Mycobacterial Osteomyelitis of the Spine Following Intravesical BCG Therapy for Bladder Cancer.

Osteomyelitis is an infection of the bone that can involve the vertebral column. A rare cause of vertebral osteomyelitis is Mycobacterium bovis after intravesical Bacillus Calmette-Guerin (BCG) therapy for transitional cell carcinoma of the bladder. In this report, we describe the case of a 64-year-old male presenting with constitutional symptoms, progressive thoracic kyphosis, and intractable T11 and T12 radiculopathies over the proceeding six months. A CT scan revealed erosive, lytic changes of the T12 and L1 vertebrae with compression of the T12 vertebra. An MRI demonstrated T11-12 osteomyelitis with intervening discitis and extensive paraspinal enhancement with a corresponding hyperintensity on a short tau inversion recovery (STIR) sequence. A needle aspiration grew out Mycobacterial tuberculosis complex that was pansensitive to all antimicrobial agent therapies, except pyrazinamide on culture, a finding consistent with an M. bovis infection. The patient's infection and neurologic compromise resolved after transthoracic T11-12 vertebrectomies with decompression of the spinal cord and nerve roots as well as T10-L1 instrumented fusion and protracted antimicrobial therapy. The epidemiology and natural history of M. bovis osteomyelitis are reviewed and the authors emphasize a mechanism of vertebral inoculation to explain the predilection of M. bovis osteomyelitis in males after intravesical BCG therapy.

Occipital condyle fracture in a patient with occipitalisation of the atlas.

Occipital condyle fractures and occipitalisation of the atlas are rare entities of the craniocervical junction. To the best of our knowledge, a patient presenting with a traumatic occipital condyle fracture and pre-existing occipitalisation of the atlas has not been previously reported. We report the case of a 79-year-old man presenting with an Anderson and Montesano type III fracture through a fused occipital condyle and lateral mass. This fracture was noted to extend into the transverse foramen and the C1-C2 joint space. The transverse ligament and ligamentum flavum were calcified but not disrupted and the atlantodental interval was within normal limits. The neurological examination was unremarkable with the exception of neck pain. The patient was treated conservatively and placed in a rigid cervical collar for 10 weeks with serial CT studies to monitor healing of the fracture. At 4 months of follow-up, the patient was pain free with nearly complete resolution of his occipital condyle fracture.

Coordination chemistry of N,N,N',N'-tetrakis(3,5-substituted benzyl-2-oxide)-2,2'-(ethylenedioxy)diethanamine modified Group 4 metal alkoxides.

The coordination behavior of a set of (ethylenedioxy)diethanamine-based tetraphenol ligands with a series of Group 4 metal alkoxides ([M(OR)(4)]) was determined. The ligands were synthesized from a modified Mannich reaction and fully characterized as N,N,N',N'-tetrakis(3,5-tert-butyl-benzyl-2-hydroxy)-2,2'-(ethylenedioxy)diethanamine, termed H(4)-OEA-DBP(4) (1), and N,N,N',N'-tetrakis(3,5-chloro-benzyl-2-hydroxy)-2,2'-(ethylenedioxy)diethanamine, termed H(4)-OEA-DCP(4) (2). The reaction of 1 with a set of [M(OR)(4)] [M = Ti, Zr, or Hf; OR = iso-propoxide (OPr(i)), neo-pentoxide (ONep), or tert-butoxide (OBu(t))] precursors led to the isolation of [(OPr(i))(2)Ti](2)(µ-OEA-DBP(4)) (3), [(ONep)(2)Ti](2)(µ-OEA-DBP(4)) (4), and [(OBu(t))(2)M](2)(µ-OEA-DBP(4)) where M = Ti (5), Zr (6), or Hf (7). In addition, the [(ONep)(2)Ti](2)(µ-OEA-DCP(4)) (4a) derivative was isolated from the reaction of 2 and [Ti(ONep)(4)], demonstrating the similarity of coordination behavior between the two OEA-R(4) ligands. For 3-7, the metal center adopts a slightly distorted octahedral geometry by binding the two O atoms of the phenoxide moiety, as well as one N and one O atom from the OEA moieties, while retaining two of the original OR ligands. Solution NMR demonstrates inequivalent protons for the majority of the bound OEA ligands, which argues for retention of structure in solution. The synthesis and characterization of these compounds are presented in detail.