Spinal epidural capillary hemangioma: case report and review of the literature.

BACKGROUND: Almost all of the epidural hemangiomas reported are cavernous hemangiomas. Purely extradural spinal capillary hemangiomas are very rare. Capillary hemangiomas are hamartomatous malformations that result from proliferations of vascular endothelial cells. Only ten cases have been reported in the English literature, treated with surgical excision. CASE DESCRIPTION: A case of a dorsal extradural spinal capillary hemangioma is described. A total surgical removal has been performed after spinal angiography and embolization. Complete surgical removal should always be the goal in these lesions. Embolization did not show to reduce bleeding during the surgical procedure in this case.

Is It Possible To Evaluate the Ideal Cervical Alignment for Each Patient Needing Surgery? An Easy Rule To Determine the Appropriate Cervical Lordosis in Preoperative Planning.

BACKGROUND: Cervical sagittal alignment parameters are essential to plan stages of surgery. The aims of this study were to evaluate the relationship between cervical sagittal alignment parameters and surgical outcomes after anterior cervical arthrodesis; to identify parameters linked to a better outcome; to determine the role of the T1 slope, C7 slope, cervical lordosis, and C2-C7 plumb line; and to describe an innovative method to calculate cervical lordosis. A cohort of 70 patients without cervical kyphosis was included in our retrospective study. We analyzed C7 slope, T1 slope, cervical lordosis, and the C2-C7 sagittal vertical axis (SVA). Clinical postoperative outcomes were evaluated with the Neck Disability Index (NDI) and Visual Analog Scale (VAS) score. RESULTS: Significant correlation was found between the C2-C7 SVA, C7 slope, T1 slope and the CL/C7 slope. Statistically significant differences were found between group 1 (NDI = 0; VAS = 0) and group 3 (NDI > 17; VAS > 5) regarding C2-C7 SVA (P = 0.0026), C7 slope (P = 0.0014), T1 slope (P = 0.0095) and CL/C7slope (P = 0.0012). A value less than 25 mm found in the C2-C7 SVA correlate with positive outcomes. C7 slope correlated with NDI and VAS (P = 0.0014). CL/C7 slope ratio is significantly correlated to NDI and VAS scores (ratio: -0.52; P = 0.0012). Patients with CL/C7 slope greater than 0.7 had better clinical outcomes. CONCLUSIONS: Sagittal parameters are directly correlated with clinical outcome. If C7 slope increases, higher cervical lordosis is necessary to obtain a good outcome. CL/C7 slope (0.7) multiplied by C7 slope can determine the ideal lordosis.

International ring trial to detect anti-Trichinella IgG by ELISA on pig sera.

To determine the reproducibility and robustness of an ELISA to detect anti-Trichinella IgG in pig sera which was previously validated at the Community Reference Laboratory for Parasites (CRLP), a ring trial was organized involving European and extra-European reference laboratories for Trichinella. The sensitivity and specificity of the assay determined by the CRLP validation resulted to be 100% and 98.29%, respectively. The assay was reproducible, moreover, based on the receiver-operator characteristic (ROC) curve, the sensitivity and specificity of the assay reached 97.5% and 96.9%, respectively. The analysis of the differences in optical density (OD) between duplicates indicated a high repeatability of the ELISA with about 95% of the differences between -0.16 and 0.17 absorbance units. The accuracy of the test was determined by calculating the area under the ROC curve (AUC). Overall, the ELISA index (I(E)) showed a very high accuracy (AUC=0.9965) and it performed significantly better than the mean of the duplicated ODs (AUC=0.9387). Of the 21 participating laboratories, nine performed the test without any modification of the original protocol, and 14 with some modifications. Of the laboratories that followed the protocol exactly, three produced false-negatives; whereas of the laboratories that modified the protocol, five produced false-negatives (differences between these two groups of laboratories were not significant, p=0.18). When comparing these two groups of laboratories, the AUCs were very similar (0.9988 and 0.9955, respectively). Finally, a normal mixed multiple model effect was used to evaluate if the I(E) obtained was only related to the serum or to other parameters such as the laboratory, dilution of the serum tested and application of the proposed protocol. The variability found in the test results was mainly due to the serum samples. The assay proposed is robust and reproducible and can be used for monitoring the lack of Trichinella infection in domestic pigs.