Early application of percutaneous vertebroplasty reduces pain without affecting peripheral blood stem cell (PBSC) collection and transplant in newly diagnosed multiple myeloma (MM) patients.

Vertebral fractures occur in over 60% of newly diagnosed multiple myeloma (MM) patients and can cause pain, disability and poor quality of life. Antimyeloma therapy can lead to symptoms improvement, but these effects can take time to be perceived. Application of radiotherapy prior to peripheral blood stem cells (PBSC) mobilisation can impair stem cell collection. Percutaneous vertebroplasty has been proposed as a suitable option to rapidly relieve bone pain from vertebral fractures in MM patients, but, little is known about the effects of this procedure on subsequent PBSC mobilisation, collection and transplant. Eighteen patients (10M/8F, median age 64.5 years) with untreated MM and painful vertebral lesions underwent vertebroplasty prior to proceed to the planned transplant program at our Institution. Forty-one procedures were performed at C2-L5 levels, eight patients were treated at ≥2 levels. Ninety-five per cent of the cases obtained a complete or optimal pain control. All the patients successfully mobilised PBSC (median CD34+ cells = 10.8 × 10(6) /kg) and underwent autologous PBSC transplant; both polymorphonucleates and platelets recovery averaged 11 days. Our data seem to suggest that percutaneous vertebroplasty is useful in newly diagnosed MM patients with painful vertebral fractures as it allows rapid and durable achievement of pain control, without interfering with further treatment.

Acute mastoiditis with complications: a report of two cases.

The authors report two cases of lateral sinus thrombosis (LST) which were recently observed after more than a 20-year absence of such pathology at their Institutions. After reviewing the epidemiologic data, the clinical observations are described in detail. Changes in symptomatology mainly due to the improper use of antibiotics are then discussed as well as the diagnostic improvement offered by modern imaging techniques. Problems still under debate concern the therapeutic strategy: internal jugular vein ligation or anticoagulation therapy versus aminoglycoside administration for patients refractory to the conventional antibiotic therapy. The necessity of close cooperation between general practitioner, pediatrician and otolaryngologist is stressed.

MRI of an unenhancing tuberculum sellae meningioma.

We present a tuberculum sellae meningioma with intrasellar extension which did not enhance with intravenous gadolinium. Identification of the diaphragma sellae, possible only on the unenhanced short TR/TE sequence, was crucial for differentiating the lesion from a pituitary adenoma, and therefore for the correct surgical approach.

Fractures of the occipital condyles: report of four cases and review of the literature.

Fractures of the occipital condyle are rare; 32 cases have been reported in the literature. Here, the authors describe four additional cases of occipital condylar fracture. Anderson's classification is used: type I fracture: comminution of the condyle without significant displacement; type II: basilar fracture extending into the condyle; type III: condylar avulsion. The possible mechanisms are identified. Computed tomography proved essential in diagnosing these fractures; coronal reconstructions together with axial scans are particularly helpful. Three-dimensional reconstruction did not prove essential in diagnosing these fractures.

Chronic spastic atrophic hemiparesis with benign course.

We present the clinical and neuroimaging data of 4 patients (mean age: 62 years, range 54-67; mean follow-up: 19.5 years, range: 26 months-29 years) with chronic spastic atrophic hemiparesis (CSAH). Neuroimaging findings were non specific, CT scan and MRI showing white matter lesions located within the centrum semiovale in two cases, parieto-occipital lobe and pons in one case each. This study underlines that patients with CSAH may have a good long-term prognosis. MRI studies may demonstrate associated lesions within the white matter or brainstem and are advisable in all subjects with CSAH, but further studies are necessary to clarify the nature of the observed lesions.

Paretic neurosyphilis and cerebral gumma. Case report.

A rare case of neurosyphilis presenting with dementia paralytica and radiological appearance of cerebral gumma is reported. In accordance with previous comparable reports Authors noticed that diagnosis of this disease actually is still based on serological tests and clinical examination. CT, NMR and Cerebral angiography were not able to provide diagnostic findings, although NMR confirmed its ability to detect lesions not discovered by CT scan. Also findings from stereotactic biopsy only revealed an old not active infection.