recurrent both leg weakness. Leptomeningeal dissemination was present in the whole spinal cord and only partial resection of tumor was performed. The symptoms slightly improved after surgery. Primary spinal cord melanoma is extremely rare but complete resection and additional radiotherapy or chemotherapy can prolong the disease free interval. Hydrocephalus or signs of increased intracranial pressure may be the diagnostic clue of spinal cord malignancy and progression. PMID:24904904

Jeong, Dong Hwan; Lee, Chunl Kyu; You, Nam Kyu; Kim, Sang Hyun; Cho, Ki Hong

2013-10-01

140

Primary Spinal Cord Melanoma in Thoracic Spine with Leptomeningeal Dissemination and Presenting Hydrocephalus  

PubMed Central

Primary spinal cord melanoma is a rare central nervous system malignant tumor. Usually it resembles an intradural extramedullary (IDEM) nerve sheath tumor or melanoma. We experienced a patient with upper thoracic primary IDEM spinal cord melanoma who was diagnosed to be with hydrocephalus and without intracranial lesions. Initial symptoms of the patient were related to the hydrocephalus and the primary spinal cord melanoma was diagnosed eight months later. At the first operation, complete resection was impossible and the patient refused additional radiotherapy or chemotherapy. At 22 months after surgery, the patient revisited our institution with recurrent both leg weakness. Leptomeningeal dissemination was present in the whole spinal cord and only partial resection of tumor was performed. The symptoms slightly improved after surgery. Primary spinal cord melanoma is extremely rare but complete resection and additional radiotherapy or chemotherapy can prolong the disease free interval. Hydrocephalus or signs of increased intracranial pressure may be the diagnostic clue of spinal cord malignancy and progression. PMID:24904904

Jeong, Dong Hwan; Lee, Chunl Kyu; Kim, Sang Hyun; Cho, Ki Hong

2013-01-01

141

Spinal cord malformations.  

PubMed

Malformations of the spinal cord are one of the most frequent malformations. They should be clearly divided into two completely different families of malformations: open dysraphisms and occult dysraphisms. Open dysraphism mostly consists in myelomeningocele (MMC). Its incidence is 1/1000 live births with a wide variation. Folic acid supplementation has been shown to reduce its risk. In most cases, the diagnosis is done prenatally by serum screening and ultrasound and may lead to termination of pregnancy. In case of decision to continue pregnancy, surgical treatment must be achieved during the first days of life, and in 50 to 90% of cases, a ventricular shunt must be installed. The follow-up of these children must be continued throughout life looking for late complications (Chiari II and syringomyelia, vertebral problems, neuropathic bladder, tethered cord). Occult dysraphisms are a heterogeneous group of malformations. Lipomas (filum and conus) are the most frequent and their treatment remains controversial. Diastematomyelia, neurenteric cysts, dermal sinus, and more complex forms (Currarino syndrome) belong to this group. Most of them can and must be diagnosed prenatally or at birth by careful examination of the lower back for the cutaneous stigmata of the disease to decrease the risk of neurological, urological, or orthopedic permanent handicap. PMID:23622306

Zerah, Michel; Kulkarni, Abhaya V

2013-01-01

142

[Spinal canal stenosis].  

PubMed

Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. PMID:25398571

Papanagiotou, P; Boutchakova, M

2014-11-01

143

Idiopathic spinal epidural lipomatosis.  

PubMed

Spinal epidural lipomatosis is a rare disorder characterized by the pathological overgrowth of epidural fat and often causes extradural compression which may mimic other spinal disorders. Steroid administration is a well-documented etiology. We report a case of spinal epidural lipomastosis without history of steroid administration. The initial manifestation was bizarre and was misdiagnosed as a degenerative vertebral or disc disease for long. Posterior decompression with debulking of the extradural fat successfully and thoroughly relieved his symptoms. We emphasize the importance of taking this disease into consideration for a markedly obese patient with persisting back pain or symptoms suggesting spinal cord or other spinal neural elements compression. PMID:15357116

Fan, Cheng-Yu; Wang, Shih-Tien; Liu, Chien-Lin; Chang, Ming-Chau; Chen, Tain-Hsiung

2004-05-01

144

Diagnosing Tic Disorders  

MedlinePLUS

... Other Websites Information For... Media Policy Makers Diagnosing Tic Disorders Language: English Español (Spanish) Share Compartir The ... or postviral encephalitis). Persistent (Chronic) Motor or Vocal Tic Disorder For a person to be diagnosed with ...

145

How Is COPD Diagnosed?  

MedlinePLUS

... page from the NHLBI on Twitter. How Is COPD Diagnosed? Your doctor will diagnose COPD based on ... Rate This Content: Next >> Featured Video What is COPD? 10/15/2014 The NHLBI "Grand Opportunity" Exome ...

146

How Is Sarcoidosis Diagnosed?  

MedlinePLUS

... page from the NHLBI on Twitter. How Is Sarcoidosis Diagnosed? Your doctor will diagnose sarcoidosis based on ... Content: Next >> Featured Video Living With and Managing Sarcoidosis 10/15/2014 June 14, 2013 Sarcoidosis Clinical ...

147

Detection of a low-grade enteroviral infection in the islets of Langerhans of living patients newly diagnosed with type 1 diabetes.  

PubMed

The Diabetes Virus Detection study (DiViD) is the first to examine fresh pancreatic tissue at the diagnosis of type 1 diabetes for the presence of viruses. Minimal pancreatic tail resection was performed 3-9 weeks after onset of type 1 diabetes in 6 adult patients (age 24-35 years). The presence of enteroviral capsid protein 1 (VP1) and the expression of class I HLA were investigated by immunohistochemistry. Enterovirus RNA was analyzed from isolated pancreatic islets and from fresh frozen whole pancreatic tissue using PCR and sequencing. Non-diabetic organ donors served as controls. VP1 was detected in the islets of all type 1 diabetes patients (2 of 9 controls). Hyperexpression of class I HLA molecules was found in the islets of all patients (1 of 9 controls). Enterovirus specific RNA sequences were detected in 4 of 6 cases (0 of 6 controls). The results were confirmed in different laboratories. Only 1.7 % of the islets contained VP1 positive cells and the amount of enterovirus RNA was low. The results provides evidence for the presence of enterovirus in pancreatic islets of type 1 diabetic patients, being consistent with the possibility that a low grade enteroviral infection in the pancreatic islets contribute to disease progression in humans. PMID:25422108

Krogvold, Lars; Edwin, Bjørn; Buanes, Trond; Frisk, Gun; Skog, Oskar; Anagandula, Mahesh; Korsgren, Olle; Undlien, Dag; Eike, MortenC; Richardson, Sarah J; Leete, Pia; Morgan, Noel G; Oikarinen, Sami; Oikarinen, Maarit; Laiho, Jutta E; Hyöty, Heikki; Ludvigsson, Johnny; Hanssen, Kristian F; Dahl-Jørgensen, Knut

2014-11-24

148

Sarcoidosis of the spinal cord: literature review and report of eight cases.  

PubMed Central

Sarcoidosis, which affects African Americans more than it does other racial/ethnic groups, only rarely manifests initially as spinal cord dysfunction. This paper presents the findings of eight patients with spinal cord dysfunction as part of a presentation of sarcoidosis. After reviewing these cases, we devised an algorithm to diagnose and manage spinal cord sarcoidosis. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:16775923

Saleh, Samer; Saw, Chandan; Marzouk, Kamel; Sharma, Om

2006-01-01

149

Focal thoracolumbar spinal cord lymphosarcoma in a ferret (Mustela putorius furo)  

PubMed Central

A 6-year-old, castrated male domestic ferret (Mustela putorius furo) was euthanized following progressive hind limb paresis and atonia of the bladder of 1-year duration. Neurological evaluation localized the lesion to the thoracolumbar spinal region, and magnetic resonance imaging showed a focal intramedullary spinal cord lesion. Histopathology revealed an extensive, unencapsulated, poorly demarcated mass within the thoracolumbar spinal cord, diagnosed as lymphosarcoma. PMID:24982519

Ingrao, Joelle C.; Eshar, David; Vince, Andrew; Lee-Chow, Bridget; Nykamp, Stephanie; DeLay, Josepha; Smith, Dale

2014-01-01

150

Giant erosive spinal schwannomas: surgical management.  

PubMed

Giant erosive spinal schwannomas can be distinguished from other spinal schwannomas by its growth in myofascial planes and vertebral body erosion. Therapeutic radical tumour excision without neurologic deterioration is possible in the management. Prognosis is good after total tumour removal. In this article, it is aimed to report six patients who were diagnosed as giant erosive spinal schwannomas between 2001 and 2004 according to the criteria of Sridhar et al. Three of the patients were male and three female with the age range of 16-63 (mean age 39.7). Three of the tumours were located in the cervical region, one in the lumbar region, one in the thoracic region and one in the sacral region. Total excision of the tumours was achieved in four patients. However, one additional operation was required in two patients. Follow-up periods ranged from 6 weeks to 7 years (mean follow-up 51 months). Four patients had a good clinical outcome and there were no radiologic signs of instability or recurrence. Our experience and other published literature suggest that giant erosive spinal schwannoma has significant features such as local invasive nature together with vertebral body erosion and large size but benign histology, long duration for clinical presentation, common preoperative misdiagnosis and good prognosis after total excision. These tumours rarely need spinal instrumentation because the disc capsule and ligaments remain intact even if the pedicle and posterior elements are compromised. PMID:20515264

Ozdemir, Nail; Bezircio?lu, Hamdi; Akar, Omer

2010-10-01

151

The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment  

PubMed Central

Background This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities. Methods Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles each of which was surveyed for content related to 'pathology' and related terms such as 'etiology,' 'inheritance,' 'pathomechanism,' 'signs and symptoms.' Additional resources included all books published on 'scoliosis' and available through the Arizona Health Sciences Library, Interlibrary Loan, or through direct contact with the authors or publishers. Results A lateral curvature of the spine–'scoliosis'–can develop in association with postural imbalance due to genetic defects and injury as well as pain and scarring from trauma or surgery. Irrespective of the factor that triggers its appearance, a sustained postural imbalance can result, over time, in establishment of a state of continuous asymmetric loading relative to the spinal axis. Recent studies support the longstanding hypothesis that spinal deformity results directly from such postural imbalance, irrespective of the primary trigger, because the dynamics of growth within vertebrae are altered by continuous asymmetric mechanical loading. These data suggest that, as long as growth potential remains, evolution of a spinal curvature into a spinal deformity can be prevented by reversing the state of continuous asymmetric loading. Conclusion Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and thereby yield strategies to prevent development of spinal deformity. Even within the normal spine there is considerable flexibility with the possibility of producing many types of curves that can be altered during the course of normal movements. To create these curves during normal movement simply requires an imbalance of forces along the spine and, extending this concept a little further, a scoliotic curve is produced simply by a small but sustained imbalance of forces along the spine. In fact I would argue that no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine [1]. PMID:16759413

Hawes, Martha C; O'Brien, Joseph P

2006-01-01

152

Incidence Density of Invasive Fungal Infections during Primary Antifungal Prophylaxis in Newly Diagnosed Acute Myeloid Leukemia Patients in a Tertiary Cancer Center, 2009 to 2011  

PubMed Central

Although primary antifungal prophylaxis (PAP) is routinely administered in patients with acute myeloid leukemia (AML) during remission-induction and consolidation chemotherapy, the impact of PAP on the incidence of invasive fungal infections (IFIs) is not well described. We retrospectively analyzed the incidence of IFIs in 152 patients with AML who had been admitted to a tertiary cancer center between August 2009 and March 2011 and received PAP within 120 days after first remission-induction chemotherapy. We excluded patients who had undergone stem cell transplantation. Patients received a PAP drug with anti-Aspergillus activity during 72% (7,660/10,572) of prophylaxis-days. The incidence of documented IFIs (definite or probable according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) was 2.0/1,000 prophylaxis-days (95% confidence interval [CI], 1.23 to 3.04). IFIs due to molds were more common than IFIs due to yeasts (1.5/1,000 prophylaxis-days versus 0.4/1,000 prophylaxis-days; P = 0.01). Echinocandin-based PAP (8.6 and 7.1/1,000 prophylaxis-days, respectively) was associated with higher rates of documented IFIs than anti-Aspergillus azoles (voriconazole or posaconazole) (2.4 and 1.1/1,000 prophylaxis-days, respectively) at both 42 days (P = 0.03) and 120 days (P < 0.0001) after first remission-induction chemotherapy. The incidence of overall (documented and presumed) IFIs (P < 0.001), documented IFIs (P < 0.01), and empirical antifungal therapies (P < 0.0001) was higher during the first 42 days than after day 42. Despite the broad use of PAP with anti-Aspergillus activity, IFIs, especially molds, remain a significant cause of morbidity and mortality in AML patients, predominantly during the remission-induction phase. Patients receiving echinocandin-based PAP experienced higher rates of IFIs than did those receiving anti-Aspergillus azoles. PMID:24277033

Mulanovich, Victor E.; Jiang, Y.; Lewis, Russell E.

2014-01-01

153

How Are Brain and Spinal Cord Tumors in Children Diagnosed?  

MedlinePLUS

... specific tasks (such as answering simple questions or moving their fingers) while the scans are being done. ... head. This helps make sure the surgeon will target the tumor precisely. A small cut is made ...

154

Intramedullary spinal cord metastasis from salivary ductal carcinoma of the parotid gland mimicking transverse myelitis in a patient with radiologically isolated syndrome.  

PubMed

Intramedullary spinal cord metastases (ISCMs) are rare lesions but their presence should not be underestimated in a cancer patient with rapidly progressive neurological compromise. Due to similar timing of clinical progression and imaging characteristics, these lesions may be misdiagnosed as transverse myelitis, an inflammatory disorder of the spinal cord that may be idiopathic or secondary to other diseases including infections, connective tissue disorders, nutritional deficiencies, and demyelinating disorders. We present a case of a 44 year-old male with a history of parotid gland metastatic salivary ductal carcinoma (SDC) and incidental demyelinating white matter lesions on brain magnetic resonance imaging (MRI) diagnosed as radiologically isolated syndrome with a CSF that was positive for oligoclonal bands. The patient initially presented with mid-thoracic dermatomal numbness, bilateral lower extremity weakness, and neurogenic bladder. MRI spine demonstrated an enhancing T5-7 intramedullary lesion initially diagnosed as transverse myelitis. After progressing to complete motor and sensory loss below T6 despite high-dose intravenous steroids and plasmapheresis, surgical biopsy was undertaken. Intraoperative findings revealed an intramedullary tumor for which a subtotal resection was performed. Pathology was consistent with a metastatic deposit from the patient's primary parotid SDC. The patient underwent postoperative chemotherapy but expired due to systemic disease progression seven months following surgery without neurological improvement. This is the first reported case of ISCM from a primary SDC. The median survival is 6 months for patients with ISCMs treated surgically. The goals of surgery are spinal cord decompression, functional preservation, and tissue diagnosis. PMID:24199731

Ding, Dale; Fullard, Michelle; Jarrell, Heather S; Jones, David E

2014-01-15

155

Bridging spinal cord injuries  

E-print Network

Minireview Bridging spinal cord injuries James W Fawcett Address: Cambridge University Centre for Brain Repair, Robinson Way, Cambridge CB2 0PY, UK. Email: jf108@cam.ac.uk Repair of the injured spinal cord has been one of the great quests... why not transplant Abstract One strategy for spinal cord injury repair is to make cellular bridges that support axon regeneration. However, the bridging cells often fail to integrate with host tissue and may lead to increased pain sensitivity. Recent...

2008-10-15

156

Diagnosability and sensor reduction  

Microsoft Academic Search

Device-centered model-based reasoning (MBR) models are used to determine the diagnosability of individual components and of the system as a whole. Given a satisfactory device-centered model that can be used dependably for diagnosis, the author first considers the specification of diagnosability for individual components. This is expressed through uniqueness requirements for the isolation of faults in those components. The diagnosability

E. Scarl

1991-01-01

157

[Spinal segmental myoclonus in multiple sclerosis (case report).  

PubMed

Multiple sclerosis (MS) is a disease with multicentric lesions of central nervous system. These numerous lesions can cause a lot of different symptoms. Sometimes these signs are atypical and make difficulties for MS diagnosing. Hyperkinesis is extremely rare manifestation of MS especially if it concerns spinal myoclonus. Spinal myoclonic jerks can be caused by various focal damages of neuraxis including demyelination lesions. This report describes the case of spinal segmental myoclonus as an unusual manifestation of MS. The patient was diagnosed definite MS according to the McDonald criteria (2010). The nature of movement disorders was defined by careful neurologic and neurophysiologic examination. These movement disorders were reliably caused by demyelinating type lesions in the cervical cord. PMID:24662357

Khafizova, I F; Zalialova, Z A; Baranova, E A; Khakimova, A R; Iakupov, E Z; Gafurov, M S

2014-01-01

158

Post traumatic stress disorder and spinal cord injuries  

Microsoft Academic Search

Post Traumatic Stress Disorder (PTSD) was first recognised by psychiatric international classification systems in 1980 and a wealth of research and treatment literature has developed since. This paper provides a review of PTSD and Spinal Cord Injuries. A brief history of the disorder is provided before descriptions of the defining characteristics, assessment and differential diagnoses. The paper provides an overview

Paul Kennedy; Jane Duff

2001-01-01

159

Spinal Cord Infarction  

MedlinePLUS

... prevent and treat them. NIH Patient Recruitment for Spinal Cord Infarction Clinical Trials At NIH Clinical Center Throughout the U.S. and Worldwide NINDS Clinical Trials Organizations Column1 Column2 ... National Spinal Cord Injury Association 75-20 Astoria Blvd Suite ...

160

Intramedullary spinal cord astrocytomas  

Microsoft Academic Search

Intramedullary spinal cord tumors (IMSCT) are rare lesions and can occur in any age group. They are the most common intramedullary spinal cord tumors in children and the second most common in adults. Most of these astrocytomas are low-grade and may present after a symptomatic period of months to years. They can become symptomatic with back or neck pain, radicular

Scott P. Sanderson; Paul R. Cooper

2003-01-01

161

Spinal tuberculosis: A review  

PubMed Central

Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good. PMID:22118251

Garg, Ravindra Kumar; Somvanshi, Dilip Singh

2011-01-01

162

Spinal Myoclonus After Spinal Cord Injury  

PubMed Central

Background/Objective: In the course of examining spinal motor function in many hundreds of people with traumatic spinal cord injury, we encountered 6 individuals who developed involuntary and rhythmic contractions in muscles of their legs. Although there are many reports of unusual muscle activation patterns associated with different forms of myoclonus, we believe that certain aspects of the patterns seen with these 6 subjects have not been previously reported. These patterns share many features with those associated with a spinal central pattern generator for walking. Methods: Subjects in this case series had a history of chronic injury to the cervical spinal cord, resulting in either complete (ASIA A; n = 4) or incomplete (ASIA D; n = 2) quadriplegia. We used multi-channel electromyography recordings of trunk and leg muscles of each subject to document muscle activation patterns associated with different postures and as influenced by a variety of sensory stimuli. Results: Involuntary contractions spanned multiple leg muscles bilaterally, sometimes including weak abdominal contractions. Contractions were smooth and graded and were highly reproducible in rate for a given subject (contraction rates were 0.3–0.5 Hz). These movements did not resemble the brief rapid contractions (ie, "jerks") ascribed to some forms of spinal myoclonus. For all subjects, the onset of involuntary muscle contraction was dependent upon hip angle; contractions did not occur unless the hips (and knees) were extended (ie, subjects were supine). In the 4 ASIA A subjects, contractions occurred simultaneously in all muscles (agonists and antagonists) bilaterally. In sharp contrast, contractions in the 2 ASIA D subjects were reciprocal between agonists and antagonists within a limb and alternated between limbs, such that movements in these 2 subjects looked just like repetitive stepping. Finally, each of the 6 subjects had a distinct pathology of their spinal cord, nerve roots, distal trunk, or thigh; in 4 of these subjects, treatment of the pathology eliminated the involuntary movements. Conclusion: The timing, distribution, and reliance upon hip angle suggest that these movement patterns reflect some elements of a central pattern generator for stepping. Emergence of these movements in persons with chronic spinal cord injury is extremely rare and appears to depend upon a combination of the more rostrally placed injury and a pathologic process leading to a further enhancement of excitability in the caudal spinal cord. PMID:17044393

Calancie, Blair

2006-01-01

163

Spectrophotometric Quantification of Bilirubin in Hemorrhagic Spinal Fluid using an Innovative Algorithm  

Microsoft Academic Search

Annually, approximately 30,000 people suffer from aneurysmal subarachnoid hemorrhage (SAH) in the United States. In an estimated 5% of these patients, the hemorrhage is difficult to diagnose using conventional methods. Clini- cians must rely upon a combination of clinical history, Computerized Tomography (CT) scan evidence and lumbar punc- ture results to diagnose and differentiate SAH from a traumatic spinal tap

Prashant R. Bhadri; Vasant A. Salgaonkar; Gail J. Pyne-Geithman; James J. Caffery Jr; Rakesh Shukla; Fred R. Beyette Jr; Joseph F. Clark

2007-01-01

164

Spinal Cord Lesions in Congenital Toxoplasmosis Demonstrated with Neuroimaging, Including Their Successful Treatment in an Adult  

PubMed Central

Neuroimaging studies for persons in the National Collaborative Chicago-Based Congenital Toxoplasmosis Study (NCCCTS) with symptoms and signs referable to the spinal cord were reviewed. Three infants had symptomatic spinal cord lesions, another infant a Chiari malformation, and another infant a symptomatic peri-spinal cord lipoma. One patient had an unusual history of prolonged spinal cord symptoms presenting in middle age. Neuroimaging was used to establish her diagnosis and response to treatment. This 43 year-old woman with congenital toxoplasmosis developed progressive leg spasticity, weakness, numbness, difficulty walking, and decreased visual acuity and color vision without documented re-activation of her chorioretinal disease. At 52 years of age, spinal cord lesions in locations correlating with her symptoms and optic atrophy were diagnosed with 3 Tesla MRI scan. Treatment with pyrimethamine and sulfadiazine decreased her neurologic symptoms, improved her neurologic examination, and resolved her enhancing spinal cord lesions seen on MRI. PMID:23487348

Burrowes, Delilah; Boyer, Kenneth; Swisher, Charles N.; Noble, A. Gwendolyn; Sautter, Mari; Heydemann, Peter; Rabiah, Peter; Lee, Daniel; McLeod, Rima

2012-01-01

165

Spinal cystic schwannoma: an MRI evaluation.  

PubMed

Spinal cystic schwannomas are a very rare entity and have been reported in only a few case reports in literature; its diagnosis and management has remained a challenge. This study reviewed the results of magnetic resonance imaging (MRI) of 12 patients (7 men and 5 women; aged 37 - 67 years; mean age: 52.75 years) with pathologically proven cystic schwannoma of the spine and discussed their differential diagnosis. All patients underwent surgery at our institutions between June 2000 and April 2012. MRI showed well-delineated intradural and extramedullary lesion of iso- to low signal intensity on T1 weighted images, high signal intensity on T2 weighted images, and rim enhancement on contrast-enhanced images. A precise understanding of the MRI features of spinal schwannomas, especially the typical characteristic of enhancement, may help clinicians in their pre-operative diagnoses and surgical planning. PMID:24491015

Netra, Rana; Hui, Ma Shao; Gang, Min Zhi; Ming, Zhang

2014-02-01

166

How Is Hypotension Diagnosed?  

MedlinePLUS

... a sign of coronary heart disease (also called coronary artery disease). Stress Test Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing , you exercise (or are given medicine if you' ...

167

How Is Anemia Diagnosed?  

MedlinePLUS

... to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood. The test ... can explain your test results to you. The CBC also checks the number of red blood cells, ...

168

Metal levels in corrosion of spinal implants  

PubMed Central

Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants. PMID:17256156

Beguiristain, Jose; Duart, Julio

2007-01-01

169

Rehabilitation of spinal cord injuries.  

PubMed

Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary. PMID:25621206

Nas, Kemal; Yazmalar, Levent; ?ah, Volkan; Ayd?n, Abdulkadir; Öne?, Kadriye

2015-01-18

170

Rehabilitation of spinal cord injuries  

PubMed Central

Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients’ family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary. PMID:25621206

Nas, Kemal; Yazmalar, Levent; ?ah, Volkan; Ayd?n, Abdulkadir; Öne?, Kadriye

2015-01-01

171

What Is Spinal Stenosis?  

MedlinePLUS

... publication. To order the Spinal Stenosis Q&A full-text version, please contact NIAMS using the contact information above. To view the complete text or to order online, visit ... NIAMS Site NIH… Turning Discovery Into Health ® Home | ...

172

Spinal Cord Injury 101  

MedlinePLUS Videos and Cool Tools

... Braingate" research? What is the status of stem-cell research? How would stem-cell therapies work in the treatment of spinal cord injuries? What does stem-cell research on animals tell us? When can we ...

173

Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity.  

PubMed

The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV. PMID:22863686

Mooney, James F; Glazier, Stephen S; Barfield, William R

2012-11-01

174

Modeling spinal cord biomechanics  

NASA Astrophysics Data System (ADS)

Regeneration after spinal cord injury is a serious health issue and there is no treatment for ailing patients. To understand regeneration of the spinal cord we used a system where regeneration occurs naturally, such as the lamprey. In this work, we analyzed the stress response of the spinal cord to tensile loading and obtained the mechanical properties of the cord both in vitro and in vivo. Physiological measurements showed that the spinal cord is pre-stressed to a strain of 10%, and during sinusoidal swimming, there is a local strain of 5% concentrated evenly at the mid-body and caudal sections. We found that the mechanical properties are homogeneous along the body and independent of the meninges. The mechanical behavior of the spinal cord can be characterized by a non-linear viscoelastic model, described by a modulus of 20 KPa for strains up to 15% and a modulus of 0.5 MPa for strains above 15%, in agreement with experimental data. However, this model does not offer a full understanding of the behavior of the spinal cord fibers. Using polymer physics we developed a model that relates the stress response as a function of the number of fibers.

Luna, Carlos; Shah, Sameer; Cohen, Avis; Aranda-Espinoza, Helim

2012-02-01

175

Intramedullary Spinal Cord Metastasis From Rectal Cancer  

PubMed Central

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed. PMID:25360432

Yang, Kyung Ho; Yi, Seong Yoon; Jung, Joo Hyuk; Kang, Seung Hee; Choi, Pyong Hwa

2014-01-01

176

Intramedullary spinal cord metastasis from rectal cancer.  

PubMed

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed. PMID:25360432

Yang, Kyung Ho; Lee, Hye Ran; Yi, Seong Yoon; Jung, Joo Hyuk; Kang, Seung Hee; Choi, Pyong Hwa

2014-10-01

177

Transection method for shortening the rat spine and spinal cord  

PubMed Central

Previous studies have presented evidence which indicates that the regeneration of axons in the spinal cord occurs following spinal cord transection in young rats. However, in a transection-regeneration model, the completeness of the transection is often a matter of dispute. We established a method for shortening the rat spine and spinal cord to provide a spinal cord injury (SCI) model in which there was no doubt about whether the axonal transection was complete. In the future, this model may be applied to the chronic period of complete paralysis following SCI. Adult, female Wistar rats (220–250g) were used in the study. The spinal cord was exposed and a 4-mm-long segment of the spinal cord was removed at Th8. Subsequently, the Th7/8 and Th8/9 discs were cut between the stumps of the spinal cord to remove the Th8 vertebra. The stitches which had been passed through the 7th and 9th ribs bilaterally were tied gradually to bring together the stumps of the spinal cord. Almost all the rats survived until the end of the experiment. Uncoordinated movements of the hind limbs in locomotion were observed at 4 weeks after surgery. However coordinated movements of the hind limbs in locomotion were not observed until the end of the experiment. After 12 weeks, an intracardiac perfusion was performed to remove the thoracic spine and the spinal cord. There were no signs of infection. The bone fusion of the Th7 and Th9 vertebrae was observed to be complete in all specimens and the alignment of the thoracic spine was maintained. The spinal canal was also correctly reconstituted. The stumps of the spinal cord were connected. Light microscopy of the cord showed that scar tissue intervened at the connection site. Cavitation inhibiting the axonal regeneration was also observed. This model was also made on the assumption that glial scar tissue inhibits axonal regeneration in chronic SCI. Axonal regeneration was not observed across the transected spinal cord in this model. Attempts should be made to minimize the damage to the spinal cord and the surgery time for successful axonal regeneration to occur. The model developed in this study may be useful in the study of axonal regeneration in SCI. PMID:23403404

YOSHIDA, YUICHIRO; KATAOKA, HIDEO; KANCHIKU, TSUKASA; SUZUKI, HIDENORI; IMAJYO, YASUAKI; KATO, HIDETOYO; TAGUCHI, TOSHIHIKO

2013-01-01

178

Diagnosing ADHD in Adolescence  

ERIC Educational Resources Information Center

Objective: This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and…

Sibley, Margaret H.; Pelham, William E., Jr.; Molina, Brooke S. G.; Gnagy, Elizabeth M.; Waschbusch, Daniel A.; Garefino, Allison C.; Kuriyan, Aparajita B.; Babinski, Dara E.; Karch, Kathryn M.

2012-01-01

179

Spinal surgery -- cervical - series (image)  

MedlinePLUS

Cervical spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes on the vertebral ... spinal column around the spinal cord. Symptoms of cervical spine problems include: pain that interferes with daily activities ...

180

Myeloneuropathic presentation of spinal epidural lipomatosis.  

PubMed

Spinal epidural lipomatosis (SEL) is accumulation of unencapsulated fat tissue within the epidural space of the spinal canal. The most common cause of SEL is corticosteroid therapy, whereas most of the non-corticosteroid-dependent cases are idiopathic. If unrecognized, it may result in diagnostic confusion with other neuropathic or myelopathic conditions. We report 2 cases of SEL. The first case is of a 30-year-old man who received corticosteroid therapy for an acute and probably immune-mediated demyelinating process. Subsequently, the addition of compressive effects of SEL resulted in diagnostic confusion and initial workup at other centers for spinal cord malignancy and vascular malformation. The patient's symptoms improved after decompression surgery. The second case is of a 63-year-old woman with a history of type 1 diabetes mellitus that presented with increasing numbness in the lower extremities. She was initially diagnosed with diabetic neuropathy; however, the presence of myelopathic signs led to further investigation and diagnosis of SEL. Decompression surgery resulted in improvement of symptoms. PMID:19078799

Izadyar, Shahram; Kwan, Justin Y; Harati, Yadollah

2006-03-01

181

Metastatic Spinal Tumor  

PubMed Central

In accordance with extending survival periods of cancer patients, number of consecutively developing metastatic spinal tumor is also increasing. There have been improvements in the treatment results of metastatic spine tumor by virtue of the developments in diagnostic radiology, chemotherapy, adjuvant treatment, operative device and technique, discrete preoperative plan, and standardized operation. Accordingly, surgical indication has also increased. Clinically, in case of metastatic spine tumor, treatment of tumor itself should be focused on pain relief, preservation of neurologic function, prevention of pathologic fracture, prevention of pathologic fracture, and correction of spinal instability for improving quality of life, rather than for extension of survival. Additionally, etiology of spinal tumor, correct diagnosis and subsequent treatment principles should be thoroughly understood before establishing treatment plans for effective treatments. PMID:22439092

Jung, Chul-Hee

2012-01-01

182

[Spinal epidural lipomatosis].  

PubMed

Spinal epidural lipomatosis (SEL) is a rare condition affecting the thoracic and lumbar spine, characterized by a hypertrophy and hyperplasia of the rich vascularized fat tissue inside the spinal canal. The etiology of SEL is unknown. A high number of cases are associated with obesity, corticosteroid intake and a dysbalance in adrenocorticotropic hormone (ACTH)-cortisone metabolism. It can be an incidental radiographic finding or present with symptoms, such as low back pain, weakness of the lower limbs, dysesthesia, radiculopathy, claudication or even cauda equina syndrome. The interdisciplinary treatment consists of weight reduction, weaning from corticosteroids and in persisting cases or neurologic alterations in surgical decompression of the spinal canal. The following article presents a current review and a case report of this rare entity. PMID:22772944

Artner, J; Leucht, F; Cakir, B; Reichel, H; Lattig, F

2012-11-01

183

Effectiveness of olfactory ensheathing cell transplantation for treatment of spinal cord injury.  

PubMed

The aim of this study was to determine the effectiveness and safety of transplantation of olfactory ensheathing cells for functional repair of the spinal cord. An olfactory bulb was obtained from a 4- to 5-month-old aborted fetus, and it was digested into single olfactory ensheathing cells and then cultured and purified for 1 to 2 weeks. Under general anesthesia, these single-cell suspensions of olfactory ensheathing cells were injected into the corresponding spinal injury site with 0.45-mm-diameter injections. The American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate spinal function. A total of 15 patients (12 men, 3 women; age range, 18-56 years; mean age, 40) were admitted for obsolete spinal injuries. Spinal functions of the 15 patients were observed and followed postoperatively for a period ranging from 2 weeks to 1 month. All the 15 patients exhibited improvements in spinal function, and the improvement tendencies continued. Twelve patients had obvious spinal function improvement, and three had slight improvement according to the ASIA scale, with an obvious difference between preoperation and postoperation measures (P < 0.05). No fevers, infections, functional deteriorations, or deaths were seen. Thus, transplantation of olfactory ensheathing cells promoted spinal and neurofunctional recovery in patients with malignant spinal injuries, and this therapeutic method was safe. PMID:24938704

Rao, Y J; Zhu, W X; Du, Z Q; Jia, C X; Du, T X; Zhao, Q A; Cao, X Y; Wang, Y J

2014-01-01

184

Acute neurological signs as the predominant clinical manifestation in four dogs with Angiostrongylus vasorum infections in Denmark  

PubMed Central

Four dogs with acute neurological signs caused by haemorrhages in the central nervous system were diagnosed with Angiostrongylus vasorum infection as the underlying aetiology. Two dogs presented with brain lesions, one dog with spinal cord lesions and one with lesions in both the brain and spinal cord. Only one dog presented with concurrent signs of classical pulmonary angiostrongylosis (respiratory distress, cough), and only two dogs displayed overt clinical signs of haemorrhages. Results of coagulation assays were inconsistent. Neurological signs reflected the site of pathology and included seizures, various cranial nerve deficits, vestibular signs, proprioceptive deficits, ataxia and paraplegia. One dog died and three were euthanised due to lack of improvement despite medical treatment. This emphasises canine angiostrongylosis as a potential cause of fatal lesions of the central nervous system and the importance of including A. vasorum as a differential diagnosis in young dogs with acute neurological signs in Denmark. PMID:21711538

2011-01-01

185

Spinal tuberculosis: with reference to the children of northern India  

Microsoft Academic Search

Background Tuberculosis is a necrotizing bacterial infection with protean manifestation and wide distribution. There has been a great fall in the prevalence of tuberculosis in the United States since 1990, although the impact of acquired immunodeficiency syndrome (AIDS) has increased the resurgence of tuberculosis (TB). Spinal tuberculosis is the commonest form of skeletal tuberculosis. In this article, an overview of

Raj Kumar

2005-01-01

186

Topical irrigation with polymyxin and bacitracin for spinal surgery  

Microsoft Academic Search

BACKGROUND The purpose of the present study was to evaluate constant irrigation with saline containing 50,000 units each of polymyxin and bacitracin in a regimen of antimicrobial prophylaxis for clean spinal surgery at two community hospitals with a zero infection rate.METHODS The focus was on the bactericidal effects of prophylactic topical antibiotics by assessing random contamination in neurosurgical wounds from:

Sean I Savitz; Martin H Savitz; Howard B Goldstein; Corinne T Mouracade; Sylvester Malangone

1998-01-01

187

Diagnosing Deep Venous Thrombosis  

PubMed Central

Patients often present with unexplained lower limb pain and swelling. It is important to exclude deep venous thrombosis in the diagnosis because of the threat of sudden death. Simple clinical diagnosis is unacceptable, and noninvasive tests should be used initially. Serial testing detects proximal extension of isolated calf thrombi. Multiple diagnostic modalities are employed to diagnose a new deep venous thrombosis in patients with postphlebitic syndrome. PMID:21221369

Doyle, D. Lynn

1992-01-01

188

Anterior spinal cord syndrome of unknown etiology  

PubMed Central

A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome. PMID:25552812

Klakeel, Merrine; Thompson, Justin; McDonald, Frank

2015-01-01

189

Ischemic spinal cord infarction in children without vertebral fracture  

PubMed Central

Spinal cord infarction in children is a rare condition which is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treament and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular inujury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult due to the small transverse area of the cord, cerebrospinal fluid artifact and inadequate resolution of MRI. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature which highlight the difficulties and controversies in the management of this condition. PMID:17437902

Nance, Jessica R.; Golomb, Meredith R.

2007-01-01

190

Cerebral Subdural Hematoma Following Spinal Anesthesia: Report of Two Cases  

PubMed Central

Postdural puncture headache and cerebral subdural hematoma are among complications of spinal anesthesia with some common characteristics; however misdiagnosis of these two could result in a catastrophic outcome or prevent unwanted results by urgent interventions. With the purpose of increasing awareness of such complications and a speedy diagnosis, we report two cases of postspinal anesthesia headache that was timely diagnosed as cerebral subdural hematoma and prevented the likelihood of a disastrous outcome. PMID:22536262

Moradi, Mehrdad; Shami, Shoaleh; Farhadifar, Fariba; Nesseri, Karim

2012-01-01

191

Automated identification of spinal cord and vertebras on sagittal MRI  

NASA Astrophysics Data System (ADS)

We are developing an automated method for the identification of the spinal cord and the vertebras on spinal MR images, which is an essential step for computerized analysis of bone marrow diseases. The spinal cord segment was first enhanced by a newly developed hierarchical multiscale tubular (HMT) filter that utilizes the complementary hyper- and hypo- intensities in the T1-weighted (T1W) and STIR MRI sequences. An Expectation-Maximization (EM) analysis method was then applied to the enhanced tubular structures to extract candidates of the spinal cord. The spinal cord was finally identified by a maximum-likelihood registration method by analysis of the features extracted from the candidate objects in the two MRI sequences. Using the identified spinal cord as a reference, the vertebras were localized based on the intervertebral disc locations extracted by another HMT filter applied to the T1W images. In this study, 5 and 30 MRI scans from 35 patients who were diagnosed with multiple myeloma disease were collected retrospectively with IRB approval as training and test set, respectively. The vertebras manually outlined by a radiologist were used as reference standard. A total of 422 vertebras were marked in the 30 test cases. For the 30 test cases, 100% (30/30) of the spinal cords were correctly segmented with 4 false positives (FPs) mistakenly identified on the back muscles in 4 scans. A sensitivity of 95.0% (401/422) was achieved for the identification of vertebras, and 5 FPs were marked in 4 scans with an average FP rate of 0.17 FPs/scan.

Zhou, Chuan; Chan, Heang-Ping; Dong, Qian; He, Bo; Wei, Jun; Hadjiiski, Lubomir M.; Couriel, Daniel

2014-03-01

192

Hypothetico-deductive diagnoses  

NASA Astrophysics Data System (ADS)

A diagnostic is inference to the state of a system from its observed and its expected behaviors. When no complete description is available--and this is not out of the ordinary in real-world applications--diagnosing a system cannot be done in a pure deductive way. To be more specific, deduction allows us to derive only partial diagnoses that must be completed to get closer to the actual one. Subsequently, searching for better diagnoses requires hypothetical reasoning, where the assumptions to be generated aim at reflecting the diagnostician beliefs. In the frame of hypothetico-deductive diagnostic, several approaches have been pointed out so far. The consistency-based method is the simplest one. It sanctions the lack of evidence that a component of a system fails by jumping to the conclusion that this component behaves correctly. In contrast to the consistency-based approach, the circumscription-based and the deductive/abductive methods take into account how components behave to complete what is deductively generated. This paper is devoted to a comparison of the consistency-based, the circumscription-based, and the deductive/abductive approaches to diagnostic. Its expected purpose is to provide a deeper understanding of both techniques. It is organized as follows: problem formulation and terminology are introduced in Section 2; Section 3 proposes a brief overview of the consistency-based, the circumscription-based, and the deductive/abductive methods; Section 4 details and compares the preference criteria each approach supports; Section 5 illustrates this comparison on a simple example; and Section 6 concludes this paper.

Marquis, Pierre

1992-03-01

193

An easily diagnosable PLA  

E-print Network

than the common stuck-at faults [4). Existing testing algorithms, such as the D-algorithm [6]. , PODE1VI 7] and FAN [8', , cannot efficiently test or localize faults inside s. PLA. Vote that the testing and diagnosing problems are quite different..., s); begin for ii = 1, :3, 5, p ? 1 do begin /" diagnosis of product line"/ /s initiate shift register'/ end; 25 Shift in S and record product line output v=0; if f=0 and s=0 then begin for ii = 1 to p do begin /* Apply test vectors/ /* v...

Kao, Chung Min

1989-01-01

194

Transverse myelitis and acute HIV infection: a case report  

PubMed Central

Background Most HIV infected patients will develop some sort of neurologic involvement of the disease throughout their lives, usually in advanced stages. Neurologic symptoms may occur in acute HIV infection but myelopathy in this setting is rare. Up until this date, only two cases of transverse myelitis as a manifestation of acute HIV infection have been reported in the literature. Therapeutic approach in these patients is not well defined. Case presentation A 35 year-old male Caucasian recently returned from the tropics presented to our hospital with urinary retention and acute paraparesis. After extensive diagnostic workup he was diagnosed with acute HIV infection presenting as transverse myelitis. Full neurologic recovery was observed without the use of anti-retroviral therapy. Conclusion Acute spinal cord disorders are challenging, as they present a wide array of differential diagnosis and may lead to devastating sequelae. Timely and rigorous diagnostic workup is of the utmost importance when managing these cases. Clinicians should be aware of the protean manifestations of acute HIV infection, including central nervous system involvement, and have a low threshold for HIV screening. PMID:24646059

2014-01-01

195

How Is Cystic Fibrosis Diagnosed?  

MedlinePLUS

... page from the NHLBI on Twitter. How Is Cystic Fibrosis Diagnosed? Doctors diagnose cystic fibrosis (CF) based on ... tested to see whether the baby has CF. Cystic Fibrosis Carrier Testing People who have one normal CFTR ...

196

How Are Uterine Fibroids Diagnosed?  

MedlinePLUS

... it? How is it diagnosed? What are the treatments for it? Other FAQs NICHD Research Information Clinical Trials Resources and Publications En Español How are uterine fibroids diagnosed? Skip sharing on social media links Share ...

197

Diagnosing Dementia—Positive Signs  

MedlinePLUS

... Navigation Bar Home Current Issue Past Issues Diagnosing Dementia—Positive Signs Past Issues / Fall 2007 Table of ... easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even before symptoms began to show? Researchers ...

198

Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia  

PubMed Central

A case of an iatrogenic spinal arteriovenous fistula with progressive paraplegia in a young woman is reported. The fistula was eventually created after repetitive lumbar punctures performed in the process of spinal anaesthesia. Her symptoms were progressed to paraplegia over a period of 2 years. The digital subtraction angiography demonstrated a single-hole fistula, involving the anterior spinal artery and vein. The lesion was occluded by embolization with immediate improvement. The potential mechanism is discussed. PMID:24653807

Argyrakis, Nikolaos; Matis, Georgios K.; Mpata-Tshibemba, Stephanie

2014-01-01

199

Diagnosable structured logic array  

NASA Technical Reports Server (NTRS)

A diagnosable structured logic array and associated process is provided. A base cell structure is provided comprising a logic unit comprising a plurality of input nodes, a plurality of selection nodes, and an output node, a plurality of switches coupled to the selection nodes, where the switches comprises a plurality of input lines, a selection line and an output line, a memory cell coupled to the output node, and a test address bus and a program control bus coupled to the plurality of input lines and the selection line of the plurality of switches. A state on each of the plurality of input nodes is verifiably loaded and read from the memory cell. A trusted memory block is provided. The associated process is provided for testing and verifying a plurality of truth table inputs of the logic unit.

Whitaker, Sterling (Inventor); Miles, Lowell (Inventor); Gambles, Jody (Inventor); Maki, Gary K. (Inventor)

2009-01-01

200

Spinal cord tumors  

Microsoft Academic Search

.   Spinal cord tumors are rare; however, every radiologist should be able to recognize and readily identify those lesions often\\u000a found in younger patients or children [1, 2, 3, 4, 5, 6, 7, 8,9]. Early diagnosis plays an important role in the management\\u000a of the lesions and interferes with the prognosis and final outcome of the patient [10]. Plain X-ray

D. L. F. Balériaux; Service de Radiologie

1999-01-01

201

Aspergillus spinal epidural abscess  

SciTech Connect

A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

Byrd, B.F. III (Vanderbilt Univ. School of Medicine, Nashville, TN); Weiner, M.H.; McGee, Z.A.

1982-12-17

202

Discordance in CD4+T-Cell Levels and Viral Loads with Co-Occurrence of Elevated Peripheral TNF-? and IL-4 in Newly Diagnosed HIV-TB Co-Infected Cases  

PubMed Central

Background Cytokines are the hallmark of immune response to different pathogens and often dictate the disease outcome. HIV infection and tuberculosis (TB) are more destructive when confronted together than either alone. Clinical data related to the immune status of HIV-TB patients before the initiation of any drug therapy is not well documented. This study aimed to collect the baseline information pertaining to the immune status of HIV-TB co-infected patients and correlate the same with CD4+T cell levels and viral loads at the time of diagnosis prior to any drug therapy. Methodology/Principal Findings We analyzed the cytokines, CD4+T cell levels and viral loads to determine the immune environment in HIV-TB co-infection. The study involved four categories namely, Healthy controls (n?=?57), TB infected (n?=?57), HIV infected (n?=?59) and HIV-TB co-infected (n?=?57) patients. The multi-partite comparison and correlation between cytokines, CD4+T-cell levels and viral loads prior to drug therapy, showed an altered TH1 and TH2 response, as indicated by the cytokine profiles and skewed IFN-?/IL-10 ratio. Inadequate CD4+T cell counts in HIV-TB patients did not correlate with high viral loads and vice-versa. When compared to HIV category, 34% of HIV-TB patients had concurrent high plasma levels of IL-4 and TNF-? at the time of diagnosis. TB relapse was observed in 5 of these HIV-TB co-infected patients who also displayed high IFN-?/IL-10 ratio. Conclusion/Significance With these studies, we infer (i) CD4+T-cell levels as baseline criteria to report the disease progression in terms of viral load in HIV-TB co-infected patients can be misleading and (ii) co-occurrence of high TNF-? and IL-4 levels along with a high ratio of IFN-?/IL-10, prior to drug therapy, may increase the susceptibility of HIV-TB co-infected patients to hyper-inflammation and TB relapse. PMID:23936398

Benjamin, Ronald; Banerjee, Atoshi; Sunder, Sharada Ramaseri; Gaddam, Sumanlatha; Valluri, Vijaya Lakshmi; Banerjee, Sharmistha

2013-01-01

203

West Nile virus infection in free-ranging squirrels in Illinois.  

PubMed

West Nile virus (WNV) infection was diagnosed in 13 gray squirrels (Sciurus carolinensis) and 3 fox squirrels (Sciurus niger) that were observed with neurologic signs before death or found dead. All 16 had gliosis throughout all sections of the brain. Most had lymphoplasmacytic encephalitis or meningoencephalitis, many with admixed neutrophils. Neuronal necrosis and neuronophagia were also prominent features. West Nile virus antigen was demonstrated in the brain, spleen, heart or kidney in 10 of 13 gray squirrels and 3 of 3 fox squirrels by immunohistochemistry. Nucleic acid amplification tests (NAATs) confirmed the presence of WNV in the brain or spinal cord of 10/10 gray squirrels and 1/3 fox squirrels tested. Viral levels were quantified in various tissues of selected gray squirrels, and titers were highest in spleen and brain, with no virus detected in serum. This is the first description of lesions associated with WNV infection in gray and fox squirrels. PMID:15152831

Heinz-Taheny, Kathleen M; Andrews, John J; Kinsel, Michael J; Pessier, Allan P; Pinkerton, Marie E; Lemberger, Karin Y; Novak, Robert J; Dizikes, George J; Edwards, Eric; Komar, Nicholas

2004-05-01

204

Spontaneous resolution of spinal epidural lipomatosis.  

PubMed

Spinal epidural lipomatosis (SEL) is an abnormal accumulation of unencapsulated, epidural fat. SEL can be divided into idiopathic and secondary. Secondary SEL is often associated with chronic steroid use and endocrinopathies. Idiopathic SEL has been associated with obesity. SEL has been implicated in a variety of neurologic impairments and surgical decompression has been shown to prevent further worsening or result in improvement. We report a 53-year-old man with obesity and a history of chronic back pain who developed idiopathic SEL diagnosed by MRI, which subsequently resolved completely over an 8 month follow-up period. To our knowledge, this is the first reported case of complete radiographic resolution of SEL without any treatment. PMID:23726369

Patel, Akash J; Sellin, Jonathan; Ehni, Bruce L; Tatsui, Claudio E

2013-11-01

205

The history of spinal biomechanics.  

PubMed

The history of spinal biomechanics has its origins in antiquity. The Edwin Smith surgical papyrus, an Egyptian document written in the 17th century BC, described the difference between cervical sprain, fracture, and fracture-dislocation. By the time of Hippocrates (4th century BC), physical means such as traction or local pressure were being used to correct spinal deformities but the treatments were based on only a rudimentary knowledge of spinal biomechanics. The Renaissance produced the first serious attempts at understanding spinal biomechanics. Leonardo da Vinci (1452-1519) accurately described the anatomy of the spine and was perhaps the first to investigate spinal stability. The first comprehensive treatise on biomechanics, De Motu Animalium, was published by Giovanni Borelli in 1680, and it contained the first analysis of weight bearing by the spine. In this regard, Borelli can be considered the "Father of Spinal Biomechanics." By the end of the 19th century, the basic biomechanical concepts of spinal alignment and immobilization were well entrenched as therapies for spinal cord injury. Further anatomic delineation of spinal stability was sparked by the anatomic analyses of judicial hangings by Wood-Jones in 1913. By the 1960s, a two-column model of the spine was proposed by Holdsworth. The modern concept of Denis' three-column model of the spine is supported by more sophisticated testing of cadaver spines in modern biomechanical laboratories. The modern explosion of spinal instrumentation stems from a deeper understanding of the load-bearing structures of the spinal column. PMID:8880756

Sanan, A; Rengachary, S S

1996-10-01

206

Risk Factors for Chest Illness in Chronic Spinal Cord Injury  

PubMed Central

Objective Chest illnesses commonly cause morbidity in persons with chronic spinal cord injury. Risk factors remain poorly characterized because previous studies have not accounted for factors other than spinal cord injury. Design Between 1994 and 2005, 403 participants completed a respiratory questionnaire and underwent spirometry. Participants were contacted at a median of 1.7 yrs [interquartile range: 1.3–2.5 yrs] apart over a mean (SD) of 5.1 ± 3.0 yrs and asked to report chest illnesses that had resulted in time off work, spent indoors, or in bed since prior contact. Results In 97 participants, there were 247 chest illnesses (0.12/person-year) with 54 hospitalizations (22%). Spinal cord injury level, completeness of injury, and duration of injury were not associated with illness risk. Adjusting for age and smoking history, any wheeze (relative risk = 1.92; 95% confidence interval: 1.19, 3.08), pneumonia or bronchitis since spinal cord injury (relative risk = 2.29; 95% confidence interval: 1.40, 3.75), and physician-diagnosed chronic obstructive pulmonary disease (relative risk = 2.17; 95% confidence interval: 1.08, 4.37) were associated with a greater risk of chest illness. Each percent-predicted decrease in forced expiratory volume in 1 sec was associated with a 1.2% increase in risk of chest illness (P = 0.030). Conclusions In chronic spinal cord injury, chest illness resulting in time spent away from usual activities was not related to the level or completeness of spinal cord injury but was related to reduced pulmonary function, wheeze, chronic obstructive pulmonary disease, a history of pneumonia and bronchitis, and smoking. PMID:20463565

Stolzmann, Kelly L.; Gagnon, David R.; Brown, Robert; Tun, Carlos G.; Garshick, Eric

2011-01-01

207

Diagnosing mucopolysaccharidosis IVA.  

PubMed

Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is an autosomal recessive lysosomal storage disorder resulting from a deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS) activity. Diagnosis can be challenging and requires agreement of clinical, radiographic, and laboratory findings. A group of biochemical genetics laboratory directors and clinicians involved in the diagnosis of MPS IVA, convened by BioMarin Pharmaceutical Inc., met to develop recommendations for diagnosis. The following conclusions were reached. Due to the wide variation and subtleties of radiographic findings, imaging of multiple body regions is recommended. Urinary glycosaminoglycan analysis is particularly problematic for MPS IVA and it is strongly recommended to proceed to enzyme activity testing even if urine appears normal when there is clinical suspicion of MPS IVA. Enzyme activity testing of GALNS is essential in diagnosing MPS IVA. Additional analyses to confirm sample integrity and rule out MPS IVB, multiple sulfatase deficiency, and mucolipidoses types II/III are critical as part of enzyme activity testing. Leukocytes or cultured dermal fibroblasts are strongly recommended for enzyme activity testing to confirm screening results. Molecular testing may also be used to confirm the diagnosis in many patients. However, two known or probable causative mutations may not be identified in all cases of MPS IVA. A diagnostic testing algorithm is presented which attempts to streamline this complex testing process. PMID:23371450

Wood, Timothy C; Harvey, Katie; Beck, Michael; Burin, Maira Graeff; Chien, Yin-Hsiu; Church, Heather J; D'Almeida, Vânia; van Diggelen, Otto P; Fietz, Michael; Giugliani, Roberto; Harmatz, Paul; Hawley, Sara M; Hwu, Wuh-Liang; Ketteridge, David; Lukacs, Zoltan; Miller, Nicole; Pasquali, Marzia; Schenone, Andrea; Thompson, Jerry N; Tylee, Karen; Yu, Chunli; Hendriksz, Christian J

2013-03-01

208

Diagnostic value of the lumbar extension-loading test in patients with lumbar spinal stenosis: a cross-sectional study  

PubMed Central

Background The gait-loading test is a well known, important test with which to assess the involved spinal level in patients with lumbar spinal stenosis. The lumbar extension-loading test also functions as a diagnostic loading test in patients with lumbar spinal stenosis; however, its efficacy remains uncertain. The purpose of this study was to compare the diagnostic value of the lumbar extension-loading test with that of the gait-loading test in patients with lumbar spinal stenosis. Methods A total of 116 consecutive patients (62 men and 54 women) diagnosed with lumbar spinal stenosis were included in this cross-sectional study of the lumbar extension-loading test. Subjective symptoms and objective neurological findings (motor, sensory, and reflex) were examined before and after the lumbar extension-loading and gait-loading tests. The efficacy of the lumbar extension-loading test for establishment of a correct diagnosis of the involved spinal level was assessed and compared with that of the gait-loading test. Results There were no significant differences between the lumbar extension-loading test and the gait-loading test in terms of subjective symptoms, objective neurological findings, or changes in the involved spinal level before and after each loading test. Conclusions The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level. PMID:25080292

2014-01-01

209

Novel approaches in diagnosing tuberculosis  

NASA Astrophysics Data System (ADS)

The WHO declared tuberculosis (TB) a global emergency. An estimated 8-9 million new cases occur each year with 2-3 million deaths. Currently, TB is diagnosed mostly by chest-X ray and staining of the mycobacteria in sputum with a detection limit of 1x104 bacteria /ml. There is an urgent need for better diagnostic tools for TB especially for developing countries. We have validated the electronic nose from TD Technology for the detection of Mycobacterium tuberculosis by headspace analysis of 284 sputum samples from TB patients. We used linear discriminant function analysis resulting in a sensitivity of 75% a specificity of 67% and an accuracy of 69%. Further research is still required to improve the results by choosing more selective sensors and sampling techniques. We used a fast gas chromatography- mass spectrometry method (GC-MS). The automated procedure is based on the injection of sputum samples which are methylated inside the GC injector using thermally assisted hydrolysis and methylation (THM-GC-MS). Hexacosanoic acid in combination with tuberculostearic acid was found to be specific for the presence of M. tuberculosis. The detection limit was similar to microscopy. We found no false positives, all microscopy and culture positive samples were also found positive with the THM-GC-MS method. The detection of ribosomal RNA from the infecting organism offers great potential since rRNA molecules outnumber chromosomal DNA by a factor 1000. It thus may possible to detect the organism without amplification of the nucleic acids (NA). We used a capture and a tagged detector probe for the direct detection of M. tuberculosis in sputum. So far the detection limit is 1x106 bacteria / ml. Currently we are testing a Lab-On-A-Chip Interferometer detection system.

Kolk, Arend H. J.; Dang, Ngoc A.; Kuijper, Sjoukje; Gibson, Tim; Anthony, Richard; Claassens, Mareli M.; Kaal, Erwin; Janssen, Hans-Gerd

2011-06-01

210

What Is Spinal Cord Injury?  

MedlinePLUS

... addition, there are two degrees of SCI severity : Complete injury is the situation when the injury is so ... National Spinal Cord Injury Association. Understanding spinal cord injury . Retrieved May 21, 2012, from http://www.spinalcord.org/resource-center/askus/index.php?pg=kb. ...

211

Imaging modalities in spinal disorders  

SciTech Connect

This book provides an approach to the various imaging modalities used to view the spine. It discusses the indications, limitations and practical use of each in the diagnosis, work-up and staging of various spinal disorders, and compares each of them in various clinical settings. Topics covered include low back pain syndrome, disk disease, spinal cord lesions, congenital abnormalities, and trauma.

Kricun, M.E.

1986-01-01

212

Spinal astrocytic activation is involved in a virally-induced rat model of neuropathic pain.  

PubMed

Postherpetic neuralgia (PHN), the most common complication of herpes zoster (HZ), plays a major role in decreased life quality of HZ patients. However, the neural mechanisms underlying PHN remain unclear. Here, using a PHN rat model at 2 weeks after varicella zoster virus infection, we found that spinal astrocytes were dramatically activated. The mechanical allodynia and spinal central sensitization were significantly attenuated by intrathecally injected L-?-aminoadipate (astrocytic specific inhibitor) whereas minocycline (microglial specific inhibitor) had no effect, which indicated that spinal astrocyte but not microglia contributed to the chronic pain in PHN rat. Further study was taken to investigate the molecular mechanism of astrocyte-incudced allodynia in PHN rat at post-infection 2 weeks. Results showed that nitric oxide (NO) produced by inducible nitric oxide synthase mediated the development of spinal astrocytic activation, and activated astrocytes dramatically increased interleukin-1? expression which induced N-methyl-D-aspartic acid receptor (NMDAR) phosphorylation in spinal dorsal horn neurons to strengthen pain transmission. Taken together, these results suggest that spinal activated astrocytes may be one of the most important factors in the pathophysiology of PHN and "NO-Astrocyte-Cytokine-NMDAR-Neuron" pathway may be the detailed neural mechanisms underlying PHN. Thus, inhibiting spinal astrocytic activation may represent a novel therapeutic strategy for clinical management of PHN. PMID:21969850

Zhang, Gui-He; Lv, Miao-Miao; Wang, Shuang; Chen, Lei; Qian, Nian-Song; Tang, Yu; Zhang, Xu-Dong; Ren, Peng-Cheng; Gao, Chang-Jun; Sun, Xu-De; Xu, Li-Xian

2011-01-01

213

Totally Ossified Metaplastic Spinal Meningioma  

PubMed Central

A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma. PMID:24278660

Hida, Kazutoshi; Yamauchi, Tomohiro; Houkin, Kiyohiro

2013-01-01

214

Totally ossified metaplastic spinal meningioma.  

PubMed

A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma. PMID:24278660

Ju, Chang Il; Hida, Kazutoshi; Yamauchi, Tomohiro; Houkin, Kiyohiro

2013-09-01

215

Retraining the injured spinal cord  

NASA Technical Reports Server (NTRS)

The present review presents a series of concepts that may be useful in developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury. First, the loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent (dorsal root ganglion) origin. Second, following a complete transection the lumbrosacral spinal cord can recover greater levels of motor performance if it has been exposed to the afferent and intraspinal activation patterns that are associated with standing and stepping. Third, the spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. Fourth, robotic assistive devices can be used to guide the kinematics of the limbs and thus expose the spinal cord to the new normal activity patterns associated with a particular motor task following spinal cord injury. In addition, such robotic assistive devices can provide immediate quantification of the limb kinematics. Fifth, the behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord. Evidence is presented that both the GABAergic and glycinergic inhibitory systems are up-regulated following complete spinal cord transection and that step training results in some aspects of these transmitter systems being down-regulated towards control levels. These concepts and observations demonstrate that (a) the spinal cord can interpret complex afferent information and generate the appropriate motor task; and (b) motor ability can be defined to a large degree by training.

Edgerton, V. R.; Leon, R. D.; Harkema, S. J.; Hodgson, J. A.; London, N.; Reinkensmeyer, D. J.; Roy, R. R.; Talmadge, R. J.; Tillakaratne, N. J.; Timoszyk, W.; Tobin, A.

2001-01-01

216

Arachnoid calcification producing spinal cord compression.  

PubMed Central

A case of spinal cord compression, presumed to be due to a calcification in the arachnoid, is presented. Its relationship to a previous spinal subarachnoid haemorrhage is mentioned. The literature is reviewed and the relationship of this condition to spinal subarachnoid haemorrhage, previous myelogram, and spinal anaesthetic is stressed. Images PMID:1206414

McCullough, G A

1975-01-01

217

Attitudes Towards Individuals with Spinal Cord Injuries  

ERIC Educational Resources Information Center

This paper will shed light on the lives of persons with spinal cord injuries by revealing the literature on spinal cord injuries that focuses on research that can shed light on attitudes towards persons with spinal cord injuries. The background literature related to incidences, the definition of spinal cord injury, and vocational opportunities are…

Conway, Cassandra Sligh D.; Gooden, Randy; Nowell, Jennifer; Wilson, Navodda

2010-01-01

218

Thoracic spinal cord intramedullary aspergillus invasion and abscess.  

PubMed

Invasive central nervous system aspergillosis is a rare form of fungal infection that presents most commonly in immunocompromised individuals. There have been multiple previous reports of aspergillus vertebral osteomyelitis and spinal epidural aspergillus abscess; however to our knowledge there are no reports of intramedullary aspergillus infection. We present a 19-year-old woman with active acute lymphoblastic leukemia who presented with several weeks of fevers and bilateral lower extremity weakness. She was found to have an intramedullary aspergillus abscess at T12-L1 resulting from adjacent vertebral osteomyelitis and underwent surgical debridement with ultra-sound guided aspiration and aggressive intravenous voriconazole therapy. To our knowledge this is the first reported case of spinal aspergillosis invading the intramedullary cavity. Though rare, this entity should be included in the differential for immunocompromised patients presenting with fevers and neurologic deficit. Early recognition with aggressive neurosurgical intervention and antifungal therapy may improve outcomes in future cases. PMID:25088481

McCaslin, Addason F; Lall, Rishi R; Wong, Albert P; Lall, Rohan R; Sugrue, Patrick A; Koski, Tyler R

2015-02-01

219

Outcomes in Treatment for Intradural Spinal Cord Ependymomas  

SciTech Connect

Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy.

Volpp, P. Brian [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)], E-mail: pvolpp@yahoo.com; Han, Khanh [Huntington Memorial Medical Center, Pasadena, CA (United States); Kagan, A. Robert; Tome, Michael [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)

2007-11-15

220

Brain and Spinal Tumors  

MedlinePLUS

... be used to diagnose or monitor a particular disorder) of CNS tumors. Other researchers are testing different drugs and molecules to see if they can modulate the normal activity of the blood-brain barrier and better target ... Headache: Hope Through Research Information ...

221

Care of the Spinal Cord-Injured Patient  

PubMed Central

Family physicians are often unfamiliar with the care of patients with spinal cord injuries because they may have only one such patient in their practice. Urinary tract infections, constipation, and decubitus ulcers are the most common problems, and autonomic dysreflexia the most serious emergency that family physicians treat in this population. This article addresses these areas, as well as spasticity, sexuality, depression, and the acute abdomen. PMID:20469504

Boxall, Jan

1989-01-01

222

Spinal-injured neuropathic bladder antisepsis (SINBA) trial  

Microsoft Academic Search

Objective:To determine whether Methenamine Hippurate (MH) or cranberry tablets prevent urinary tract infections (UTI) in people with neuropathic bladder following spinal cord injury (SCI).Study design:Double-blind factorial-design randomized controlled trial (RCT) with 2 year recruitment period from November 2000 and 6 month follow-up.Setting:In total, 543 eligible predominantly community dwelling patients were invited to participate in the study, of whom 305 (56%)

B B Lee; M J Haran; L M Hunt; J M Simpson; O Marial; S B Rutkowski; J W Middleton; G Kotsiou; M Tudehope; I D Cameron; BB Lee

2007-01-01

223

Spinal dural arteriovenous fistula with lipomyelodysplasia.  

PubMed

A 72-year-old man presented with a very rare case of spinal dural arteriovenous fistula (AVF) with lipomyelodysplasia manifesting as progressive paraparesis and bladder dysfunction. Magnetic resonance imaging revealed a spinal lipoma associated with tethered cord and spinal cord swelling with dilated perimedullary veins. Embolization of the spinal dural AVF was successfully performed, and is an optional treatment for coexisting spinal dural AVF and lipomyelocele in adults. PMID:23438662

Sato, Masayuki; Takigawa, Tomoji; Shiigai, Masanari; Tamura, Goichiro; Masumoto, Tomohiko; Nakai, Yasunobu; Zaboronok, Alexander; Tsurushima, Hideo; Matsumura, Akira

2013-01-01

224

Primary lumbar epidural abscess without spondylodiscitis caused by Fusobacterium necrophorum diagnosed by 16S rRNA PCR.  

PubMed

We report the case of a 71-year-old woman who presented a primary spinal epidural abscess caused by Fusobacterium necrophorum. This is the second report in the medical literature to associate this organism with a primary spinal epidural abscess without spondylodiscitis. After treatment with emergency laminectomy followed by 8 weeks of antibiotic treatment the patient was cured. Oral metronidazole (500 mg every 8 h) was the definitive choice of treatment. F. necrophorum spinal epidural abscess is rare, although samples for anaerobic culture should be collected in order to improve detection of anaerobic spinal infections. PCR amplification and sequencing of the 16S rRNA permits early diagnosis in anaerobic infections. PMID:23845584

Sanmillán, Jose Luis; Pelegrín, Iván; Rodríguez, David; Ardanuy, Carmen; Cabellos, Carmen

2013-10-01

225

Unusual presentation of spinal lipomatosis.  

PubMed

Spinal epidural lipomatosis (SEL) is a rare condition characterized by overgrowth of normal adipose tissue in the extradural space within the spinal canal that can lead to significant spinal cord compression. It is most commonly reported in patients receiving chronic glucocorticoid therapy. Other causes can include obesity and hypercortisolism. Occasionally, idiopathic SEL will occur in patients with no known risk factors, but cases are more generally reported in obesity and males. We present the case of a 35 year-old non-obese woman found to have rapidly progressive SEL that was not associated with any of the common causes of the disorder. PMID:25285024

Stephenson, William; Kauflin, Matthew J

2014-01-01

226

Unusual presentation of spinal lipomatosis  

PubMed Central

Spinal epidural lipomatosis (SEL) is a rare condition characterized by overgrowth of normal adipose tissue in the extradural space within the spinal canal that can lead to significant spinal cord compression. It is most commonly reported in patients receiving chronic glucocorticoid therapy. Other causes can include obesity and hypercortisolism. Occasionally, idiopathic SEL will occur in patients with no known risk factors, but cases are more generally reported in obesity and males. We present the case of a 35 year-old non-obese woman found to have rapidly progressive SEL that was not associated with any of the common causes of the disorder. PMID:25285024

Stephenson, William; Kauflin, Matthew J

2014-01-01

227

DISCUSSION ON SPINAL INJURIES  

PubMed Central

(1).—Varieties of spinal injuries, the three groups of common usage: fractures, dislocations, fracture-dislocations. Shall not refer in detail to fractures of the spinous or transverse processes. (2) Mechanics of injury to vertebræ. Two variables: (1) the nature of the bones; (2) the qualities of the force. Spinal injury usually caused by indirect violence. (3) The different results of injuries applied to the head; may break skull, failing that, the neck. Atlas fracture. Difference in qualities of the force causing atlas fracture and low cervical dislocation. (4) The compound nature of the vertebral body. The two columns, anterior, spongy; posterior, compact. The nature of wedge-compression of the vertebral body. Variations in the shape of the wedge. Reasons. Occur at all levels, including cervical spine. (5) Frequency of injury at different levels of vertebral column. “Localization” of injury. The two places of the graph of injury. The cervical at C. 5. Reason. The thoracic-lumbar peak at T. 12, L. 1 industrial. Is there a third peak at C. 2? (6) The effects of violent flexion of the spine: cervical flexion causes luxation at C. 5 or so. Extension causes fracture of odontoid. Violent flexion and extension therefore cause injury at very different levels. Thoracic region, why is there no “peak” of injury at T.6, 7? Lumbar region. (7) Displacement of fragments. Continuation of violence after the essential injury has been effected. Kümmell's disease, no inflammatory process involved. (8) Injury to the intervertebral discs, essential for displacement. Imperfect rupture a cause for difficulty in reducing luxations. The worst cases those in which it is most easily done, but most of these have cord damage. (9) Spinal injury from minimal violence. Examples of trivial cases, diving, brushing hair and so forth. Vertebral displacement in disease a much more serious thing. (10) Curious stability of many cervical luxations. Reasons. Locking of the inferior zygaphophyses. (11) Injury to nervous elements left principally to other speakers. Cord compression very rare. Immediate and irremediable damage. Root injuries. Falling mortality of modern statistics due to better diagnosis. (12) Primary operation for fractures of spine relegated to oblivion. Rarity of indications for open operation. Reduction the best treatment. ImagesFig. 5Fig. 6 PMID:19986314

1928-01-01

228

Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study  

PubMed Central

Introduction Accurate and timely diagnosis of community-acquired bacterial infections in patients with systemic inflammation remains challenging both for clinician and laboratory. Combinations of markers, as opposed to single ones, may improve diagnosis and thereby survival. We therefore compared the diagnostic characteristics of novel and routinely used biomarkers of sepsis alone and in combination. Methods This prospective cohort study included patients with systemic inflammatory response syndrome who were suspected of having community-acquired infections. It was conducted in a medical emergency department and department of infectious diseases at a university hospital. A multiplex immunoassay measuring soluble urokinase-type plasminogen activator (suPAR) and soluble triggering receptor expressed on myeloid cells (sTREM)-1 and macrophage migration inhibitory factor (MIF) was used in parallel with standard measurements of C-reactive protein (CRP), procalcitonin (PCT), and neutrophils. Two composite markers were constructed – one including a linear combination of the three best performing markers and another including all six – and the area under the receiver operating characteristic curve (AUC) was used to compare their performance and those of the individual markers. Results A total of 151 patients were eligible for analysis. Of these, 96 had bacterial infections. The AUCs for detection of a bacterial cause of inflammation were 0.50 (95% confidence interval [CI] 0.40 to 0.60) for suPAR, 0.61 (95% CI 0.52 to 0.71) for sTREM-1, 0.63 (95% CI 0.53 to 0.72) for MIF, 0.72 (95% CI 0.63 to 0.79) for PCT, 0.74 (95% CI 0.66 to 0.81) for neutrophil count, 0.81 (95% CI 0.73 to 0.86) for CRP, 0.84 (95% CI 0.71 to 0.91) for the composite three-marker test, and 0.88 (95% CI 0.81 to 0.92) for the composite six-marker test. The AUC of the six-marker test was significantly greater than that of the single markers. Conclusion Combining information from several markers improves diagnostic accuracy in detecting bacterial versus nonbacterial causes of inflammation. Measurements of suPAR, sTREM-1 and MIF had limited value as single markers, whereas PCT and CRP exhibited acceptable diagnostic characteristics. Trial registration NCT 00389337 PMID:17362525

Kofoed, Kristian; Andersen, Ove; Kronborg, Gitte; Tvede, Michael; Petersen, Janne; Eugen-Olsen, Jesper; Larsen, Klaus

2007-01-01

229

Learning about Spinal Muscular Atrophy  

MedlinePLUS

... by Families of SMA. Muscular Dystrophy Association - USA [mda.org] A national voluntary health agency dedicated to ... all ages. Facts About Spinal Muscular Atrophy (SMA) [mda.org] Questions and answers about SMA from the ...

230

Adjustment to Spinal Cord Injury  

MedlinePLUS

... to adjusting to spinal cord injury is personal motivation . Individuals who are newly injured are often motivated ... to find purpose in your life and the motivation to achieve your goals. It may help to ...

231

Currarino syndrome and spinal dysraphism.  

PubMed

Currarino syndrome is a rare constellation of congenital anomalies characterized by the triad of sacral dysgenesis, presacral mass, and anorectal malformation. It is frequently associated with other congenital anomalies, often including occult spinal dysraphism. Mutations in the MNX1 gene are identified in the majority of cases. The authors report a rare case of Currarino syndrome in an infant with tethered cord syndrome and a dorsal lipomyelomeningocele continuous with a presacral intradural spinal lipoma, in addition to an imperforate anus and a scimitar sacrum. They review the literature to highlight patterns of occult spinal dysraphism in patients with Currarino syndrome and their relationship to tethered cord syndrome. Approximately 60% of the patients with Currarino syndrome reported in the literature have an occult spinal dysraphism. Published studies suggest that the risk of tethered cord syndrome may be higher among patients with a lipoma and lower among those with a teratoma or anterior meningocele. PMID:24745342

Kole, Matthew J; Fridley, Jared S; Jea, Andrew; Bollo, Robert J

2014-06-01

232

Primary spinal epidural Hodgkin's lymphoma  

PubMed Central

Primary spinal epidural Hodgkin's lymphoma is very rare. We will discuss the clinical features and treatment of primary spinal epidural Hodgkin's lymphoma. In this paper, a 30-year-old male patient who presented with spinal epidural tumor at the T9–11 level is reported. Subtotal resection of the tumor was performed and the histological examination of the tumor specimen revealed Hodgkin's lymphoma. All other examinations were negative for an occult disease. Six courses of chemotheraphy containing adriamycin, bleomycin, vinblastine and dacarbazine were given to the patient. Surgery is the first therapeutic approach in malignancies compressing the spinal cord. Hodgkin's lymphoma is a very chemo- and radio-sensitive tumor. The indications for surgery were reduced and limited to laminectomy or even biopsy only, leaving the major role to chemo- and radiotheraphy. PMID:24964329

Yaman, Onur; Özdemir, Nail; Sevin, ?smail Ertan; Özer, Füsun Demirçivi; Ünlüo?lu, Saime

2013-01-01

233

How Is Lactose Intolerance Diagnosed?  

MedlinePLUS

... following tests also can help diagnose lactose intolerance: Hydrogen breath test. For this test, a person drinks ... beverage that has lactose in it. Then, the hydrogen level in the breath is measured at set ...

234

How Is Polycythemia Vera Diagnosed?  

MedlinePLUS

... PV. These tests include a complete blood count (CBC) and other tests, if necessary. Complete Blood Count ... first test used to diagnose PV is a CBC. The CBC measures many parts of your blood. ...

235

How Is an Aneurysm Diagnosed?  

MedlinePLUS

... Is an Aneurysm Diagnosed? If you have an aortic aneurysm but no symptoms, your doctor may find it ... or abdominal pain. If you have an abdominal aortic aneurysm (AAA), your doctor may feel a throbbing mass ...

236

Reflections on shunt infection.  

PubMed

The placement and revision of ventriculoperitoneal (VP) shunts remains a mainstay in the surgical treatment of hydrocephalus. While the North American infection rate averages nearly 8-10%, published infection rates for VP shunt infection below 1% have been reported. We retrospectively reviewed shunt operations by a single surgeon over 62 months to analyze the infection rate. In 62 months, we performed 526 shunt placements or revisions in patients up to 18 years of age. There were 7 shunt infections (1.33%). In 5 cases, the organism was Staphylococcus epidermidis, and a single shunt each was infected with Haemophilus influenzae and Staphylococcus aureus. Each infection was treated with external ventriculostomy drainage and intravenous antibiotics. The new shunt was placed at a new incision site after at least 5 days of sterile spinal fluid cultures. The mean follow-up among these patients after shunt insertion was 25 months. VP shunting remains the most common operation for hydrocephalus. Infections are linked with seizures, higher future risks of shunt infection and malfunction, and reduced IQ and school performance. Our infection rate during 62 months was limited to 1.33%. Uniform surgical technique, limited hardware and skin edge manipulation and double gloving may be important factors in limiting shunt infections. PMID:14734861

Kanev, Paul M; Sheehan, Jonas M

2003-12-01

237

Neurotrophins and spinal circuit function  

PubMed Central

Work early in the last century emphasized the stereotyped activity of spinal circuits based on studies of reflexes. However, the last several decades have focused on the plasticity of these spinal circuits. These considerations began with studies of the effects of monoamines on descending and reflex circuits. In recent years new classes of compounds called growth factors that are found in peripheral nerves and the spinal cord have been shown to affect circuit behavior in the spinal cord. In this review we will focus on the effects of neurotrophins, particularly nerve growth factor (NGF), brain derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), on spinal circuits. We also discuss evidence that these molecules can modify functions including nociceptive behavior, motor reflexes and stepping behavior. Since these substances and their receptors are normally present in the spinal cord, they could potentially be useful in improving function in disease states and after injury. Here we review recent findings relevant to these translational issues. PMID:24926235

Boyce, Vanessa S.; Mendell, Lorne M.

2014-01-01

238

Neurological Consequences of Cytomegalovirus Infection  

MedlinePLUS

... with altered immune function. Infection may affect the brain (encephalitis), spinal cord (myelitis), eye (retinitis), or other organs such as the lungs (pneumonia) or intestinal gract (gastritis, enteritis, or colitis). In addition, transplant recipients may develop organ rejection or graft-versus- ...

239

Intradural extramedullary spinal ependymoma: a case report of malignant transformation occurring.  

PubMed

Intradural extramedullary spinal ependymomas are extremely rare. Herein, we describe a lesion-type spinal ependymoma that followed a malignant course, and discuss its clinical presentation, etiopathogenesis, and treatment. We present a patient who was diagnosed with an intradural extramedullary spinal tumor at T4-T6. The patient underwent gross total resection of the tumor without damage to the spinal cord. Histological examination, classified the lesion as a World Health Organization (WHO)-grade 2 ependymoma. One and a half years later, magnetic resonance imaging detected a recurring tumor at T4-T5. The tumor was removed and classified as a WHO-grade 3 anaplastic ependymoma. The patient was started on a course of regional spinal cord radiotherapy. The patient achieved tumoral control and clinical stabilization after the recurrence. We must consider the differential diagnosis of intradural extramedullary spinal tumors. The best treatment for this lesion is gross total resection and adjunctive radiotherapy is necessary in cases of malignant-change. PMID:23741554

Moriwaki, Takashi; Iwatsuki, Koichi; Ohnishi, Yu-Ichiro; Umegaki, Masao; Ishihara, Masahiro; Yoshimine, Toshiki

2013-06-01

240

Low-Grade Inflammation and Spinal Cord Injury: Exercise as Therapy?  

PubMed Central

An increase in the prevalence of obesity in people with spinal cord injury can contribute to low-grade chronic inflammation and increase the risk of infection in this population. A decrease in sympathetic activity contributes to immunosuppression due to the lower activation of immune cells in the blood. The effects of physical exercise on inflammatory parameters in individuals with spinal cord injury have not been well described. We conducted a review of the literature published from 1974 to 2012. This review explored the relationships between low-grade inflammation, spinal cord injury, and exercise to discuss a novel mechanism that might explain the beneficial effects of exercise involving an increase in catecholamines and cytokines in people with spinal cord injury. PMID:23533315

da Silva Alves, Eduardo; de Aquino Lemos, Valdir; Ruiz da Silva, Francieli; Lira, Fabio Santos; dos Santos, Ronaldo Vagner Thomathieli; Rosa, João Paulo Pereira; Caperuto, Erico; Tufik, Sergio; de Mello, Marco Tulio

2013-01-01

241

Spinal muscular atrophy  

PubMed Central

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by degeneration of alpha motor neurons in the spinal cord, resulting in progressive proximal muscle weakness and paralysis. Estimated incidence is 1 in 6,000 to 1 in 10,000 live births and carrier frequency of 1/40-1/60. This disease is characterized by generalized muscle weakness and atrophy predominating in proximal limb muscles, and phenotype is classified into four grades of severity (SMA I, SMAII, SMAIII, SMA IV) based on age of onset and motor function achieved. This disease is caused by homozygous mutations of the survival motor neuron 1 (SMN1) gene, and the diagnostic test demonstrates in most patients the homozygous deletion of the SMN1 gene, generally showing the absence of SMN1 exon 7. The test achieves up to 95% sensitivity and nearly 100% specificity. Differential diagnosis should be considered with other neuromuscular disorders which are not associated with increased CK manifesting as infantile hypotonia or as limb girdle weakness starting later in life. Considering the high carrier frequency, carrier testing is requested by siblings of patients or of parents of SMA children and are aimed at gaining information that may help with reproductive planning. Individuals at risk should be tested first and, in case of testing positive, the partner should be then analyzed. It is recommended that in case of a request on carrier testing on siblings of an affected SMA infant, a detailed neurological examination should be done and consideration given doing the direct test to exclude SMA. Prenatal diagnosis should be offered to couples who have previously had a child affected with SMA (recurrence risk 25%). The role of follow-up coordination has to be managed by an expert in neuromuscular disorders and in SMA who is able to plan a multidisciplinary intervention that includes pulmonary, gastroenterology/nutrition, and orthopedic care. Prognosis depends on the phenotypic severity going from high mortality within the first year for SMA type 1 to no mortality for the chronic and later onset forms. PMID:22047105

2011-01-01

242

Spinal trauma. Pathophysiology and management of traumatic spinal injuries.  

PubMed

Spinal trauma can originate from internal or external sources. Injuries to the spinal cord can be classified as either concussive or compressive and concussive. The pathophysiologic events surrounding spinal cord injury include the primary injury (compression, concussion) and numerous secondary injury mechanisms (vascular, biochemical, electrolyte), which are mediated by excessive oxygen free radicles, neurotransmitter and electrolyte alterations in cell membrane permeability, excitotoxic amino acids, and various other biochemical factors that collectively result in reduced SCBF, ischemia, and eventual necrosis of the gray and white matter. Management of acute spinal cord injuries includes the use of a high-dose corticosteroid regimen within the initial 8 hours after trauma. Sodium prednisolone and methylprednisolone, at recommended doses, act as oxygen radical scavengers and are anti-inflammatory. Additional considerations are the stability of the vertebral column, other conditions associated with trauma (i.e., pneumothorax), and the presence or absence of spinal cord compression, which may warrant surgical therapy. Vertebral fractures or luxations can occur in any area of the spine but most commonly occur at the junction of mobile and immobile segments. Dorsal and dorsolateral surgical approaches are applicable to the lumbosacral and thoracolumbar spine and dorsal and ventral approaches to the cervical spine. Indications for surgical intervention include spinal cord compression and vertebral instability. Instability can be determined from the type of fracture, how many of the three compartments of the vertebrae are disrupted, and on occasion, by carefully positioned stress studies of fluoroscopy. Decompression (dorsal laminectomy, hemilaminectomy, or ventral cervical slot) is employed when compression of the spinal cord exists. The hemilaminectomy (unilateral or bilateral) causes less instability than dorsal laminectomy and therefore should be used when practical. The preferred approach for atlantoaxial subluxation is ventral, and the cross pinning, vertebral fusion technique is used for stabilization. Fracture luxations of C-2 are repaired with small plates on the ventral vertebral body. The thoracic and upper lumbar spine is stabilized with dorsal fixation techniques or combined dorsal spinal plate/vertebral body plate fixation. Several methods of fixation can be used with lower lumbar or lumbosacral fractures, including the modified segmental technique and the combined dorsal spinal plate/Kirschner-Ehmer technique. PMID:1641921

Shores, A

1992-07-01

243

Spinal Osteotomy Techniques in Management of Severe Pediatric Spinal Deformity and Analysis of Postoperative Complications.  

PubMed

Study Design. Retrospective analysis.Objective. To compare radiographic analysis and clinical outcomes of spinal osteotomy techniques, including Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), and analyze the relationship between preoperative evaluation and postoperative complication incidence.Summary of Background Data. These three techniques have been extensively reported previously, while, few literatures are available on comparing these three techniques in management of severe pediatric spinal deformity.Methods. In all of these 34 pediatric patients, 14 were treated with SPO, 12 were treated with PSO and 8 were treated with VCR. All operations were performed by the senior author beteen 2005 and 2009 in our institute. Preoperative Halo-gravity traction was applied for 2 weeks in all patients, patients were evaluated by standing radiographs taken before and after traction and post operation and a prospectively collected database with ourcomes questionnaires. The postoperative complications and its relationship to preoperative assessment were also analyzed in this study.Results. All these 34 patient were diagnosed as severe pediatric spinal deformity (22 females and 12 males), with an average age of 11.97 years (range, 6-17 years) and an average follow-up of 66.38 months (range, 48-97 months). The mean preoperative major curve for each group was 103.43° in SPO group, 108.08° in PSO group and 117.00° in VCR group, and was corrected to 15.21°, 16.83° and 25.88°, respectively. The apical vertebral translation was corrected by 73.29% by SPO, 73.35% by PSO and 59.71% by VCR. The coronal balance were improved from 16.57 mm to 1.50 mm in SPO group, 17.33 mm to 3.83 mm in PSO group and 29.38 mm to 3.63 mm in VCR group. The mean correction of the kyphotic angle for single SPO was 19.00°, for those with two and three SPOs, the average correction was 34.40° and 47.5°, and 33.83° for the PSO group, 47.38° for VCR group. There were significant improvements in the overall clinical outcomes. The overall complication rate was 35.3%. Complication rate was high in patients with respiratory insufficiency and rigid spine.Conclusion. There was no significant difference in coronal correction among these three techniques, while, the average corrections in the sagittal plane were progressively higher from single SPO to two SPOs or PSO to three SPOs or VCR. Preoperative respiratory insufficiency and rigidity of the spinal deformity are associated with high complication rate. PMID:25494310

Xia, Lei; Li, Peng; Wang, Dan; Bao, Deming; Xu, Jinglei

2014-12-01

244

Comparative analysis of spinal hemangioblastomas in sporadic disease and Von Hippel-Lindau syndrome.  

PubMed

The clinical differences were evaluated in spinal hemangioblastoma between patients with sporadic disease and patients with von Hippel-Lindau (VHL) syndrome. The distribution of hemangioblastomas in the central nervous system was investigated in 56 patients treated between 1988 and 2008 at the University of Tokyo Hospital. The characteristics of spinal hemangioblastomas were compared in 35 patients including 17 with sporadic disease and 18 with VHL syndrome treated between 1988 and 2008 at our hospital and three affiliated institutions. Spinal hemangioblastomas were much more prevalent in patients with VHL syndrome (88.2%) than in patients with sporadic disease (20.5%, p < 0.001). Spinal hemangioblastomas associated with VHL syndrome were diagnosed a decade earlier (p = 0.007) and were associated with less severe neurological symptoms than sporadic lesions (p = 0.004). Most patients with sporadic disease had a single lesion at the cervical or thoracic level, whereas patients with VHL syndrome had multiple lesions at all spinal levels (p = 0.04). Patients with sporadic disease exhibited significant improvement in postoperative neurological status (p = 0.02), whereas patients with VHL syndrome had no change in status (p = 1.00). Number of removed lesions (p = 0.03) and lower spinal cord lesions (p = 0.05) were associated with poor surgical outcome. Tumor recurrence was correlated with partial removal of lesions (p = 0.05). One third of patients with VHL syndrome developed new lesions every 2 years. The major finding of this study is that the incidence of spinal hemangioblastoma, distributed through all spinal levels, may be as high as 88% in patients with VHL syndrome, which is much greater than previously reported. PMID:20671381

Takai, Keisuke; Taniguchi, Makoto; Takahashi, Hiroshi; Usui, Masaaki; Saito, Nobuhito

2010-01-01

245

Gaucher's disease diagnosed by splenectomy  

PubMed Central

Context: Splenectomy continues to find common therapeutic indications for hematologic disorders. In addition, recently it is also performed in surgical clinics to assist diagnose of some illnesses. Gaucher's disease, especially Type I, is the most frequently encountered lysosomal storage disorder in man. Manifestations of it are highly variable. The most frequently found symptoms include splenomegaly with anaemia and thrombocytopenia, mostly due to hypersplenism, hepatomegaly and bone disease. Cases: Four patients were reported in the present study. Three of them were easily diagnosed with Gaucher's disease via bone marrow cytology, and one with Gaucher's disease was detected by pathological examination following the splenectomy. Conclusions: For the pouse of diagnosis of the Gaucher's disease, performing surgery is generally not necessary. However, for the cases of difficult to diagnose by classical methods, the corect diagnosis of Gaucher's disease can only be made by a special operation. PMID:22666685

Adas, Mine; Adas, Gokhan; Karatepe, Oguzhan; Altiok, Merih; Ozcan, Deniz

2009-01-01

246

Pain Management Following Spinal Cord Injury  

MedlinePLUS

... signals are Rehabilitation Research and Training Center on Secondary Conditions of SCI & Model SCI Care Center Spinal Cord Injury InfoSheet 10 Level - Consumer Pain Management following Spinal ...

247

46-year-old man with a spinal cord mass.  

PubMed

Medulloblastoma accounts for only 1% of all adult CNS tumors. Likewise, recurrence of adult medulloblastoma greater than 20 years after initial diagnosis is extremely rare.We describe a case of adult medulloblastoma with late relapse of disease. The patient was 24 years old when first diagnosed and was treated with total tumor resection and craniospinal radiation. At the age of 45, an enhancing 1.3 cm intradural extramedullary spinal cord lesion at T5 was discovered on MRI. This was presumed to be recurrent medulloblastoma in the form of drop metastasis and the patient was treated with spinal radiation. Several months following treatment, at the age of 46, a follow-up MRI demonstrated an enhancing 1.4 cm intradural extramedullary spinal cord lesion at T7. The lesion was resected and histopathologic examination was most consistent with medulloblastoma, late drop metastasis. Although rare, adult medulloblastoma recurring 20 years after initial diagnosis should always be considered in the main differential diagnosis when working up CNS lesions at or outside the primary tumor site. PMID:21129065

Sanders, Mary Ann; Vitaz, Todd; Rosenblum, Marc; Plaga, Alexis R; Parker, Joseph C; Parker, John R

2011-01-01

248

Spinal stimulator peri-electrode masses: case report.  

PubMed

The authors describe a case of delayed spastic quadriparesis caused by a peri-electrode mass following the implantation of a minimally invasive percutaneous spinal cord stimulator (SCS). Prior reports with paddle-type electrodes are reviewed, and a detailed histological and pathophysiological comparison with the present case is made. The patient developed tolerance to a cervical percutaneous SCS 4 months after implantation, followed by the onset of spastic quadriparesis 9 months after implantation. The stimulator was removed, and contrast-enhanced MRI revealed an enhancing epidural mass where the system had been placed, with severe spinal cord compression. Decompression was carried out, and the patient experienced neurological improvement. Pathological examination revealed fibrotic tissue with granulomatous and multinucleated giant cell reactions. No evidence of infection or hemorrhage was found. Professionals treating patients with SCSs or contemplating their insertion should be aware of this delayed complication and associated risk factors. PMID:25380541

Scranton, Robert A; Skaribas, Ioannis M; Simpson, Richard K

2015-01-01

249

Spinal Cord Injury—Past, Present, and Future  

PubMed Central

Summary: This special report traces the path of spinal cord injury (SCI) from ancient times through the present and provides an optimistic overview of promising clinical trials and avenues of basic research. The spinal cord injuries of Lord Admiral Sir Horatio Nelson, President James A. Garfield, and General George Patton provide an interesting perspective on the evolution of the standard of care for SCI. The author details the contributions of a wide spectrum of professionals in the United States, Europe, and Australia, as well as the roles of various government and professional organizations, legislation, and overall advances in surgery, anesthesia, trauma care, imaging, pharmacology, and infection control, in the advancement of care for the individual with SCI. PMID:17591221

Donovan, William H

2007-01-01

250

Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery  

Microsoft Academic Search

The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At

Peter C. Gerszten; Steven A. Burton

2008-01-01

251

Evaluation of spinal cord injury animal models  

PubMed Central

Because there is no curative treatment for spinal cord injury, establishing an ideal animal model is important to identify injury mechanisms and develop therapies for individuals suffering from spinal cord injuries. In this article, we systematically review and analyze various kinds of animal models of spinal cord injury and assess their advantages and disadvantages for further studies. PMID:25598784

Zhang, Ning; Fang, Marong; Chen, Haohao; Gou, Fangming; Ding, Mingxing

2014-01-01

252

Isolated intramedullary spinal cord cysticercosis.  

PubMed

We report a case of intradural, intramedullary, spinal cord neurocysticercosis at dorsal 10-11 (D10-11) level in a mentally retarded male. A 38-year-old, mentally retarded male presented with weakness and stiffness in both the lower limbs and waist since one year. Magnetic resonance imaging revealed a D10-D11 intradural space occupying lesion with cord compression. Intraoperatively, the tumor was grayish white, soft, cystic, and intramedullary with a well-defined plane with surrounding cord tissue. Gross examination revealed a cystic lesion of 1.5×1×0.8 cm, with a whitish nodule of 0.3 cm in diameter. The cyst wall was thin, shiny, and translucent. Microscopic examination revealed cysticercous cyst. Spinal neurocysticercosis should be considered in differential diagnosis of spinal mass lesion in patients residing in endemic area such as India. PMID:22870160

Agale, Shubhangi V; Bhavsar, Shweta; Choudhury, Barnik; Manohar, Vidhya

2012-04-01

253

3D visualization of Thoraco-Lumbar Spinal Lesions in German Shepherd Dog  

SciTech Connect

Computed tomography (CT) has been found to be an excellent imaging modality due to its sensitivity to characterize the morphology of the spine in dogs. This technique is considered to be particularly helpful for diagnosing spinal cord atrophy and spinal stenosis. The three-dimensional visualization of organs and bones can significantly improve the diagnosis of certain diseases in dogs. CT images were acquired of a German shepherd's dog spinal cord to generate stacks and digitally process them to arrange them in a volume image. All imaging experiments were acquired using standard clinical protocols on a clinical CT scanner. The three-dimensional visualization allowed us to observe anatomical structures that otherwise are not possible to observe with two-dimensional images. The combination of an imaging modality like CT together with imaging processing techniques can be a powerful tool for the diagnosis of a number of animal diseases.

Azpiroz, J.; Krafft, J.; Cadena, M.; Rodriguez, A. O. [Centro de Investigacion en Imagenologia e Instrumentacion Medica, UAM Iztapalapa, Av. San Rafael Atlixco 186, Mexico, D. F. 09340 (Mexico)

2006-09-08

254

How Is Atrial Fibrillation Diagnosed?  

MedlinePLUS

... test for diagnosing AF. An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart. A standard EKG only records the heartbeat for a few seconds. It won't detect AF that doesn't ...

255

Psychiatric diagnoses, trauma, and suicidiality  

Microsoft Academic Search

BACKGROUND: This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. METHODS: During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%). RESULTS: Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma

Silje K Floen; Ask Elklit

2007-01-01

256

[Frequent nursing diagnoses and interventions for women under critical care].  

PubMed

This study aimed at identifying the most frequent Nursing Diagnoses and propose interventions for women under critical care into a maternal intensive care unit in a public hospital in Fortaleza, CE, Brazil. Retrospective study conducted with women's hospital health records. Ten Nursing Diagnoses were elaborated, being four risk: risk of infection, risk of unbalance of liquids volume, risk of aspiration, risk of damaged skin integrity and six real: altered maternity, impaired physical mobility, anxiety and impaired verbal communication. For the referred Nursing Diagnoses, nursing interventions are proposed according to the link between NANDA, NIC and NOC. It was concluded that the use of ND is a necessary technology for the Nursing reality, as it makes possible the integral care. PMID:19597654

Oliveira, Mirna Fontenele de; Freitas, Maria Célia de

2009-01-01

257

Spinal cord monitoring during spinal surgery using somatosensory spinal evoked potentials.  

PubMed

Intraoperative monitoring of spinal cord function has been carried out in 59 patients during spinal instrumentation for scoliosis. Posterior tibial nerve stimulation in the popliteal space was performed and spinal evoked potentials from electrodes in the spinous processes observed. A rod artifact problem causing partial obliteration of the wave form can be minimized or eliminated by careful selection of the insertion of the fixation device. A drop in amplitude of the signal occurred in many of the tracings from control to distraction observations but did not result in neurologic deficit. One patient had a loss of the signal after maximum distraction with a Harrington rod and a return with release of distraction. This patient awoke with paralytic urinary bladder retention which resolved spontaneously but no other neurologic deficit. This method has been used for monitoring of spinal cord function during Harrington rod instrumentation, using both compression and distraction systems as well as Luque rod instrumentation. This method is safe, simple, and provides consistent and predictable wave forms; it appears to be reliable in indicating continuation of spinal cord function during the procedure. PMID:6841600

LaMont, R L; Wasson, S L; Green, M A

1983-02-01

258

Epidural anaesthesia and spinal haematoma  

Microsoft Academic Search

Purpose  Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents\\u000a a comprehensive review of case reports.\\u000a \\u000a \\u000a \\u000a Source  Sampling of case reports over a 10 yr period, medline® -research (1966–1995) and cross-check with former reviews.\\u000a \\u000a \\u000a \\u000a Findings  Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion\\u000a of

Hinnerk Wulf

1996-01-01

259

[Diagnosis of congenital infection].  

PubMed

In general, congenital diagnosis is based on: a) maternal serologic assays; b) microbiologic study of amniotic fluid or fetal blood sampling; and c) serology in children and microorganism detection by polymerase chain reaction (PCR) or culture. Congenital infections due to cytomegalovirus, herpes simplex, varicella, B19 erythrovirus and toxoplasmosis are usually the result of primary infection in the mother. Therefore, when IgG antibodies are detected before pregnancy, these infections are ruled out. Definitive serologic diagnosis of acute infection in pregnant women requires the demonstration of seroconversion (i.e., from seronegative to seropositive). In these cases, amniotic fluid or fetal blood sampling should be performed to determine the presence of intrauterine congenital infection. Cytomegalovirus, rubella and toxoplasmosis can be diagnosed by detection of specific IgM antibodies in fetal blood. However, PCR in amniotic fluid has replaced conventional prenatal diagnostic techniques, including fetal blood sampling, in the diagnosis of these infections. In the newborn, these infections may be confirmed by measuring IgM specific antibodies. B19 erythrovirus can be detected by PCR in amniotic fluid or fetal blood. Congenital varicella-zoster infection may be diagnosed on the basis of persistence of IgG antibodies after birth. Definitive diagnosis of herpes simplex virus infection requires viral isolation. Swabs or scraping from clinical specimens can be inoculated into susceptible cell lines for isolation. PMID:22305665

Sampedro Martínez, Antonio; Martínez, Luis Aliaga; Teatino, Pablo Mazuelas; Rodríguez-Granger, Javier

2011-12-01

260

Spinal Hydatid Disease: A Case Series  

PubMed Central

Background: Over the past 10 years, 4 cases of spinal hydatid disease (3 men, 1 woman) were diagnosed and treated at our institution, with an average follow-up of 4 years. Hydatid disease of the spine is a rare condition with a poor prognosis that presents diagnostic and therapeutic challenges. Methods: The patients were evaluated clinically, using the latest imaging modalities available in our institution. Decompressive surgeries were performed and the diagnosis was confirmed by histopathologic examination. All patients received long-term antihelminthic therapy with 400 mg of albendazole 3 times daily for 1 year. Results: After surgery, all patients improved; however, over time, recurrence and residual disease were observed. Two patients had complete neurologic recovery at follow-up at 2 to 3 years, although there were radiographic signs of recurrence. The other 2 patients did not achieve complete neurologic recovery despite anterior decompression; they developed recurrent disease and the neurologic status deteriorated to spastic paraplegia. All patients refused further surgeries for recurrences and 2 patients died of complications of paraplegia. Conclusion: Diagnosis was challenging, eradication was difficult, and hydatid disease recurred in all 4 patients. In our experience, morbidity and mortality were high and prognosis was poor. PMID:16869090

Prabhakar, Mukund M; Acharya, Apurv J; Modi, Dhaval R; Jadav, Bhavin

2005-01-01

261

Spinal cord atrophy in early Huntington's disease  

PubMed Central

Despite evidence for spinal cord involvement, it remains unclear whether spinal cord atrophy exists in early Huntington's disease. We studied magnetic resonance images, covering both brain and upper cervical cord, in two cohorts of Huntington's patients and in one cohort of Alzheimer's patients. All cohorts included healthy controls comparable with regard to age and gender. We found significant spinal cord atrophy in both cohorts of Huntington's patients but not in the cohort of Alzheimer's patients. Furthermore, spinal cord atrophy correlated with motor symptoms indicating that spinal cord atrophy occurs in the clinical stages and does not result from abnormal development.

Mühlau, Mark; Engl, Christina; Boucard, Christine C; Schmidt, Paul; Biberacher, Viola; Görsch, Isabel; Sorg, Christian; Wohlschläger, Afra; Zimmer, Claus; Hemmer, Bernhard; Weindl, Adolph

2014-01-01

262

Melatonin lowers edema after spinal cord injury  

PubMed Central

Melatonin has been shown to diminish edema in rats. Melatonin can be used to treat spinal cord injury. This study presumed that melatonin could relieve spinal cord edema and examined how it might act. Our experiments found that melatonin (100 mg/kg, i.p.) could reduce the water content of the spinal cord, and suppress the expression of aquaporin-4 and glial fibrillary acidic protein after spinal cord injury. This suggests that the mechanism by which melatonin alleviates the damage to the spinal cord by edema might be related to the expression of aquaporin-4 and glial fibrillary acidic protein.

Li, Cheng; Chen, Xiao; Qiao, Suchi; Liu, Xinwei; Liu, Chang; Zhu, Degang; Su, Jiacan; Wang, Zhiwei

2014-01-01

263

GeneXpert polymerase chain reaction for spinal tuberculosis: an accurate and rapid diagnostic test.  

PubMed

The lack of an accurate, rapid diagnostic test for mycobacterium tuberculosis (TB) is a major handicap in the management of spinal TB. GeneXpert, a new, rapid molecular diagnostic test is recommended as the first line investigation for suspected pulmonary TB in areas with a high prevalence of HIV or drug resistance, yet it has not been validated for the diagnosis of musculoskeletal TB. The aim of this study was to assess the accuracy of GeneXpert in diagnosing spinal TB. A prospective clinical study of 69 consecutive adults with suspected spinal TB was conducted at a tertiary hospital in an area with the highest incidence and prevalence of TB in the world. GeneXpert was used on tissue samples of the enrolled patients and its diagnostic accuracy compared with a reference standard of tissue in liquid culture. A total of 71 spine samples from 69 patients (two re-biopsies) were included in the study. The GeneXpert test showed a sensitivity of 95.6% and specificity of 96.2% for spinal TB. The results of the GeneXpert test were available within 48 hours compared with a median of 35 days (IQR 15 to 43) for cultures. All cases of multi-drug resistant TB (MDR TB) were diagnosed accurately with the GeneXpert test. The MDR TB rate was 5.8%. PMID:25274923

Held, M; Laubscher, M; Zar, H J; Dunn, R N

2014-10-01

264

Acute Spontaneous Spinal Epidural Hematoma  

Microsoft Academic Search

BACKGROUND AND PURPOSE:Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (#48 hours) spontaneous EDH with clinical management and outcome. METHODS: Eight patients with acute spontaneous

R. D. Henderson; Amar S. Swarnkar; Robert L. Williams

2001-01-01

265

SPINAL CORD INJURY (SCI) DATABASE  

EPA Science Inventory

The National Spinal Cord Injury Database has been in existence since 1973 and captures data from SCI cases in the United States. Since its inception, 24 federally funded Model SCI Care Systems have contributed data to the National SCI Database. Statistics are derived from this da...

266

Intradural extramedullary tuberculous spinal granulomas.  

PubMed

Four cases of intradural extramedullary tuberculous spinal granulomas without bony involvement are presented. Both, the rarity of the disease, as well as the successful microsurgical resection with good recovery prompted this report. The pathogenesis with the controversies therein, is discussed and pertinent literature is reviewed. PMID:3208471

Mathuriya, S N; Khosla, V K; Banerjee, A K

1988-01-01

267

MicroRNA Analysis in the Spinal Fluid of Alzheimer Patients: A Methodological Feasibility Study  

Microsoft Academic Search

\\u000a MicroRNAs form a novel class of functional biomolecules with a great potential to be used as informative biomarkers for clinical\\u000a diagnostics such as for Alzheimer’s disease (AD). For this purpose, we tested the prerequisite: can microRNAs be isolated\\u000a and quantified from the spinal fluid of patients at risk for or diagnosed with Alzheimer disease? Our data show that quantitative\\u000a analysis

Argonde van Harten; Joyce Mulders; Cagla Çevik; Maartje Kester; Philip Scheltens; Wiesje van der Flier; Cees Oudejans

268

A case of intradural-extramedullary form of primary spinal cysticercosis misdiagnosed as an arachnoid cyst.  

PubMed

We describe a rare case of intradural-extramedullary primary spinal cysticercosis. A 42-year-old man visited our institute for lower back pain. He denied having consumed raw meet. Magnetic resonance (MR) images revealed an intradural pure cystic mass at the L3-L4 level. A radiologic diagnosis of spinal arachnoid cyst was established. Three years later, he complained of aggravated back pain, and follow-up MR examination showed a markedly expanded cyst, occupying the subarachnoid space from the T11 to the S1 level. L2 hemilaminectomy was performed, and a yellowish infected cyst bulged out through the dural opening. The cyst was removed en bloc. The histopathological findings of the cyst were consistent with parasitic infection. Serum enzyme-linked immunosorbent assay (ELISA) confirmed the presence of spinal cysticercosis. As there was no intracranial lesion, the final diagnosis was primary spinal cysticercosis, which is very rare. MR imaging is a sensitive diagnostic tool for detecting cystic lesions in the spine; however, it is difficult to distinguish cysticercosis from non-infectious cysts such as an arachnoid cyst without using gadolinium enhancement. Clinicians treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. We recommend contrast-enhanced MR imaging and serum ELISA in the diagnostic work-up of such cases. PMID:25024830

Yoo, Minwook; Lee, Chang-Hyun; Kim, Ki-Jeong; Kim, Hyun-Jib

2014-04-01

269

A Case of Intradural-Extramedullary Form of Primary Spinal Cysticercosis Misdiagnosed as an Arachnoid Cyst  

PubMed Central

We describe a rare case of intradural-extramedullary primary spinal cysticercosis. A 42-year-old man visited our institute for lower back pain. He denied having consumed raw meet. Magnetic resonance (MR) images revealed an intradural pure cystic mass at the L3-L4 level. A radiologic diagnosis of spinal arachnoid cyst was established. Three years later, he complained of aggravated back pain, and follow-up MR examination showed a markedly expanded cyst, occupying the subarachnoid space from the T11 to the S1 level. L2 hemilaminectomy was performed, and a yellowish infected cyst bulged out through the dural opening. The cyst was removed en bloc. The histopathological findings of the cyst were consistent with parasitic infection. Serum enzyme-linked immunosorbent assay (ELISA) confirmed the presence of spinal cysticercosis. As there was no intracranial lesion, the final diagnosis was primary spinal cysticercosis, which is very rare. MR imaging is a sensitive diagnostic tool for detecting cystic lesions in the spine; however, it is difficult to distinguish cysticercosis from non-infectious cysts such as an arachnoid cyst without using gadolinium enhancement. Clinicians treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. We recommend contrast-enhanced MR imaging and serum ELISA in the diagnostic work-up of such cases. PMID:25024830

Yoo, Minwook; Lee, Chang-Hyun; Kim, Hyun-Jib

2014-01-01

270

Spinal extradural angiolipoma: report of two cases and review of the literature  

PubMed Central

Spinal angiolipomas are benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04–1.2% of all spinal tumors. We report two cases of lumbar extradural angiolipoma and review previously reported cases. We found 118 cases of spinal epidural angiolipoma (70 females and 48 males; age range 1.5–85 years, mean 44.03) spanning from 1890 to 2006. Prior to diagnosis 40.6% of the patients had weakness of the lower limbs. The interval between the initial symptoms and tumor diagnosis ranged from 1 day to 17 years (mean 20.2 months). Except for four cases diagnosed at autopsy, 109 patients underwent surgery and gross-total resection was performed in 79 cases (72.4%). Spinal angiolipomas are tumors containing angiomatous and lipomatous tissue, predominantly located in the mid-thoracic region. All angiolipomas show iso- or hyperintensity on T1-weighted images and hyperintensity on T2-weighted images and most lesions enhance with gadolinium administration. The treatment for spinal extradural angiolipomas is total surgical resection and no adjuvant therapy should be administered. PMID:19127373

García-Allut, Alfredo

2009-01-01

271

Congestive myelopathy (Foix-Alajouanine Syndrome) due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: Case report and review of literature  

PubMed Central

Spinal arteriovenous fistulas are rare entities. They often present with congestive myelopathy but are infrequently diagnosed as the cause of the patients’ symptoms. Only one such case has been described previously in Indian literature. We describe one such case who presented to us after a gap of 3 years since symptom onset and following a failed laminectomy where the cause was later diagnosed to be an intradural fistula in the filum terminale fed by the anterior spinal artery and review the available literature. PMID:24101838

Krishnan, Prasad; Banerjee, Tapas Kumar; Saha, Manash

2013-01-01

272

Evaluation of Risk Factors for Vertebral Compression Fracture after Stereotactic Radiosurgery in Spinal Tumor Patients  

PubMed Central

Objective Stereotactic radiosurgery (SRS) is an emerging treatment modality for malignant spinal tumors. After SRS, some patients suffered from pain aggravation due to development of vertebral compression fracture (VCF). In these cases, surgery should be considered. Methods This study consisted of 72 patients who underwent SRS due to spinal tumors. In them, whether post-SRS VCF developed or not was investigated. We retrospectively analyzed their medical records and radiological imaging data. VCF was diagnosed with X-ray and magnetic resonance imaging (MRI). The incidence, time to development and risk factors for VCF were investigated. Age, sex, whole vertebral body involvement rate, vertebral body osteolysis rate, pre-SRS spinal deformity, spinal instability neoplastic score (SINS), spinal canal encroachment, lesion level, and radiation dose were analyzed as potential risk factors. A multi-variate logistic regression model was used for statistical analysis. Results In our study population, VCF was observed in 26 patients (36%). The mean time to VCF development was 1.5 months. Using uni-variate analyses, the significant risk factors were pre-SRS spinal deformity, SINS, vertebral body osteolysis rate, and whole vertebral body involvement rate. However, using multi-variate analyses, the only significant risk factor was vertebral body osteolysis rate. The patients whose vertebral body was destroyed by more than 60% showed an 8.4 times higher risk of VCF than those who had vertebral body destruction of less than 60%(p=0.016). Conclusion The most significant prognostic factor for post-SRS VCF was vertebral body osteolysis rate, rather than whole vertebral body involvement rate. When more than 60% of the vertebral body was destroyed, the risk of VCF or spinal deformity was high. PMID:25346753

Sung, Sang-Hyun

2014-01-01

273

Middle Ear Infections (For Parents)  

MedlinePLUS

After the common cold , ear infections are the most frequently diagnosed childhood illness in the United States. Most kids will have had ... winter season, when lots of people get upper respiratory tract infections or colds. Signs and Symptoms The signs and ...

274

[Deep neck infections].  

PubMed

Deep neck infection is relatively rare but potentially life threatening complication of common oropharyngeal infections. This retrospective study was aimed at analyzing the occurrence of complications, diagnostic methods and proper management of deep neck infection. A review was conducted in 32 cases who were diagnosed as having deep neck infection from 1995 to 2005. The causes of deep neck infections were tonsillitis (16 cases), tooth diseases (6 cases), paratonsillar abscess (4 cases), parotitis (1 case), pussy lymphonodes after tonsillectomy (2 cases), pussy congenital neck cyst (1 case), chronic otitis media (1 case), parotitis (1 case), foreign body of the esophagus (1 case). All the puss bacterial cultivation were positive. All the patients were treated by different ways of chirurgical drainage and use of large dosage of antibiotics. Deep neck infection should be suspected in patients with long lasting fever and painful swelling of the neck and treatment should begin quick as possible. PMID:17152800

Nowak, Katarzyna; Szyfter, Witold

2006-01-01

275

Chemotherapy in newly diagnosed primary central nervous system lymphoma  

PubMed Central

Primary central nervous system lymphoma (PCNSL) accounts for only 3% of brain tumors. It can involve the brain parenchyma, leptomeninges, eyes and the spinal cord. Unlike systemic lymphoma, durable remissions remain uncommon. Although phase III trials in this rare disease are difficult to perform, many phase II trials have attempted to define standards of care. Treatment modalities for patients with newly diagnosed PCNSL include radiation and/or chemotherapy. While the role of radiation therapy for initial management of PCNSL is controversial, clinical trials will attempt to improve the therapeutic index of this modality. Routes of chemotherapy administration include intravenous, intraocular, intraventricular or intra-arterial. Multiple trials have outlined different methotrexate-based chemotherapy regimens and have used local techniques to improve drug delivery. A major challenge in the management of patients with PCNSL remains the delivery of aggressive treatment with preservation of neurocognitive function. Because PCNSL is rare, it is important to perform multicenter clinical trials and to incorporate detailed measurements of long-term toxicities. In this review we focus on different chemotherapeutic approaches for immunocompetent patients with newly diagnosed PCNSL and discuss the role of local drug delivery in addition to systemic therapy. We also address the neurocognitive toxicity of treatment. PMID:21789140

Hashemi-Sadraei, Nooshin; Peereboom, David M.

2010-01-01

276

A distinctive cytologic pattern for diagnosing tuberculous lymphadenitis in AIDS.  

PubMed

Tuberculous lymphadenitis (TL) is a very common infection in human immunodeficiency virus (HIV)-infected patients. We performed fine-needle aspiration biopsy (FNAB) of enlarged lymph nodes in 57 HIV-infected patients to evaluate its usefulness in this population. We observed three cytologic patterns in 21 patients diagnosed as having TL: granulomatous lymphadenitis (GL) in 4 FNABs, necrotizing granulomatous lymphadenitis (NGL) in 7 FNABs, and necrotizing lymphadenitis (NL) in 12 FNABs. GL and NGL are already well-known and considered to be highly suggestive of TL. Our results support the idea that NL should have the same diagnostic value as GL or NGL. In the group of 12 patients with NL, TL was confirmed in 11 by microbiologic methods (7 by a positive Ziehl-Neelsen stain and 4 by a positive Löwenstein culture) and in the remaining patient by a biopsy that showed NGL with acid-fast bacilli. We conclude that FNAB is a useful, inexpensive, and safe technique for diagnosing TL in HIV-infected patients. The finding of a NL pattern is suggestive enough of TL to start antituberculous treatment. PMID:8254472

Llatjos, M; Romeu, J; Clotet, B; Sirera, G; Manterola, J M; Pedro-Botet, M L; Raventos, A; Foz, M

1993-12-01

277

CT-guided percutaneous biopsy of spinal lesions  

PubMed Central

Accurate diagnosis of spine lesions is important for its successful management. Imaging–guided percutaneous biopsy is gaining increasing acceptance as a means for obtaining tissue for diagnosis. Most biopsies can be rapidly performed under local anaesthesia, with little patient discomfort and improved safety. Spinal anatomy is, however, complex with many adjacent vital structures. Good knowledge of anatomy and precise needling technique is, therefore, important. Today, biopsy of spinal lesions is best performed under computed tomography (CT) fluoroscopic guidance. Indications for imaging-guided biopsy include confirming metastasis in a patient with a known primary tumour, determining the nature of a solitary bone lesion, excluding malignancy in vertebral body compression, and investigating for infection. Among the various issues to be considered are site of lesion, location of adjacent vital structures, approach, and type and size of needle. Complications are rare, particularly when a meticulous technique is applied. In summary, CT-guided percutaneous biopsy is a safe and an effective technique for the evaluation of spinal lesions and useful in planning therapy. PMID:21614239

Peh, WCG

2006-01-01

278

Diagnosing foetal atrioventricular heart blocks.  

PubMed

Foetal echocardiographic ultrasound techniques still remain the dominating modality for diagnosing foetal atrioventricular block (AVB). Foetal electrocardiography might become a valuable tool to measure time intervals, but magnetocardiography is unlikely to get a place in clinical practice. Assuming that AVB is a gradually progressing and preventable disease, starting during a critical period in mid-gestation with a less abnormal atrioventricular conduction before progressing to a complete irreversible AVB (CAVB), echocardiographic methods to detect first-degree AVB have been developed. The time intervals obtained with these techniques are all based on the identification of mechanical or hemodynamic events as markers of atrial (A) and ventricular (V) depolarizations and will accordingly include both electrical and mechanical components. Prospective observational studies have demonstrated a transient prolongation of AV time intervals in anti-Ro/SSA antibody-exposed foetuses, but it has not succeeded to identify a degree of AV time prolongation predicting irreversible cardiac damage and progression to CAVB. Causes of sustained bradycardia include CAVB, 2:1 AVB, sinus bradycardia and blocked atrial bigeminy (BAB). Using foetal echocardiographic techniques and a systematic approach, a correct diagnosis can be made in almost every case. Sinus bradycardia and CAVB are usually easy to diagnose, but BAB has a tendency to be sustained and shows a high degree of resemblance with 2:1 AVB when diagnosed during mid-gestational. As BAB resolves without treatment and 2:1 AVB may respond to treatment with fluorinated steroids, a correct diagnosis becomes an issue of major importance to avoid unnecessary treatment of harmless and spontaneously reversing conditions. PMID:20696017

Sonesson, S-E

2010-09-01

279

Acute hand infections.  

PubMed

The continued emergence of antibiotic-resistant bacteria and the development of only a few new classes of antibiotics over the past 50 years have made the treatment of acute hand infections problematic. Prompt diagnosis and treatment are important, because hand stiffness, contractures, and even amputation can result from missed diagnoses or delayed treatment. The most common site of hand infections is subcutaneous tissue and the most common mechanism is trauma. An immunocompromised state, intravenous drug abuse, diabetes mellitus, and steroid use all predispose to infections. PMID:25070032

Osterman, Meredith; Draeger, Reid; Stern, Peter

2014-08-01

280

Diagnosing dementia: No easy job  

Microsoft Academic Search

Background  From both clinical experience and research we learned that in complex progressive disorders such as dementia, diagnosis includes\\u000a multiple steps, each with their own clinical and research characteristics.\\u000a \\u000a \\u000a \\u000a \\u000a Discussion  Diagnosing starts with a trigger phase in which the GP gradually realizes that dementia may be emerging. This is followed\\u000a by a disease-oriented diagnosis and subsequently a care -oriented diagnosis. In parallel

Frank Buntinx; Jan De Lepeleire; Louis Paquay; Steve Iliffe; Birgitte Schoenmakers

2011-01-01

281

Major Medical Outcomes with Spinal Augmentation versus Conservative Therapy  

PubMed Central

Importance The symptomatic benefits of spinal augmentation (vertebroplasty or kyphoplasty) for the treatment of osteoporotic vertebral compression fractures are controversial. Recent population-based studies using medical billing claims have reported significant reductions in mortality with spinal augmentation compared to conservative therapy, but in non-randomized settings such as these, there is the potential for selection bias to influence results. Objective To compare major medical outcomes following treatment of osteoporotic vertebral fractures with spinal augmentation or conservative therapy. Additionally, we will evaluate the role of selection bias using pre-procedure outcomes and propensity score analysis. Design, Setting, and Participants Retrospective cohort analysis of Medicare claims for 2002–2006. We compared 30-day and 1-year outcomes in patients with newly-diagnosed vertebral fractures treated with spinal augmentation (augmented; n=10 541) or conservative therapy (control; n=115 851). Outcomes were compared using traditional multivariate analyses adjusted for patient demographics and comorbid conditions. We also used propensity score matching to select 9017 pairs from the initial groups to compare the same outcomes. Main Outcomes and Measures Mortality, major complications, and healthcare utilization. Results Using traditional covariate adjustments, mortality was significantly lower in the augmented group compared to controls (5.2% vs 6.7% at one year; hazard ratio, 0.83; 95% CI, 0.75–0.92). However, patients in the augmented group who had not yet undergone augmentation (pre-procedure subgroup) had lower rates of medical complications 30 days post-fracture compared to controls (6.5% vs 9.5%; odds ratio, 0.66; 95% CI, 0.57–0.78), suggesting that the augmented group was less medically ill. After propensity score matching to better account for selection bias, one-year mortality was not significantly different between groups. Furthermore, one-year major medical complications were also similar between groups, and the augmented group had higher rates of healthcare utilization, including hospital and intensive care unit admissions and discharges to skilled nursing facilities. Conclusions and Relevance After accounting for selection bias, spinal augmentation did not improve mortality or major medical outcomes and was associated with greater healthcare utilization compared to conservative therapy. Our results also highlight how analyses of claims-based data that do not adequately account for unrecognized confounding can arrive at misleading conclusions. PMID:23836009

McCullough, Brendan J.; Comstock, Bryan A.; Deyo, Richard A.; Kreuter, William; Jarvik, Jeffrey G.

2014-01-01

282

How Is Alpha-1 Antitrypsin Deficiency Diagnosed?  

MedlinePLUS

... page from the NHLBI on Twitter. How Is Alpha-1 Antitrypsin Deficiency Diagnosed? Alpha-1 antitrypsin (AAT) deficiency usually is diagnosed after ... is. Rate This Content: Next >> October 11, 2011 Alpha-1 Antitrypsin Deficiency Clinical Trials Clinical trials are ...

283

How Do Health Care Providers Diagnose Vulvodynia?  

MedlinePLUS

... Trials Resources and Publications En Español How do health care providers diagnose vulvodynia? Skip sharing on social media ... been ruled out. To diagnose vulvodynia, 1 a health care provider may recommend that a woman have blood ...

284

How Are Obesity and Overweight Diagnosed?  

MedlinePLUS

... Trials Resources and Publications En Español How are obesity & overweight diagnosed? Skip sharing on social media links ... and Blood Institute. (2012). How are overweight and obesity diagnosed? Retrieved August 8, 2012, from http://www. ...

285

Whole Spontaneous Spinal Epidural Hematoma  

PubMed Central

A 26-year-old male who had no underlying disease, including coagulopathy, underwent thoracotomy and bleeding control due to hemothorax. On the fifth postoperative day, paralysis of both lower limbs occurred. Urgent spine magnetic resonance imaging showed a massive anterior spinal epidural hematoma from C2 to L1 level with different signal intensities, which was suspected to be staged hemorrhage. Hematoma evacuation with decompressive laminectomy was performed. The patient's neurologic deterioration was recovered immediately, and he was discharged without neurological deficits. A drug history of naftazone, which could induce a drug-induced platelet dysfunction, was revealed retrospectively. To our knowledge, this is the first report of whole spontaneous spinal epidural hematoma in a young patient, with a history of hemorrhoid medication. PMID:24967052

Yoon, Kyeong-Wook; Song, Jae Gyok; Ryu, Jae-Wook

2014-01-01

286

Primary vertebral and spinal epidural non-Hodgkin's lymphoma with spinal cord compression  

Microsoft Academic Search

We examined eight patients with primary spinal epidural non-Hodgkin's lymphoma presenting with spinal cord compression and proven histologically after laminectomy (7 cases) or biopsy (1 case) by MRI. The most common findings were an isointense or low signal relative to the spinal cord on T1-weighted images (T1WI) and high signal on T2-weighted images (T2WI). Spinal cord compression, vertebral bone marrow

M. Boukobza; C. Mazel; E. Touboul

1996-01-01

287

Intradural spinal granular cell tumor  

PubMed Central

Granular cell tumor is a rare, usually benign tumor with classical histomorphology. Location of tumor varies widely within body, but spine is distinctly a rare location for this tumor. We report a rare case of granular cell tumor involving intradural extramedullary portion of lumbar region of spinal cord. Knowledge of which is important as subsequent prognosis differs from other tumor at same location. PMID:25126126

Vaghasiya, Viren L.; Nasit, Jitendra G.; Parikh, Pinki A.; Trivedi, Priti P.

2014-01-01

288

Intradural spinal granular cell tumor.  

PubMed

Granular cell tumor is a rare, usually benign tumor with classical histomorphology. Location of tumor varies widely within body, but spine is distinctly a rare location for this tumor. We report a rare case of granular cell tumor involving intradural extramedullary portion of lumbar region of spinal cord. Knowledge of which is important as subsequent prognosis differs from other tumor at same location. PMID:25126126

Vaghasiya, Viren L; Nasit, Jitendra G; Parikh, Pinki A; Trivedi, Priti P

2014-04-01

289

General Information About Staging Childhood Brain and Spinal Cord Tumors  

MedlinePLUS

General Information About Childhood Brain and Spinal Cord Tumors A childhood brain or spinal cord tumor is a disease in which abnormal cells form in the tissues of the brain or spinal cord. There are many types of ...

290

21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.  

...false Spinal intervertebral body fixation orthosis. 888...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL...3060 Spinal intervertebral body fixation orthosis. (a... A spinal intervertebral body fixation orthosis is a...

2014-04-01

291

21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.  

Code of Federal Regulations, 2013 CFR

...false Spinal intervertebral body fixation orthosis. 888...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL...3060 Spinal intervertebral body fixation orthosis. (a... A spinal intervertebral body fixation orthosis is a...

2013-04-01

292

21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.  

Code of Federal Regulations, 2012 CFR

...false Spinal intervertebral body fixation orthosis. 888...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL...3060 Spinal intervertebral body fixation orthosis. (a... A spinal intervertebral body fixation orthosis is a...

2012-04-01

293

21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.  

Code of Federal Regulations, 2011 CFR

...false Spinal intervertebral body fixation orthosis. 888...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL...3060 Spinal intervertebral body fixation orthosis. (a... A spinal intervertebral body fixation orthosis is a...

2011-04-01

294

Testosterone Plus Finasteride Treatment After Spinal Cord Injury  

ClinicalTrials.gov

Spinal Cord Injury; Spinal Cord Injuries; Trauma, Nervous System; Wounds and Injuries; Central Nervous System Diseases; Nervous System Diseases; Spinal Cord Diseases; Gonadal Disorders; Endocrine System Diseases; Hypogonadism; Genital Diseases, Male

2014-09-22

295

Alpine skiing, snowboarding, and spinal trauma  

Microsoft Academic Search

This 10-year retrospective review of spinal injuries at a destination ski resort was done to determine the incidence and\\u000a type of spinal and neurologic injury associated with alpine winter sports. Spinal injury patterns and outcomes in skiers and\\u000a snowboarders over a period of 11 seasons at a destination resort were studied. One-fourth of cervical injuries were associated\\u000a with a temporary

Timothy Floyd

2001-01-01

296

Spinal intradural teratomas: developmental programs gone awry?  

PubMed

Intradural spinal teratomas are rare tumors of the spinal cord that are infrequently encountered in children. Although the mechanistic basis for the formation of these tumors is unclear, several lines of evidence suggest that a dysembryogenic process in the embryo results in their formation. The authors present a case of spinal intradural teratoma in an 18-year-old, previously healthy man and review the literature linking the development of these tumors to defects in neurulation and embryogenesis. PMID:23025442

Kalani, M Yashar S; Iyer, Sudarshan; Coons, Stephen W; Smith, Kris A

2012-10-01

297

Diagnosing Diabetes and Learning about Prediabetes  

MedlinePLUS

... positive test, your doctor may not require a second test to diagnose diabetes. A1C The A1C test measures your average blood glucose for the past 2 to 3 months. The advantages of being diagnosed this way are that you don't have to fast or drink anything. Diabetes is diagnosed at an ...

298

MRI of anterior spinal artery syndrome of the cervical spinal cord  

Microsoft Academic Search

Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one

S. Takahashi; T. Yamada; K. Ishii; H. Saito; H. Tanji; T. Kobayashi; Y. Soma; K. Sakamoto

1992-01-01

299

The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment  

Microsoft Academic Search

BACKGROUND: This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities. METHODS: Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles

Martha C Hawes; Joseph P O'Brien

2006-01-01

300

Diagnosing clostridial enteric disease in poultry.  

PubMed

The world's poultry industry has grown into a multibillion-dollar business, the success of which hinges on healthy intestinal tracts, which result in effective feed conversion. Enteric disease in poultry can have devastating economic effects on producers, due to high mortality rates and poor feed efficiency. Clostridia are considered to be among the most important agents of enteric disease in poultry. Diagnosis of enteric diseases produced by clostridia is usually challenging, mainly because many clostridial species can be normal inhabitants of the gut, making it difficult to determine their role in virulence. The most common clostridial enteric disease in poultry is necrotic enteritis, caused by Clostridium perfringens, which typically occurs in broiler chickens but has also been diagnosed in various avian species including turkeys, waterfowl, and ostriches. Diagnosis is based on clinical and pathological findings. Negative culture and toxin detection results may be used to rule out this disease, but isolation of C. perfringens and/or detection of its alpha toxin are of little value to confirm the disease because both are often found in the intestine of healthy birds. Ulcerative enteritis, caused by Clostridium colinum, is the other major clostridial enteric disease of poultry. Diagnosis of ulcerative enteritis is by documentation of typical pathological findings, coupled with isolation of C. colinum from the intestine of affected birds. Other clostridial enteric diseases include infections produced by Clostridium difficile, Clostridium fallax, and Clostridium baratii. PMID:23572451

Cooper, Kerry K; Songer, J Glenn; Uzal, Francisco A

2013-05-01

301

Anemia after traumatic spinal cord injury.  

PubMed

The incidence and natural history of anemia in patients with spinal cord injuries (SCI) were investigated in a prospective study of 68 patients consecutively admitted to a regional acute SCI unit. Fifty had SCI and 18 had spine injuries (SI) without neurologic deficit. Thirty-six of 41 males (88%) and six of nine females (67%) with SCI were anemic on at least one occasion. In the first two weeks after injury, in females and in males, there was no significant difference in mean hemoglobin level between SI and SCI patients. At six weeks, no male with SI was anemic, and males with SCI had significantly lower mean hemoglobin levels than those with SI (121.6 g/L vs 145.4 g/L, p less than .001). Identified early causes of anemia were blood loss due to bony soft tissue or visceral injury, gastrointestinal bleeding, and surgery. In the postacute phase (more than six weeks after injury), anemia occurred in 25 of 41 male and three of nine female SCI patients, and its occurrence was associated with the presence of an identified chronic disease, especially urinary tract infection. PMID:1998453

Hirsch, G H; Menard, M R; Anton, H A

1991-03-01

302

Toxoplasmosis of Spinal Cord in Acquired Immunodeficiency Syndrome Patient Presenting as Paraparesis: A Rare Entity  

PubMed Central

Although brain has been the most common site for toxoplasma infection in acquired immunodeficiency syndrome patients, involvement of spinal cord by toxoplasma has been rarely found. Spinal cord toxoplasmosis can present as acute onset weakness in both lower limbs associated with sensory and bladder dysfunction. A presumptive diagnosis can be made in patients with CD4 count <100/mm3 based on a positive serum Toxoplasma gondii IgG antibodies, no recent prophylaxis against toxoplasmosis, intramedullary ring enhancing lesion in spinal cord supported by similar lesions in brain parenchyma. Institutions of antitoxoplasma treatment in such patients result in prompt clinical response and therefore avoiding the need of unnecessary invasive diagnostic tests. Here, we report a case of toxoplasmic myelitis in immunocompromised patient presenting as myelopathy who showed significant clinical improvement after starting antitoxoplasma treatment. Hence toxoplasmic myelitis should be considered in toxoplasma seropositive immunocompromised patients presenting as myelopathy and imaging studies showing ring enhancing intramedullary lesion. PMID:25538456

Agrawal, Sachin R; Singh, Vinita; Ingale, Sheetal; Jain, Ajeet Prasad

2014-01-01

303

The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis  

PubMed Central

Objective: In this study, the evaluation of the clinical, laboratory and radiological findings belonging to 55 cases that were hospitalized in our clinic to be followed-up and were diagnosed with tuberculous, brucellar and pyogenic spondylodiscitis (SD) was aimed. Materials and Methods: The cases with SD were evaluated retrospectively. Hematological, serological, biochemical laboratory tests and imaging technics were used for diagnosis. Results: Of 55 cases aged ranging between 25 to 79, 33 (59%) were female. The cases with tuberculous SD (TBSD), brucellar SD (BSD) and pyogenic SD (PSD) were found in 24 (43%), 12 (21%) and in 19 (34%) patients. Erytrocyte sedimentation rate, increased C-reactive protein, and leucocytosis were present in 51 (91%), 22 (39%) and 8 (14%) cases. The number of the cases with history of previous surgery or trauma was 14 (25%). Diagnosis of TBSD was established by acid fast bacilli positiveness and Löwenstein Jensen culture positiveness, in two and seven patients, respectively. While all 12 cases with BSD had positive standard tube aglutination test, only 3 (25%) had hemoculture positivity. In PSDs, diagnosis was confirmed with culture positivity in 9 of 19 cases.Of the cases in our study, 89% responded to medical treatment while three required surgery and three died (5.5% and 5.5%, respectively). Conclusion: SD may develop secondary to infections or following spinal surgical procedures and traumas. Also, the importance of endemicity should be kept in mind, beside the helpful diagnostic findings while treatment regulation. PMID:22346185

Yasar, Kadriye; Pehlivanoglu, Filiz; Cicek, Gulten; Sengoz, Gonul

2012-01-01

304

Pulmonary symptoms and diagnoses are associated with HIV in the MACS and WIHS cohorts  

PubMed Central

Background Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment. Methods A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled. Results Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia. Conclusions In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher prevalence of chronic respiratory symptoms, testing for non-infectious respiratory diseases may be underutilized in the HIV-infected population. PMID:24884738

2014-01-01

305

Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism  

PubMed Central

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma. PMID:25328656

Son, Doo Kyung; Choi, Chang Hwa; Song, Geun Sung

2014-01-01

306

Steroid-induced Spinal Epidural Lipomatosis after Suprasella Tumor Resection  

PubMed Central

Spinal epidural lipomatosis (SEL) is an abnormal localized accumulation of fat tissues in the epidural space. It is strongly related with steroid administration. The symptoms of SEL are various and range from back pain to paraplegia. In severe cases, decompressive laminectomy is the choice of treatment. A 32-year-old woman who had been under long-term steroid administration after suprasellar tumor resection was admitted for both leg radiating pain and weakness. She was diagnosed with SEL and had a decompressive laminectomy. During the operation, we found the nerve roots were compressed by epidural fat tissues and engorged vessels. After the operation, her radiating pain was relieved and motor weakness was improved. PMID:24757466

Kim, Si On; Park, Keuk Kyu; Kwon, Young Jun; Shin, Hyun Chul

2013-01-01

307

Steroid-induced Spinal Epidural Lipomatosis after Suprasella Tumor Resection.  

PubMed

Spinal epidural lipomatosis (SEL) is an abnormal localized accumulation of fat tissues in the epidural space. It is strongly related with steroid administration. The symptoms of SEL are various and range from back pain to paraplegia. In severe cases, decompressive laminectomy is the choice of treatment. A 32-year-old woman who had been under long-term steroid administration after suprasellar tumor resection was admitted for both leg radiating pain and weakness. She was diagnosed with SEL and had a decompressive laminectomy. During the operation, we found the nerve roots were compressed by epidural fat tissues and engorged vessels. After the operation, her radiating pain was relieved and motor weakness was improved. PMID:24757466

Kim, Si On; Park, Keuk Kyu; Kwon, Young Jun; Shin, Hyun Chul; Choi, Chun Sik

2013-06-01

308

Spinal deformity after multilevel osteoplastic laminotomy  

PubMed Central

Multilevel laminectomy in children has a significant rate of postoperative spinal deformity. To decrease the incidence of this complication, the use of osteoplastic laminotomy is advocated to minimise the risk of spinal deformity by preserving the normal architecture of the spine. In this retrospective study, a 10-year series of a paediatric population undergoing multilevel osteoplastic laminotomy is reviewed to determine the incidence, especially in contrast to laminectomies, and to identify factors that affect the occurrence of spinal column deformity. Seventy patients (mean age 4.2 years) underwent multilevel osteoplastic laminotomy for congenital anomalies or removal of spinal tumours. All patients had a clinical and radiographic examination preoperatively, 12 months postoperatively and at follow-up. Mean follow-up was 5.3 years (range 3–12.6 years). Nineteen patients (27%) had a new or progressive spinal deformity. There was an increased incidence in patients who had surgery for spinal tumours (P?spinal deformity found a significantly higher (46%) compared to our study group. This study demonstrates that osteoplastic laminotomy was found to be very effective in decreasing the incidence of spinal deformities after spinal-canal surgery for spinal-cord tumours or congenital anomalies in children and adolescents. The choice of an anatomical reconstructive surgical technique such as osteoplastic laminotomy seems to be essential to minimise secondary problems due to the surgical technique itself. Nevertheless, growing patients should be followed up for several years after the initial operation for early detection and consequent management of any possible deformity of the spinal column. PMID:17323095

Juergen, Krauss; Gloger, Harald; Soerensen, Nils; Wild, Alexander

2007-01-01

309

Electrical stimulation of lumbar spinal nerve roots in dogs.  

PubMed

The aim of this study was to test the applicability of electrical stimulation of lumbar spinal nerve roots and obtain normative electrical root stimulation (ERS) data for L7 nerve root and sciatic nerve in dogs. For that purpose ERS and sciatic nerve stimulations were performed consecutively, in totally 40 healthy dogs. ERS was applied in the L7/S1 intervertebral space via monopolar needle electrodes. Muscle responses were recorded from the gastrocnemius muscles on the left and right hind limbs. Sciatic nerve stimulation was performed at the greater trochanter level on the left hind limb, with records obtained from the left gastrocnemius muscle. Mean root latencies of the left and right side were 5.22?±?0.49 ms and 5.29?±?0.53 ms, respectively. There was no significant difference in root latency between the right and left sides. The mean terminal latency was 3.82?±?0.46 ms. The proximal motor nerve conduction velocity of the sciatic nerve was 63.15?±?3.43 m/s. The results of this study show that ERS provides objective data about the integrity of lumbar spinal nerve roots by evaluating the entire population of motor fibres and total length of the motor axon in dogs. ERS can be considered a useful diagnostic method for confirmation of diagnoses of lumbosacral diseases. PMID:24930120

Turan, Erkut; Unsal, Cengiz; Oren, Mehmet Utkan; Dilek, Omer Gurkan; Yildirim, Ismail Gokce; Sarierler, Murat

2014-09-01

310

Intraspinal penetrating stab injury to the middle thoracic spinal cord with no neurologic deficit.  

PubMed

The annual incidence of traumatic spinal cord injury worldwide is estimated to be 35 patients per million. Nonmissile penetrating spinal injuries most commonly occur in the thoracic region, and the majority has neurologic deficits on admission. The management of patients who lack neurologic deficits is controversial due to the risk of neurologic status alteration intraoperatively. However, failure to intervene increases the risk of infection, delayed onset of neurologic deficits, and worsening functional outcome.A 17-year-old boy presented with an intradural T7-T8 knife penetration injury to the spinal cord with no neurologic deficit. Rapid surgical intervention was critical because the knife was lodged between the 2 hemispheres of the spinal cord. The patient was intubated in the lateral position, transferred to the prone position on a Jackson table, and underwent surgical decompression with laminectomy 1 level above and below the injury site, removal of the knife blade in the original path of trajectory, and repair of the dural tear with a collagen matrix. The patient sustained no neurologic sequelae from the penetrating knife injury. He was able to ambulate at discharge and had no complications. To our knowledge, this is the only report of a patient with intradural spinal cord penetration by a foreign object (knife blade) presenting with a normal neurologic preoperative examination that persisted throughout the course of postoperative care. PMID:22588426

Li, Xinning; Curry, Emily J; Blais, Micah; Ma, Richard; Sungarian, Arno S

2012-05-01

311

Clinical therapeutic effects of anterior decompression on spinal osteoporotic fracture and inflammatory cytokines  

PubMed Central

Objective: To evaluate the clinical therapeutic effects of anterior decompression on spinal osteoporotic fracture and inflammatory cytokines. Methods: A total of 140 patients with spinal osteoporotic fracture were selected and randomly divided into a treatment group and a control group (n=70). The control group was treated by central corpectomy, and the control group was treated by anterior decompression. Results: The rate of excellent and good outcomes in the treatment group was 94.3%, and that of the control group was 78.6%, which differed significantly (P<0.05). Cobb angle and cord occupancy in the spinal canal of both groups significantly decreased (P<0.05), while height ratio of the injured vertebral body significantly increased (P<0.05). Meanwhile, there were statistically significant inter-group differences (P<0.05). During the three-month follow-up period, the treatment group was significantly less prone to complications such as superficial infection, spinal instability and screw breakage compared with the control group (P<0.05). The postoperative serum MMP-3 and IL-6 levels of both groups significantly decreased compared with those before surgeries (P<0.05), with statistically significant inter-group differences (P<0.05). Conclusion: Compared with central corpectomy, anterior decompression exerted better effects on spinal osteoporotic fracture by improving the prognosis and stabilizing the spine safely, which may be associated with the effectively reduced serum MMP-3 and IL-6 levels. PMID:25225501

Liao, Qi; Liu, Shi-Qing; Ming, Jiang-Hua; Chen, Qing; Zhao, Qi; Yang, Yue

2014-01-01

312

Spinal dysraphism: A challenge continued to be faced by neurosurgeons in developing countries  

PubMed Central

Objectives: The incidence of spinal dysraphism has significantly decreased over the last few decades, all over the world; however, still the incidence is much higher in developing countries with poor socioeconomic status. Materials and Methods: The present study includes all patients managed for spinal dysraphism over a period of one year (January 2011-December 2011). Details including demographics, antenatal care history, site and type of lesion, neurological examination, imaging finding, associated congenital anomalies, management offered, and outcome were recorded. Results: A total of 27 children were operated for spinal dysraphism during the study period (17 males and 11 females). Median age was 120 days (age range, 1 day to 6 years). Mothers of 15 children did not seek any regular antenatal checkup and only 13 mothers received folic acid supplementation during pregnancy. Fourteen children were delivered at home and 13 were at hospital. The most common site was lumbosacral region (67.8%). Seven patients had rupture of the sac at the time of presentation, one child had local infection, and four patients had hydrocephalus (requiring shunt before surgical repair). Two patients developed hydrocephalus at follow up, needing shunt surgery. The mean hospital stay was 7 days (range, 5 days to 31 days; median, 10 days). Conclusion: Spinal dysraphism is still a major public health problem in developing countries. Management of patients with spinal dysraphism is complex and needs close coordination between pediatrician, neurologist, neurosurgeon, and rehabilitation experts. A large number of factors influence the outcome. PMID:25126121

Agrawal, Amit; Sampley, Sunil

2014-01-01

313

Unplanned Reoperation within 30 Days of Fusion Surgery for Spinal Deformity  

PubMed Central

No recent studies have analyzed the rates of or reasons for unanticipated revision surgery within 30 days of primary surgery in spinal deformity patients. Our aim was to examine the incidence, characteristics, reasons, and risk factors for unplanned revision surgery in spinal deformity patients treated at one institution. All patients with a diagnosis of spinal deformity presenting for primary instrumented spinal fusion at a single institution from 1998 to 2012 were reviewed. All unplanned reoperations performed within 30 days after primary surgery were analyzed in terms of demographics, surgical data, and complications. Statistical analyses were performed to obtain correlations and risk factors for anticipated revision. Of 2758 patients [aged 16.07 years (range, 2–71), 69.8% female] who underwent spinal fusion surgery, 59 (2.1%) required reoperation within 30 days after primary surgery. The length of follow up for each patient was more than 30 days. Of those that required reoperation, 87.0% had posterior surgery only, 5.7% had anterior surgery, and 7.3% underwent an anteroposterior approach. The reasons for reoperation included implant failure (n?=?20), wound infection (n?=?12), neurologic deficit (n?=?9), pulmonary complications (n?=?17), and coronal plane imbalance (n?=?1). The risk factors for reoperation were age, diagnosis, and surgical procedure with osteotomy. PMID:24595145

Li, Zheng; Shen, Jianxiong; Qiu, Guixing; Yu, Haiquan; Wang, Yipeng; Zhang, Jianguo; Zhao, Hong; Zhao, Yu; Li, Shugang; Weng, Xisheng; Liang, Jinqian; Zhao, Lijuan

2014-01-01

314

Training clinicians treating HIV to diagnose cytomegalovirus retinitis  

PubMed Central

Abstract Problem Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed. Approach We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation. Local setting Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease. Relevant changes Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data. Lessons learnt Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries. PMID:25552774

Tun, NiNi; Maningding, Ernest; Heiden, Matthew; Rose-Nussbaumer, Jennifer; Chan, Khin Nyein; Khizniak, Tamara; Yakubenko, Alexandra; Lewallen, Susan; Keenan, Jeremy D; Saranchuk, Peter

2014-01-01

315

Delay in diagnosis of primary intradural spinal cord tumors  

PubMed Central

Background: It has been our impression in recent years that there is a significant delay in diagnosis (DID) of patients in Israel harboring intradural spinal cord tumors (IDSCTs). DID can lead to irreversible deficits and unnecessary suffering. Our goal was to identify the incidence and the specific reasons for DID of IDSCTs in patients operated upon at our institution. Methods: A retrospective record review, with additional telephone survey, of 101 patients operated upon at our institute between the years 1996 and 2009 was conducted. The patients who were not diagnosed locally and those who were diagnosed during routine spinal imaging studies as part of their basic disease check-up were excluded. Accordingly, neurofibromatosis and medical tourist patients were excluded. Results: The clinical presentation of IDSCTs in our study was similar to the descriptions given in previous reports. The average age was 41.9 ± 23.3 years. Most tumors were ependymomas, astrocytomas, and schwannomas. The most common symptoms were motor or sensory disturbance, back pain, walking disturbance, and sphincter control deficit. The median time to diagnosis was 12.0 ± 37.0 months (range 3 days to 20 years). We found DID in 82.2% of the cases. 62.4% of the cases were defined as “unreasonable delay.” The most common reasons for DID were “classical symptoms with a wrong diagnosis” and “delayed imaging.” Conclusions: Based on the results of this study, the incidence of unreasonable delays in diagnosis of primary IDSCTs in Israel is very high. In order to shorten the time to diagnosis, primary and secondary care physicians need to increase their awareness of symptoms that may be associated with these lesions. We hereby offer feedback for care providers, relevant to the diagnostic workup of these patients. Such a feedback must be delivered by neurosurgeons to the community they are serving. PMID:22629489

Segal, David; Lidar, Zvi; Corn, Akiva; Constantini, Shlomi

2012-01-01

316

Probing spinal circuits controlling walking in mammals  

Microsoft Academic Search

Locomotion in mammals is a complex motor act that involves the activation of a large number of muscles in a well-coordinated pattern. Understanding the network organization of the intrinsic spinal networks that control the locomotion, the central pattern generators, has been a challenge to neuroscientists. However, experiments using the isolated rodent spinal cord and combining electrophysiology and molecular genetics to

Ole Kiehn; Kimberly J. Dougherty; Martin Hägglund; Lotta Borgius; Adolfo Talpalar; Carlos Ernesto Restrepo

2010-01-01

317

Tuberculous spinal cord compression in pregnancy  

Microsoft Academic Search

A case of tuberculous spinal cord compression causing acute paraparesis in a pregnant woman of 33 weeks gestation is described. Immediate Caesarean section followed by aggressive surgical decompression of the spine via an anterior approach with reconstruction achieved a good outcome for mother and fetus. The management of tuberculous spinal cord compression in pregnancy is discussed, with particular reference to

J. V Rosenfeld; E. I Torey; M. S Michael; M. M Johnson

1998-01-01

318

Spinal Cord Astrocytomas: Presentation, Management and Outcome  

Microsoft Academic Search

Intramedullary spinal cord astrocytomas are uncommon tumors. They are the most common spinal cord tumor in children and in adults are second only to ependymomas in frequency of occurrence. Low-grade histology predominates with high-grade lesions comprising only ten to fifteen percent of pediatric tumors and a slightly higher proportion in adults. Presenting symptoms typically evolve over months to years with

John K. Houten; Paul R. Cooper

2000-01-01

319

Anterior Spinal Artery Syndrome: a case report  

Microsoft Academic Search

Nontraumatic spinal cord ischemia is uncommon, especially at the cervical spinal cord. We describe a 30-year-old man presenting with acute onset of quadriparesis and impaired sensation for pain and temperature after backing up the car. He was diag- nosed noninvasively with magnetic resonance imaging (MRI) and electrophysiological studies. The image studies had revealed a high signal intensity lesion in the

YI-MIN CHEN; HELEN L PO; SHING-NIN MEI; SHO-JEN CHENG

2003-01-01

320

Minimally Invasive Treatment of Spinal Metastases: Techniques  

PubMed Central

With improved treatments and increasingly life expectancy, the burden of metastatic disease in the spine is expected to rise. The role of conventional surgery for spinal metastases is well established but often involves procedures of large magnitude. We describe minimally invasive techniques for spinal stabilization and decompression in patients with symptomatic metastatic disease of the spine. PMID:22312512

Rose, Peter S.; Clarke, Michelle J.; Dekutoski, Mark B.

2011-01-01

321

Echinococcus ortleppi Infections in Humans and Cattle, France  

PubMed Central

In 2011 and 2012, liver infections caused by Echinococcus ortleppi tapeworms were diagnosed in 2 humans in France. In 2012, a nationwide slaughterhouse survey identified 7 E. ortleppi infections in cattle. The foci for these infections were spatially distinct. The prevalence of E. ortleppi infections in France may be underestimated. PMID:25417697

Umhang, Gérald; Arbez-Gindre, Francine; Mantion, Georges; Delabrousse, Eric; Millon, Laurence; Boué, Franck

2014-01-01

322

Recovery after spinal cord infarcts  

PubMed Central

Objective: To investigate the long-term outcome of patients with spinal cord infarct (SCI) and identify prognostic predictors. Methods: We reviewed 115 patients with SCI treated between 1990 and 2007. Severity of impairment was defined using the American Spinal Injury Association (ASIA) scoring. Functional outcome endpoints were ambulatory status, need for bladder catheterization, and pain. Results: Mean age was 64 years; 72 (62.6%) patients were men. A total of 45% of infarcts were perioperative (69% aortic surgeries). A total of 68% reached maximal deficit within 1 hour (mean = 5 hours). Impairment at nadir was ASIA A 23%, B 26%, C 14%, and D 37%. A total of 75/93 (81%) patients studied with MRI had cord signal abnormality. At nadir, 81% required wheelchair, 86% required catheterization, and 32% had pain. At last follow-up (mean = 3 years), 23% had died. Among survivors, 42% required a wheelchair, 54% required catheterization, and 29% had pain upon last follow-up. Of 74 patients using a wheelchair at hospital dismissal, 41% were walking by final follow-up. Of 83 patients catheterized at dismissal, 33% were catheter-free at last follow-up. Older age (p < 0.0001), increased severity of impairment at nadir (p = 0.02), and peripheral vascular disease (p = 0.003) were independent risk factors for mortality. Severe impairment (ASIA A/B) at nadir predicted wheelchair use (p < 0.0001) and bladder catheterization (p < 0.0001) at last follow-up. Conclusions: Gradual improvement in not uncommon after spinal cord infarction and it may continue long after hospital dismissal. While severe impairment at nadir is the strongest predictor of poor functional outcome, meaningful recovery is also possible in a substantial minority of these patients. PMID:22205760

Robertson, Carrie E.; Brown, Robert D.; Wijdicks, Eelco F.M.

2012-01-01

323

Spinal Cord Ischemia Secondary to Hypovolemic Shock  

PubMed Central

A 44-year-old male presented with symptoms of spinal cord compression secondary to metastatic prostate cancer. An urgent decompression at the cervical-thoracic region was performed, and there were no complications intraoperatively. Three hours postoperatively, the patient developed acute bilateral lower-limb paralysis (motor grade 0). Clinically, he was in class 3 hypovolemic shock. An urgent magnetic resonance imaging (MRI) was performed, showing no epidural hematoma. He was managed aggressively with medical therapy to improve his spinal cord perfusion. The patient improved significantly, and after one week, he was able to regain most of his motor functions. Although not commonly reported, spinal cord ischemia post-surgery should be recognized early, especially in the presence of hypovolemic shock. MRI should be performed to exclude other potential causes of compression. Spinal cord ischemia needs to be managed aggressively with medical treatment to improve spinal cord perfusion. The prognosis depends on the severity of deficits, and is usually favorable.

Kapoor, Siddhant; Koh, Roy KM; Yang, Eugene WR; Hee, Hwan-Tak

2014-01-01

324

Carrier testing for spinal muscular atrophy  

PubMed Central

Spinal muscular atrophy is the most common fatal hereditary disease among newborns and infants. There is as yet no effective treatment. Although a carrier test is available, currently there is disagreement among professional medical societies who proffer standards of care as to whether or not carrier screening for spinal muscular atrophy should be offered as part of routine reproductive care. This leaves health care providers without clear guidance. In fall 2009, a meeting was held by National Institutes of Health to examine the scientific basis for spinal muscular atrophy carrier screening and to consider the issues that accompany such screening. In this article, the meeting participants summarize the discussions and conclude that pan-ethnic carrier screening for spinal muscular atrophy is technically feasible and that the specific study of implementing a spinal muscular atrophy carrier screening program raises broader issues about determining the scope and specifics of carrier screening in general. PMID:20808230

Gitlin, Jonathan M.; Fischbeck, Kenneth; Crawford, Thomas O.; Cwik, Valerie; Fleischman, Alan; Gonye, Karla; Heine, Deborah; Hobby, Kenneth; Kaufmann, Petra; Keiles, Steven; MacKenzie, Alex; Musci, Thomas; Prior, Thomas; Lloyd-Puryear, Michele; Sugarman, Elaine A.; Terry, Sharon F.; Urv, Tiina; Wang, Ching; Watson, Michael; Yaron, Yuval; Frosst, Phyllis; Howell, R. Rodney

2014-01-01

325

Isolated intramedullary spinal cord cysticercosis  

PubMed Central

Neurocysticercosis is a major cause of epilepsy in developing countries. Cysticercal involvement of the spinal cord is rare even in endemic areas and accounts for 0.7 to 5.85% of all cases. We present a 19-year-old man who presented with weakness of both lower limbs and urinary complaints in the form of straining of micturition with increased frequency, in whom preoperative MRI revealed a well-defined cystic lesion in dorso-lumber cord extending from D11 to L1 level, which on pathological examination was found to be intramedullary cysticercosis. PMID:25540546

Qazi, Zeeshan; Ojha, Bal Krishna; Chandra, Anil; Singh, Sunil Kumar; Srivastava, Chhitij; Patil, Tushar B.

2014-01-01

326

Spinal meningiomas in dogs: description of 8 cases including a novel radiological and histopathological presentation.  

PubMed

Clinical, imaging, and histological features of 8 canine spinal meningiomas, including a cervical cystic meningioma with imaging and intraoperative features of an arachnoid cyst, are described. All meningiomas were histologically classified and graded following the international World Health Organization human classification for tumors. Six meningiomas were located in the cervical spinal cord. Myelography showed intradural/ extramedullary lesions in 3/4 cases. Magnetic resonance imaging revealed hyperintense intradural/extramedullary masses on pre-contrast T1-weighted and T2-weighted images with homogeneous contrast enhancement in 7/8 cases. One dog had a cerebrospinal fluid-filled subarachnoid cavity dorsal to the cervical spinal cord. A spinal arachnoid cyst was diagnosed on imaging, but the histopathological study of the resected tissue revealed a grade I meningothelial cystic meningioma. There were no differences in outcome associated with tumor grade and surgical treatment (6/8). Cystic meningioma should be considered in the differential diagnosis of intraspinal cystic lesions, and biopsy is necessary for definitive diagnosis. PMID:24155414

José-López, Roberto; de la Fuente, Cristian; Pumarola, Martí; Añor, Sonia

2013-10-01

327

Spinal meningiomas in dogs: Description of 8 cases including a novel radiological and histopathological presentation  

PubMed Central

Clinical, imaging, and histological features of 8 canine spinal meningiomas, including a cervical cystic meningioma with imaging and intraoperative features of an arachnoid cyst, are described. All meningiomas were histologically classified and graded following the international World Health Organization human classification for tumors. Six meningiomas were located in the cervical spinal cord. Myelography showed intradural/ extramedullary lesions in 3/4 cases. Magnetic resonance imaging revealed hyperintense intradural/extramedullary masses on pre-contrast T1-weighted and T2-weighted images with homogeneous contrast enhancement in 7/8 cases. One dog had a cerebrospinal fluid-filled subarachnoid cavity dorsal to the cervical spinal cord. A spinal arachnoid cyst was diagnosed on imaging, but the histopathological study of the resected tissue revealed a grade I meningothelial cystic meningioma. There were no differences in outcome associated with tumor grade and surgical treatment (6/8). Cystic meningioma should be considered in the differential diagnosis of intraspinal cystic lesions, and biopsy is necessary for definitive diagnosis. PMID:24155414

José-López, Roberto; de la Fuente, Cristian; Pumarola, Martí; Añor, Sonia

2013-01-01

328

Ochronosis diagnosed after knee arthroscopy  

PubMed Central

INTRODUCTION Ochronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid, which have high affinity to collogen, in the connective tissues. It is a clinical condition characterized with ochronotic pigmentation of tissues, degenerative arthropathy of especially large joints and black discoloration of urine. In this paper we present a case of ochronosis diagnosed with biopsy and additional tests when a black discoloration of menisci and joint cartilage were detected during arthroscopic intervention for a degenerative meniscus tear. PRESENTATION OF CASE A forty two year-old male patient was operated for lateral meniscus tear of his right knee. The arthroscopic examination of right knee revealed black colored synovial hypertrophy and torn lateral meniscus. Partial meniscectomy was performed. The diagnosis of ochronosis was made after histopathologic examination. DISCUSSION Ochronotic pigment can accumulate in hyaline cartilage, tendon, skin, teeth, nail, sclera, tympanic membrane, heart valves, renal tubular cells, duramater, pancreas and walls of large arteries. In ochronosis the most frequently involved joints are knee and hip. In ochronotic arthropathy, articular cartilage become more sensitive to mechanical stresses. Our patient had meniscal tear, cartilage damage and black discoloration of synovial tissues and meniscus. CONCLUSION Arthroscopy may be helpful in diagnosis of ochronotic arthropathy. PMID:24993694

Kara, Adnan; Celik, Haluk; Seker, Ali; Sezer, Hasan Basri; Kilinc, Eray; Uzun, Metin

2014-01-01

329

Spinal Lipomas in Children: Outcome of 270 Procedures  

Microsoft Academic Search

Spinal lipomas are a common cause of spinal cord tethering. Recently, prophylactic surgical removal of spinal lipomas has been questioned, especially of the conus medullaris. Unfortunately, few statistically significant series have been reported. A total of 213 children with spinal lipomas were operated on at the Children’s Memorial Hospital in Chicago, Ill., USA, on whom 270 procedures were carried out

Frank La Marca; John A. Grant; Tadanori Tomita; David G. McLone

1997-01-01

330

Perspectives of Linkage to Care Among People Diagnosed With HIV.  

PubMed

Timely linkage to HIV care and treatment has led to improved individual and population benefits; however, 25%-31% of people diagnosed with HIV do not engage in care. Most linkage to care research has focused on larger metropolitan areas, but smaller metropolitan and rural areas encounter unique challenges to linkage to care. Our purpose was to examine factors influencing the decision to seek care by 27 people infected with HIV living in smaller metropolitan and rural areas of Florida. We used grounded theory methods to develop a theoretical model describing the decision-making process and participant recommendations within the context of stigma. Participants described support, defining care, activating care, conflicting messages of care, and pivotal events influencing the care decision. Findings highlight the complexities of HIV care and suggest a client-centered approach to address the multifaceted social and structural challenges people with HIV face in the journey from infection to care. PMID:25665884

Cook, Christa L; Lutz, Barbara J; Young, Mary-Ellen; Hall, Allyson; Stacciarini, Jeanne-Marie

2015-01-01

331

Encephalomyelitis due to Cryptococcus neoformans var gattii presenting as spinal tumour: case report and review of the literature  

PubMed Central

A 24 year old immunocompetent German resident is described who developed multifocal encephalomyelitis due to infection with Cryptococcus neoformans var gatti, commonly considered a disease of tropical regions. In the light of current knowlege on the epidemiology of C neoformans var gatti and the travel history of the patient it is assumed that the infection was aquired outside Europe. As exclusive intramedullary involvement is an outstandingly rare manifestation in spinal cryptococcosis, the particular diagnostic procedure and the therapeutic stratagies are discussed?? PMID:11118259

Grosse, P; Tintelnot, K; Sollner, O; Schmitz, B

2001-01-01

332

[Instruments for spinal cord stimulation].  

PubMed

Development of instruments for spinal cord stimulation is remarkable. We can implant two cylinder-type stimulation electrodes in parallel into the spinal epidural space. We call this method for dual-lead SCS. Dual lead-SCS is useful to induce paresthesia over the painful area, and the success rate of pain reduction induced by dual-lead SCS is increasing. For dual-lead stimulation, the RestoreSensor, the EonMini, and the Precision Plus are suitable and useful for the treatment of intractable pain. Based on the results of a drug-challenge test with ketamine, we applied dual-SCS for the treatment of various kinds of neuropathic pain. Comparing with the results of single-lead SCS, dual-lead SCS has obvious advantages to evoke paresthesia over the painful area, and showed a remarkable effects for pain reduction. Dual-lead SCS combined with low-dose ketamine drip infusion method is useful for the treatment of various kinds of neuropathic pain. Even if the direct effect of ketamine is transient, effects that provide release from central sensitization and the wind-up phenomenon may be important to increase the effects of dual-lead SCS. Based on the development of dual-lead SCS, SCS therapy has become an important and powerful method for the treatment of intractable pain. PMID:25098136

Yamamoto, Takamitsu; Fukaya, Chikashi; Yoshino, Atsuo

2014-07-01

333

IL-12p40 Deficiency Leads to Uncontrolled Trypanosoma cruzi Dissemination in the Spinal Cord Resulting in Neuronal Death and Motor Dysfunction  

PubMed Central

Chagas’ disease is a protozoosis caused by Trypanosoma cruzi that frequently shows severe chronic clinical complications of the heart or digestive system. Neurological disorders due to T. cruzi infection are also described in children and immunosuppressed hosts. We have previously reported that IL-12p40 knockout (KO) mice infected with the T. cruzi strain Sylvio X10/4 develop spinal cord neurodegenerative disease. Here, we further characterized neuropathology, parasite burden and inflammatory component associated to the fatal neurological disorder occurring in this mouse model. Forelimb paralysis in infected IL-12p40KO mice was associated with 60% (p<0.05) decrease in spinal cord neuronal density, glutamate accumulation (153%, p<0.05) and strong demyelization in lesion areas, mostly in those showing heavy protein nitrosylation, all denoting a neurotoxic degenerative profile. Quantification of T. cruzi 18S rRNA showed that parasite burden was controlled in the spinal cord of WT mice, decreasing from the fifth week after infection, but progressive parasite dissemination was observed in IL-12p40KO cords concurrent with significant accumulation of the astrocytic marker GFAP (317.0%, p<0.01) and 8-fold increase in macrophages/microglia (p<0.01), 36.3% (p<0.01) of which were infected. Similarly, mRNA levels for CD3, TNF-?, IFN-?, iNOS, IL-10 and arginase I declined in WT spinal cords about the fourth or fifth week after infection, but kept increasing in IL-12p40KO mice. Interestingly, compared to WT tissue, lower mRNA levels for IFN-? were observed in the IL-12p40KO spinal cords up to the fourth week of infection. Together the data suggest that impairments of parasite clearance mechanisms in IL-12p40KO mice elicit prolonged spinal cord inflammation that in turn leads to irreversible neurodegenerative lesions. PMID:23152844

Bombeiro, André Luis; Gonçalves, Lígia Antunes; Penha-Gonçalves, Carlos; Marinho, Claudio Romero Farias; D’Império Lima, Maria Regina; Chadi, Gerson; Álvarez, José Maria

2012-01-01

334

Disseminated fungal infection in two species of captive sharks.  

PubMed

In this report, two cases of systemic mycosis in captive sharks are characterized. These cases were progressive and ultimately culminated in terminal disease. Paecilomyces lilacinus, an uncommon pathogen in human and veterinary medicine, was associated with areas of necrosis in the liver, heart, and gill in a great hammerhead shark (Sphyrna mokarran). Fungal growth was observed from samples of kidney, spleen, spinal fluid, and coelomic cavity swabs. Dual fungal infection by Exophiala pisciphila and Mucor circinelloides was diagnosed in a juvenile zebra shark (Stegostoma fasciatum). Both fungi were present in the liver, with more severe tissue destruction associated with E. pisciphila. E. pisciphila also produced significant necrosis in the spleen and gill, while M. circinelloides was associated with only minimal tissue changes in the heart. Fungal cultures from liver, kidney, and spleen were positive for both E. pisciphila and M. circinelloides. Identification of P. lilacinus and M. circinelloides was based on colonial and hyphal morphology. E. pisciphila was identified by sequence analysis of the 28S rRNA D1/D2 region and the internal transcribed spacer (ITS) region between the 18S and 28S rRNA subunit. These cases, and a lack of information in the literature, highlight the need for further research and diagnostic sampling to further characterize the host-pathogen interaction between elasmobranchs and fungi. PMID:22204064

Marancik, David P; Berliner, Aimee L; Cavin, Julie M; Clauss, Tonya M; Dove, Alistair D M; Sutton, Deanna A; Wickes, Brian L; Camus, Alvin C

2011-12-01

335

Nosocomial Infection Reduction in VLBW Infants With a Statewide Quality-Improvement Model  

PubMed Central

OBJECTIVE: To evaluate the effectiveness of the California Perinatal Quality Care Collaborative quality-improvement model using a toolkit supplemented by workshops and Web casts in decreasing nosocomial infections in very low birth weight infants. DESIGN: This was a retrospective cohort study of continuous California Perinatal Quality Care Collaborative members' data during the years 2002–2006. The primary dependent variable was nosocomial infection, defined as a late bacterial or coagulase-negative staphylococcal infection diagnosed after the age of 3 days by positive blood/cerebro-spinal fluid culture(s) and clinical criteria. The primary independent variable of interest was voluntary attendance at the toolkit's introductory event, a direct indicator that at least 1 member of an NICU team had been personally exposed to the toolkit's features rather than being only notified of its availability. The intervention's effects were assessed using a multivariable logistic regression model that risk adjusted for selected demographic and clinical factors. RESULTS: During the study period, 7733 eligible very low birth weight infants were born in 27 quality-improvement participant hospitals and 4512 very low birth weight infants were born in 27 non–quality-improvement participant hospitals. For the entire cohort, the rate of nosocomial infection decreased from 16.9% in 2002 to 14.5% in 2006. For infants admitted to NICUs participating in at least 1 quality-improvement event, there was an associated decreased risk of nosocomial infection (odds ratio: 0.81 [95% confidence interval: 0.68–0.96]) compared with those admitted to nonparticipating hospitals. CONCLUSIONS: The structured intervention approach to quality improvement in the NICU setting, using a toolkit along with attendance at a workshop and/or Web cast, is an effective means by which to improve care outcomes. PMID:21339273

Powers, Richard J.; Pettit, Janet S.; Lee, Henry C.; Boscardin, W. John; Ahmad Subeh, Mohammad; Gould, Jeffrey B.

2011-01-01

336

Spinal destruction induced by chronic contained rupture of an abdominal aortic aneurysm: report of a case.  

PubMed

We report a case of spinal destruction caused by chronic contained rupture of an abdominal aortic aneurysm (AAA). The patient was a 73-year-old man who had undergone coronary artery bypass grafting, sigmoidectomy for colon cancer, and axillofemoral bypass with AAA resection within months of each other, 3 years earlier. Abdominal computed tomography and magnetic resonance imaging showed destruction of the 12th thoracic and 1st lumbar vertebrae. The possibility of a metastatic spine tumor prompted us to consult the orthopedic surgeons, who recommended a spinal percutaneous needle aspiration biopsy. However, the cardiovascular surgeons diagnosed chronic contained rupture of an inflammatory AAA. The patient gradually improved with antimicrobial treatment, but died of disseminated intravascular coagulation the following year. The definitive diagnosis was confirmed by autopsy. We report this case for its educational value, considering the serious consequences that might have occurred had we attempted to biopsy the lesion. PMID:15864425

Ubukata, Hideyuki; Kasuga, Teruhiko; Motohashi, Gyou; Katano, Motonobu; Tabuchi, Takafumi

2005-01-01

337

Spinal Intradural Hematoma and Permanent Paraparesis after a Lumboperitoneal Shunt Operation: An Unusual Complication  

PubMed Central

Pseudotumor cerebri is a condition of increased intracranial pressure in the absence of clinical, laboratory or radiological pathology. Spinal intradural hematoma formation after lumboperitoneal shunt (LPS) implantation is very rare, but it can cause sudden and serious deterioration. In this report, we present a patient who developed an intradural hematoma following LPS operation. A 27-year-old male patient suffering from headaches and progressive vision loss was diagnosed with pseudotumor cerebri. He underwent LPS operation in January 2009. Four hours after the operation, he developed urinary and fecal incontinence with paraparesis (1/5). Lumbar magnetic resonance imaging identified an intradural hematoma at the level of L2-L3, and he was reoperated. The intradural hematoma was removed. Physical therapy was started because of paraparesis. Two months later, the patient's muscle strength had increased to 3/5. Surgeons must remember that, LPS implantation can cause a spinal intradural hematoma in a small percentage of patients, with catastrophic results. PMID:25187872

Efendioglu, Mustafa; Bolukbasi, Fatih Han; Aslan, Sahin; Isik, Nejat; Kaner, Tuncay

2014-01-01

338

Spinal intradural hematoma and permanent paraparesis after a lumboperitoneal shunt operation: an unusual complication.  

PubMed

Pseudotumor cerebri is a condition of increased intracranial pressure in the absence of clinical, laboratory or radiological pathology. Spinal intradural hematoma formation after lumboperitoneal shunt (LPS) implantation is very rare, but it can cause sudden and serious deterioration. In this report, we present a patient who developed an intradural hematoma following LPS operation. A 27-year-old male patient suffering from headaches and progressive vision loss was diagnosed with pseudotumor cerebri. He underwent LPS operation in January 2009. Four hours after the operation, he developed urinary and fecal incontinence with paraparesis (1/5). Lumbar magnetic resonance imaging identified an intradural hematoma at the level of L2-L3, and he was reoperated. The intradural hematoma was removed. Physical therapy was started because of paraparesis. Two months later, the patient's muscle strength had increased to 3/5. Surgeons must remember that, LPS implantation can cause a spinal intradural hematoma in a small percentage of patients, with catastrophic results. PMID:25187872

Basaran, Recep; Efendioglu, Mustafa; Bolukbasi, Fatih Han; Aslan, Sahin; Isik, Nejat; Kaner, Tuncay

2014-08-01

339

Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report  

SciTech Connect

A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a case of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism.

Han, Young-Min, E-mail: ymhan@chonbuk.ac.kr; Kwak, Ho-Sung; Jin, Gong-Young; Chung, Gyung-Ho [Chonbuk National University Medical School, Departments of Radiology (Korea, Republic of); Song, Kyung-Jin [Chonbuk National University Medical School, Departments of Orthopedic Surgery (Korea, Republic of)

2006-06-15

340

Spinal cord injury rehabilitation in Nepal.  

PubMed

Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the establishment of the various hospitals with rehabilitation units, rehabilitation centres and physical therapy units in different institutions. However, the spinal cord injury rehabilitation setting and scenario is different in Nepal from those in the developed countries since spinal cord injury rehabilitation care has not been adequately incorporated into the health care delivery system nor its importance has been realized within the medical community of Nepal. To name few, lack of human resource for the rehabilitation care, awareness among the medical personnel and general population, adequate scientific research evidence regarding situation of spinal injury and exorbitant health care policy are the important hurdles that has led to the current situation. Hence, it is our responsibility to address these apparent barriers to successful implementation and functioning of rehabilitation so that those with spinal injury would benefit from enhanced quality of life. PMID:24362674

Shah, Nabina; Shrestha, Binav; Subba, Kamana

2013-01-01

341

Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an HIV-positive patient  

Microsoft Academic Search

.  \\u000a Tuberculous involvement of the spinal subdural and intramedullary compartments is extremely uncommon. Simultaneous involvement\\u000a of both compartments has never been reported, to our knowledge. We present an HIV-positive patient with such kind of combined\\u000a involvement. Diagnosis was made on the basis of a prior history of pulmonary tuberculous infection and a positive therapeutic\\u000a response to antituberculous chemotherapy. Magnetic resonance

Giovanni Alessi; Marc Lemmerling; Narendra Nathoo

2003-01-01

342

A draping technique for spinal surgery using the Stagnara wake-up test.  

PubMed

This draping procedure has been used at our hospital in more than 200 spinal procedures. The main advantage is that the surgeon has a direct view of the feet and can personally observe the results of the test. The draping procedure is simple, and it eliminates the chance of contamination when lifting the drapes. No disadvantages have been noted to date, and there have been no infections. PMID:3178197

Huss, G K; Betz, R R; Clancy, M

1988-09-01

343

What is different about spinal pain?  

PubMed Central

Background The mechanisms subserving deep spinal pain have not been studied as well as those related to the skin and to deep pain in peripheral limb structures. The clinical phenomenology of deep spinal pain presents unique features which call for investigations which can explain these at a mechanistic level. Methods Targeted searches of the literature were conducted and the relevant materials reviewed for applicability to the thesis that deep spinal pain is distinctive from deep pain in the peripheral limb structures. Topics related to the neuroanatomy and neurophysiology of deep spinal pain were organized in a hierarchical format for content review. Results Since the 1980’s the innervation characteristics of the spinal joints and deep muscles have been elucidated. Afferent connections subserving pain have been identified in a distinctive somatotopic organization within the spinal cord whereby afferents from deep spinal tissues terminate primarily in the lateral dorsal horn while those from deep peripheral tissues terminate primarily in the medial dorsal horn. Mechanisms underlying the clinical phenomena of referred pain from the spine, poor localization of spinal pain and chronicity of spine pain have emerged from the literature and are reviewed here, especially emphasizing the somatotopic organization and hyperconvergence of dorsal horn “low back (spinal) neurons”. Taken together, these findings provide preliminary support for the hypothesis that deep spine pain is different from deep pain arising from peripheral limb structures. Conclusions This thesis addressed the question “what is different about spine pain?” Neuroanatomic and neurophysiologic findings from studies in the last twenty years provide preliminary support for the thesis that deep spine pain is different from deep pain arising from peripheral limb structures. PMID:22764841

2012-01-01

344

A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures  

PubMed Central

Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS) has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the “pros” of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other) in various subspecialties, and correlated these with patients’ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors) contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery), preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection), along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS. PMID:24843814

Epstein, Nancy E.

2014-01-01

345

Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia  

PubMed Central

Summary HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later. This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography PMID:20584440

Ling, J.C.M.; Agid, R.; Nakano, S.; Souza, M.P.S.; Reintamm, G.; TerBrugge, K.G.

2005-01-01

346

Urinary Tract Infections  

Microsoft Academic Search

\\u000a Urinary tract infection (UTI) is among the most commonly diagnosed and treated infectious disease in ambulatory practice.\\u000a Key principles in the management of UTI include empiric short-course therapy for appropriate patients, initiation of (or rapid\\u000a conversion to) effective oral therapy, implementing measures to prevent recurrent UTI, and avoiding antimicrobial therapy\\u000a for asymptomatic bacteriuria, aside from a few clearly indicated circumstances.

Dimitri M. Drekonja; James R. Johnson

347

Diagnosing and managing postherpetic neuralgia.  

PubMed

Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. Varicella zoster infection is almost universally prevalent, making prevention of acute herpes zoster (AHZ) infection and prompt diagnosis and aggressive management of PHN of critical importance. Despite the recent development of a herpes zoster vaccine, prevention of AHZ is not yet widespread or discussed in PHN treatment guidelines. Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. PHN pain is typically localized, unilateral and chronic, but may be constant, intermittent, spontaneous and/or evoked. PHN is likely to interfere with sleep and daily activities. First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. Tricyclic antidepressants, gabapentinoids and strong opioids are effective but are also associated with systemic adverse events that may limit their use in many patients, most notably those with significant medical comorbidities or advanced age. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Given the low systemic drug exposure, adverse events with topical therapies are generally limited to application-site reactions, which are typically mild and transient with lidocaine 5 % patch, but may involve treatment-limiting discomfort with capsaicin cream or 8 % patch. Based on available clinical data, clinicians should consider administering the herpes zoster vaccine to all patients aged 60 years and older. Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies. PMID:23038608

Nalamachu, Srinivas; Morley-Forster, Patricia

2012-11-01

348

TNF(alpha) modulation of visceral and spinal sensory processing.  

PubMed

The cytokine tumor necrosis factor(alpha) (TNF(alpha)) is associated with a constellation of physiological and behavioral characteristics that follow in response to infection such as fever, fatigue, listlessness, loss of appetite, malaise, and tactile hypersensitivity. These responses are examples of central nervous system (CNS) functions modified by the activated immune system. Our studies have focused on the involvement of TNF(alpha) in CNS control of gastrointestinal function and "visceral malaise". We have demonstrated that TNF(alpha) can elicit gastric stasis in a dose-dependent fashion via its interaction with vago-vagal neurocircuitry in the brainstem. Sensory elements of the vago-vagal reflex circuit (i.e., neurons of the solitary tract [NST] and area postrema [AP]) are activated by exposure to TNF(alpha), while the efferent elements (i.e., dorsal motor neurons of the vagus [DMN]) cause gastroinhibition. Transient exposure to low doses of TNF(alpha) cause potentiated (exaggerated) NST responses to stimulation. Subsequent studies suggest that TNF(alpha) presynaptically modulates the release of glutamate from primary afferents to the NST. Using immunohistochemical studies, we have observed the constitutive expression of the TNFR1 receptor on central vagal afferents and spinal trigeminal afferents in the medulla, as well as on cells and afferent fibers within the dorsal root ganglia and within laminae I and II of the dorsal horn throughout the spinal cord. The constitutive presence of these receptors on these afferents may explain why inflammatory or infectious processes that generate TNF(alpha) can disrupt gastrointestinal functions and cause tactile hypersensitivity. These receptors may also play a critical role in the chronic allodynia and hyper-reflexia observed after spinal cord injury or peripheral nerve damage. PMID:15853670

Hermann, G E; Holmes, G M; Rogers, R C

2005-01-01

349

Long Term Outcome of Non-Dysraphic Intramedullary Spinal Cord Lipomas in Adults: Case Series and Review  

PubMed Central

Study Design It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature. Purpose The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas. Overview of Literature Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013. Methods Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases. Results Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status. Conclusions Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit. PMID:25187865

Raghunathan, Natarajan; Radhi, Lawrence

2014-01-01

350

CHRONIC PAIN FOLLOWING SPINAL CORD INJURY  

PubMed Central

Most patients with insults to the spinal cord or central nervous system suffer from excruciating, unrelenting, chronic pain that is largely resistant to treatment. This condition affects a large percentage of spinal cord injury patients, and numerous patients with multiple sclerosis, stroke and other conditions. Despite the recent advances in basic science and clinical research the pathophysiological mechanisms of pain following spinal cord injury remain unknown. Here we describe a novel mechanism of loss of inhibition within the thalamus that may predispose for the development of this chronic pain and discuss a potential treatment that may restore inhibition and ameliorate pain. PMID:23281514

Masri, Radi; Keller, Asaf

2013-01-01

351

Increasing proportion of AIDS diagnoses among older adults in Italy.  

PubMed

We evaluated the impact of AIDS among older persons in Italy and compared these cases with cases among younger persons. The data source was Italy's National AIDS Registry. We considered adults diagnosed with AIDS between 1982 and 2005. Older adults were defined as those aged 50 years or older at diagnosis. Of the total adult cases, 8.8% were among older adults. This proportion increased over time, from 4.9% in 1982-1990 to 15.9% in 2000-2005. Among older adults, the most represented exposure category (80.8%) was sexual intercourse (heterosexual and homosexual). At AIDS diagnosis, older adults, compared to younger adults, had a higher risk of developing AIDS dementia complex or wasting syndrome, and of presenting multiple AIDS-defining illnesses. A significantly lower proportion of older adults were undergoing antiretroviral therapy, compared to younger adults. Among older adults, 67.2% were late testers, compared to 32.8% of younger adults. Most of the older adults acquired the infection through sexual contact; approximately two thirds of them were diagnosed late (i.e., first HIV-positive test 6 months or less before AIDS diagnosis); and only one fourth were undergoing antiretroviral therapy at diagnosis. These observations stress the need to more seriously consider the possibility of HIV infection among older individuals and to collect more detailed information on their sexual behavior. PMID:18435593

Longo, Benedetta; Camoni, Laura; Boros, Stefano; Suligoi, Barbara

2008-05-01

352

Spinal epidural lipomatosis in korean.  

PubMed

Spinal epidural lipomatosis (SEL) is a rare disorder, regarded in literature as a consequence of administration of exogenous steroids, associated with a variety of systemic diseases, endocrinopathies and the Cushing's syndrome. Occasionally, SEL may occur in patients not exposed to steroids or suffering from endocrinopathies, namely, idiopathic SEL. Thus far, case studies of SEL among Korean have been published rather sporadically. We reviewed the clinical features of SEL cases, among Koreans with journal review, including this report of three operated cases. According to this study, there were some differences between Korean and western cases. Koreans had higher incidences of idiopathic SEL, predominant involvement in the lumbar segments, very few thoracic involvement and lower MBI, as opposed to westerners. PMID:25237435

Yoo, Je Chul; Choi, Jeong Jae; Lee, Dong Woo; Lee, Sang Pyung

2014-06-01

353

Spinal Epidural Lipomatosis in Korean  

PubMed Central

Spinal epidural lipomatosis (SEL) is a rare disorder, regarded in literature as a consequence of administration of exogenous steroids, associated with a variety of systemic diseases, endocrinopathies and the Cushing's syndrome. Occasionally, SEL may occur in patients not exposed to steroids or suffering from endocrinopathies, namely, idiopathic SEL. Thus far, case studies of SEL among Korean have been published rather sporadically. We reviewed the clinical features of SEL cases, among Koreans with journal review, including this report of three operated cases. According to this study, there were some differences between Korean and western cases. Koreans had higher incidences of idiopathic SEL, predominant involvement in the lumbar segments, very few thoracic involvement and lower MBI, as opposed to westerners. PMID:25237435

Yoo, Je Chul; Choi, Jeong Jae; Lee, Dong Woo

2014-01-01

354

Managing complications of posterior spinal instrumentation and fusion.  

PubMed

Complications of posterior spinal instrumentation for adolescent idiopathic scoliosis are often preventable. Preoperative planning helps to minimize intraoperative and postoperative problems. Late recurrence of rotational deformity (crankshaft) in skeletally immature patients can be prevented by adding anterior surgery. Intraoperative complications are minimized by controlled hypotensive anesthesia and sequencing of surgical steps to allow for autocoagulation, reducing blood loss. Use of spinal cord monitoring, Stagnara wakeup test, and careful distraction decreases the risk of neurologic deficit. Good hook-site preparation helps avoid dural tears. The incidence of postoperative pneumothorax and hemothorax is decreased by careful hook attachment, avoiding pleural penetration, judicious use of rib excision thoracoplasty, and roentgenographic verification of central venous pressure line position. Postoperative recommendations include bed position at 30 degrees, frequent log rolling, incentive spirometry, early sitting and standing, early Foley catheter and nasogastric tube removal, prophylactic antibiotics, and prompt attention to wound infections. Postoperative orthotic wear, prescribed exercise, and activity restriction decrease the risk of early instrumentation failure and help correct early postoperative trunk imbalance. The late complications include suspected pseudarthrosis; this should be surgically treated again if there is persistent pain or marked loss of curve correction. PMID:1395301

Wenger, D R; Mubarak, S J; Leach, J

1992-11-01

355

MRI features of spinal Fluorosis: Results of an endemic community screening  

PubMed Central

Objectives: Fluorosis is endemic in many parts of the world. However community studies on MRI features of fluorosis are lacking. The aim of this study was to determine MRI features of spinal changes in a community with endemic fluorosis in the Thar Desert Pakistan. Methodology: Randomly selected adults from the Village Samorindh, district Tharparker, Sindh, Pakistan, with spinal fluorosis diagnosed on plain x-rays and raised serum fluoride levels were studied from June 2008 to January 2009. MRI was carried out on 0.5 T open magnet MRI system. Features of vertebral body, spinal ligaments, intervertebral disc, facet joints, iliac wings and other incidental findings were noted. Sclerosis was defined as low signal intensity on both T1 and T2 weighted images. Results were described as mean and percentage values. Results: All the studied 27 subjects complained of back ache without neurological signs. The average age was 43.33 ± 10.45 years; 21 being male (77.8%). The most frequent findings included generalized vertebral sclerosis (24, 88.8%), ligamentum flavum hypertrophy (23, 85%), anterior (20, 74%) and lateral (17, 62.9%) disc herniation, thickened longitudinal ligaments, and narrowing of spinal foramina. Hemangioma was seen in 04(14.8%). The most commonly involved level was L1-2, L4-5 and lower dorsal spine. Conclusion: Vertebral sclerosis, a combination of premature degeneration with anterior disc herniation and an unusually high frequency of vertebral hemangioma formed the spectrum of MRI findings in subjects with spinal fluorosis having back ache but no neurological findings. PMID:24353535

Ahmed, Iftekhar; Sohail, Saba; Hussain, Munawwar; Khan, Nazeer; Hameed Khan, Masood

2013-01-01

356

Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647  

PubMed Central

Background The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis. Methods The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study. Patients were enrolled into the two antimicrobial therapy groups (doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin) consecutively. For the cost analysis of the two regimens, only the cost of antibiotic therapy was analysed for each patient. Results During the study period, 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups. Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group. Forty-two levels of spinal column were involved in 31 patients. The most common affected site was lumbar spine (n = 32, 76%) and involvement level was not different in two groups. Despite the disadvantages (older age, more prevalent operation and abscess formation before the therapy) of the patients in the ciprofloxacin plus rifampicin group, the duration of the therapy (median 12 weeks in both groups) and clinical response were not different from the doxycycline plus streptomycin. The cost of ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy. Conclusion Classical regimen (doxycycline plus streptomycin), with the appropriate duration (at least 12 weeks), is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed. PMID:16606473

Alp, Emine; Koc, Rahmi Kemal; Durak, Ahmet Candan; Yildiz, Orhan; Aygen, Bilgehan; Sumerkan, Bulent; Doganay, Mehmet

2006-01-01

357

Immunodiffusion test for diagnosing basidiobolomycosis.  

PubMed

An immunodiffusion test was developed for the diagnosis of basidiobolomycosis. When culture filtrate antigen (CFA) from Basidiobolus ranarum was reacted against two human patient and two rabbit antisera, 2 precipitin bands, inner (N) and outer (Y), were revealed for both patient and rabbit antisera. A line of identity was also observed between precipitin bands obtained with patient and rabbit sera. When CFA from B. ranarum (B CFA) was reacted against rabbit sera which contained antibody to Conidiobolus coronatus and Pythium insidiosum, 1 precipitin band corresponding to inner band (N) was observed. This finding showed that B. ranarum, C. coronatus and P. insidiosum shared at least one common antigen. After B CFA was absorbed with Pythium rabbit antiserum, the inner precipitin line that occurred between B CFA and rabbit antisera of Pythium and Conidiobolus disappeared. However, with Basidiobolus rabbit antiserum, the result did not change. The antigens which could be demonstrated by inner (N) and outer (Y) precipitin bands were heat stable at 56 degrees C for 30 min. The titer of the antibodies specific to these antigens decreased as the lesions subsided. When B. ranarum CFA was reacted against sera from 20 apparently normal persons, 20 diabetes mellitus patients, 5 aspergillosis patients, 2 candidosis patients and 3 pythiosis patients, no precipitin band was found. B. ranarum CFA was also treated with each rabbit antiserum specific to Candida albicans, Malassezia furfur and Aspergillus fumigatus. No precipitin bands occurred with any of these antisera. Thus, this test was found to be practical, sensitive and specific, and can be used to monitor patients infected with Basidiobolus ranarum. PMID:1528227

Imwidthaya, P; Srimuang, S

1992-06-01

358

Isolated spinal neurobehçet disease. MR imaging findings.  

PubMed

MR imaging findings of a patient with isolated cervical spinal cord involvement of neurobehçet disease is presented. To our knowledge this will be the sixth case reported in the literature. PMID:14510765

Cakirer, S

2003-09-01

359

Genetics Home Reference: Spinal muscular atrophy  

MedlinePLUS

... children. Spinal muscular atrophy, lower extremity, dominant (SMA-LED) is characterized by leg muscle weakness that is ... to another. DYNC1H1 gene mutations that cause SMA-LED disrupt the function of the dynein complex. As ...

360

Epidural Angiolipoma With Spinal Cord Compression  

PubMed Central

A case of epidural angiolipoma is reported. This tumor rarely occurs in the spinal canal. The most common location is in the thoracic region, and its histogenesis is probably congenital. ImagesFigure 1Figure 2Figure 3 PMID:3351973

Poon, Tung P.; Behbahani, M.; Matoso, Ivone M.; Katz, Marcia A.; Pearl, Marilyn

1988-01-01

361

Stenosis of the spinal canal in achondroplasia  

Microsoft Academic Search

Stenosis of the spinal canal is a very frequent finding in achondroplastic patients. It is secondary to abnormalities of endochondrial ossification, which is responsible for formation of the vertebral bone structures, and, subsequently, to bone degeneration.

L. Ferrante; M. Acqui; L. Mastronardi; P. Celli; A. Fortuna

1991-01-01

362

Spinal cord implants for nerve regeneration  

E-print Network

It has only been in the last couple decades that the potential for regeneration in the spinal cord became accepted. However, there is still no proven method for enabling this regeneration. An implant model was developed ...

Abbaschian, Lara Suzanne, 1979-

2004-01-01

363

The Impact Biomechanics of Spinal Column Injuries  

Microsoft Academic Search

The vertebral column is the central bony pillar of the body and serves to protect the spinal cord from injury. Vertebrae show\\u000a regional differences but they all possess a common pattern. Analysis of the biomechanics of individual components of the spine\\u000a allows one to predict how the spinal column behaves during impact. Although many forces and moments in different directions

M. J. Shelly; A. R. Poynton

364

Uncommon Progression of an Extradural Spinal Meningioma  

PubMed Central

Extradural spinal meningiomas are rare. Our understanding of purely extradural spinal meningiomas is still incomplete and they may be easily confused with malignant neoplasms, much more common in this location. We report a rare case of a purely extradural thoracic spine meningioma in a 70-year-old man, with an unusual progression. In addition we discuss the pathogenesis of these tumors and the potential pitfalls in differential diagnosis and review the relevant literature concerning their treatment and outcome. PMID:25243091

Boughamoura, Mohamed; Mahmoudi, Houda; Kilani, Mohamed; Hattab, Nejib

2014-01-01

365

Spinal subdural hematoma mimicking epidural lipomatosis.  

PubMed

We report a case of spinal subdural hematoma in the lumbar spine of a 75-year-old woman. Magnetic resonance imaging showed lesions of homogeneous high intensity in the spinal canal on both T?- and T?-weighted images, findings closely resembling those for epidural lipomatosis. Identification of 2-layered signal intensity surrounding the cauda equina on axial images is the key for accurate diagnosis. PMID:23037565

Kamo, Minobu; Watanabe, Yoshiyuki; Numaguchi, Yuji; Saida, Yukihisa

2012-01-01

366

Spinal cord protection for thoracic aortic surgery.  

PubMed

Spinal cord protection is critical for successful outcomes after descending thoracic and thoracoabdominal aortic aneurysm repair. For descending thoracic aneurysms which end above T9, optimum protection is maintained by distal aortic perfusion via a left atrial to distal arterial bypass circuit with a centrifugal pump. In repairs of extensive thoracoabdominal aneurysms, additional measures are required of extensive thoracoabdominaal aneurysms, additional measures are required including hypothermia, intercostal artery implantation into the graft, and spinal fluid drainage. PMID:10589347

Hilgenberg, A D

1999-11-01

367

Regeneration of ascending spinal axons in goldfish.  

PubMed

Regeneration of descending spinal cord tracts occur spontaneously in adult goldfish. Very little information is available regarding the fate of ascending fibers. Using Dextran amines as a tracer, we studied the normal and regenerated ascending axonal projection patterns in adult goldfish brain nuclei. Present study includes spinal projections to torus semicircularis, hypothalamus, thalamus and the telencephalon. Regenerated fibers had finer caliber axons and the terminal axonal arbors covered a larger area than the corresponding normal ones. PMID:9593911

Hanna, G F; Nawar, N N; Sharma, S C

1998-04-27

368

Pituitary and intradural spinal metastases: an unusual initial presentation of lung cancer.  

PubMed

The authors report the clinical and imaging findings for a 47-year-old woman who presented with the classic symptoms of a sellar or suprasellar mass; the lesion was initially diagnosed as germinoma and was treated accordingly. The patient also had intradural, extramedullary spinal metastases. Radiotherapy failed, and the patient died. Autopsy revealed that the lesions were metastatic from previously unrecognized large-cell carcinoma of the lung. This distribution of metastases from a primary lesion not located within the central nervous system is unusual but should be considered in any patient presenting with masses at these sites, particularly if the response to therapy is less than expected. PMID:7704674

Struk, D W; Knapp, T R; Munk, P L; Poon, P Y

1995-04-01

369

The effect of clinical bias on the interpretation of myelography and spinal computed tomography  

SciTech Connect

Spinal computed tomograms and myelograms of 107 patients with sciatica or low back pain were interpreted with and without knowledge of clinical history. A significant number of interpretations was changed by knowledge of the clinical history. More studies were interpreted correctly without the clinical history than with it. Knowledge of the clinical history increased the number of false-positive and decreased the number of false-negative diagnoses. This study suggest a tendency of observers to interpret questionable myelographic or computed tomograhic findings as positive when they correlate with clinical findings.

Eldevik, O.P. (Ulleval Hospital, Oslo, Norway); Dugstad, G.; Orrison, W.W.; Haughton, V.M.

1982-10-01

370

Serotonergic transmission after spinal cord injury.  

PubMed

Changes in descending serotonergic innervation of spinal neural activity have been implicated in symptoms of paralysis, spasticity, sensory disturbances and pain following spinal cord injury (SCI). Serotonergic neurons possess an enhanced ability to regenerate or sprout after many types of injury, including SCI. Current research suggests that serotonine (5-HT) release within the ventral horn of the spinal cord plays a critical role in motor function, and activation of 5-HT receptors mediates locomotor control. 5-HT originating from the brain stem inhibits sensory afferent transmission and associated spinal reflexes; by abolishing 5-HT innervation SCI leads to a disinhibition of sensory transmission. 5-HT denervation supersensitivity is one of the key mechanisms underlying the increased motoneuron excitability that occurs after SCI, and this hyperexcitability has been demonstrated to underlie the pathogenesis of spasticity after SCI. Moreover, emerging evidence implicates serotonergic descending facilitatory pathways from the brainstem to the spinal cord in the maintenance of pathologic pain. There are functional relevant connections between the descending serotonergic system from the rostral ventromedial medulla in the brainstem, the 5-HT receptors in the spinal dorsal horn, and the descending pain facilitation after tissue and nerve injury. This narrative review focussed on the most important studies that have investigated the above-mentioned effects of impaired 5-HT-transmission in humans after SCI. We also briefly discussed the promising therapeutical approaches with serotonergic drugs, monoclonal antibodies and intraspinal cell transplantation. PMID:24866695

Nardone, Raffaele; Höller, Yvonne; Thomschewski, Aljoscha; Höller, Peter; Lochner, Piergiorgio; Golaszewski, Stefan; Brigo, Francesco; Trinka, Eugen

2015-02-01

371

Sexually transmitted infections in women.  

PubMed

Sexually transmitted infections (STIs) are highly prevalent and cause a wide spectrum of disease. However, the majority of these infections may be unrecognized due to lack of overt signs or symptoms of infection. Asymptomatic infections remain significant as a result of the potential for long-term sequelae, predominately in women, and the risks of complications during pregnancy as well as mother-to-child transmission. Laboratory diagnostics play an important role in identifying infection and in public health efforts to reduce the prevalence of these diseases. Serologic diagnosis is appropriate for syphilis and, in some settings, for herpes infections. However, the organisms that cause discharge such as Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium are best diagnosed using molecular assays. Currently available molecular assays are suitable for use with non-invasively collected sample types, most notably vaginal swabs for women thus expanding the potential reach of STI control programs to include non-clinic based screening. PMID:25083897

Van Der Pol, Barbara

2014-01-01

372

A Structural Analysis of Health Outcomes After Spinal Cord Injury  

PubMed Central

Objective: To develop and validate a latent model of health outcomes among persons with spinal cord injury. Methods: Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures). Results: We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation ?=? 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation ?=? 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics. Conclusion: Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators. PMID:20397441

Krause, James S; Reed, Karla S; McArdle, John J

2010-01-01

373

How Are Pelvic Floor Disorders Diagnosed?  

MedlinePLUS

... Trials Resources and Publications En Español How are pelvic floor disorders diagnosed? Skip sharing on social media ... bulge that suggests a prolapse during a routine pelvic exam. In other cases, a woman may see ...

374

How Is High Blood Cholesterol Diagnosed?  

MedlinePLUS

... Is High Blood Cholesterol Diagnosed? Explore High Blood Cholesterol What Is... Other Names Causes Signs & Symptoms Diagnosis Treatments Clinical Trials Links Related Topics Atherosclerosis Carotid Artery Disease Coronary Heart Disease Heart Attack Peripheral Arterial Disease Send a ...

375

Diagnosing spatial variation patterns in manufacturing processes  

E-print Network

This dissertation discusses a method that will aid in diagnosing the root causes of product and process variability in complex manufacturing processes when large quantities of multivariate in-process measurement data are available. As in any data...

Lee, Ho Young

2004-09-30

376

How Is High Blood Pressure Diagnosed?  

MedlinePLUS Videos and Cool Tools

... are here Home » Health Information for the Public » Health Topics » High Blood Pressure » How Is High Blood Pressure Diagnosed? Explore High Blood Pressure What Is... Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical ...

377

Neuroblastoma in Children: Just Diagnosed Information  

MedlinePLUS

... mistake that happens during cell division. Symptoms of Neuroblastoma There are no symptoms of neuroblastoma that are ... High blood pressure Rapid heartbeat Persistent diarrhea Diagnosing Neuroblastoma There are many procedures and tests that might ...

378

How Is Sickle Cell Anemia Diagnosed?  

MedlinePLUS

... from the NHLBI on Twitter. How Is Sickle Cell Anemia Diagnosed? A simple blood test, done at ... Next >> Featured Video Living With and Managing Sickle Cell Disease (Nicholas) 10/14/2014 Living With and ...

379

How Do Health Care Providers Diagnose Endometriosis?  

MedlinePLUS

... Trials Resources and Publications En Español How do health care providers diagnose endometriosis? Skip sharing on social media ... under a microscope, to confirm the diagnosis. 1 Health care providers may also use imaging methods to produce ...

380

How Do Health Care Providers Diagnose Pheochromocytoma?  

MedlinePLUS

... Trials Resources and Publications En Español How do health care providers diagnose pheochromocytoma? Skip sharing on social media links Share this: Page Content A health care provider uses blood and urine tests that measure ...

381

How Do Health Care Providers Diagnose Hypoparathyroidism?  

MedlinePLUS

... Information Clinical Trials Resources and Publications How do health care providers diagnose hypoparathyroidism? Skip sharing on social media links Share this: Page Content A health care provider will order a blood test to determine ...

382

Diagnosing Asthma in Very Young Children  

MedlinePLUS

... Asthma in Babies & Toddlers Health Issues Listen Diagnosing Asthma in Babies & Toddlers Article Body One of the ... family with recurrent bronchitis or sinus problems. When Asthma is Not the Cause Your pediatrician will listen ...

383

Clinical assessment of stereotactic IGRT: spinal radiosurgery.  

PubMed

The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At our institution, we have developed a successful multidisciplinary spinal radiosurgery program in which 542 spinal lesions (486 malignant and 56 benign lesions) were treated with a single-fraction radiosurgery technique. Patient ages ranged from 18 to 85 years (mean 56 years). Lesion location included 92 cervical, 234 thoracic, 130 lumbar, and 86 sacral. The most common metastatic tumors were renal cell (89 cases), breast (74 cases), and lung (71 cases). The most common benign tumors were neurofibroma (24 cases), schwannoma (13 cases), and meningioma (7 cases). Eighty-nine cervical lesions were treated using skull tracking. Thoracic, lumbar, and sacral tumors were tracked relative to either gold or stainless steel fiducial markers. The maximum intratumoral dose ranged from 12.5 to 30 Gy (mean 20 Gy). Tumor volume ranged from 0.16 to 298 mL (mean 47 mL). Three hundred thirty-seven lesions had received prior external beam irradiation with spinal cord doses precluding further conventional irradiation. The primary indication for radiosurgery was pain in 326 cases, as a primary treatment modality in 70 cases, for tumor radiographic tumor progression in 65 cases, for post-surgical treatment in 38 cases, for progressive neurological deficit in 35 cases, and as a radiation boost in 8 cases. Follow-up period was at least 3 to 49 months. Axial and/or radicular pain improved in 300 of 326 cases (92%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Thirty of 35 patients (85%) with progressive neurological deficits experienced at least some improvement after treatment. Spinal stereotactic radiosurgery is now a feasible, safe, and clinically effective technique for the treatment of a variety of spinal lesions. The potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with essentially no recovery time and excellent symptomatic response. This technique offers a new therapeutic modality for the primary treatment of a variety of spinal lesions, including the treatment of neoplasms in medically inoperable patients, previously irradiated sites, for lesions not amenable to open surgical techniques, and as an adjunct to surgery. PMID:18456162

Gerszten, Peter C; Burton, Steven A

2008-01-01

384

The accuracy of bedside neurological diagnoses.  

PubMed

The accuracy of bedside diagnoses was prospectively studied in 100 consecutive patients admitted to the neurology service at New England Medical Center, Boston. Each patient was evaluated independently by a junior resident, a senior resident, and a staff neurologist, who were required to make an anatomical and etiological diagnosis based solely on the history and physical examination. Fourteen patients were excluded because their diagnoses were known before admission. Of the remaining 86 patients, it was possible to confirm anatomical and etiological diagnoses in 40 by matching the clinical syndromes with highly specific laboratory findings. In the other 46 patients, the diagnoses could not be confirmed because the laboratory studies (including magnetic resonance imaging) were negative or nondiagnostic. In the 40 patients with laboratory confirmed final diagnoses, the clinical diagnoses of the junior residents, senior residents, and staff neurologists were correct in 26 (65%), 30 (75%), and 31 (77%), respectively. There was a trend for error rates to be higher among junior residents than staff (p = 0.06). The errors by the junior residents, [senior residents], (staff) were attributed to incomplete history and examination in 4 [1] (0), inadequate fund of knowledge in 4 [3] (3), and poor diagnostic reasoning in 6 [6] (6). These results indicate that technology is not a panacea for our diagnostic difficulties and that there is room for improvement in our clinical skills, especially diagnostic reasoning. PMID:2375637

Chimowitz, M I; Logigian, E L; Caplan, L R

1990-07-01

385

Learn About Spinal Muscular Atrophy  

NSDL National Science Digital Library

What is spinal muscular atrophy (SMA)? It is an inherited disease that affects approximately 1 in 10,000 infants born in the United States each year. There are four types of SMA, which can cause the muscles to function improperly and become smaller and weaker over time. Visitors to this site, which was created by researchers at Cold Spring Harbor Laboratory, should start their journey here by clicking on the What is SMA? section. Here they can watch Dr. Darryl De Vivo provide an overview of the four types of SMA and then look through video clips from other professionals who provide additional insights into the genetics behind SMA. Moving on, the SMA Science area provides high-quality animations that illustrate the various processes involved with the SMN gene (mutations of which are responsible for SMA) and protein splicing. Visitors can also click on the SMA Therapies to learn more about what's being done for people living with SMA, along with potential new treatments.

2011-01-01

386

New Aspects of Salmonella Infection in Broiler Production  

Microsoft Academic Search

POULTRY are a considerable reservoir of salmonellae and a common source of infection in human Salmonella epidemics1. In 1971 a severe outbreak of Salmonella infantis infection occurred among Finnish broiler flocks, and 277 human cases2 were diagnosed as caused by the same serotype. The broiler industry suffered serious losses through confiscation of broiler meat and elimination of infected birds.

E. Nurmi; M. Rantala

1973-01-01

387

Spinal cord pilocytic astrocytoma with leptomeningeal dissemination to the brain. Case report and review of the literature.  

PubMed

Leptomeningeal dissemination of low-grade spinal cord gliomas is an uncommon event. The authors report a unique case of leptomeningeal dissemination of a spinal cord pilocytic astrocytoma (PCA) to the intracranial cerebral subarachnoid spaces in a child. A 2-year-old boy presented with a loss of balance and the inability to walk or stand. An intradural intramedullary spinal cord tumor was identified, and the lesion was subtotally resected and diagnosed by the pathology department to be a PCA. Subsequently, the patient had recurrences of the intradural intramedullary tumor at 6 months and 2 years after his original presentation. He underwent a repeated resection of the recurrent tumor and fenestration of an associated syrinx on both occasions. The pathological characteristics of the reresected tumor remained consistent with those of a PCA. Postoperative imaging after his last surgery revealed diffuse intracranial leptomeningeal dissemination into the cisternal space surrounding the midbrain, the suprasellar region, and the internal auditory canal, as well as nodular subarachnoid disease in the upper cervical region. The patient then underwent chemotherapy, and total spine magnetic resonance (MR) imaging 2 months later demonstrated stability in the size of the spinal cord tumor and a decrease in the associated syrinx. However, an MR image of the head demonstrated two new areas of supratentorial subarachnoid leptomeningeal spread of the primary spinal cord tumor at the 2-month follow-up examination. At the 6-month follow-up examination, MR imaging of the head and spine demonstrated stable metastatic disease. This case illustrates a unique instance of supratentorial leptomeningeal dissemination of an intramedullary spinal cord PCA in a child. PMID:17184088

Abel, Taylor J; Chowdhary, Abhineet; Thapa, Mahesh; Rutledge, Joe C; Geyer, J Russell; Ojemann, Jeffrey; Avellino, Anthony M

2006-12-01

388

Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review  

PubMed Central

Background Context: Chronic low back pain (CLBP) is a prevalent disorder that has a significant burden to society in terms of loss of work time and increased economic cost. Two common treatment choices of intervention for CLBP are spinal manipulation and prescribed exercise. Purpose: The purpose of this systematic review was to examine the effectiveness of spinal manipulation vs prescribed exercise for patients diagnosed with CLBP. Studies that compared head-to-head spinal manipulation to an exercise group were included in this review. Methods: A search of the current literature was conducted using a keyword process in CINAHL, Cochrane Register of Controlled Trials Database, Medline, and Embase. The search was conducted on, and included studies available up to August 29th 2014. Studies were included based on PICOS criteria 1) individuals with CLBP defined as lasting 12 weeks or longer; 2) spinal manipulation performed by a health care practitioner; 3) prescribed exercise for the treatment of CLBP and monitored by a health care practitioner; 4) measurable clinical outcomes for reducing pain, disability or improving function; 5) randomized controlled trials. The quality of included articles was determined by the author using the criteria developed and used by the Physiotherapy Evidence Database (PEDro). Results: Three randomized controlled trials met the inclusion criteria of this systematic review and were included in this review. The outcomes used in these studies included Disability Indexes, Pain Scales and function improvement scales. The results included a mix of effects with one study finding spinal manipulation as more effective and another finding the exercises more so. The third study found both interventions offering equal effects in the long term. Conclusion: Based on the findings of this systematic review there is no conclusive evidence that clearly favours spinal manipulation or exercise as more effective in treatment of CLBP. More studies are needed to further explore which intervention is more effective.

Merepeza, Alban

2014-01-01

389

Persistent paralysis after spinal anesthesia for cesarean delivery.  

PubMed

Anterior spinal artery syndrome has rarely been reported as a cause of permanent neurologic complications after neuraxial anesthesia in obstetric patients. A parturient developed anterior spinal artery syndrome after spinal anesthesia for cesarean delivery. A healthy 32-year-old parturient presented at 41(2/7) weeks for primary elective caesarean delivery for breech presentation. Spinal anesthesia was easily performed with clear cerebrospinal fluid, and block height was T4 at 5 minutes. Intraoperative course was uneventful except for symptomatic bradycardia (37-40 beats per minute) and hypotension (88/44 mm Hg) 4 minutes postspinal anesthesia, treated with ephedrine and atropine. Dense motor block persisted 9 hours after spinal anesthesia, and magnetic resonance imaging of the lumbosacral region was normal, finding no spinal cord compression or lesion. Physical examination revealed deficits consistent with a spinal cord lesion at T6, impacting the anterior spinal cord while sparing the posterior tracts. PMID:25433726

Zaphiratos, Valerie; McKeen, Dolores M; Macaulay, Bruce; George, Ronald B

2014-11-26

390

Genetics Home Reference: Spinal and bulbar muscular atrophy  

MedlinePLUS

... Spinal and bulbar muscular atrophy, also known as Kennedy disease, is a disorder of specialized nerve cells that ... muscular atrophy? bulbospinal muscular atrophy, X-linked KD Kennedy disease Kennedy's disease Kennedy spinal and bulbar muscular atrophy ...

391

Spinal intradural cystic venous angioma originating from a nerve root in the cauda equina.  

PubMed

A spinal intradural extramedullary venous angioma is extremely rare and has not been previously reported. In this paper, the authors report on this entity with morphological and immunohistochemical evidence, and discuss the surgical strategy for its treatment. A 54-year-old woman presented to Nagoya University Hospital complaining of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the previous 2 weeks. Lumbar spine MRI showed an intradural extramedullary cyst at the level of T12-L1, which extended from the conus medullaris to the cauda equina. The cyst wall was not enhanced on T1-weighted MRI with Gd. Intraoperatively, a midline dural opening allowed the authors to easily visualize a dark-reddish cyst behind the spinal nerve rootlets in the cauda equina adjacent to the conus medullaris. The cyst was believed to originate from one of the spinal nerve rootlets in the cauda equina and a cluster of veins was identified on the cyst wall. The cyst was resected with the affected nerve rootlet. The surgery left no detectable neurological deficit. Based on the morphological and immunohistochemical evidence, the lesion was diagnosed as a venous angioma. No tumor recurrence was confirmed based on MRI at the time of the 2-year follow up. This is the first report of an intradural extramedullary cystic venous angioma that was successfully resected. PMID:24093468

Nishimura, Yusuke; Hara, Masahito; Natsume, Atsushi; Nakajima, Yasuhiro; Fukuyama, Ryuichi; Wakabayashi, Toshihiko; Ginsberg, Howard J

2013-12-01

392

Intramedullary Sarcoidosis Presenting with Delayed Spinal Cord Swelling after Cervical Laminoplasty for Compressive Cervical Myelopathy  

PubMed Central

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis.

Kwon, Du Ho; Kim, Eun-Sang; Eoh, Whan

2014-01-01

393

Intramedullary sarcoidosis presenting with delayed spinal cord swelling after cervical laminoplasty for compressive cervical myelopathy.  

PubMed

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis. PMID:25535524

Kwon, Du Ho; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

2014-11-01

394

Central Causes of Foot Drop: Rare and Underappreciated Differential Diagnoses  

PubMed Central

Background/Objective: Peripheral causes of foot drop are well recognized. However, causes stemming from the central nervous system represent rare, important, and underappreciated differential etiologies. Methods: Two cases of foot drop stemming from central causes are described. Patients: The first patient, a 46-year-old man with a remote history of lumbar spine fracture and L4-L5 instrumentation/fusion, presented with progressive weakness and numbness of the left foot, followed within 3 months by similar symptoms in the right foot. Lumbar spine imaging failed to reveal compressive nerve root pathology. Electromyography, nerve conduction studies, and muscle and nerve biopsy suggested a preganglionic lesion and ruled out a peripheral cause. Upper spine magnetic resonance imaging (MRI) revealed significant spinal stenosis at C4-C7 and T11-T12. Patient 2 was a 66-year-old man with a known left parasagittal convex meningioma diagnosed 2 years prior presented with a progressive right foot drop over 2 months. Spine imaging was normal, and serial brain MRI confirmed a slowly enlarging parasagittal meningioma. Results: Following decompressive laminectomies at C4-C7 and T11-T12, patient 1's gait improved, with marked resolution of his right foot drop and significant improvement on the left. Patient 2 underwent craniotomy for microsurgical tumor resection. At the 2-week follow-up examination, he was taking daily walks. Conclusions: Central causes, although rare, need to be considered in the differential diagnosis of foot drop. Central causative lesions usually occur at locations where pyramidal tract connections are condensed and specific and the function is somatotopically organized. These cases confirm that good results can be achieved when correctable central causes of foot drop are recognized. PMID:17385271

Westhout, Franklin D; Paré, Laura S; Linskey, Mark E

2007-01-01

395

Staphylococcal Infections  

MedlinePLUS

... of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections (pronounced "staff infections"), including ... Some staph bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) are resistant to certain antibiotics, making infections harder ...

396

Tinea Infections  

MedlinePLUS

... infections? My child has to take showers after gym class. How can I keep him/her from getting tinea infections? If I have cracks in my skin, ... Diagnosis and Management of Common Tinea Infections by SL Noble, Pharm. ...

397

Whipworm infection  

MedlinePLUS

Whipworm infection is caused by the roundworm, Trichuris trichiura. It is a common infection that mainly affects children. Children may become infected if they swallow soil contaminated with whipworm eggs. When ...

398

Value of Micro-CT for Monitoring Spinal Microvascular Changes after Chronic Spinal Cord Compression  

PubMed Central

Neurological degeneration can occur after compression of the spinal cord. It is widely accepted that spinal cord compression leads to ischemic lesions and ultimately neurological dysfunction due to a narrowed spinal canal. Therefore, an in-depth understanding of the pathogenesis of spinal cord compression injury is required to help develop effective clinical interventions. In the present study, we propose a new method of quantitative 3D micro-CT to observe microvascular events in a chronic spinal cord compression rat model. A total of 36 rats were divided into two groups: sham control group (n = 12) and compressive spinal cord injury group (n = 24). Rats were scarified at four weeks after surgery. In each group, CD34 micro-vessel immunohistochemical staining was performed in half of the animals, while micro-CT scanning was performed in the other half. Microvessel density (MVD) was measured after immunohistochemical staining, while the vascular index (VI) was measured in 3D micro-CT. In comparison with sham control, abnormal somatosensory evoked potentials (SEP) can be seen in all 24 cases of the compression group, and VI shows the amount of microvessels reduced consistently and significantly (p < 0.01). A significant correlation is also found between MVD and VI (r = 0.95, p < 0.01). These data suggest that quantitative 3D micro-CT is a sensitive and promising tool for investigating microvascular changes during chronic compressive spinal cord injury. PMID:25003643

Long, Hou-Qing; Xie, Wen-Han; Chen, Wen-Li; Xie, Wen-Lin; Xu, Jing-Hui; Hu, Yong

2014-01-01

399

MRI Evaluation of Spinal Length and Vertebral Body Angle During Loading with a Spinal Compression Harness  

NASA Technical Reports Server (NTRS)

Weight bearing by the spinal column during upright posture often plays a role in the common problem of low back pain. Therefore, we developed a non-ferromagnetic spinal compression harness to enable MRI investigations of the spinal column during axial loading. Human subjects were fitted with a Nest and a footplate which were connected by adjustable straps to an analog load cell. MRI scans of human subjects (5 males and 1 female with age range of 27-53 yrs) during loaded and unloaded conditions were accomplished with a 1.5 Tesla GE Signa scanner. Studies of two subjects undergoing sequentially increasing spinal loads revealed significant decreases (r(sup 2) = 0.852) in spinal length between T4 and L5 culminating in a 1.5 to 2% length decrease during loading with 75% body weight. Sagittal vertebral body angles of four subjects placed under a constant 50% body weight load for one hour demonstrated increased lordotic and kyphotic curvatures. In the lumbar spine, the L2 vertebral body experienced the greatest angular change (-3 deg. to -5 deg.) in most subjects while in the thoracic spine, T4 angles increased from the unloaded state by +2 deg. to +9 deg. Overall, our studies demonstrate: 1) a progressive, although surprisingly small, decrease in spinal length with increasing load and 2) relatively large changes in spinal column angulation with 50% body weight.

Campbell, James A.; Hargens, Alan R.; Murthy, G.; Ballard, R. E.; Watenpaugh, D. E.; Hargens, Alan, R.; Sanchez, E.; Yang, C.; Mitsui, I.; Schwandt, D.; Fechner, K. P.; Holton, Emily M. (Technical Monitor)

1998-01-01

400

Spinal Cord Tolerance in the Age of Spinal Radiosurgery: Lessons from Pre-clinical Studies  

PubMed Central

Clinical implementation of spinal radiosurgery has increased rapidly in recent years but little is known regarding human spinal cord tolerance to single-fraction irradiation. In contrast, preclinical studies in single-fraction spinal cord tolerance have been ongoing since the 1970’s. The influences of field length, dose rate, inhomogeneous dose distributions and reirradiation have all been investigated. This review summarizes literature regarding single-fraction spinal cord tolerance in pre-clinical models with an emphasis on practical clinical significance. The outcomes of studies that incorporate uniform irradiation are surprisingly consistent among multiple small and large animal models. Extensive investigation of inhomogeneous dose distributions in the rat has demonstrated a significant dose-volume effect while preliminary results from one pig study are contradictory. Pre-clinical spinal cord dose-volume studies indicate that dose distribution is more critical than the volume irradiated suggesting that neither dose volume histogram analysis nor absolute volume constraints are effective in predicting complications. Reirradiation data is sparse, but results from guinea pig, rat and pig studies are consistent with the hypothesis that the spinal cord possesses a large capacity for repair. The mechanisms behind the phenomena observed in spinal cord studies are not readily explained and the ability of dose response models to predict outcomes is variable underscoring the need for further investigation. Animal studies provide insight into the phenomena and mechanisms of radiosensitivity but the true significance of animal studies can only be discovered through clinical trials. PMID:21183290

Medin, Paul M.; Boike, Thomas P.

2010-01-01

401

Donald Munro Lecture. Spinal cord injury--past, present, and future.  

PubMed

This special report traces the path of spinal cord injury (SCI) from ancient times through the present and provides an optimistic overview of promising clinical trials and avenues of basic research. The spinal cord injuries of Lord Admiral Sir Horatio Nelson, President James A. Garfield, and General George Patton provide an interesting perspective on the evolution of the standard of care for SCI. The author details the contributions of a wide spectrum of professionals in the United States, Europe, and Australia, as well as the roles of various government and professional organizations, legislation, and overall advances in surgery, anesthesia, trauma care, imaging, pharmacology, and infection control, in the advancement of care for the individual with SCI. PMID:17591221

Donovan, William H

2007-01-01

402

MRI of extradural spinal tumours at 0.3 T  

Microsoft Academic Search

Ninety-one patients with extradural spinal tumours were examined by magnetic resonance imaging. There were 76 metastases (6 from unknown primary tumours). Seven patients had primary spinal tumours and 8 had multiple myeloma. Sixteen had bulging, diseased vertebral bodies compressing the subarachnoid space and 67 had extradural tumour compressing the spinal cord. Sixty patients had paravertebral involvement. Intraspinal involvement did not

M. H. Li; S. Holtås; E. M. Larsson

1993-01-01

403

Towards Optimal Pain Relief: Acupuncture and Spinal Cord Stimulation  

E-print Network

Towards Optimal Pain Relief: Acupuncture and Spinal Cord Stimulation Richard Al'o 1 , Kenneth Al is a discrete optimization problem, e.g., for pain relief methodologies such as acupuncture and spinal cord problems related to pain relief: ffl problems of acupuncture, and ffl problems related to spinal cord

Kreinovich, Vladik

404

[Urgent indications for spinal surgery in patients with rheumatoid inflammation].  

PubMed

The urgency of spinal procedures for rheumatoid inflammatory disease is presented in three typical spinal involvements. Characteristic connections between rheumatoid arthritis and the cervical spine, spinal fractures in ankylosing spondylitis and the occurrence of bacterial spondylodiscitis as a side effect of immunosuppression are discussed. PMID:17268787

Wiesner, L; Steinhagen, J; Hansen-Algenstaedt, N; Rüther, W

2007-02-01

405

The Neuroanatomy of an Amphibian Embryo Spinal Cord  

Microsoft Academic Search

Horseradish peroxidase has been used to stain spinal cord neurons in late embryos of the clawed toad (Xenopus laevis). It has shown clearly the soma, dendrites and axonal projections of spinal sensory, motor and interneurons. On the basis of light microscopy we describe nine differentiated spinal cord neuron classes. These include the Rohon-Beard cells and extramedullary cells which are both

Alan Roberts; J. D. W. Clarke

1982-01-01

406

Infections of the Central Nervous System  

Microsoft Academic Search

\\u000a Infections of the nervous system can be devastating. Their diagnosis and treatment are often challenging, resulting in high\\u000a rates of morbidity and mortality. Early diagnosis and aggressive treatment can have a significant impact on the outcome. For\\u000a patients in whom the clinical and radiological features are not characteristic, diagnosis may require high-volume spinal taps\\u000a and for some, brain and\\/or meningeal

Nicoline Schiess; Avindra Nath

407

Causes of Spinal Cord Injury  

PubMed Central

Background: Knowledge of the causes of spinal cord injury (SCI) and associated factors is critical in the development of successful prevention programs. Objective: This study analyzed data from the National SCI Database (NSCID) and National Shriners SCI Database (NSSCID) in the United States to examine specific etiologies of SCI by age, sex, race, ethnicity, day and month of injury, and neurologic outcomes. Methods: NSCID and NSSCID participants who had a traumatic SCI from 2005 to 2011 with known etiology were included in the analyses (N=7,834). Thirty-seven causes of injury documented in the databases were stratified by personal characteristics using descriptive analysis. Results: The most common causes of SCI were automobile crashes (31.5%) and falls (25.3%), followed by gunshot wounds (10.4%), motorcycle crashes (6.8%), diving incidents (4.7%), and medical/surgical complications (4.3%), which collectively accounted for 83.1% of total SCIs since 2005. Automobile crashes were the leading cause of SCI until age 45 years, whereas falls were the leading cause after age 45 years. Gunshot wounds, motorcycle crashes, and diving caused more SCIs in males than females. The major difference among race/ethnicity was in the proportion of gunshot wounds. More SCIs occurred during the weekends and warmer months, which seemed to parallel the increase of motorcycle- and diving-related SCIs. Level and completeness of injury are also associated with etiology of injury. Conclusions: The present findings suggest that prevention strategies should be tailored to the targeted population and major causes to have a meaningful impact on reducing the incidence of SCI. PMID:23678280

2013-01-01

408

Spinal Neurofibroma Masquerading as a Herniated Disc  

PubMed Central

We present the only case in English medical literature of a spinal neurofibroma misdiagnosed as a herniated disc using magnetic resonance imaging (MRI). This case presented with typical symptoms and radiological findings of a herniated disc. Intraoperatively, an abnormality was noted at the S1 nerve root sleeve. Further exploration revealed a spinal neurofibroma which was completely resected, resulting in an improvement in the patient’s symptoms. Currently, there is heavy reliance on MRI as a highly sensitive and specific tool used in the diagnosis of herniated lumbar discs. Although there have been occasional reports of misdiagnoses using MRI, there are no reported cases of a spinal neurofibroma being misdiagnosed as a herniated lumbar disc. Despite great advances in radiological diagnostic imaging, surgical surprises do still occur. Ultimately, instinct is still essential in intraoperative surgical decisions. PMID:23275853

Lamki, Tariq; Ammirati, Mario

2012-01-01

409

Acute hydrocephalus following cervical spinal cord injury.  

PubMed

We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms. PMID:24175033

Son, Seong; Lee, Sang Gu; Park, Chan Woo; Kim, Woo Kyung

2013-08-01

410

Radiation-Induced Spinal Cord Hemorrhage (Hematomyelia)  

PubMed Central

Intraspinal hemorrhage is very rare and intramedullary hemorrhage, also called hematomyelia, is the rarest form of intraspinal hemorrhage, usually related to trauma. Spinal vascular malformations such intradural arteriovenous malformations are the most common cause of atraumatic hematomyelia. Other considerations include warfarin or heparin anticoagulation, bleeding disorders, spinal cord tumors. Radiation-induced hematomyelia of the cord is exceedingly rare with only one case in literature to date. We report the case of an 8 year old girl with Ewing’s sarcoma of the thoracic vertebra, under radiation therapy, presenting with hematomyelia. We describe the clinical course, the findings on imaging studies and the available information in the literature. Recognition of the clinical pattern of spinal cord injury should lead clinicians to perform imaging studies to evaluate for compressive etiologies. PMID:25568739

Agarwal, Amit; Kanekar, Sangam; Thamburaj, Krishnamurthy; Vijay, Kanupriya

2014-01-01

411

Evaluation of Diagnosis Techniques Used for Spinal Injury Related Back Pain  

PubMed Central

Back pain is a prevalent condition affecting much of the population at one time or the other. Complications, including neurological ones, can result from missed or mismanaged spinal abnormalities. These complications often result in serious patient injury and require more medical treatment. Correct diagnosis enables more effective, often less costly treatment methods. Current diagnosis technologies focus on spinal alterations. Only approximately 10% of back pain is diagnosable, with current diagnostic technologies. The objective of this paper is to investigate and evaluate based on specific criteria current diagnosis technique. Nine diagnostic techniques were found in the literature, namely, discography, myelography, single photon emission computer tomography (SPECT), computer tomography (CT), combined CT & SPECT, magnetic resonance imaging (MRI), upright and kinematic MRI, plain radiography and cineradiography. Upon review of the techniques, it is suggested that improvements can be made to all the existing techniques for diagnosing back pain. This review will aid health service developers to focus on insufficient areas, which will help to improve existing technologies or even develop alternative ones. PMID:22110925

Janssen, Meaghan; Nabih, Aliaa; Moussa, Walied; Kawchuk, Gregory N.; Carey, Jason P.

2011-01-01

412

[Spinal infarction in the anterior spinal territory with possible relation with bilharziasis].  

PubMed

We report a case of spinal cord infarction in the anterior spinal artery territory with selective involvement of the anterior horns. A 35-year-old Mauritanian woman was hospitalized because of an acute and severe flaccid paraplegia without any sphincter dysfunction or sensory disturbance. MRI abnormalities (hypersignal on T2-weighted sequences) were restricted to the anterior horns of the lower thoracic spinal cord and conus medullaris. Adamkiewicz's artery appeared abnormally thin at arteriography. The infarction was probably related to vasculitis of schistosomal origin. PMID:1962071

Liblau, R; Chiras, J; Orssaud, C; Dormont, D; Duclos, H; Gentilini, M

1991-01-01

413

Rare case of trilateral retinoblastoma with spinal canal drop metastasis detected with fluorine-18 fluorodeoxyglucose positronemission tomography/computed tomography imaging.  

PubMed

Trilateral retinoblastoma (TRb) is a rare syndrome associating hereditary bilateral or unilateral retinoblastoma (Rb) with an intracranial neuroblastic tumor. The latter arises in the midline, most often in the pineal gland, less frequently in the suprasellar or parasellar region. The outcome is usually fatal because of secondary spinal dissemination. We report 10-year-old boy presented with a right eye proptosis and leukocoria, and the magnetic resonance imaging (MRI) showed right orbital mass lesion infiltrating optic nerve and diagnosis of retinoblastoma was made. He was referred for fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) to find out the extent of the disease. PET/CT showed abnormal FDG-uptake within right orbital mass lesion, suprasellar enhancing lesion and drop metastasis in the cervical spinal canal level. He was diagnosed as a case of TRb with spinal canal drop metastasis. He underwent chemotherapy and craniospinal irradiation. PMID:24761068

Kamaleshwaran, Koramadai Karuppusamy; Shibu, Deepu K; Mohanan, Vyshakh; Shinto, Ajit Sugunan

2014-04-01

414

Improving Multiple Fault Diagnosability using Possible Conflicts  

NASA Technical Reports Server (NTRS)

Multiple fault diagnosis is a difficult problem for dynamic systems. Due to fault masking, compensation, and relative time of fault occurrence, multiple faults can manifest in many different ways as observable fault signature sequences. This decreases diagnosability of multiple faults, and therefore leads to a loss in effectiveness of the fault isolation step. We develop a qualitative, event-based, multiple fault isolation framework, and derive several notions of multiple fault diagnosability. We show that using Possible Conflicts, a model decomposition technique that decouples faults from residuals, we can significantly improve the diagnosability of multiple faults compared to an approach using a single global model. We demonstrate these concepts and provide results using a multi-tank system as a case study.

Daigle, Matthew J.; Bregon, Anibal; Biswas, Gautam; Koutsoukos, Xenofon; Pulido, Belarmino

2012-01-01

415

Vascular dysfunctions following spinal cord injury  

PubMed Central

The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1–L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life–threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5–T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin–angiotensin–aldosterone activity, peripheral alpha–adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein thrombosis and long–term risk for coronary heart disease and systemic atherosclerosis are also described. Proper prophylaxis, including non–pharmacologic and pharmacological strategies, diminishes the occurrence of the vascular dysfunction following SCI. Each vascular disturbance requires a specific treatment. PMID:20945818

Popa, F; Grigorean, VT; Onose, G; Sandu, AM; Popescu, M; Burnei, G; Strambu, V; Sinescu, C

2010-01-01

416

Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour  

PubMed Central

Background: Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. Aims: The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. Study Design: Retrospective study. Methods: This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. Results: The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. Conclusion: Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes. PMID:25207152

?ahin, Soner; Atabey, Cem; ?im?ek, Mehmet; Naderi, Sait

2013-01-01

417

Spinal Angiolipoma: Case Report and Literature Review  

PubMed Central

Background/Objective: Spinal angiolipoma (SAL) is an uncommon clinico-pathological entity. Design: Single case report. Methods: Retrospective data analysis. Findings: An obese woman with a 1-year history of progressive spastic paraparesis and acute deterioration underwent magnetic resonance imaging of the thoracic spine, the results of which suggested a tumor compressing the thoracic spinal cord. The histopathological examination of the completely resected tumor revealed an epidural angiolipoma. Conclusions: This case report offers a reminder that SAL should be considered in the differential diagnosis of long-standing, slowly progressive paraparesis. It remains unclear whether an increased body mass index might be a contributing factor to the development of SAL. PMID:18795485

Hungs, Marcel; Paré, Laura S

2008-01-01

418

Common surgical complications in degenerative spinal surgery  

PubMed Central

The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved (cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed. PMID:23610753

Papadakis, Michael; Aggeliki, Lianou; Papadopoulos, Elias C; Girardi, Federico P

2013-01-01

419

Multilevel Intramedullary Spinal Neurocysticercosis With Eosinophilic Meningitis  

PubMed Central

Background Cysticercal involvement of the spinal cord is a very rare form of neurocysticercosis. Intramedullary cysts are even less common. Objective To describe a novel presentation of multilevel intramedullary neurocysticercosis with eosinophilic meningitis. Design Case report. Patient A 35-year-old man with a history of cerebral neurocysticercosis who presented with both cauda equina and Brown-Sequard syndromes associated with cerebrospinal fluid findings of eosinophilic meningitis. Results Magnetic resonance imaging confirmed the multilevel intramedullary cord lesions. The patientwas treated medically with dexamethasone and albendazole and had a good recovery. Conclusion Intramedullary neurocysticercosis should be considered as a potentially treatable cause of multilevel spinal lesions with subacute meningitis. PMID:15148157

Torabi, Amir M.; Quiceno, Mary; Mendelsohn, Dianne B.; Powell, Craig M.

2014-01-01

420

Neural correlates of sexual arousal in the spinal cords of able-bodied men: A spinal fMRI investigation  

Microsoft Academic Search

The purpose of this study was to determine whether functional magnetic resonance imaging of the spinal cord (spinal fMRI) could be used to map neural activity throughout the lower thoracic, lumbar and sacral spinal cord regions during sexual arousal in healthy men. To this end, it was found that viewing erotic films and genital self-stimulation both elicited predominantly increased signal,

Natalie Kozyrev; Chase R. Figley; Marcalee S. Alexander; J. Scott Richards; Rachael L. Bosma; Patrick W. Stroman

2012-01-01

421

Infected dermoid tumor causing tethered cord after myelomeningocele repair  

PubMed Central

Intramedulary dermoid tumors are rare tumors mostly found associated with dermal sinus tracts. Spinal dermoid tumor can occur after myelomeningocele repair. Infected dermoid tumors are reported in patients with dermal sinus tracts as well, but have never been reported subsequent to myelomeningocele surgery. Here, we report a rare association of infected dermoid tumor with tethered cord without dermal sinus tract in a child who had been operated for myelomeningocele during infancy. PMID:22837783

Niknejad, Anushirvan; Nejat, Farideh; El Khashab, Mostafa

2012-01-01

422

Pneumocystis pneumonia in South African children diagnosed by molecular methods  

PubMed Central

Background Pneumocystis pneumonia (PCP) is an important cause of hospitalization and mortality in HIV-infected children. However, the incidence of PCP has been underestimated due to poor sensitivity of diagnostic tests. The use of polymerase chain reaction (PCR) for pneumocystis has enabled more reliable diagnosis. This study describes the incidence, clinical features and outcome of PCP in South African children diagnosed using PCR. Methods A prospective study of children hospitalised in South Africa with suspected PCP was done from November 2006 to August 2008. Clinical, laboratory and radiological information were collected. Lower respiratory tract specimens were obtained for PCP immunofluorescence (IF), real- time PCR for pneumocystis, bacterial and mycobacterial culture. Nasopharyngeal aspirates were taken for immunofluorescence (IF), real-time PCR for pneumocystis and PCR for respiratory viruses. A blood specimen for bacterial culture and for cytomegalovirus PCR was taken. Children were followed for the duration of their hospitalisation and the outcome was recorded. Results 202 children [median (interquartile range, IQR) age 3.2 (2.1– 4.6) months] were enrolled; 124 (61.4%) were HIV infected. PCP was identified in 109 (54%) children using PCR, compared to 43 (21%) using IF and Grocott staining (p?infected children. All 21 cases (19%) occurring in HIV- negative children had another risk factor for PCP. On logistic regression, predictive factors for PCP were HIV infection, lack of fever, high respiratory rate and low oxygen saturation whilst cotrimoxazole prophylaxis was protective (OR 0.24; 95% CI 0.1 to 0.5; p?infected children, a CD4 less than 15% was the only independent predictor of mortality. Conclusions The diagnostic yield for PCP is more than 2.5 times higher on PCR than other detection methods. PCP is a very common cause of severe hypoxic pneumonia and is associated with high mortality in HIV-infected African infants. PMID:24410938

2014-01-01

423

Spinal epidural lipomatosis in children with hematologic malignancies  

PubMed Central

Summary Background Abnormal fat deposition in the epidural space or spinal epidural lipomatosis (SEL) due to corticosteroid treatment or obesity may cause obstruction to cerebrospinal fluid flow. Little is known about SEL in patients with hematologic malignancies who require frequent lumbar punctures and corticosteroid treatment that places them at risk. Patients and methods Records and radiologic images of patients with SEL and leukemia or non Hodgkin lymphoma (NHL) treated at a single institution from 1999–2009 were reviewed. Risk factors were compared with 405 control patients with leukemia. Results Fourteen patients with leukemia or NHL were diagnosed with SEL. The majority of patients underwent diagnostic imaging after unsuccessful lumbar punctures within one month of their primary diagnosis. Prior to SEL diagnosis, all patients received systemic and/or intrathecal corticosteroids. SEL diagnosis led to modification of intrathecal administration in 8 patients, including Ommaya reservoir placement in 4 patients. All patients completed protocol-specified chemotherapy without neurologic symptoms or surgical intervention. Risk factors for developing SEL include older age and high body mass index. Conclusions Investigation for SEL in leukemia or lymphoma patients with difficult lumbar punctures is warranted. Placement of an Ommaya reservoir may facilitate safe CNS-directed therapy in severely affected patients. PMID:21340722

Brennan, R.C.; Helton, K.J.; Pei, D.; Cheng, C.; Inaba, H.; Metzger, M.L.; Howard, S.C.; Rubnitz, J.E.; Ribeiro, R.C.; Sandlund, J.T.; Jeha, S.; Pui, CH.; Bhojwani, D.

2011-01-01

424

Spinal epidural lipomatosis in children with hematologic malignancies.  

PubMed

Abnormal fat deposition in the epidural space or spinal epidural lipomatosis (SEL) due to corticosteroid treatment or obesity may cause obstruction to cerebrospinal fluid flow. Little is known about SEL in patients with hematologic malignancies who require frequent lumbar punctures and corticosteroid treatment that places them at risk. Records and radiologic images of patients with SEL and leukemia or non-Hodgkin lymphoma (NHL) treated at a single institution from 1999-2009 were reviewed. Risk factors were compared with 405 control patients with leukemia. Fourteen patients with leukemia or NHL were diagnosed with SEL. The majority of patients underwent diagnostic imaging after unsuccessful lumbar punctures within 1 month of their primary diagnosis. Prior to SEL diagnosis, all patients received systemic and/or intrathecal corticosteroids. SEL diagnosis led to modification of intrathecal administration in eight patients, including Ommaya reservoir placement in four patients. All patients completed protocol-specified chemotherapy without neurologic symptoms or surgical intervention. Risk factors for developing SEL include older age and high body mass index. Investigation for SEL in leukemia or lymphoma patients with difficult lumbar punctures is warranted. Placement of an Ommaya reservoir may facilitate safe CNS-directed therapy in severely affected patients. PMID:21340722

Brennan, Rachel C; Helton, Kathleen J; Pei, Deqing; Cheng, Cheng; Inaba, Hiroto; Metzger, Monika L; Howard, Scott C; Rubnitz, Jeffrey E; Ribeiro, Raul C; Sandlund, John T; Jeha, Sima; Pui, Ching-Hon; Bhojwani, Deepa

2011-09-01

425

Bulbar and spinal muscular atrophy (Kennedy's disease): a review.  

PubMed

Bulbar and spinal muscular atrophy (BSMA) is an adult-onset, X-linked recessive trinucleotide, polyglutamine disorder, caused by expansion of a polymorphic CAG tandem-repeat in exon 1 of the androgen-receptor (AR) gene on chromosome Xq11-12. Pathogenetically, mutated AR accumulates in nuclei and cytoplasm of motor neurons, resulting in their degeneration and loss. Phenotypically, patients present with amyotrophic, proximal or distal weakness and wasting of the facial, bulbar and limb muscles, occasionally sensory disturbances, and endocrinologic disturbances, such as androgen resistance, gynecomastia, elevated testosterone or progesterone, and reduced fertility. There may be mild hyper-CK-emia, abnormal motor and sensory nerve conduction studies, and neuropathic and myopathic alterations on muscle biopsy. The golden standard for diagnosing BSMA is genetic analysis, demonstrating a CAG-repeat number >40. No causal therapy is available, but symptomatic therapy should be provided for tremor, endocrinologic abnormalities, sensory disturbances, or muscle cramps. The course is slowly progressive, the ability to walk lost only late in life, only few patients require ventilatory support, and life expectancy only slightly reduced. PMID:19405197

Finsterer, J

2009-05-01

426

IMAGING DIAGNOSIS-SPINAL CORD HISTIOCYTIC SARCOMA IN A DOG.  

PubMed

A 12-year-old mixed breed dog was presented for evaluation of progressive paraparesis and ataxia. Magnetic resonance (MR) imaging was performed and identified multifocal intradural spinal cord mass lesions. The lesions were hyperintense in T2-weighted sequences, isointense to mildly hyperintense in T1-weighted sequences with strong contrast enhancement of the intradural lesions and spinal cord meninges. Spinal cord neoplasia was suspected. A diagnosis of intramedullary spinal cord histiocytic sarcoma, confined to the central nervous system, was confirmed histopathologically. Spinal cord histiocytic sarcoma is a rare neoplasm, but should be included in the differential diagnosis for dogs with clinical signs of myelopathy. PMID:24382300

Taylor, Amanda; Eichelberger, Bunita; Hodo, Carolyn; Cooper, Jocelyn; Porter, Brian

2014-01-01

427

Spinal Dysraphism: A Neurosurgical Review for the Urologist  

PubMed Central

Spinal neural tube defects are congenital malformations of the spine and spinal cord (eg, myelomeningocele) and are frequently seen in pediatric urology practice. These neurologic problems have many consequences in a child’s life and affect different parts of the body, such as the brain, spinal cord, limbs, bladder, and bowels. Because of the complexity and neurologic aspects of spinal dysraphism, many related terms and aspects of the disease are unfamiliar to the urologist. This review addresses some of the most commonly used neurosurgical terms and concepts related to spinal dysraphism. PMID:19680528

Netto, José Murillo B; Bastos, André N; Figueiredo, André A; Pérez, Luis M

2009-01-01

428

Autism Spectrum Disorder Diagnoses in Stockholm Preschoolers  

ERIC Educational Resources Information Center

The aims of this study were to estimate prevalence rates of children with autism spectrum disorder (ASD) diagnoses in a cohort of 6-year-old children with birth year 2002, referred to the Autism Centre for Young Children, serving the whole of Stockholm county and on the basis of the available data discuss clinical aspects of assessment,…

Fernell, Elisabeth; Gillberg, Christopher

2010-01-01

429

How to Diagnose Allergic Bronchopulmonary Aspergillosis  

Microsoft Academic Search

An immunologically mediated lung disease, allergic bronchopulmonary aspergillosis (ABPA) is predominantly found in patients with asthma and cystic fibrosis (CF). This indolent entity is diagnosed by a set of well established criteria that have unfolded over time. Other than demonstration of central bronchiectasis (CB) with normal tapering bronchi, which is regarded as a key component for the diagnosis of ABPA

Ashok Shah

430

Dynamic Analysis for Diagnosing Integration Faults  

Microsoft Academic Search

Many software components are provided with incomplete specifications and little access to the source code. Reusing such gray-box components can result in integration faults that can be difficult to diagnose and locate. In this paper, we present Behavior Capture and Test (BCT), a technique that uses dynamic analysis to automatically identify the causes of failures and locate the related faults.

Leonardo Mariani; Fabrizio Pastore

2011-01-01

431

Children Diagnosed ADHD: Factors to guide intervention  

Microsoft Academic Search

Psychological, sociological and learning issues and their possible relevance to the behaviour of children diagnosed ADHD were investigated. A questionnaire containing 29 items derived from recommendations for assessment considerations presented in the British Psychological Society's Working Party Report, ? ADHD-A Psychological Response to an Evolving Concept ?, was circulated to schools. Teachers provided views as to the extent these items

Richard A. Cains

2000-01-01

432

Spinal function monitoring by evoked spinal cord potentials in aortic aneurysm surgery  

Microsoft Academic Search

Evoked spinal cord potentials (ESCPs) were monitored in 12 patients who underwent repair of thoracoabdominal aortic aneurysm\\u000a with a high risk of spinal ischemia. A pair of bipolar catheter electrodes were introduced into the epidural space, one at\\u000a the level of the C5-T2 vertebrae and the other at the level of T11-L2. Conductive mixed ESCP in seven patients, conductive\\u000a sensory

Tatsuhiko Kano; Michiaki Sadanaga; Morimasa Matsumoto; Yoshihiro Ikuta; Hidehiro Sakaguchi; Hiraaki Gotoh; Yoshimasa Miyauchi

1995-01-01

433

Evaluation of Human Body Fluids for the Diagnosis of Fungal Infections  

PubMed Central

Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients. Because the etiologic agents of these infections are abundant in nature, their isolation from biopsy material or sterile body fluids is needed to document infection. This review evaluates and discusses different human body fluids used to diagnose fungal infections. PMID:23984401

2013-01-01

434

Return of spinal reflex after spinal cord surgery for brachial plexus avulsion injury.  

PubMed

Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus avulsion injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors' knowledge, this case represents the first time that spinal cord surgery could restore not only motor function but also proprioception completing a spinal reflex arch. PMID:21838504

Carlstedt, Thomas; Misra, V Peter; Papadaki, Anastasia; McRobbie, Donald; Anand, Praveen

2012-02-01

435

A novel rodent model of spinal metastasis and spinal cord compression  

PubMed Central

Background Spinal cord metastatic lesions affect a high number of cancer patients usually resulting in spinal cord compression syndrome. A major obstacle in the research of spinal metastatic disease is the lack of a simple reproducible animal model that mimics the natural course of the disease. In this study, we present a highly reproducible rodent model that can be used for different types of cancers while mimicking the natural course of human metastatic spinal cord compression syndrome. Results All sixteen Fisher 344 rats survived the dorsal approach intraosseous implantation of CRL-1666 adenocarcinoma cells and both rats survived the sham control surgery. By Day 13 functional analysis via the modified Basso-Beattie-Bresnahan (BBB) locomotor rating scale showed significant decrease in motor function; median functional score was 3 for the tumor group (p = 0.0011). Median time to paresis was 8.7 days post-operatively. MR imaging illustrated repeated and consistent tumor formation, furthermore, onset of neurological sequale was the result of tumor formation and cord compression as confirmed by histological examination. Conclusions Analysis of these findings demonstrates a repeatable and consistent tumor growth model for cancer spinal metastases in rats. This novel rat model requires a less intricate surgical procedure, and as a result minimizes procedure time while subsequently increasing consistency. Therefore, this model allows for the preclinical evaluation of therapeutics for spinal metastases that more closely replicates physiological findings. PMID:23116234

2012-01-01

436

Isolation and Characterization of Adult Spinal Disc Stem Cells from Healthy Human Spinal Disc Tissues  

PubMed Central

This report details the isolation, culture, and characterization of spinal disc stem cells derived from human adult spinal disc tissue specimens. Using stem cell suspension culture methods and biology, human adult spinal disc stem cells were isolated and monoclonally cultured into multicellular sphere-like clusters (discospheres). Discospheres from the first culture series were collected, processed, and replated as single stem cells for serial expansion studies using suspension culture, demonstrating linear expansion was possible. Discospheres and adult spinal disc stem cells were plated on matrix coated culture surfaces in stem cell media for several hours to allow fixation, and assayed for the stem cell biomarkers. Discospheres and adult spinal disc stem cells were plated on laminin-coated culture surfaces in chondrogenic media and culture conditions for 14 days to differentiate them into NP cells. NP cells cultured from these experiments demonstrated NP morphology and phenotype; NP biomarker expression, secretion of extracellular matrix, and the ability to be serially passaged with large volume expansion possible. Tissue engineering studies using the “burst kinetic assay”, demonstrated that discospheres have remarkable intrinsic developmental and tissue engineering biology that is robust and organized. In summary, adult disc stem cells and NP cells have been isolated, cultured, and characterized, from healthy spinal disc tissues. These findings demonstrate the important potential to be explored for using stem cell based tissue engineering for the treatment of degenerative disc disease (DDD).

Duntsch, Christopher; Dillard, Erika; Akbar, Umar

2015-01-01

437

Seropositive Neuromyelitis Optica imitating an Intramedullary Cervical Spinal Cord Tumor: Case Report and Brief Review of the Literature  

PubMed Central

A 44-year-old woman with progressive cervical myelopathy and central cord syndrome was noted to have an extensive cervical intramedullary contrast-enhancing lesion on magnetic resonance imaging (MRI). The lesion resembled a spinal astrocytoma or ependymoma that required surgical intervention. She was subsequently diagnosed to have neuromyelitis optica (NMO), a rare idiopathic inflammatory demyelinating disorder, when the clinical examination revealed left optic atrophy. This was confirmed by a test showing seropositivity for NMO-immunoglobulin (IgG). Disease control was achieved with corticosteroids and immunosuppressive therapy. We report a rare case of a patient with NMO who had MRI features that could have easily led to the condition being misdiagnosed as a spinal cord tumor. The importance of careful history taking, awareness of typical radiological findings and the usefulness of serum NMO-IgG as a diagnostic tool are emphasized. PMID:25346824

Chiu, Jennifer Hiu-Fung; Leung, Kar-Ming; Chan, Kwong-Yau

2014-01-01

438

Spinal intradural extramedullary cavernous angioma presenting with superficial siderosis and hydrocephalus: a case report and review of the literature.  

PubMed

A 36-year-old man with progressive hearing impairment visited our hospital complaining of a severe headache. A neurological examination revealed bilateral sensorineural hearing impairment, mild ataxia, hyperreflexia and mild cognitive dysfunction. Brain MRI demonstrated hydrocephalus and typical hypointensity rimming the brain surface on T2(*)-weighted images. The patient was diagnosed as having superficial siderosis. Spinal MRI disclosed the presence of a lumbar intradural extramedullary mass. The surgically resected tumor was histologically found to be a cavernous angioma. Superficial siderosis is an important cause of hearing loss. With respect to the detection of disorders underlying this pathological condition, MRI examinations, including those of the brain and whole spinal cord, are recommended. PMID:25130126

Katoh, Nagaaki; Yoshida, Takuhiro; Uehara, Takeshi; Ito, Kiyoshi; Hongo, Kazuhiro; Ikeda, Shu-ichi

2014-01-01

439

Pediatric primary intramedullary spinal cord glioblastoma  

PubMed Central

Spinal cord tumors in pediatric patients are rare, representing less than 1% of all central nervous system tumors. Two cases of pediatric primary intramedullary spinal cord glioblastoma at ages 14 and 8 years are reported. Both patients presented with rapid onset paraparesis and quadraparesis. Magnetic resonance imaging in both showed heterogeneously enhancing solitary mass lesions localized to lower cervical and upper thoracic spinal cord parenchyma. Histopathologic diagnosis was glioblastoma. Case #1 had a small cell component (primitive neuroectodermal tumor-like areas), higher Ki67, and p53 labeling indices, and a relatively stable karyotype with only minimal single copy losses involving regions: Chr8;pter-30480019, Chr16;pter-29754532, Chr16;56160245–88668979, and Chr19;32848902-qter on retrospective comparative genomic hybridization using formalin-fixed, paraffin-embedded samples. Case #2 had relatively bland histomorphology and negligible p53 immunoreactivity. Both underwent multimodal therapy including gross total resection, postoperative radiation and chemotherapy. However, there was no significant improvement in neurological deficits, and overall survival in both cases was 14 months.This report highlights the broad histological spectrum and poor overall survival despite multi modality therapy. The finding of relatively unique genotypic abnormalities resembling pediatric embryonal tumors in one case may highlight the value of genome-wide profiling in development of effective therapy. The differences in management with intracranial and low-grade spinal cord gliomas and current management issues are discussed. PMID:21139963

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