Persistent pleural effusion in an infant with an unusual diagnosis: congenital alveolar rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is a malignant form of neoplasm that originates from skeletal muscle. RMSs can exist anywhere in the human body but are more commonly detected in the neck region and extremities. The alveolar type is one of the subtypes of RMS that has a poor prognosis. Because the clinical manifestation of a tumour can be a painless mass, symptoms might be non-contributary to the diagnosis. Herein, a four-month-old girl was admitted to the emergency department with complaints of respiratory distress without a runny nose, cough, and fever. Recurrent effusions subsided with subsequent tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was performed to determine the aetiology of the recurrent effusion. The Tru-Cut biopsy obtained during VATS resulted in the diagnosis of alveolar rhabdomyosarcoma. Pleural effusion decreased, and the tube drainage was stopped rapidly after first vincristine, actinomycin-D, and cyclophosphamide chemotherapy cycle. Persistent and recurrent pleural effusions should alert physicians to rule out unusual diagnoses like that of our case.

The Effects of Difumarate Salt S-15176 after Spinal Cord Injury in Rats.

OBJECTIVE: In the present study we analyzed neuroprotective and antiapoptotic effect of the difumarate salt S-15176, as an anti-ischemic, an antioxidant and a stabilizer of mitochondrial membrane in secondary damage following spinal cord injury (SCI) in a rat model. METHODS: Three groups were performed with 30 Wistar rats; control (1), trauma (2), and a trauma+S-15176 (10 mg/kg i.p., dimethyl sulfoxide) treatment (3). SCI was performed at the thoracic level using the weight-drop technique. Spinal cord tissues were collected following intracardiac perfusion in 3rd and 7th days of posttrauma. Hematoxylin and eosin staining for histopatology, terminal deoxynucleotidyl transferase dUTP nick end labeling assay for apoptotic cells and immunohistochemistry for proapoptotic cytochrome-c, Bax and caspase 9 were performed to all groups. Functional recovery test were applied to each group in 3rd and 7th days following SCI. RESULTS: In trauma group, edematous regions, diffuse hemorrhage, necrosis, leukocyte infiltration and severe degeneration in motor neurons were observed prominently in gray matter. The number of apoptotic cells was significantly higher (p<0.05) than control group. In the S-15176-treated groups, apoptotic cell number in 3rd and 7th days (p<0.001), also cytochrome-c (p<0.001), Bax (p<0.001) and caspase 9 immunoreactive cells (p<0.001) were significantly decreased in number compared to trauma groups. Hemorrhage and edema in the focal areas were also noticed in gray matter of treatment groups. Results of the locomotor test were significantly increased in treatment group (p<0.05) when compared to trauma groups. CONCLUSION: We suggest that difumarate salt S-15176 prevents mitochondrial pathways of apoptosis and protects spinal cord from secondary injury and helps to preserve motor function following SCI in rats.

Intraventricular glioblastoma multiforme: case report

Glioblastoma multiforme (GBM) is the most common primary brain tumor, but pure intraventricular location is extremely rare for GBM in neurosurgical practice. To our knowledge, there are only 19 reported cases to date. We present an additional case of intraventricular GBM with detailed clinical course, radiological and pathological findings

El glioblastoma multiforme (GBM) es el tumor cerebral primario más común que existe, pero una localización netamente intraventricular es muy rara en la práctica neuroquirúrgica. Según nuestro conocimiento, hasta la fecha solo se han publicado 19 casos intraventriculares. Presentamos un nuevo caso de GBM intraventricular con una descripción detallada de la evolución clínica y los hallazgos patológicos y radiológicos

Intraventricular glioblastoma multiforme: Case report.

Glioblastoma multiforme (GBM) is the most common primary brain tumor, but pure intraventricular location is extremely rare for GBM in neurosurgical practice. To our knowledge, there are only 19 reported cases to date. We present an additional case of intraventricular GBM with detailed clinical course, radiological and pathological findings.

Supra- and infra-torcular double occipital encephalocele

Un encefalocele es una protrusión del cerebro o de las meninges a través de un defecto craneal que está cerrado o cubierto con la piel. El encefalocele occipital es el tipo más frecuente en EE. UU. y Europa occidental, donde alrededor del 85% de los casos de encefalocele adoptan esta forma. Según nuestro conocimiento, solo existen publicados otros 3 casos de encefalocele occipital doble en la literatura. El presente estudio describe un encefalocele occipital doble en un neonato que además se presentaba tanto supra- como infratorcular. También se analiza la importancia de los estudios de neuroimagen preoperatorios para optimizar los resultados. El paciente, un varón de un día, presentaba 2 encefaloceles occipitales identificados mediante ecografía prenatal. Fue sometido a un cierre del encefalocele occipital en el segundo día posnatal. El niño toleró bien el procedimiento, fue extubado en el primer día del postoperatorio y sigue bien durante el seguimiento

An encephalocele is a protrusion of the brain and/or meninges through a defect in the skull that is closed or covered with skin. Occipital encephaloceles are the most frequent type in North America and Western Europe, where about 85% of encephaloceles take this form. To the best of our knowledge, there are only three other reported cases of double occipital encephaloceles in the literature. The current study reports a double and both supra and infra-torcular occipital encephalocele in a neonate and discusses the importance of preoperative neuroimaging studies to optimize the outcome. The patient was a 1-day-old male child who was identified by prenatal ultrasound to have two occipital encephaloceles. The patient underwent a closure of the occipital encephalocele on the second postnatal day. The infant tolerated the procedure well and was extubated on the first postoperative day. The child continues to do well during follow-up

Supra- and infra-torcular double occipital encephalocele.

An encephalocele is a protrusion of the brain and/or meninges through a defect in the skull that is closed or covered with skin. Occipital encephaloceles are the most frequent type in North America and Western Europe, where about 85% of encephaloceles take this form. To the best of our knowledge, there are only three other reported cases of double occipital encephaloceles in the literature. The current study reports a double and both supra- and infra-torcular occipital encephalocele in a neonate and discusses the importance of preoperative neuroimaging studies to optimize the outcome. The patient was a 1-day-old male child who was identified by prenatal ultrasound to have two occipital encephaloceles. The patient underwent a closure of the occipital encephalocele on the second postnatal day. The infant tolerated the procedure well and was extubated on the first postoperative day. The child continues to do well during follow-up.

Chiari Type I malformation yielded to the diagnosis of Crouzon syndrome.

Chiari malformation Type I (CM-I) related to syndromic craniosynostosis in pediatric patients has been well-studied. The surgical management consists of cranial vault remodeling with or without posterior fossa decompression. There were also cases, in whom CM-I was diagnosed prior to the craniosynostosis in early childhood. We present a 16-year-old boy who admitted with symptoms related to CM-I. With careful examination and further genetic investigations, a diagnosis of Crouzon syndrome was made, of which the patient and his family was unaware before. The patient underwent surgery for posterior fossa decompression and followed-up for Crouzon's syndrome. To our knowledge, this is the only case report indicating a late adolescent diagnosis of Crouzon syndrome through clinical symptoms of an associated CM-I.

[Bilateral epidural hematoma in a patient with human immunodeficiency virus infection: a case report]. / Human immunodeficiency virus ile enfekte bir hastada gelisen iki tarafli epidural hematom: Olgu sunumu.

Intracranial epidural haematomas are almost always secondary to head traumas and usually occur unilaterally. Bilateral intracranial epidural haematomas are rare, but the mortality is very high. In our case, we report a bilateral epidural haematoma in a 32 year old, HIV infected male patient who came to the emergency service with a head trauma because of a motor vehicle-pedestrian accident. The occurrence of bilateral epidural haematoma in an HIV infected patient is a rare condition as a result of head trauma in a lateral direction on one side. As a result of the vasculopathy and coagulopathy, which are complications of HIV infection, the cerebral vessels have a fragile structure that leads to complications that facilitate the development of contralateral intracranial epidural haematoma together.

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery.

BACKGROUND: Mediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery. METHODS: Sixty-two samples obtained from cadavers who did not die from chest malignancies, extrathoracic malignancies, any kind of infections or previous hospitalization before the death were included to the study. The locations of the nodes were recorded according to the American Thoracic Society Mediastinal Lymph Node Map. The number, size and weight of the nodes were determined at each station. RESULTS: Median age of the cadavers was 39 years. Primary causes of death were asphyxia in 10 (16.1%) subjects, trauma in 29 (46.8%) subjects, cardiovascular problems in 10 (16.1%) subjects, and undetermined in 13 (21%) subjects. The median number of lymph nodes resected from each patient was 23 (range: 11-54). The right sided paratracheal lymph nodes (Station 2R and 4R) were more frequent, heavier and longer than left sided lymph nodes (Station 2L and 4L) at the paratrecheal region. Right sided inferior mediastinal lymph nodes were heavier and longer than the left ones; however, their availability was more often on the left. CONCLUSIONS: The properties of mediastinal lymph nodes at particular stations are different for number, size and weight. Station 4R and 7 have the highest number of nodes followed by stations 5 and 6. We recommend removing the lymph nodes of these stations completely in lung cancer patients to rule out the possibility of micrometastatic disease. Diameter of normal lymph node may be 1 cm for the stations other than 4R and 7, but the definition of normal diameter of a lymph node at the stations 4R and 7 may be changed as 1,5 cm and 2,0 cm, respectively. Weight of the nodes may be a new subject to study and may be defined as a new modality to define a staging to be more accurate and the issue needs further investigations.

AR-A014418 como inhibidor de la glucógeno sintasa quinasa 3: potencial anti-apoptótico y terapéutico en lesión medular / No disponible

Objetivo Este trabajo tuvo como objetivo investigar los efectos del AR-A014418, un potente inhibidor específico de la GSQ-3beta, en la apoptosis y neuroprotección neuronales en el modelo de lesión medular traumática. Materiales y métodos Se generaron tres grupos a partir de 36 ratas Wistar: (1) control, (2) grupo de traumatismo medular obtenido mediante técnica de pinzamiento post-laminectomía, y (3) grupo de tratamiento mediante AR-A014418 (4mg/kg, i.v., DMSO) post-laminectomía y traumatismo medular. Se aplicaron el test TUNEL para la detección de la apoptosis, tinción inmunohistoquímica para bax y TGF-beta en los tejidos medulares. Se llevo a cabo un examen microscópico y recuento de células necróticas y apoptóticas, así como recuento de LPMN para detectar inflamación. La recuperación funcional fue verificada mediante la prueba de campo del aparato locomotor en los días 3 y 7 después de la cirugía. Resultados Se observo hemorragia difusa, cavitación, necrosis y regiones edematosas, degeneración de las neuronas motoras e infiltración leucocítica en la materia gris en los grupos traumáticos. En los grupos con tratamiento AR-A014418 se observaron células sanas con mayor (..) (AU)

AR-A014418 as a glycogen synthase kinase-3 inhibitor: anti-apoptotic and therapeutic potential in experimental spinal cord injury.

OBJECTIVES: We aimed to investigate the effects of AR-A014418, a strong inhibitor specific to GSK-3beta, on neuronal apoptosis and neuroprotection in the traumatic SCI model. MATERIALS AND METHODS: In this study, three groups were generated from 36 Wistar rats; (1) control, (2) spinal cord trauma group created by clip compression technique after laminectomy, and (3) AR-A014418 (4mg/kg, i.p., DMSO) treatment group after laminectomy and spinal cord trauma. The TUNEL assay for apoptosis detection, immunohistochemical staining for bax and TGF-beta were applied in spinal cord tissues. For light microscopic examination, necrotic, and apoptotic cells were counted, and PMNL counting was applied to detect inflammation. Functional recovery was tested by field locomotor test in the 3rd and 7th days following surgery. RESULTS: In the trauma group, diffuse hemorrhage, cavitation, necrosis and edematous regions, degeneration in motor neurons and leukocyte infiltration were observed in gray matter. In the AR-A014418-treated groups, healthy cells were observed in more places compared to the trauma groups, however, cavitation, hemorrhagic, and edematous areas were seen in gray matter. In the AR-A014418-treatment groups, the number of apoptotic cells in the 3rd and 7th days (respectively; p<0.05, p<0.01), were significantly decreased compared to the trauma groups, as were the levels of bax (p<0.01) and TGF-beta 1 immunoreactivity. Results of the locomotor test were significantly increased in the treatment group (p<0.001) as compared to the trauma group. CONCLUSIONS: In this experimental spinal cord trauma model study neural apoptosis was significantly triggered in secondary damage developed after trauma, however, neurological healing was expedited by preventing mitochondrial apoptosis and reducing the inflammation by the potent inhibitor AR-A014418, which is GSK-3beta selective.

Management of sternal segment dislocation in a child with closed reduction.

Trauma may lead to sternal fracture or dislocation. Dislocation of a sternal segment in the childhood period is very rare as for sternal fractures in children. There are only six case reports regarding the issue in the literature. Additionally, there is not an established consensus for the treatment of the pathology. In this paper we present traumatic dislocation of a sternal body segment in a 10-year-old child who was successfully managed conservatively by closed reduction together with the review of the literature. Surgical treatment is not necessary especially in acute cases. Pathology may be treated with closed reduction. Callus formation usually supports the dislocated part of the sternum in time.

Correlation between leptin and pro-inflammatory cytokines in cortical contusion injury model.

BACKGROUND: The present study aimed to investigate time-dependent changes in leptin concentrations in brain tissue following experimental traumatic brain injury and to examine the relationship with cytokines. METHODS: After circular craniectomy, 33 male Wistar-albino rats were positioned on a stereotaxic frame and subjected to cortical contusion injury and then divided into 3 groups based on the depth of deformation as: 0 mm (sham controls, n=3), 1.5 mm (moderate injury, n=15) and 2.7 mm (severe injury, n=15). Animals were sacrificed on the 1st, 3rd and 5th days post-injury. RESULTS: One day after moderate injury, interleukin-1 beta (IL-1ß), IL-6, tumor necrosis factor-alpha (TNF-?), and leptin levels were found to be markedly increased in the brain tissue. On the 3rd and 5th days, the levels returned to the shamcontrol levels. Following severe injury, IL-1ß, IL-6 and TNF-? levels increased in correlation after the 1st day and reached the sham-control levels on the same days. However, leptin tissue levels decreased on the 1st and 3rd days and normalized to the sham-control levels on the 5th day. CONCLUSION: Our results showed that the release of leptin is decreased in the early stage of severe injury. Thus, leptin replacement may play an important role in therapy in cases with severe traumatic brain injury.

Leiomyoma of the extrapleural chest wall: an atypical location.

Tumours of the thoracic wall constitute a wide histological spectrum. However, the literature includes very few reports of a leiomyoma occurring at the extrapleural chest wall. In this report we present our experience together with a review of the literature. Our patient was a 33-year-old woman who was diagnosed with leiomyoma of the chest wall and treated accordingly and successfully. To the best of our knowledge, this is the seventh report in the literature defining the clinical entity.

A rare emergency condition in neurosurgery: foot drop due to Paget's disease.

Paget's disease is a chronic, focal skeletal disorder that usually affects the pelvis and spine. Spinal cases are generally asymptomatic; in the symptomatic cases, the neurological dysfunctions are related to non-compressive vascular defects, hemorrhage, sarcomatoid degeneration, spinal stenosis, or pathological fractures, primarily in the lumbar region. The Neurosurgeon should have a fundamental understanding of the complications of Paget's disease and should be familiar with the indications for treatment, as well as available medical and surgical therapies. In the present paper, we report a case of Paget's disease that presented with an isolated foot drop due to a pathological fracture of L5 vertebra, and then discuss the therapeutic strategies presented in the literature.

Assessment of the effects of physiological release of melatonin on arterial distensibility and blood pressure.

AIM: The aim of our study was to investigate the effects of endogenous melatonin on arterial distensibility using measurements of the velocity of the aortic pulse wave between the carotid and femoral arteries in healthy young students assessed in the supine position. MATERIAL AND METHODS: We studied 29 healthy young students, aged between 18 and 27 years, with 19 being male. The measured the velocity of the aortic pulse wave between the carotid and femoral arteries, along the blood pressures and heart rate, while the subjects were in the supine position at two time points, namely from 01.30-02.30 and 13:30-14:30 hours, during a day, also taking plasma to measure the concentrations of melatonin. The velocity of the pulse waves was determined using an automatic device, the Complior Colson (France), which allowed on-line recording and automatic calculation of the velocity, the calculations being made by measuring the transit time of the pulse wave as it traversed the distance between two sites of recording according, the velocity of the pulse wave in meter per second being equal to the distance in meters divided by the time of transit in seconds. RESULTS: Although the velocity of the pulse wave, systolic, diastolic, and mean blood pressures, and heart rate were all increased in the morning relative to measurement made later in the day, levels of melatonin in the plasma were increased in the night. There was negative correlation between diurnal levels of melatonin and the velocity of the pulse wave. CONCLUSION: Our findings indicate that increased levels of melatonin during the night may cause a decreased velocity of the aortic pulse wave, along with blood pressures and heart rate.

Therapeutic efficacy of SJA6017, a calpain inhibitor, in rat spinal cord injury.

Apoptosis is an important element of the secondary processes that occur after spinal cord injury. Calpain and caspases are key proteases in apoptotic cell death. We evaluated the neuroprotective effects of SJA6017 (a calpain inhibitor) and measured functional recovery in a rat spinal cord injury model. Thirty Wistar albino rats were divided into three groups of 10 animals each: sham-operated (group 1), trauma control (group 2) and trauma-plus-SJA6017 treatment (group 3). Spinal cord trauma was produced in the thoracic region of the animals. Rats in group 3 received SJA6017 1 min after trauma. Treatment efficacy was evaluated after injury using light microscopy and TUNEL staining. Neurological performance was assessed using an inclined plane and a modified version of the Tarlov's grading scale. Group 2 rats showed moderate trauma with widespread edema, hemorrhage, vascular thrombi and necrosis 24 h after injury. Group 3 rats had significantly reduced tissue injury and apoptosis. Tarlov scores revealed that group 3 rats also had ameliorated recovery of limb function. Our results demonstrate that treatment with SJA6017 reduces apoptotic cell death, preserves spinal cord tissue and improves functional outcome. Treating calpain-induced apoptosis with this agent may be a feasible therapeutic strategy for patients with spinal cord injury.

Therapeutic efficacy of Ac-DMQD-CHO, a caspase 3 inhibitor, for rat spinal cord injury.

We investigated the therapeutic efficacy of Ac-DMQD-CHO, a caspase-3 inhibitor, and functional recovery in spinal cord injury in a rat model. Thirty rats were randomized into three groups of 10 each. In groups 2 and 3, spinal cord trauma was produced in the thoracic region. Group 3 rats were treated with Ac-DMQD-CHO. Treatment responses were evaluated based on histopathological and TUNEL staining findings at 24 h and 5 days post-injury. Neurologic performance was assessed during and following treatment. Twenty-four hours after injury, light microscopy examination revealed diffuse hemorrhagic necrosis, edema, vascular thrombi, and polymorphonuclear leukocyte infiltration in group 2 and 3 rats, but cavitation and demyelinization were less prominent in group 3. At this time point, treatment of the rats with Ac-DMQD-CHO significantly reduced the number of apoptotic cells. Traumatic injury to the spinal cord causes apoptosis and administration of Ac-DMQD-CHO decreases apoptosis and improves functional outcome.

Tauroursodeoxycholic acid and secondary damage after spinal cord injury in rats.

Greater clinical understanding of the pivotal role of apoptosis in spinal cord injury (SCI) has led to new and innovative apoptosis-based therapies for patients with an SCI. Tauroursodeoxycholic acid (TUDCA) is a biliary acid with antiapoptotic properties. To our knowledge, this is the first study in the English language to evaluate the therapeutic efficacy of TUDCA in an experimental model of SCI. Thirty rats were randomized into three groups (sham-operated, trauma only, and trauma plus TUDCA treatment) of 10 each. In groups 2 and 3, spinal cord trauma was produced at the T8-T10 level via the Allen weight drop technique. Rats in group 3 were treated with TUDCA (200 mg/kg intraperitoneal) 1 min after trauma. The rats were killed either 24 h or 5 days after injury. The neuroprotective effect of TUDCA on injured spinal cord tissue and the effects of that agent on the recovery of hind-limb function were assessed. The efficacy of treatment was evaluated with histopathologic examination and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) analysis. Histopathologic characteristics were analyzed by comparison of hematoxylin-and-eosin stained specimens. Neurologic evaluations were performed 24 h, 3 days, and 5 days after trauma. Hind-limb function was assessed with the inclined plane technique of Rivlin and Tator and the modified version of Tarlov's grading scale. Twenty-four hours after injury, there was a significantly higher number of apoptotic cells in the lesioned spinal cord group than in the sham-operated control group. Treatment of the rats with TUDCA significantly reduced the number of apoptotic cells (4.52+/-0.30 vs. 2.31+/-0.24 in group 2) and the degree of tissue injury. Histopathologic examination showed that group 3 rats had better spinal cord architecture compared with group 2 rats. Five days after injury, the mean inclined plane angles in groups 1, 2, and 3 were 65.50 degrees +/- 2.09, 42.00 degrees +/- 2.74, and 53.50 degrees +/- 1.36. Motor grading of the rats revealed a similar trend. These differences were statistically significant (p<0.05). The mechanism of neuroprotection in the treated rats, although not yet elucidated, may be related to the marked antiapoptotic properties of TUDCA. A therapeutic strategy using TUDCA may eventually lead to effective treatment of SCI without toxic effects in humans.