Penetrating injury to the cauda equina: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: To report a rare case of a penetrating injury to the cauda equina, secondary to a stab wound. SUMMARY OF BACKGROUND DATA: Penetrating injuries affecting the cauda equina by stab wounds, not by gunshot wounds, are of extremely rare occurrence compared with penetrating spinal cord injuries and have been previously reported only in 2 studies since 1969. METHODS AND RESULTS: A 43-year-old man was presented with a stab wound to the right lumbar region, with immediate paralysis of the left lower extremity accompanied by loss of perineal sensation. Magnetic resonance imaging suggested rupture of the cauda equina nerves at the L3 to L4 level. The patient was taken immediately for surgery for irrigation and debridement. We identified several cut ends of the cauda equina nerves and attempted to repair them, but had to determine that accurate matching of the severed ends would be problematic. At 2 years follow-up, there were no significant improvements in the neurological status. The patient was ambulatory with an ankle-foot orthosis, and had already returned back to work. CONCLUSIONS: We could not repair the cauda equina rootlets. However, similar to other central nervous system penetrating injuries, the priorities of treatment included an emphasis on infection control and sealing of the duro-cutaneous fistula, and we could easily manage both by the emergency surgery. Although there were no improvements in the neurological function, there were no complications and the patient returned to a reasonably good function.

Therapeutic effects of percutaneous vertebroplasty for vertebral metastases.

PURPOSE: We have performed percutaneous vertebroplasty (PV) using polymethylmethacrylate (PMMA) for patients with vertebral metastases since 2002. This study investigated the therapeutic effects of PV on vertebral metastases. MATERIALS AND METHODS: A retrospective (2002-2008) review was conducted for 69 consecutive patients with 141 metastatic vertebrae treated with PV using PMMA. The clinical background of the patients, visual analog scale (VAS), improvement rate, outcomes, and complications were evaluated. RESULTS: The mean preoperative VAS score was 7.3 and significantly improved to 1.9 postoperatively (at discharge), with a mean improvement rate of 73.3%. With regard to complications, no new fractures of adjacent vertebral bodies were encountered, but cement leakage was seen in 49% of the patients. Most patients were asymptomatic during the postoperative course, although two patients (3%) experienced dyspnea that was suspected to be adult respiratory distress syndrome or a pulmonary embolism. CONCLUSION: PV can offer pain relief to patients with painful vertebral metastases and short life expectancy whose general condition makes surgery difficult.

Internalization of MUC1 by anti-MUC1 antibody from cell membrane through the macropinocytotic pathway.

MUC1 is a type I transmembrane glycoprotein aberrantly overexpressed in various cancer cells. It is thought to serve as a physical barrier from the extracellular environment and also as a receptor for various extracellular molecules. However, little is known about the fate of MUC1 during and after the interaction with these molecules. In the present study, we used anti-MUC1 antibody as an interacting molecule and investigated the cellular trafficking of MUC1. Our results showed that: (1) anti-MUC1 antibody was internalized only in MUC1 expressing cells and triggered internalization and down-regulation of MUC1; (2) the internalization of MUC1 by anti-MUC1 antibody required the cytoplasmic tail of MUC1 and was suppressed by inhibitors of Na(+)/H(+) exchanger, and caveola/raft-dependent internalization, but not by an inhibitor of clathrin-dependent internalization. We conclude that antibody-induced internalization of MUC1 involves the macropinocytotic pathway.

Hypoxia enhances MUC1 expression in a lung adenocarcinoma cell line.

Expression of a transmembrane mucin MUC1 is emphasized in most cases of carcinoma. High expression of MUC1 is closely associated with cancer progression and metastasis, leading to poor prognosis. However, little is known about how MUC1 is overexpressed in malignant tumor. In this study, we demonstrated that: (1) Hypoxia, a typical feature of malignant tumor, enhanced the expression of MUC1 mRNA and protein in a human lung adenocarcinoma cell line; (2) the hypoxia-induced increase in MUC1 mRNA was mediated by the transcriptional activity of MUC1 promoter, but not mRNA stability. Moreover; (3) CoCl(2), an inducer of Hypoxia Inducible Factor (HIF)-1alpha, increased the expression of MUC1 mRNA; and (4) HIF-1alpha-targeted siRNA but not its control siRNA decreased hypoxia-induced MUC1 mRNA. These data suggest that hypoxia enhances the expression of MUC1 through the transcriptional regulation by HIF-1alpha in a human lung epithelial cell line.

Implantation of dendritic cells in injured adult spinal cord results in activation of endogenous neural stem/progenitor cells leading to de novo neurogenesis and functional recovery.

We report a treatment for spinal cord injury involving implantation of dendritic cells (DCs), which act as antigen-presenting cells in the immune system. The novel mechanisms underlying this treatment produce functional recovery. Among the immune cells tested, DCs showed the strongest activity inducing proliferation and survival of neural stem/progenitor cells (NSPCs) in vitro. Furthermore, in DC-implanted adult mice, endogenous NSPCs in the injured spinal cord were activated for mitotic de novo neurogenesis. These DCs produced neurotrophin-3 and activated endogenous microglia in the injured spinal cord. Behavioral analysis revealed the locomotor functions of DC-implanted mice to have recovered significantly as compared to those of control mice. Our results suggest that DC-implantation exerts trophic effects, including activation of endogenous NSPCs, leading to repair of the injured adult spinal cord.

A simple and reliable behavioral analysis of locomotor function after spinal cord injury in mice. Technical note.

To establish a simple and reliable method to assess the behavioral function after spinal cord injury (SCI) in mice, the authors used an automated animal movement analysis system, SCANET. Two different SCI lesions were created in adult female BALB/c and C57BL/6 mice by transecting both the posterior columns and the left lateral and anterior funiculi or only the left lateral and anterior funiculi at T-8. Control mice underwent laminectomy only. The SCANET system consists of a cage equipped with two crossing sensor frames arranged at different heights, by which small (M1) and large (M2) horizontal movements and the vertical movement involved in rearing (RG) can be monitored. The authors assessed locomotor function by determining the M1, M2, and RG scores; to this end, they used the SCANET system and a previously established behavior test, the 21-point open-field Basso-Beattie-Bresnahan (BBB) Locomotor Rating Scale. The results indicated that the RG scores were significantly and consistently different between the spinal cord-injured and control mice, irrespective of the mouse strain or injury model, but that M1 and M2 scores were not. Moreover, there was a statistically positive correlation between the RG score and the BBB Scale score. For the assessment of locomotor function after SCI, use of the SCANET sytem in behavioral analysis is simple and the method is highly reproducible. The analysis of vertical movement is useful for assessing the recovery of limb function in mice following thoracic hemisection.