Brown-Séquard syndrome caused by multiple knife trauma gunshot with late debridement: Two cases report and literature review.

INTRODUCTION AND IMPORTANCE: Brown-Séquard syndrome (BSS) is a rare syndrome consequence of interruption in the spinal cord following traumatic or non-traumatic injuries. Although, based on the previous literature, BSS has a good prognosis, some reports do not complete recovery following BSS. CASES PRESENTATION: In this current survey, we present two aggressive BSSs with complete recovery. One case involved a man aged 23 years without any underlying disease with multiple traumas with a knife who was transferred to the level 1 trauma center knife. Case two was a man 36 years with a gun shutting in C6 level. CLINICAL DISCUSSION: C5 total laminectomy and C4 and C6 partial laminectomy were done due to the sharp knife. Three months later, the patient achieved full recovery. After C6 total laminectomy in case 2, the patient was discharged without defect. CONCLUSION: Incomplete spinal cord injuries are challenging to diagnose and treat. Due to esophageal rupture and late debridement, full recovery was not expected. Despite neurological impairments, full recovery was achieved over three months in two cases. Also, many factors can aggravate the initial trauma in gunshot spine injury patients.

Effect of Intravenous Tranexamic Acid on Intracerebral Brain Hemorrhage in Traumatic Brain Injury.

AIM: To determine the effect of Intravenous Tranexamic Acid (TXA) on traumatic intracerebral hemorrhage. MATERIAL AND METHODS: A total of 94 cases of TBI with intracerebral hemorrhage, admitted to the emergency department who did not need surgical intervention based on a primary brain spiral computed tomography (CT) scan, were randomly assigned into two groups of 47 patients. In the intervention group, intravenous TXA was administered as one gram of bolus and one gram every 6 hours for 48 hours, and in the control group, the placebo was administered in the same way. After 6, 24, and 48 hours all the cases underwent a brain CT scan. Scans were examined for the size and diameter of hematoma and the midline shift. The information regarding the level of consciousness, hematoma volume, and diameter on CT scan were recorded on arrival and 48 hours later. RESULTS: Statistical results depict that while there was no considerable difference in the demographic aspect of the two groups, the volume and diameter of hematoma and the midline shift in the first CT scans and also their level of consciousness, the diameter and volume of hematoma and also the amount of hematoma expansion in follow up are significantly different in the two groups. CONCLUSION: The present study showed that the prescription of TXA would reduce the amount of hematoma expansion in traumatic intracerebral hemorrhage, and that medication can be introduced to reduce morbidity and complications.

Morphology of asterion and its proximity to deep vein sinuses in Iranian adult skull.

Background: The asterion is located at the posterior lateral side of the skull at the junction of the parietal, temporal and occipital bones.Methods: We examined the morphology of the asterion, its association with deep vein elements, the mastoid apex and inion in 105 adult cadavas (210 hemicraniums) including 146 males and 64 females at the anatomy lab of the Legal Medicine Organization.Results: Two types of asterion were observed. Type I was found in 14.7%, and type II in 85.3% of cases. In 70% of cases, the asterion was at or above the venous sinus. The distance between the asterion and the mastoid appendage on the right side was 47.03 mm and on the left side was 46.5 mm. The distance between the asterion and the inion at the right side was 70.55 mm and on the left side was 70.2 mm.Conclusion: The asterion in 70% of cases was at or above the level of the transverse sinus. For this reason, in posterior fossa surgical approaches, the first burr hole is preferred to start in the lower parts of the asterion.

Cystic dilation of a ventriculus terminalis. Case report and review of the literature.

The ventriculus terminalis (VT) is a small ependyma-lined cavity within the conus medullaris that is in direct continuity with the central canal of the spinal cord. Cystic dilatation of the ventriculus terminalis on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. VT has been described in children as a normal developmental phenomenon. These lesions are often diagnosed incidentally during imaging and are in most cases asymptomatic, especially in children. Symptomatic dilatation of VT in adults is a rare condition with 61cases being reported to date. Symptomatic dilatation of VT in children has not been reported till now. We present a 5 year-old-boy with a sphincteric and walking disorder. The patient was assessed by clinical, electrophysiological and urodynamic investigations as well as magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement. Lumbar-sacral MRI demonstrated the presence of a cystic lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the ventriculus terminalis dilation.The patient underwent laminectomy and the cyst wall was fenestrated with a midline myelotomy. In 6-month of follow-up, urinary problems and gait disturbance improved.

Effect of Local N-acetyl-cysteine in the Prevention of Epidural Fibrosis in Rat Laminectomy Model.

BACKGROUND: Epidural fibrosis is a major contributing factor to the onset of failed back syndrome. Many studies have attempted to prevent this physiological response. Interestingly, N-acetyl-cysteine (NAC) has been effective in some cases in the treatment of pulmonary fibrosis. OBJECTIVE: The objective of this study was to determine whether local NAC is an effective way to prevent epidural fibrosis after laminectomy in rats. MATERIALS AND METHODS: Twenty Wistar rats were used in this study. Animals were divided into two groups: NAC group and a control group. We performed two-level laminectomy (L4-L5) in these rats. Rats in the control group just had laminectomy, and in the other group, L4 and L5 laminectomy followed by local treatment with NAC. Four weeks later, the rats were killed, and the laminectomy level was subjected to histopathological examination to evaluate epidural fibrosis and fibroblast density. RESULTS: Histopathological examination showed that after 4 weeks of surgery the NAC group had significantly less epidural fibrosis and fibroblasts compared with control group. CONCLUSION: Our findings indicate that NAC decreased spinal epidural fibrosis after laminectomy in rats.

Lung Cancer Prevalence in Iran by Histologic Subtypes.

BACKGROUND: Prevalence statistics are essential for cancer control in addition to incidence and mortality data. As we know, there is no published report regarding lung cancer (LC) prevalence in Iran. Herein, we provide model-based estimates of limited time LC prevalence in Iran, 2015. MATERIALS AND METHODS: Incidence numbers of LC were extracted from Iranian National Cancer Registry reports for 2003-2009. Trends were analyzed by joinpoint regression, assuming a logarithmic poisson model. Incidence numbers were projected up to 2015, using linear regression models which were trained by corrected annual percentage changes. A Monte Carlo-based model was generated, and absolute survival rates, number of incident cases, and incompleteness of Iranian cancer registry for LC were included into it. Limited-time prevalence (within 1, 2-3, and 4-5 years from diagnosis) and its respective 95% uncertainty level (UL) were estimated by age, gender, and histopathological type. RESULTS: Five-year prevalence was estimated to be 4.21 (95% UL: 3.37-5.38) per 100,000 adult person, with a male:female ratio of 2.01. Estimated number of patients within 1, 2-3, and 4-5 years from diagnosis were 1871 (1497-2392), 993 (770-1285), and 420 (322-550), respectively. Most prevalent form of LC were squamous cell carcinoma (802; 579-999) and adenocarcinoma (319; 230-389) in males and females, respectively. CONCLUSION: According to our results, the most plausible estimates of number of alive LC patients within initial treatment, clinical follow-up, and cure phases were 2392, 1285, and 550 cases in Iran in 2015.

Can Opium Use Contribute to a Higher Risk of Colorectal Cancers? A Matched Case-control Study in Iran.

BACKGROUND: Colorectal cancers (CRCs) including colon, rectum and anal cancers are the third most prevalent cancers in the world. There are strong evidence showing the risk of the cigarette smoking, alcohol use, low physical activity and some types of diets in CRCs; however, few studies explored the relationship between opium use and CRCs. This study aimed to investigate the association between opioid use and the incidence of CRCs. METHODS: In a population-based matched case-control study in Kerman, Iran, 175 patients with colorectal cancers and 350 healthy controls (matched for age, sex, and place of residence) were interviewed from Sep 2014 to Nov 2014. Opium and its derivatives, cigarette, alcohol, and diet use were collected using a valid and reliable questionnaire. Conditional logistic regression was used to estimate odds ratios with 95% confidence intervals. RESULTS: The use of opioids was associated with an increased risk of CRCs (adjusted odds ratio= 4. 5, 95% CI: 2. 4-8. 7). In addition, a dose-response relationship was observed between the cumulative use of opioids and the incidence of CRCs (with low use OR=3. 7; 95% CI: 1. 5-8. 6 and high use OR= 8. 0; 95% CI: 2. 9-21. 7). This dose-response relationship was also strong in patients with colon cancers, with OR= 3. 9 (95% CI: 1. 5-9. 9) and 9. 4 (95% CI: 3. 3-27. 0) for the low and high uses of opioids, respectively. CONCLUSION: Opioid use can lead to an increased risk of CRCs. Therefore, it is necessary to implement preventive policies to control the use of opioids.

Elevated levels of S100A12 in the seminal plasma of infertile men with varicocele.

PURPOSE: Varicocele is among the leading causes of male infertility. Despite decades of research, its pathogenesis is still unclear. S100A12 is a member of the S100 family of calcium-binding proteins with principal extracellular activities. It is secreted by activated neutrophils and interacts with the multiligand receptor for advanced glycation end products (RAGE). Many studies have delineated the patterns of S100A12 expression in a variety of pathologic conditions. These data show that S100A12 could be a potentially useful inflammatory marker. To explore the relationship between S100A12 and infertility, we examined the amount of S100A12 in semen of infertile men who suffered from varicocele. METHODS: S100A12 levels in seminal plasma of 68 infertile men with varicocele (age range 30-45 years) and 68 healthy fertile controls were measured using ELISA. Statistical analysis was performed using both parametric and nonparametric tests. RESULTS: Results of this study showed that the seminal levels of S100A12 were significantly increased in infertile men with varicocele when compared to fertile controls (P < 0.001). CONCLUSIONS: Because of the important role(s) of these molecules in inflammatory response of cell systems, it could be possible that the spermatozoa motility is reduced following increasing neutrophils, S100A12, and reactive oxygen species in semen of infertile patients with varicocele. S100 proteins seem to be potential biomarkers and therapeutic targets for male infertility.

New insights into the role of stromal cell-derived factor 1 (SDF-1/CXCL12) in the pathophysiology of multiple sclerosis.

The etiology of several autoimmune diseases, including multiple sclerosis (MS) is still not clarified. MS is defined as an autoimmune disease with clinical features of a chronic, inflammatory, and demyelinating autoimmune disorder, which affects the central nervous system. Phases of remission and relapse are the major course of the disease, which could be exacerbated in terms of both severity and duration. As a subfamily of the cytokines, chemokines act as chemoattractants for a wide variety of cells, including immune cells. CXCL12, which is an important member of the CXC subfamily, has been widely explored in the hematopoietic system. In the peripheral immune system, CXCL12/CXCR4 performs pleiotropic functions. CXCL12 is a highly effective chemoattractant for lymphocytes and monocytes but not neutrophils. CXCL12 is present in the cerebrospinal fluid (CSF) of patients with MS and other inflammatory neurological disorders. The aim of this study is to summarize recent findings regarding the relationship between CXCL12 and MS.

Role of galectin-3 in the pathogenesis of bladder transitional cell carcinoma.

Galectins constitute an evolutionary conserved family that binds to ß-galactosides. There is growing evidence that galectins are implicated in essential biological processes such as cellular communication, inflammation, differentiation and apoptosis. Galectin-3 is one of the best-known galectins, which is found in vertebrates. Galectin-3 has been shown to be expressed in some cell lines and plays important roles in several physiological and pathological processes, including cell adhesion, cell activation and chemoattraction, cell cycle, apoptosis, cell growth, and differentiation. Moreover, this galectin is of interest due to its involvement in regulation of cancer. Changes in galectin-3 expression are commonly seen in cancerous and pre-cancerous conditions and galectin-3 may be involved in the regulation of cancer cell activities that contribute to tumourigenesis, cancer progression and metastasis. Finally, galectin-3 seems to be involved in cell events in tumor microenvironment, and therefore it could be considered as a target in transitional cell carcinoma therapies. This review aims to describe recent progress in understanding the role of galectin-3 in cancer biology, with emphasis on bladder tumor progression and metastasis.

S100A12 and RAGE expression in human bladder transitional cell carcinoma: a role for the ligand/RAGE axis in tumor progression?

BACKGROUND: Transitional cell carcinoma (TCC) and prostate cancer are the most frequent cancers in the male genitourinary tract. Measurement of biological biomarkers may facilitate clinical monitoring and aid early diagnosis of TCC. The aim of the present investigation was to detect the mRNA levels of S100A12 and RAGE (receptor for advanced glycation end products) in patients suffering from bladder TCC. MATERIALS AND METHODS: To explore the involvement of S100A12 and RAGE genes, total RNA was harvested from cancer tissues and samples obtained from normal non-tumorized urothelium of the same patients. Quantitative PCR (qPCR) was subsequently employed to determine the mRNA levels of S100A12 and RAGE. RESULTS: The results showed that mRNA expression of S100A12 and RAGE was significantly up-regulated in the cancer tissue. CONCLUSIONS: According to the results presented in the current study, mRNA expression of S100A12 and RAGE might be as a useful biomarker for TCC. Therefore, this ligand-receptor axis possibly plays important roles in the development of TCC and may serve either as an early diagnostic marker or as a key factor in monitoring of response to treatment. More research is required concerning inhibition of the S100A12-RAGE axis in different cancer models.