RESUMEN
Purpose. Extraforaminal decompression of the L5 nerve root remains a challenge due to anatomic constraints, severe level-degeneration, and variable anatomy. The purpose of this study is to introduce the use of navigation for transmuscular transtubular decompression at the L5/S1 level and report on radiological features and clinical outcome. Methods. Ten patients who underwent a navigation-assisted extraforaminal decompression of the L5 nerve root were retrospectively analyzed. Results. Six patients had an extraforaminal herniated disc and four had a foraminal stenosis. The distance between the L5 transverse process and the para-articular notch of the sacrum was 12.1 mm in patients with a herniated disc and 8.1 mm in those with a foraminal stenosis. One patient had an early recurrence and another developed dysesthesia that resolved after 3 months. There was a significant improvement from preoperative to postoperative NRS with the results being sustainable at follow-up. ODI was also significantly improved after surgery. According to the Macnab grading scale, excellent or good outcomes were obtained in 8 patients and fair ones in 2. Conclusions. The navigated transmuscular transtubular approach to the lumbosacral junction allows for optimal placement of the retractor and excellent orientation particularly for foraminal stenosis or in cases of complex anatomy.
Asunto(s)
Descompresión Quirúrgica/métodos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Nervios Espinales/cirugía , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/cirugía , Adulto , Anciano , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Sacro/cirugía , Resultado del TratamientoRESUMEN
This study investigated the changes in oxidative stress biomarkers and antioxidant status indices caused by a 3-week high-intensity interval training (HIT) regimen. Eight physically active males performed three HIT sessions/week over 3 weeks. Each session included four to six 30-s bouts of high-intensity cycling separated by 4 min of recovery. Before training, acute exercise elevated protein carbonyls (PC), thiobarbituric acid reactive substances (TBARS), glutathione peroxidase (GPX) activity, total antioxidant capacity (TAC) and creatine kinase (CK), which peaked 24h post-exercise (252 ± 30%, 135 ± 17%, 10 ± 2%, 85 ± 14% and 36 ± 13%, above baseline, respectively; p<0.01), while catalase activity (CAT) peaked 30 min post-exercise (56 ± 18% above baseline; p<0.01). Training attenuated the exercise-induced increase in oxidative stress markers (PC by 13.3 ± 3.7%; TBARS by 7.2 ± 2.7%, p<0.01) and CK activity, despite the fact that total work done was 10.9 ± 3.6% greater in the post- compared with the pre-training exercise test. Training also induced a marked elevation of antioxidant status indices (TAC by 38.4 ± 7.2%; CAT by 26.2 ± 10.1%; GPX by 3.0 ± 0.6%, p<0.01). Short-term HIT attenuates oxidative stress and up-regulates antioxidant activity after only nine training sessions totaling 22 min of high intensity exercise, further supporting its positive effect not only on physical conditioning but also on health promotion.
Asunto(s)
Antioxidantes/metabolismo , Ejercicio Físico/fisiología , Estrés Oxidativo/fisiología , Adaptación Fisiológica , Adulto , Catalasa/sangre , Creatina Quinasa/sangre , Glutatión Peroxidasa/sangre , Humanos , Masculino , Experimentación Humana no Terapéutica , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismo , Adulto JovenRESUMEN
Primary osseous leiomyosarcoma of the spine is an extremely rare entity with only 13 previous cases having been reported in the literature. We present the case of a 57-year-old woman with a tumor of the eleventh thoracic vertebra, causing compression of the spinal cord. Histopathology and immunohistochemical results of the tumor biopsy specimen disclosed a primary leiomyosarcoma of the thoracic spine. We report on the features of this rare entity but also review and summarize the imaging and pathology characteristics that can be extrapolated from the existing literature.
Asunto(s)
Leiomiosarcoma/cirugía , Neoplasias de la Columna Vertebral/cirugía , Biopsia , Cámaras de Difusión de Cultivos , Femenino , Humanos , Inmunohistoquímica , Leiomiosarcoma/diagnóstico por imagen , Leiomiosarcoma/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/patología , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Recreational scuba diving is a sport of increasing popularity. Previous studies indicating subtle brain injury in asymptomatic divers imply a cumulative effect of minor neural insults in association with diving for professional and/or recreational purposes, over the long-term. This is the first study to investigate putative neural tissue burden during recreational scuba diving by measuring circulating levels of S-100B, a sensitive biomarker of brain injury. 5 male divers performed 3 consecutive dives under conservative recreational diving settings (maximum depth 15 m, duration of dive 56 min, ascend rate 1.15 m/min) with an interval of 12 h between each session. Although a small increase in serum S-100B levels after each dive was apparent, this increase did not quite reach statistical significance (p=0.057). Moreover, no abnormal S-100B values were recorded (mean baseline: 0.06 µg/L, mean post-dive: 0.086 µg/L) and no effect of the 3 consecutive dives on changes in S-100B levels was detected. These results suggest that under the experimental conditions tested, diving does not seem to have a discernible and/or cumulative impact on central nervous system integrity. The extent to which variable diving settings and practices as well as individual susceptibility factors underlie putative neural tissue burden in asymptomatic divers, remains to be established.
Asunto(s)
Lesiones Encefálicas/etiología , Buceo/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Factores de Crecimiento Nervioso/sangre , Recreación , Proteínas S100/sangre , Adulto , Análisis de Varianza , Biomarcadores , Lesiones Encefálicas/epidemiología , Enfermedad de Descompresión/etiología , Embolia Aérea/etiología , Ejercicio Físico , Humanos , Masculino , Medición de Riesgo , Subunidad beta de la Proteína de Unión al Calcio S100 , Estadística como Asunto , Factores de Tiempo , Adulto JovenRESUMEN
Primary meningeal gliomas are uncommon tumors in the subarachnoid space, their primary characteristic being the absence of any obvious connection to the brain parenchyma. Rarely, they are quite malignant and assume a bulky, well circumscribed appearance rendering the differential diagnosis from other CNS neoplasms difficult. A 53-year-old man presented with a history of persistent headaches and left sided weakness. Magnetic resonance imaging revealed a temporoparietal mass attached to the dura that strongly resembled a meningioma. At surgery, the outer layer of the dura mater was intact and there was a clear brain-tumor interface without obvious pial disruption. Histological examination showed a biphasic pattern consisting of benign connective tissue intermingled with bundles of what seemed to be a glioblastoma. The mass demonstrated strong positivity for GFAP and the MIB labeling index focally exceeded 20%. The tumor was identified as a primary meningeal glioblastoma. The patient was disease-free for 42 months, after which he developed a recurrence for which he was re-operated. This time, the pathological findings of the tumor were those of a typical glioblastoma multiforme. We discuss the origin of the initial neoplasm and also the differential diagnosis that needs to include meningioma, aggressive glioblastoma infiltrating the dura and a recently recognized bimorphic CNS tumor: the desmoplastic glioblastoma.
Asunto(s)
Glioblastoma/patología , Glioblastoma/cirugía , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Duramadre/patología , Proteína Ácida Fibrilar de la Glía/metabolismo , Glioblastoma/radioterapia , Humanos , Antígeno Ki-67/metabolismo , Masculino , Neoplasias Meníngeas/radioterapia , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
Subependymal giant cell astrocytoma (SEGA) is an uncommon tumor that usually occurs in the setting of tuberous sclerosis (TS) syndrome. We report a rare case of an intratumoral and a small intraventricular hemorrhage complicating a SEGA in an adult patient without any signs of TS. Although pre-operative CT and MRI findings for the tumor were typical of SEGA, SEGA was not considered in the differential diagnosis because the patient was lacking any symptoms of TS. This is the second report of intraventricular and intratumoral hemorrhage complicating a SEGA and the first case in which these complications occurred in an adult patient in whom there was no previous suspicion of systemic disease.
Asunto(s)
Astrocitoma/complicaciones , Neoplasias Encefálicas/complicaciones , Hemorragia/etiología , Adulto , Proteína Ácida Fibrilar de la Glía/metabolismo , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X/métodosRESUMEN
Here is reported an extremely rare case of a large intraparotid facial nerve schwannoma in a 32-year-old female who presented with a parotid mass. There had been a long clinical course and sudden onset of facial weakness. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature.
Asunto(s)
Neoplasias de los Nervios Craneales/diagnóstico , Enfermedades del Nervio Facial/diagnóstico , Neurilemoma/diagnóstico , Glándula Parótida/inervación , Adulto , Biopsia con Aguja Fina , Parálisis Facial/diagnóstico , Femenino , Humanos , Tomografía Computarizada por Rayos XRESUMEN
We report an extremely rare case of complicated Amyand's hernia. A 61-year-old male patient was admitted with clinical signs of incarcerated right inguinal hernia and localised tenderness in the right iliac fossa. He underwent emergency surgery and the operative findings included perforated appendix and periappendicular abscess within a right inguinal hernia sac. Appendectomy and Shouldice's herniorrhaphy without prosthetic mesh placement were performed. Histology revealed the presence of a villous adenoma near the base of the appendix. We point out that although Amyand's hernia is a very rare clinical entity, it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia, especially when there are no pathological findings on the abdominal X-rays.