RESUMEN
INTRODUCTION: Subperiosteal orbital hematoma is a rare occurrence, typically developing as a result of orbital trauma. The spontaneous formation of a subperiosteal orbital hematoma (sSOH) may also occur but is less frequent. To date there has been no documented cases of sSOH as the initial presentation of an unknown metastatic neoplasm to the skull. We provide a case of a woman with unknown lung adenocarcinoma that metastasized to the skull which caused the formation of a sSOH resulting in orbital compression syndrome. CASE REPORT: A 57-year-old female presented with double vision, retro-orbital right eye pain, and vision loss in the right eye. A magnetic resonance imaging revealed a right orbital compressive lesion with an adjacent supraorbital skull lesion and separate left frontal skull lesion. Intra-operative findings along with post-operative immunohistochemistry staining revealed sSOH resulting from a metastatic lung adenocarcinoma to the skull. Further metastatic work up also revealed an occult lung mass and multiple spinal lesions. CONCLUSION: Differential diagnosis of etiologies causing the formation of sSOH in an adult without history of trauma should include metastatic neoplasm to the skull and warrants metastatic workup. Treatment options of sSOH have included observation with spontaneous resolution; however, we opted for surgical decompression of the eye and biopsy of the skull mass.
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Adenocarcinoma/secundario , Hematoma/diagnóstico , Neoplasias Pulmonares/patología , Hemorragia Retrobulbar/diagnóstico , Neoplasias Craneales/secundario , Adenocarcinoma/diagnóstico , Adenocarcinoma/metabolismo , Biomarcadores de Tumor/metabolismo , Descompresión Quirúrgica , Resultado Fatal , Femenino , Hematoma/cirugía , Humanos , Neoplasias Pulmonares/metabolismo , Imagen por Resonancia Magnética , Persona de Mediana Edad , Periostio/patología , Hemorragia Retrobulbar/cirugía , Neoplasias Craneales/diagnóstico , Neoplasias Craneales/metabolismoRESUMEN
BACKGROUND: Brain metastases are the most common adult brain tumors, frequently arising from primary tumors in the lung, breast, skin, kidneys, and colon. Transitional cell carcinoma (TCC), the most common type of urinary bladder cancer, is a rare cause of brain metastasis with an ominous prognosis. CASE DESCRIPTION: A 68-year-old female presented with right-sided paresis and focal motor seizures of her right upper and lower extremities 14 years after being diagnosed and treated for primary TCC of the urinary bladder with gemcitabine-based chemotherapy. MRI imaging revealed a 3.1 × 3.1 × 2.7 cm heterogeneously enhancing mass located along the posterior aspect of the left frontal convexity. The lesion was accessed using a transsulcal approach and was surgically debulked along the motor cortex with motor strip mapping, followed by adjuvant whole-brain radiation therapy. Pathological examination confirmed metastatic carcinoma with features of TCC, a rare entity among metastatic brain tumors. CONCLUSION: Brain metastases may present several years later in patients with TCC of the urinary bladder who have been treated with surgery and chemotherapy. Chemotherapeutic agents that penetrate the blood-brain barrier, such as gemcitabine, may delay development of cerebral metastasis from primary TCC of the urinary bladder.
RESUMEN
OBJECT: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been approved for use in the lumbar spine in conjunction with the lumbar tapered cage. However, off-label use of this osteoinductive agent is observed with anterior fusion applications as well as with both posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF). Complications using rhBMP-2 in the cervical spine have been reported. Although radiographic evidence of ectopic bone in the lumbar spine has been described following rhBMP-2 use, this finding was not previously believed to be of clinical relevance. METHODS: This study was a retrospective review of 4 patients who underwent minimally invasive spinal TLIF (MIS-TLIF) in which bone fusion was augmented with rhBMP-2 applied to an absorbable collagen sponge. Case presentations, operative findings, imaging data, and follow-up findings were reviewed. RESULTS: Four cases with delayed symptomatic neural compression following the off-label use of rhBMP-2 with MIS-TLIF were identified. CONCLUSIONS: Although previously believed to be only a radiographic finding, the development of ectopic bone following rhBMP-2 use in lumbar fusion can be clinically significant. This paper describes 4 cases of delayed neural compression following MIS-TLIF. The reader should be aware of this potential complication following the off-label use of rhBMP-2 in the lumbar spine.
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Proteína Morfogenética Ósea 2/efectos adversos , Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Uso Fuera de lo Indicado , Osificación Heterotópica/inducido químicamente , Complicaciones Posoperatorias/inducido químicamente , Implantación de Prótesis/métodos , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Administración Tópica , Adulto , Anciano , Proteína Morfogenética Ósea 2/uso terapéutico , Discectomía , Femenino , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/diagnóstico , Laminectomía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Mielografía , Síndromes de Compresión Nerviosa/inducido químicamente , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/cirugía , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Reoperación , Raíces Nerviosas Espinales/cirugía , Espondilolistesis/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
To describe a new posterior minimally invasive method of facet stabilization for treatment of the degenerating lumbar motion segment. The biomechanics of this Percudyn (Interventional Spine; Irvine, CA) system are distinct from that of other interspinous dynamic stabilization systems as it acts bilaterally directly within the middle column of the spine. Based on biomechanical evalution, the paired prosthesis supports, cushions, and reinforces the facet complexes by limiting both extension and lateral bending thereby maintaining central and foraminal volumes. METHODS: the Percudyn device consists of a pedicle anchor upon which sits a cushioning polycarbonate-urethane stabilizer that serves as a mechanically reinforcing stop between the inferior and superior articular facets. A 1.5 cm skin incision is made bilaterally over the lower pedicle of the treated segment through which a Jamshidi needle is percutaneously targeted under biplanar fluoroscopic guidance into the caudal aspect of the superior articular process directly underneath the lip of the inferior facet from the level above. Progressive onestep tubular dilation is then performed to secure a small disposable working portal. Through this access, the Percudyn stabilizers are then placed over the wire and anchored bilaterally into the inferior pedicles of the degenerated motion segment. RESULTS: three patients (ages 26-41, male) with significant low back pain as well as radiculopathy with lateral recess stenosis from a large disc herniation/ ligamentum and facet hypertrophy (L4-5 and/or L5-S1) underwent a minimally invasive decompression/ discectomy and bilateral Percudyn placement at each disease level. Each patient had significant relief of both his radiculopathy and axial back pain post-operatively and was discharged home within 18 hours without sequelae. CONCLUSION: this novel technique of percutaneous posterior facet augmentation allows for safe placement of bilateral...
Descrever um método de estabilização facetária posterior minimamente invasivo para tratamento de segmento móvel degenerativo. A biomecânica do sistema Percudyn (Interventional Spine, Irvine, Califórnia) é distinta de outros sistemas de estabilização dinâmica inter-espinhosa, pois este atua direta e bilateralmente dentro da coluna média da coluna vertebral. Baseada em avaliações biomecânicas, a prótese dupla dá suporte, atua como amortecedor e reforça os complexos facetários limitando a extensão e a inclinação lateral, mantendo assim os volumes centrais e foraminais. MÉTODOS: o sistema Percudyn consiste de uma ancora pedicular sobre a qual está apoiado um estabilizador de plicarbonato-uretano que atua como um bloqueio mecanicamente reforçado entre as facetas inferiores e superiores. Uma incisão na pele de 1,5cm é feita bilateralmente sobre o pedículo inferior do segmento a ser tratado, por meio da qual é introduzida percutaneamente uma agulha de Jamshidi com auxílio de fluoroscopia biplanar em direção da porção caudal do processo articular superior, diretamente abaixo da borda da faceta inferior do nível superior. É feita uma dilatação tubular progressiva para assegurar um pequeno e temporário portal de trabalho. Por meio desse acesso, os estabilizadores Percudyn são colocados sobre o fio e ancorados bilateralmente nos pedículos inferiores de cada segmento móvel degenerativo. RESULTADOS: três pacientes (idade de 26 a 41 anos, sexo masculino) com lombalgia significativa, assim como radiculopatia e estenose do recesso lateral em consequência de um grande fragmento de disco herniado, ou hipertrofia ligamentar e facetária (L4-5 e/ou L5-S1) foram submetidos a uma descompressão/discectomia minimamente invasiva e implantação do Percudyn bilateralmente em cada segmento afetado. Todos os pacientes tiveram um alivio pós-operatório significante, tanto da radiculopatia como da dor axial lombar, e alta hospitalar até 18 horas sem sequelas...
Describir un método de estabilización facetárea posterior mínimamente invasiva para tratamiento del segmento móvil degenerativo. La biomecánica del sitema Percudyn (Interventional Spine, Irvine, California) es distinta de otros sistemas de estabilización dinámica interespinosa, pues ésta actúa directamente y bilateralmente dentro de la columna media de la columna vertebral. Con base en evaluaciones biomecánicas, la prótesis dupla da soporte, actúa como amortiguador y refuerza los complejos facetáreos limitando la extensión y la inclinación lateral, manteniendo así los volúmenes centrales y foraminales. MÉTODOS: el sistema Percudyn consiste de un áncora pedicular sobre la cual está apoyado un estabilizador de policarbonato-uretano, que actúa como un bloqueo mecánicamente reforzado entre las facetas inferiores y superiores. Una incisión en la piel de 1.5 cm es hecha bilateralmente sobre el pedículo inferior del segmento a ser tratado, a través del cual es introducida percutáneamente una aguja de Jamshidi con auxilio de fluoroscopia biplanar en dirección a la porción caudal del proceso articular superior, directamente abajo del borde de la faceta inferior del nivel superior. Es hecha una dilatación tubular progresiva para sujetar un pequeño y temporal portal de trabajo. A través de este acceso, los estabilizadores Percudyn son puestos sobre el hilo o alambre y ancorados bilateralmente en los pedículos inferiores de cada segmento móvil degenerativo. RESULTADOS: tres pacientes (edad de 26 a 41 años, sexo masculino) con lumbalgia significativa, así como radiculopatía y estenosis del receso lateral en consecuencia de un fragmento grande del disco herniado, o hipertrofia ligamentar y facetárea (L4-5 y/o L5-S1) fueron sometidos a una descompresión/ disectomía mínimamente invasiva e implantación del Percudyn bilateralmente en cada segmento afectado. Todos los pacientes tuvieron un alivio postoperatorio significativo tanto de la radiculopatía...
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Humanos , Fenómenos Biomecánicos , Dolor de la Región Lumbar , Procedimientos Ortopédicos , Radiculopatía , Procedimientos Quirúrgicos OperativosRESUMEN
A detailed phylogenetic analysis of tetraspanins from 10 fully sequenced metazoan genomes and several fungal and protist genomes gives insight into their evolutionary origins and organization. Our analysis suggests that the superfamily can be divided into four large families. These four families-the CD family, CD63 family, uroplakin family, and RDS family-are further classified as consisting of several ortholog groups. The clustering of several ortholog groups together, such as the CD9/Tsp2/CD81 cluster, suggests functional relatedness of those ortholog groups. The fact that our studies are based on whole genome analysis enabled us to estimate not only the phylogenetic relationships among the tetraspanins, but also the first appearance in the tree of life of certain tetraspanin ortholog groups. Taken together, our data suggest that the tetraspanins are derived from a single (or a few) ancestral gene(s) through sequence divergence, rather than convergence, and that the majority of tetraspanins found in the human genome are vertebrate (21 instances), tetrapod (4 instances), or mammalian (6 instances) inventions.
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Evolución Biológica , Proteínas de la Membrana/genética , Vertebrados/genética , Animales , HumanosRESUMEN
Three species of flying fox (Pteropus hypomelanus, P. vampyrus, and P. lylei) from Malaysia and Vietnam were screened for apicomplexan parasites by thin blood smears and polymerase chain reaction. Only 1 of 16 bats sampled from 3 localities in southeast Asia was found to be infected (P. hypomelanus from Pulau Pangkor, Malaysia). We observed micro- and macrogametocytes, with morphology consistent with Hepatocystis sp. parasites, using light microscopy. Phylogenetic analysis of the cytochrome b gene showed that the parasite from P. hypomelanus groups with 2 published sequences from Hepatocystis spp., including one from Cynopterus brachyotis, another fruit bat in the Pteropodidae.
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Quirópteros/parasitología , Haemosporida/aislamiento & purificación , Infecciones Protozoarias en Animales/parasitología , Animales , Citocromos b/genética , ADN Protozoario/sangre , ADN Protozoario/química , Eritrocitos/parasitología , Haemosporida/clasificación , Haemosporida/genética , Malasia , Masculino , Filogenia , Reacción en Cadena de la Polimerasa/veterinaria , Alineación de Secuencia/veterinaria , VietnamRESUMEN
The generalized/primitive nature of the hominoid dentition and often fragmentary nature of fossils, coupled with enthusiastic optimism for making revolutionary finds, has wreaked havoc with recognition of early human ancestors and reconstruction of fossil hominoid phylogeny. As such, the history of paleoanthropology is one of repeated misidentification of fossil ancestors and of occasional fraud. Although this history has led many workers to lose confidence in morphology based systematics (MBS), past and present misidentifications are actually due to a disregard of systematic methodology. Systematics depends on the continuity of life and gains its objectivity largely from the order alpha taxonomy imposes on morphologic discontinuities in closely related taxa (i.e., species and genera). Transformation of characters fixed in species into character complexes, as manifested in taxa nested at different levels of relationship, form the foundation for higher-level taxonomy and for phylogeny. Because in most cases, hominoid fossils are unable to provide the data needed to resolve alpha taxonomy, classification and phylogeny of fossil taxa must be guided by analogies to living taxa. Hominid and hominoid fossil taxonomy and phylogeny, however, has been based largely on preevolutionary notions and on misinterpretations of the polarity of assumed diagnostic characters. More often than not, fossils lack resolution for the taxonomic level or rank they are assigned to and taxa are erected without appropriate analogies to living forms. As such, phylogenies based on these classifications are unlikely to be correct. More in-depth anatomical studies that are in accordance with systematic methodology are likely to hold the key to correctly classifying fossils and unraveling hominoid and hominid phylogeny.