Migration of bullet in the spinal canal: a case report

As the spinal canal expands at T10 level naturally, it has been thought that the migration of a bullet within the spinal canal above this level is prevented and the migration of a bullet may only occur between T10 and S1 level. Here, a very rare case of a bullet traversing the length of the spinal canal is reported.     

Idiopathic lumbosacral plexus neuropathy in child. Case report

We describe a lumbosacral plexus neuropathy case in childhood in which detailed investigation, including electromyography and magnetic resonance imaging, was normal. Muscle biopsy showed mild denervation. No underlying condition was detected. The patient presented with pain, weakness and light atrophy in left lower limb, reduced reflex at the ankle, loss of the quadriceps reflex and paresthesy in involved limb. Recovery after one year was almost complete, with persistent slight weakness and atrophy.     

The contribution of peridurography to the anatomy of the lumbosacral spinal canal

Phonocardiography and echocardiography were used to examine 20 patients with a normally functioning Beall disc mitral valve prosthesis. Phonocardiographic intervals were: Q-S1 interval 67 +/- 3 msec; A2-OC interval 118 +/- 8 msec. Maximal variation of the Q-S1 interval within one examination was 21 +/- 2 msec, for A2-OC interval it was 31 +/- 5 msec. Echocardiographic disc velocities were: opening velocity 296 +/- 30 mm/sec, closing velocity 414 +/- 44 mm/sec. Maximal variation of the opening velocity was 126 +/- 25 msec; maximal variation of the closing velocity was 334 +/- 57 msec. Abnormal poppet function was suspected in one patient with unusual prolongation and variability of A2-OC interval.     

Genesis of spontaneous rhythmic motor patterns in the lumbosacral spinal cord of neonate mouse

The isolated spinal cord of the neonatal mouse spontaneously generates two different motor patterns of continuous rhythmic bursting: one in lumbar ventral roots in earliest postnatal preparations (P0-2) and another at the sacral level at later postnatal times (P3-5). Lumbar rhythmic motor discharges clearly alternate on contralateral roots and are in a frequency range (approximately 1 Hz) usually described for locomotor-like activity, while sacral motor sequences include mixed synchrony and irregular bilateral alternation that differ from typical locomotor-like activity. A significant decrease in the frequency and increase in the duration of spontaneous rhythmic bursts occur between lumbar and sacral motor patterns. In quiescent preparations from both postnatal periods, perfusion with Mg(2+)-free medium systematically induces a rhythmic activity at both lumbar and sacral level. Temporal characteristics of motor patterns under Mg(2+)-free medium are similar to spontaneous rhythms. Activating NMDA receptor channels by diminishing their Mg2+ block appears to be an efficient way of decreasing the threshold for genesis of the spinal rhythm in mouse. Bath application of NMDA and non-NMDA receptor antagonists blocks Mg(2+)-free-induced rhythmic activities in an irreversible or reversible manner, respectively. The effects of Mg(2+)-free medium and of glutamate antagonists provide evidence for the excitatory amino acid (EAA) dependence of both rhythmic motor patterns. Finally, the possibility that the recording of two different motor patterns may reflect a rostrocaudal developmental process is discussed.     

Gas in the spinal canal associated with injury of the cervical spinal cord: a diagnostic dilemma. A case report

This pilot study compared haloperidol, fluoxetine, and placebo for reduction of agitation in 15 outpatients with AD. The two drugs were no more effective than placebo at reducing agitation in these subjects; however, both drugs produced more toxicity than did placebo.     

Spontaneous subarachnoid hemorrhage first from an intracranial and then from a spinal arteriovenous malformation. Case report

A patient presented with spontaneous subarachnoid hemorrhage (SAH) from a cerebral arteriovenous malformation (AVM) which was later totally removed at surgery. The patient presented again with a new SAH from a spinal AVM that was also totally removed at surgery. Coexistence of spinal and cerebral arteriovenous malformations are exceedingly rare and hemorrhage from each is not previously reported. This case emphasizes the importance of investigating the spinal canal in otherwise unexplained spontaneous SAH.     

Case report of spontaneous splenic rupture in splenoma

We report one case of splenoma, a rare benign tumor of the spleen. Initial symptoms were repeated attacks of tail pancreatitis, that led to splenectomy for spontaneous splenic rupture. Splenomas may be asymptomatic or cause haematologic symptoms. Recently their association with neoplastic and haematologic disorders has been emphasized. Therefore such diseases must be ruled out when a splenoma is diagnosed.     

Arthroscopic removal of a .44 caliber bullet from the hip

Hip arthroscopy is far less invasive than standard open arthrotomy and offers unparalleled visualization of the acetabulum and femoral head. Diagnostic arthroscopy is becoming increasingly accepted as therapeutic options are still evolving. We report the case of the arthroscopic removal of a .44 caliber bullet from the femoral head of a 45-year-old man. The procedure afforded the opportunity to thoroughly irrigate the joint, debride the articular surface, and remove several loose bodies.     

Lumbar spinal canal stenosis associated with progressive degenerative changes of the spine. A case report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of spinal canal stenosis associated with progressive degenerative changes of the lumbar spine. SUMMARY OF BACKGROUND DATA: As far as the authors are aware, there has been no similar case reported. METHODS: The clinical features of the case are reported, and the pathology is discussed. RESULTS: In a 40-year-old man, spinal canal stenosis developed, associated with progressive degenerative changes of the lumbar spine. The man underwent posterior decompression and fusion using pedicle screws. The surgical results were satisfactory at the time of writing this report. CONCLUSIONS: This case presented a peculiar clinical course, which could not be categorized under previously reported disorders. It may be a new disease entity of spinal canal stenosis. The surgical outcome was satisfactory 2 years, 6 months after surgery.     

Multiple dural metastases from a pituitary adenoma. Case report

Only 12 cases of pituitary tumors that metastasized within the central nervous system have been reported. A further case is presented in which the histology of the multiple dural metastases remained identical to that of the original tumor, a pituitary adenoma. The authors discuss management of these rare lesions that appear histologically benign.     

Compression of the upper cervical spinal cord causing symptoms of brainstem compromise. A case report

STUDY DESIGN: A case is reported in which a flexion-induced compression of the upper cervical spinal cord caused symptoms of brainstem compromise in the absence of radiographic evidence of osseous instability. OBJECTIVES: A 41-year-old woman developed postoperative cervical instability with flexion-induced neurologic symptoms referable to the brainstem. The instability was caused by direct compression at the third cervical vertebral body, which in turn was caused by differential movements between the neuraxis and skeletal elements in the upper cervical spine. SUMMARY OF BACKGROUND DATA: Pathologic processes at the craniocervical junction may cause brainstem compromise with neurologic symptoms. The mechanism of brainstem involvement is usually either vertebrobasilar insufficiency or direct mechanical compression. In cases where the brainstem is compressed by skeletal elements, the compressing osseous structures usually are the walls of the foramen magnum or the odontoid process, or, less frequently, the atlas or axis vertebrae. Symptoms of brainstem dysfunction caused by dynamic compression at the level of the third cervical vertebra in the absence of hindbrain herniation are unusual and, to the best of the authors' knowledge, have not been described previously. METHODS: The patient underwent initial examination, evaluation, and periodic follow-up examination with magnetic resonance imaging from the time of her first visit until 26 months after the surgical treatment. The patient experienced postsurgical instability with dynamic compression by the C3 vertebral body, which caused brainstem compromise. Surgical treatment consisted of decompressive C3 corpectomy and fusion of C2 to C6, supplemented by anterior fixation. RESULTS: After undergoing surgical decompression of C3, reconstruction, and anterior internal fixation of C2 to C6, the patient had dramatic neurologic improvement. Diplopia, paresthesia, and nystagmus disappeared immediately after surgery. Swallowing difficulties, hoarseness, and vertigo improved gradually. At follow-up examination 26 months after surgery, the patient was asymptomatic. Magnetic resonance imaging showed good position of the construct, with no evidence of compression of the spinal cord or brainstem. CONCLUSIONS: Instability of the cervical spine may result in symptoms of brainstem dysfunction, even in the absence of hindbrain herniation. This instability is explained by the differential movement between the bony structures and neuraxis in the upper cervical region. Diagnosis and adequate management of this instability alleviates the neurologic symptoms and prevents possible hazardous complications.     

Symptomatic hamartoma of the spinal cord associated with neurofibromatosis type 1. Case report

The authors present a case in which a symptomatic hamartoma was found in the spinal cord of a patient with neurofibromatosis type 1 (NF-1). This 52-year-old woman presented with painful urinary incontinence. Magnetic resonance (MR) imaging revealed an intramedullary lesion within the lower thoracic spinal cord and conus medullaris, which was surgically removed. Pathological investigation showed a hamartomatous lesion consisting of glial cells, ganglion cells, abundant disoriented axons, and thin-walled vessels. This case provides a pathological correlate to the hamartomatous lesions demonstrated on MR imaging in patients with NF-1 and illustrates that these benign lesions may become symptomatic and require neurosurgical intervention.     

The spontaneous aortocaval fistula: a complication of the abdominal aortic aneurysm. Case report and review of the literature

AIMS: (i) to compare Helicobacter pylori serology in two 70-year-old cohorts in Gothenburg, Sweden, born 21 years apart, (ii) to study H. pylori serology in a 70-year-old cohort over 20 years. POPULATION AND METHOD: H. pylori serology at the age of 70 was investigated in 98 men and 132 women born in 1901/02 and in 77 men and 113 women born in 1922. In 21 men and 40 women Helicobacter serology was monitored longitudinally with examinations at 70, 81, and 90 years of age. The analyses were performed on frozen samples by use of an in-house enzyme immunoassay with a sensitivity of 0.99, specificity of 1.00 and positive and negative predictive values of 0.96 and 1.00, respectively. Absorbance values <0.500 were interpreted as negative; values of > or = 0.700 were interpreted as positive, and values in between as inconclusive. RESULTS: The 70-year-old cohort, born in 1922, showed a significantly lower proportion of subjects with positive H. pylori serology in both men (57.1% vs 80.6%) and women (48.7% vs 75.8%) compared with 70-year-olds born in 1901/02. There were no significant sex differences in either cohort. No longitudinal increase or decrease could be demonstrated in those who were examined at 70, 81 and 90 years of age. CONCLUSIONS: The difference in H. pylori prevalence between the two cohorts may reflect a rapid change in socio-economic conditions in Sweden during this 20-year period.     

Incomplete calcium hydroxide removal from the root canal: a case report

This case demonstrates failure of root canal treatment of a maxillary central incisor following incomplete mechanical removal of a Ca(OH)2 intracanal dressing and subsequent resorption of the material from the apical portion of the root canal. Retreatment some 4 years later involved the removal of the contents of the root canal and permanent obturation by lateral condensation of cold gutta-percha with a sealer. Follow-up showed complete periradicular bone healing with a lamina dura evident. An explanation of the processes involved is offered, based upon histopathological and microbiological evidence in the literature.     

Severe calcifying atherosclerosis of the thoracic aorta with symptoms of aortic isthmus stenosis. Case report

Mesenteric cysts are relatively rare tumors, and most patients present nonspecific abdominal symptoms until developing larger cysts. We report two cases of mesenteric cysts that were totally excised during laparoscopic surgery. The cysts of both patients were located in the mesenterium of the cecum or ascending colon. Under laparoscopy, the cyst was punctured to collect the cystic fluid for cytology and then completely removed without bowel resection. Histological examination revealed cystic lymphangiomas with endothelial cell lining. The postoperative course was uneventful. Laparoscopic treatment of benign abdominal cysts is an alternative safe and less invasive operation.     

Ear canal reflectance in the presence of spontaneous otoacoustic emissions. I. Limit-cycle oscillator model

Allen et al. [Abstract in Eighteenth Midwinter Research Meeting of the Association for Research in Otolaryngology, Des Moines, IA (1995)] have found that the ear canal reflectance passes through a minimum around the frequency of a spontaneous otoacoustic emission (SOAE). They considered this result to constitute evidence against active nonlinear cochlear function as the basis for SOAEs. In order to investigate theoretically the expected behavior of ear canal reflectance in the neighborhood of a SOAE associated with an active-nonlinear cochlea, we use a simplified model in which the ear drum end of the ear canal is effectively terminated by a nonlinear-active element. Under the influence of a sinusoidal driver at the entrance of the ear canal, this element will, to a good approximation, either (1) oscillate at both the frequency of the driver (at which the reflectance is determined) and the SOAE (at a suppressed level, corresponding to nonentrainment), or (2) be entrained and only oscillate at the driving frequency. The magnitude of the nonlinear ear canal reflectance is found to exceed unity only at sufficiently low stimulus levels, and occurs under conditions of entrainment and nonentrainment of the spontaneous emission. Otherwise, the reflectance is less than unity and, as a function of frequency, has a minimum around the SOAE frequency.