Spontaneous epidural hematoma of thoracic spine presenting as Brown-Séquard syndrome: report of a case with review of the literature.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is an uncommon clinical entity. It produces a severe neurological deficit and prompt decompression is usually the first choice of treatment. Brown-Séquard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm, but rarely caused by SSEH. METHODS: Case report and literature review. FINDINGS: A previously healthy man presented with Brown-Séquard syndrome below T5-T6 cord segment secondary to spontaneous epidural hematoma. He opted for conservative treatment, which was followed by rapid resolution. CONCLUSIONS: Although Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH.

[Enhancement effect of caffeine on chemotherapy of osteosarcoma in Fischer 344/N rats].

OBJECTIVE: To determine the enhancement effects of caffeine on chemotherapy of transplanted osteosarcoma in Fischer 344/N rats. METHODS: Osteosarcoma-bearing Fischer 344/N rats were treated with cisplatin 2.5 mg/kg (Group DDP), caffeine 90 mg/kg x 2 d (Group caffeine), and cisplatin 2.5 mg/kg plus caffeine 90 mg/kg x 2 d (Group DDP+caffeine), and the control group was treated with normal saline in the same volume. All drugs were given by intra-peritoneum injection with micro-pump, in the rate of 0.5 ml/h. The tumor volume was measured and evaluated. The tumors were stained in TUNEL, and PCNA was detected with immunohistochemistry. The tumor growth inhibition rate, PCNA index and apoptosis index were calculated, and the survival time were recorded. RESULTS: The tumor inhibition rate was -0.5219 +/-0.1429 in control group, 0.0362 +/-0.0957 in Group DDP, -0.4193 +/-0.1345 in Group caffeine, and 0.3646 +/-0.1313 in Group DDP+caffeine (P <0.01). PCNA index was 0.4587 +/-0.1312 in control group, 0.1847+/-0.0535 in Group DDP, 0.4381 +/-0.0706 in Group caffeine, and 0.0314 +/-0.0231 in Group DDP+caffeine (P <0.01). Apoptosis index was 0.0008 +/-0.0005 in control group, 0.0077 +/-0.0060 in Group DDP, 0.0011 +/-0.0003 in Group caffeine, and 0.0295 +/-0.0069 in Group DDP+caffeine (P <0.01). And the survival time was (33.63 +/-4.63)d in control group, (52.13 +/-11.74)d in Group DDP, (35.63 +/-5.15)d in Group caffeine, and (55.13 +/-16.23)d in Group DDP+caffeine (P <0.01). CONCLUSION: Caffeine could enhance the anti-tumor effect of cisplatin in rat osteosarcoma.

[Cytotoxic effect of thermo-chemotherapy with cisplatin on osteosarcoma OS-732 cell line].

OBJECTIVE: To observe the cytotoxic effect of thermo-chemotherapy with cisplatin on osteosarcoma OS-732 cell line and to explore its mechanism. METHODS: The osteosarcoma OS-732 cell line was treated with different temperature, cisplatin alone and 43 degrees C +cisplatin for 1 h, respectively and the in vitro cytotoxic effect was observed with MTT assay. The cell cycle and the apoptotic rate were analyzed with flow cytometry (FCM); the cellular apoptosis was observed also with electron microscope. RESULT: The cytotoxicity index increase markedly as the temperature elevated or the concentration of cisplatin increased. While treated with 43 degrees C hyperthermia and cisplatin simultaneously, the cytotoxicity index increased to 72.37%;the cell cycle of the treated OS-732 cells line was changed with marked increase in S phase and decreasing in G(2)/M phase. The apoptotic rate increased markedly with the highest of 56.47%. Electron microscope showed the characteristic apoptotic alterations. CONCLUSION: Hyperthermia with cisplatin enhance cytotoxicity on osteosarcoma OS-732 cell line and the induced cell apoptosis may be one of the mechanisms of enhanced cytotoxicity by thermo-chemotherapy.

[Anterior instrumentation for the treatment of tuberculotic spinal deformity].

OBJECTIVES: To summarize the clinical results in the treatment of spinal tuberculosis with debridement, bone grafting and anterior fixation and to evaluate the safety and the value of this procedure. METHODS: From June 1997 to May 2001, 18 patients with spinal tuberculosis were treated using anterior debridement, autograft of bone and primary internal instrumentation. They were 8 men and 10 women, aged from 25 to 59 years (mean 41 years). The degree of kyphosis before surgery was 27.0 degrees to 75.5 degrees (mean 47.5 degrees +/- 11.4 degrees ). The involved spines included cervical spine (1 patient), thoracic spine (10), thoracic-lumbar spine (2), and lumbar spine (5). Average 2.8 intervertebral bodies in each patient were afflicted with tuberculosis disease. Spinal fusions were done with iliac bone grafts. RESULTS: All patients were followed up for an average of 25 months. No deep wound infection and sinus were observed after surgery. The grafted bones were fused in all patients with an average time of 3.6 months. The degree of spine kyphosis correction was 32.7 degrees +/- 8.3 degrees, and 3.2 degrees +/- 2.8 degrees was lost on average in the late stage. CONCLUSION: Anterior instrumentation for spinal tuberculosis could stabilize the spine, correct kyphosis and fuse the grafted bone.