Muscle invasive bladder cancer culminating with leptomeningeal carcinomatosis.

This case reports highlights a rare metastatic manifestation of transitional cell carcinoma of the bladder. The onset of symptoms associated with meningeal irritation should be investigated. However, there is little consensus in the treatment of leptomeningeal carcinomatosis and it should be considered a poor prognostic sign with symptomatic management.

Genetic and management factors that influence the susceptibility of cattle to Mycobacterium bovis infection.

Genetic variation in the susceptibility of cattle to Mycobacterium bovis infection exists in differences between families and species, but not breeds. Susceptibility to M. bovis infection increases with age of cattle. Natural exposure to M. bovis or environmental mycobacteria may assist in the development of specific immunity, but there is no direct evidence for such immunological priming of tuberculosis resistance in cattle. This has, however, been demonstrated in humans and other animals. Since non-specific mechanisms have a role in protective immunity, developing an effective vaccine will be difficult, even though some protection of other species has been achieved. Immunological suppression in the periparturient period can produce anergic reactors, which may act as a constant source of infection for cattle-to-cattle transmission. Circumstantial evidence suggests that an adequate intake of mineral, vitamin and protein reduces the susceptibility of cattle. Although weather patterns have been implicated in the susceptibility of herds to M. bovis infection, there is insufficient information to determine the risk factors precisely. It is concluded that some reduction in the susceptibility of cattle to M. bovis infection can be achieved by modifications to the management system to minimize risk factors, but that a considerable amount of further research is required.

Aspergillus osteomyelitis of the spine.

Aspergillosis involving either the vertebral body or the intervertebral disc is a rare cause of osteomyelitis of the spine. The following is a report of five cases of Aspergillus fumigatus infection of the spine treated successfully with amphotericin B and 5-flucytosine. In three patients, the diagnosis was established at closed-needle biopsy; two patients with paraplegia had an anterior decompression and fusion. The follow-up period ranged from 19 to 48 months.

Anterior decompression of burst fractures with neurological deficit.

We reviewed 30 patients with burst fractures of the thoracic and lumbar spine treated by anterior surgical decompression and fusion between January 1983 and December 1987; 21 had partial neurological involvement while nine had complete paraplegia. At follow-up all patients with partial neurological involvement improved by one to three Frankel grades, whereas of the nine patients with complete paraplegia only one improved. Late kyphotic deformity was seen in 12 patients.

Spinal injuries in children.

We reviewed 47 children with spinal injuries. Three distinct patterns of injury were observed: subluxations and dislocations without a fracture (type 1), spinal cord injury without radiographic abnormality (type 2), and spinal fractures which may be associated with subluxation or dislocation (type 3). The neurological recovery was poor in complete lesions associated with type 2 injuries.

Level of termination of the spinal cord during normal and abnormal fetal development.

The level of termination of the spinal cord in 115 autopsies on subjects ranging from a 20-week stillborn to an 8-month-old infant is reported. The study showed that the adult level (lower border L1) is attained at birth. In a clinical study of 10 children with diastematomyelia between the ages of 3 years and 7 years the spinal cord, which was found to terminate in the region of the lower lumbar spine, was tethered by a short thickened filum terminale.

Sarcoma associated with bone infarction. A report of 2 cases.

Two cases of an unusual association between bone infarction and sarcomatous change are reported. The exact incidence of sarcomatous change in bone infarction is unknown. It seems that the risk is greatest in large medullary infarcts of bones. Also, once sarcoma has developed the prognosis is poor. Patients should therefore be advised to report any pain or swelling in an area of known medullary infarction.

Localized osseous cryptococcal infection. Report of 2 cases.

Cryptococcal infection in man is widely disseminated and commonly involves the central nervous system. Primary bone involvement is rare. We report on 2 cases of localized cryptococcal osseous lesions treated successfully by surgery.

Results of surgical decompression in chronic tuberculous paraplegia.

The results of surgical decompression in 117 patients with chronic tuberculous paraplegia, defined as paraplegia persisting for more than 3 months, were reviewed. After surgery 90 patients were able to walk. Significant findings at surgery were marked extradural fibrosis with very little caseation and pus. The study showed that paraplegia of greater than 6 months' duration was associated with a poor result. There were no cases of reactivation of the disease in the follow-up period ranging from 1 year to 4 years.

Cervical spine fracture in diffuse idiopathic skeletal hyperostosis.

The occurrence of spinal fractures in ankylosing spondylitis is well documented but fractures are uncommon in patients with diffuse idiopathic skeletal hyperostosis (DISH). We report a 58-year-old Black male with DISH who developed quadriplegia after fracture dislocation of the cervical spine.

Echinococcal infection of the spine with neural involvement.

Hydatid disease due to Taenia echinococcus involves bone in about 1% of all cases. The spine is involved in about 50% of cases. Neural compression is common in the form of paraplegia or nerve root compression. The prognosis with spinal involvement is generally regarded as very poor and often likened to that of spinal cancer. Four cases of spinal hydatid with neural involvement are presented. Three were treated by anterior spinal decompression and all four were treated with mebendazole. The results show good neural recovery and it is concluded that the prognosis is not as dismal as it was formerly thought to be.

Vertebral osteomyelitis after a closed fracture of the spine. A case report.

A case of spinal tuberculosis after a closed fracture, differing from the usual tuberculous spondylitis in that trauma appeared to have predisposed the affected vertebrae to haematogenous infection, is described.

Vertebral haemangiomas. A report of 2 cases.

Vertebral haemangiomas are benign lesions but can be responsible for a variety of symptoms varying from localised pain to myelopathy and paralysis. Two successfully treated cases of spinal cord compression caused by vertebral haemangiomas are reported.

Traumatic spondylolisthesis of the axis.

A prospective study of 39 patients with traumatic spondylolisthesis of the axis is reported. Classification of the fracture was based on the criteria of White and Punjabi (1978). In previous studies (Effendi et al., 1981; Levine and Edwards, 1985) stability of the undisplaced and slightly displaced fracture was based on flexion/extension radiographs. Union was obtained in all fractures without using a rigid cervical orthosis. We feel that assessing stability dynamically soon after injury when there is marked muscle spasm does not provide an accurate assessment, nor does it not alter the management of these injuries, as shown in this study.

Cryptococcal infection of the spine. A case report.

Osseous infection due to Cryptococcus neoformans is rare. A case of paraplegia due to vertebral cryptococcal infection in a child is reported.