Coccidioidal spondylitis: MR findings in 15 patients.

OBJECTIVE: MR imaging studies of 15 patients with documented vertebral column coccidioidomycosis infection were retrospectively reviewed to determine the MR imaging features of coccidioidal spondylitis. CONCLUSION: On MR imaging, coccidioidal spondylitis may be unifocal or multifocal. Involvement of an intervertebral disk, vertebral body marrow, and adjacent epidural and soft tissue is generally seen.

Treatment of coccidioidal spinal infection: experience in 16 cases.

Sixteen patients with spinal infection from Coccidioides immitis were treated. Lesion location was cervical in two, thoracic in four, lumbar in six, sacroiliac joint in one, and disseminated spinal in three. The neurological status was intact in 11 patients. One patient had incomplete quadriplegia, three patients had incomplete paraplegia, and a fifth patient had a lumbar root lesion. Treatment was medical only in 4 patients (one of whom required surgery 2 years later) and combined medical and surgical in 13 patients. All patients received amphotericin B intravenously. Follow-up averaged 24 months in 15 patients (range, 12-42 months). The outcome in four patients treated medically alone was one death, one remission, one relapse with disease progression, and one without follow-up. The outcome in the combined medical and surgical group was nine fusions, one pseudarthrosis, and three lesional excisions, all with remission. Successful treatment outcome is disease arrest, as opposed to "cure."

Evaluating the efficacy of a new flossing aid.

The purpose of this clinical trial was to compare the efficacy of a new flossing aid (Flosser) with finger flossing on preventing plaque and gingival inflammation. 35 adults who did not use dental floss routinely were assigned randomly to one of 2 treatment groups (Flosser or finger flossing) in a 2-period, single-blind crossover study. After prophylaxis, subjects were instructed to use the flossing aid or finger floss 1 x per day and to continue brushing for 30 days. Gingival inflammation (GI & BPI) and plaque (PI) were assessed prior to the prophylaxis and at 30 days. After a 30 day "washout" period, subjects were again reassessed for gingival inflammation and plaque, given a prophylaxis, assigned the opposite treatment (2nd treatment period) that they received the first treatment period, and assessed (GI, BPI & PI) after 30 days. Comparing the mean difference of the 30-day buccal interproximal scores between the treatment groups (flossing aid scores minus finger flossing scores) showed that the mean differences with 95% CI were: -0.013 +/- 0.067 [GI], -0.017 +/- 0.044 [BP] and 0.019 +/- 0.014 [PI]. No statistically significant differences from zero (0.05 alpha) were observed using the t-test. There was a high level of compliance (90%) with the prescribed regiment, and subjects preferred (56%) the flossing aid slightly over finger flossing. Even though there were no statistically or clinically significant differences in gingivitis and plaque scores between the 2 flossing groups, the positive inclination for the flossing aid makes it a desirable addition to the armamentarium of preventive dentistry.

Posttraumatic anterior cervical osteophyte and dysphagia: surgical report and literature review.

Degenerative changes in the cervical spine can produce osteophytes and other hypertrophic abnormalities. Asymptomatic osteophytes of the anterior margins of the cervical vertebrae may occur in 20-30% of the population. Occasionally, dysphagia or dysphonia may be caused by such cervical osteophytes pressing against the esophagus or trachea. Recently, the authors treated a patient with posttraumatic dysphagia and dysphonia secondary to osteophytic spurring of the anterior cervical spine. This 43-year-old man presented 2 years after sustaining a flexion/extension soft tissue injury to his cervical spine. Radiographic studies depict the progression of his osteophyte growth, which resulted in surgical intervention to relieve his inability to swallow solid foods. One year follow-up studies demonstrate normal alignment and no instability. A search of the literature revealed approximately 75 previously reported cases of anterior osteophyte-induced dysphagia, with the majority secondary to diffuse idiopathic skeletal hyperostosis. The literature briefly mentions trauma as a possible etiology of anterior osteophytosis; however, our case is unique, as it documents the time course and progression of the pathologic process.

Differential effect of recombinant tissue plasminogen activator-induced thrombolysis in the central nervous system and systemic arteries.

Recombinant tissue plasminogen activator (rTPA) has been more effective in inducing thrombolysis in laboratory studies of intracranial thrombosis than clinical studies of systemic or coronary thrombosis would indicate. To evaluate this discrepancy, 21 rabbits were subjected to embolic occlusion of the right internal carotid artery (ICA) by retrograde injection of a tin-tagged, 2-hour-old autologous clot through the external carotid artery with angiographic monitoring in the same manner as in a previously reported model. The emboli lodged intracranially at the bifurcation of the ICA in 10 animals and in the cervical ICA in 11 animals. Digital subtraction angiography confirmed total occlusion of the ICA in all animals. Treatment started one-half hour after embolization and consisted of a bolus of 0.5 mg/kg of rTPA followed by an infusion of 1 mg/kg/h for 2 hours. All of the animals with intracranial emboli and 6 of the animals with cervical emboli were treated intravenously. The remaining 5 animals with cervical emboli were treated by intracarotid infusion of the same dose of rTPA. In the intravenously treated group, serial digital subtraction angiography documented thrombolysis in 9 of the 10 animals with intracranial emboli and only 1 of the 6 with cervical emboli. Thrombolysis occurred in 4 of the 5 rabbits with cervical emboli treated with intracarotid rTPA. Intravenous rTPA therapy produced a significantly (P less than 0.01) higher rate of thrombolysis in intracranial as compared to cervical thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)

Cavernous angioma of the tentorium cerebelli. Case report.

The case of a cavernous angioma of the tentorium cerebelli is described. This is the seventh reported case of a cavernous angioma in this unusual location and the first of a dural cavernous angioma demonstrated by magnetic resonance imaging. The clinical presentation, radiographic features, and surgical treatment of these rare tumors are discussed, along with a review of the literature.

CT evolution of an acute venous epidural hematoma.

Acute traumatic epidural hematoma may develop secondary to an arterial or venous bleed. The computed tomography (CT scan) appearance of the hematoma depends on the source and severity of bleeding, the interval between injury and CT scan, and the degree of clot organization or breakdown. We report the emergency evaluation, CT scan evolution, and clinical management of one such acute venous epidural hematoma.

31P spectroscopy in thrombolytic treatment of experimental cerebral infarct.

Ischemic changes produced by autogenous clot embolization of intracranial arteries were monitored by continuous surface-coil 31P spectroscopy in 12 rabbits: six were used as controls and six were treated intravenously with tissue-type plasminogen activator. The animals were sacrificed and the brains were fixed with intravital stains. The results indicate that spectral changes are reversible only when thrombolysis therapy is started within 30 min after ischemic changes are detected. The improvement of the 31P spectrum correlated with postmortem changes.

Evaluation of recombinant tissue plasminogen activator in embolic stroke.

In an effort to determine the value of tissue-type plasminogen activator (TPA) in the treatment of embolic stroke, 17 rabbits were subjected to a model of embolic stroke in which 2-hour-old, tin-impregnated, autologous clots were embolized to the bifurcation of the internal carotid artery at the circle of Willis via retrograde injection into the cannulated external carotid artery. High-resolution digital subtraction radiography was used to localize clots intracranially at the carotid bifurcation. Circulation through the internal carotid artery and intracranial vessels was monitored with serial digital subtraction angiography before and after embolization and during treatment. Disappearance of the tin marker on the digital subtraction radiograph indicated dissolution of clot and was associated with reestablishment of circulation on the digital subtraction angiogram. Experimental animals were treated with human-specific recombinant TPA 30 minutes, 2 hours, or 4 hours after clot embolization. TPA was administered as an intravenous bolus of 0.5 mg/kg followed by an infusion of 1 mg/kg/h for 2 hours. Digital subtraction angiograms were performed every 30 minutes. All clots dissolved, and cerebral circulation was reestablished within 120 minutes of treatment. In control animals treated with saline, embolized clots were stable, and the internal carotid artery remained occluded. At the completion of each study, the animal was perfused with freshly prepared, buffered 2,3,5-triphenyltetrazolium chloride (TTC) for demarcation of cerebral infarction. Control animals demonstrated infarction of 50 +/- 3.6% of the ipsilateral cerebral hemisphere, with an infarct weight of 2.1 +/- 0.2 g.(ABSTRACT TRUNCATED AT 250 WORDS)

Digital angiographic quantification of blood flow dynamics in embolic stroke treated with tissue-type plasminogen activator.

Computer analysis of digital subtraction angiography (DSA) was utilized to quantify the effectiveness of tissue-type plasminogen activator (TPA) in a rabbit cerebroembolic stroke model. Fourteen animals underwent cannulation of the facial artery and a preembolus angiogram. Autologous blood clots were then injected, and occlusion of the internal carotid artery at the circle of Willis was documented with repeat angiogram. The experimental group received a 1-mg/kg intravenous infusion of TPA via a femoral catheter for 90 minutes. A control group received an equivalent volume of saline. Follow-up angiograms were performed every 15 minutes. The TPA-treated animals showed progressive improvement in flow through previously occluded vessels. Time-density curves of the contrast material over the middle cerebral artery trunk and brain parenchyma were generated. The best integrated curves for the two groups were compared at 30 minutes after occlusion and 90 minutes after treatment. Animals were then observed for 24 hours and their neurological status was documented. Premortem infusion of either Evans blue dye or neutral red dye was performed and the integrity of the blood-brain barrier and tissue perfusion were assessed by video planometry. Significant improvements were noted by DSA, and Evans blue and neutral red dye studies in animals treated with TPA.

Myasthenia gravis in monozygotic twins. Clinical follow-up nine years after thymectomy.

Genetically proved monozygotic female twins in whom myasthenia gravis developed in their 20s initially had their disease well controlled with anticholinesterase medication. Because of increasing resistance to medication, twin 1 had her thymus removed, after which the symptoms decreased. Predicated on the improvement in her sister and the need for increasing medication to allay symptoms, and after proof of monozygosity, twin 2 also underwent thymectomy, with subsequent symptomatic improvement. The twins were followed up nine and six years after thymectomy, respectively. Monozygotic twins with myasthenia gravis are generally young women, with onset of disease in one occurring within one to three years of the other. Reports of only one affected twin may be misleading because of inadequate documentation of monozygosity, absence of long-term observation, or both. Serial investigations of the "uninvolved" twin in a monozygous pair and proof of monozygosity should be obtained to aid in early diagnosis and treatment of this illness, as well as to study the pathogenesis of myasthenia gravis prior to symptom onset.

HLA antigens and hereditary hemorrhagic telangiectasia.

HLA antigens (27 HLA alleles of the A and B loci) were determined in 20 subjects of the same family, covering three generations; 6 of them were suffering from hereditary hemorrhagic telangiectasia. The haplotype HLA A2, Bw17 was found in all the sufferers. The same haplotype was not found in clinically health members except two of the generation III, but a visceral angiomatosis without clinical evidence cannot be excluded. An association of hereditary hemorrhagic telangiectasia with the haplotype HLA A2, Bw17 can be suspected in this family.

[Parkinson's disease and anosmia in monozygotic twin sisters (author's transl)]. / Maladie de Parkinson et anosmie chez deux jumelles monozygotiques

Monozygotic twin sisters developed Parkinson's disease and anosmia at the age of 39. The disease was kept under control and regressed with L. Dopa. Two families with the same association had been previously reported. An anomaly of the metabolism of dopamine, genetically determined, is probably responsible for these disorders.

[Chemodectomas of the vagus nerve. Pathogenic hypothesis based on a review of 100 cases]. / Les chémodectomes du vague. Hypothèses pathogéniques à partir d'une revue de cent cas

In connection with a personal case, 100 chemodectomas of the vagus described in the literature have been collected: revealing themselves in 75p. 100 of the cases in the form of cervical and pharyngeal tumours, 50p. 100 of the tumours of the vagal glomus involve some neurological manifestations mainly in the form of lesion of the lower cranial nerves. These appear to be either affected in isolation (41 p. 100) or in a dissociated manner (59 p. 100). Intra-cranial extension is rare (7 p. 100 of the cases) and delayed. Carotid angiography is characteristic. 76 p 100 are intra-vagal, 24 p. 100 are para-vagal and 60 p. 100 are located in the plexiform ganglion. Multifocal forms which account for 17 p. 100 of the cases are more usually, but not exclusively, familial. Surgical treatment is followed by sequelae or complications in more than half the cases. Close attention has been paid to pathogenetic theories: chemodectomas of the vagus may develop from type I chemoreceptor cells of the carotid glomera or from distinct cells with different properties (S.I.F. cells). They may equally well develop from nonchromaffin paraganglionic cells which have not migrated in the normal manner. The finding of such cells in the nerves of new-born babies and adults supports this theory, at least for some chemodectomas of the vagus.