Ceramic substitutes, failure to achieve solid fusion in posterolateral instrumented fusion: a surgical and histological evaluation.

PURPOSE: As the number of instrumented fusions increases, so does the utilization of bone substitutes. However, controversies persist regarding the effectiveness of ceramics in promoting solid fusion. Few histological studies have been conducted on patients to address this issue. To contribute insights into this topic, we assessed bony fusion both intraoperatively and histologically in patients who underwent posterolateral instrumented fusions enhanced with a biphasic ceramic compound. METHODS: We analyzed a series of 13 patients who underwent revision surgery due to adjacent segment disease following the initial use of ceramics as bone extenders in the index surgery. In each case, patients exhibited apparent radiological fusion in the instrumented posterolateral fusions. Follow-up exceeded 18 months. Bone fusion was assessed intraoperatively, and biopsies of the bone mass at the intertransverse area were examined under an optical microscope. RESULTS: Surgical exploration of the fusion block at the intertransverse space did not indicate solid fusion. Moreover, histological analysis of the 13 biopsies revealed a lack of proper integration of the bone substitutes, incomplete resorption of hydroxyapatite granules, and substitution of ceramic particles by immature fibrous tissue lacking the structural competence to bear loads or add stability to spinal fusion. CONCLUSION: The utilization of biphasic ceramics proved ineffective in attaining a proper fusion mass between the intertransverse space. Both surgical inspection and histological studies confirmed the absence of integration. Prudence should be exercised regarding the use of ceramics. While no clear instability was observed, neither was there any integration.

[Cerebral phaeohyphomycosis: description of a case and review of the literature]. / Feohifomicosis cerebral: descripción de un caso y revisión de la literatura.

Cerebral phaeohyphomycosis is a rare invasive fungal infection with very few cases referenced in the literature. There is no standardized treatment, and it is associated with poor outcomes. Cladophialophora bantiana, a fungus with special tropism for the central nervous system, is one of the causal agents of phaeohyphomycosis. The case presented here deals with a brain abscess by C. bantiana in an adult with Crohn's disease had beed being treated with immunosuppressive drugs. Despite the correct etiological diagnosis, surgical and pharmacological treatments, the patient died 32 days after surgery. A description of the case is followed by a review of all cerebral C. bantiana phaeohyphomycosis cases published in the last 10 years. Regardless of the use of advanced new imaging techniques in the diagnosis and treatment with new antifungal agents, cerebral phaeohyphomycosis by C. bantiana continues to have very poor prognosis. While new more successful therapeutic treatments appear, a combined surgical and pharmacological approach seems to be more appropriate for this severe mycosis.

Feohifomicosis cerebral: descripción de un caso y revisión de la literatura / Cerebral phaeohyphomycosis: description of a case and review of the literature

La feohifomicosis cerebral es una micosis invasiva infrecuente, de mal pronóstico, sin tratamiento estandarizado y con muy pocos casos referenciados en la literatura. Entre los hongos responsables de la feohifomicosis se encuentra Cladophialophora bantiana, un hongo con especial tropismo por el sistema nervioso central. Se presenta un caso de absceso cerebral por C. bantiana en un adulto con enfermedad de Crohn y tratado con inmunosupresores. A pesar de la identificación del agente etiológico y del tratamiento quirúrgico y farmacológico administrado, el paciente evoluciona desfavorablemente y fallece 32 días después de la cirugía. La descripción del caso clínico se acompaña de una revisión de los episodios de feohifomicosis cerebral por C. bantiana publicados en los últimos 10 años. Los avances diagnósticos, incluyendo las nuevas técnicas de imagen, y el empleo de los nuevos antifúngicos no han mejorado el mal pronóstico de la feohifomicosis cerebral por C. bantiana, siendo aconsejable la combinación de tratamiento quirúrgico y farmacológico, aunque ninguna pauta terapéutica descrita en la literatura destaca por el éxito obtenido (AU)

Cerebral phaeohyphomycosis is a rare invasive fungal infection with very few cases referenced in the literature. There is no standardized treatment, and it is associated with poor outcomes. Cladophialophora bantiana, a fungus with special tropism for the central nervous system, is one of the causal agents of phaeohyphomycosis. The case presented here deals with a brain abscess by C. bantiana in an adult with Crohn's disease had beed being treated with immunosuppressive drugs. Despite the correct etiological diagnosis, surgical and pharmacological treatments, the patient died 32 days after surgery. A description of the case is followed by a review of all cerebral C. bantiana phaeohyphomycosis cases published in the last 10 years. Regardless of the use of advanced new imaging techniques in the diagnosis and treatment with new antifungal agents, cerebral phaeohyphomycosis by C. bantiana continues to have very poor prognosis. While new more successful therapeutic treatments appear, a combined surgical and pharmacological approach seems to be more appropriate for this severe mycosis (AU)

Cristales de sevelamer asociados a lesión de la mucosa del tracto gastrointestinal. Presentación de 2 casos, revisión de la literatura y diagnóstico diferencial morfológico con los cristales de kayexalato / Sevelamer crystals associated with mucosal lesions of the gastrointestinal tract. A report of 2 cases with emphasis on the morphological differential diagnosis with kayexalate crystals and a review of the literature

Sevelamer es un quelante no absorbible del fosfato, usado para tratar la hiperfosfatemia en pacientes con enfermedad renal crónica. La morfología de sevelamer ha sido descrita en un artículo recientemente publicado por Swanson et al., en el que se hace la primera descripción histológica de esta resina en el tracto gastrointestinal. En este artículo informamos de la presencia de cristales de sevelamer asociados a lesión mucosa en 2 pacientes con insuficiencia renal crónica en tratamiento con este fármaco, que presentaron apendicitis aguda perforada con peritonitis el primer caso, y úlceras esofágicas el segundo. Realizamos la descripción histológica de los cristales de sevelamer y hacemos un diagnóstico diferencial morfológico con los cristales de kayexalato, otra resina también usada en pacientes con enfermedad renal crónica (AU)

Sevelamer is a non-absorbable phosphate binder used to treat hyperphosphatemia in patients with chronic renal disease. Sevelamer morphology has been described in a recently published article by Swanson et al., in which the first histological description of this resin in the gastrointestinal tract is made. In this article we report the presence of sevelamer crystals associated with mucosal injury in 2 patients with chronic renal failure treated with this drug; one of them suffered acute perforated appendicitis with peritonitis and other developed oesophageal ulcers. We describe the histology of sevelamer crystals and the morphological differential diagnosis with kayexalate crystals, another resin used in chronic renal disease (AU)

Expresión de calretinina en el tumor de células granulares: análisis del gradiente de intensidad en la inmunotinción con correlación clínico-patológica / Calretinin expression in granular cell tumour: an analysis of the immunostaining intensity gradient and its clinicopathological correlation

Introducción. El tumor de células granulares (TCG) es una lesión poco frecuente que aparece predominantemente en mujeres y en el área de cabeza y cuello. Múltiples estudios apuntan a que deriva de las células de Schwann y su perfil inmunohistoquímico ha sido ampliamente estudiado. La expresión de calretinina (CRT) es, sin embargo, la peor caracterizada en el TCG, por ello en este estudio se pretende analizar en detalle su expresión en esta forma tumoral. Material y método. Se analizó una amplia muestra de TCG (n = 43), de los que se recogieron datos clínico-epidemiológicos y se realizó inmunotinción en todos ellos con anticuerpo anti CRT estudiando su patrón de expresión. Resultados. Se encontró que este tumor muestra positividad global frente a CRT en una amplia mayoría de los casos (74%), encontrando un gradiente en la inmunotinción en el 53% de los TCG estudiados, situación observada en los tumores con superficies epiteliales en proximidad y que no ocurre cuando estos epitelios se encuentran ausentes o alejados del TCG. Conclusiones. La tinción frente a CRT es útil para el diagnóstico del TCG y se demuestra la existencia de un gradiente en la inmunotinción cuando el TCG se encuentra en la proximidad de epitelios escamosos, sobre todo cuando estos muestran hiperplasia epitelial pseudoepiteliomatosa, lesión a la que frecuentemente se encuentran asociados (AU)

Introduction. Granular cell tumour (GCT) is a rare lesion which predominately affects women and occurs most frequently in the head and neck. Many reports suggest that the tumour cells are probably derived from Schwann cells. The immunohistochemical profile of GCT has been extensively studied, although calretinin expression (CRT) is the least understood. Our aim is to undertake a detailed analysis of its expression in this tumour. Materials and methods. A large sample of GCT (n = 43) was analysed. Clinical-epidemiological data were collected and immunostaining with CRT was performed in all of them with anti-CRT antibody to study its expression pattern. Results. We found that most of the GCT cases were positive to CRT (74%). Furthermore, in 53% of cases, we detected an intensity gradient in the immunostaining in tumour cells with epithelial surfaces in proximity, which does not occur when these epithelia are absent or distant from the GCT. Conclusions. CRT is a useful marker for the diagnosis of GCT. We found the existence of an immunostaining intensity gradient when the tumour is in close proximity to squamous epithelia, especially when these show pseudoepitheliomatous epithelial hyperplasia, which is often associated with GCT (AU)