Lumbar disc sequestration mimicking a tumor: Report of four cases and a literature review.

BACKGROUND: Disc herniation refers to the displacement of disc material beyond its anatomical space. Disc sequestration is defined as migration of the herniated disc fragment into the epidural space, completely separating it from the parent disc. The fragment can move in upward, inferior, and lateral directions, which often causes low back pain and discomfort, abnormal sensation, and movement of lower limbs. The free disc fragments detached from the parent disc often mimic spinal tumors. Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors, such as lumbar soreness, pain, numbness and weakness of lower limbs, radiation pain of lower limbs, etc. It is usually necessary to diagnose the disease according to the doctor's clinical experience, and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging (MRI) and contrast-enhanced MRI. However, pathological examination is the gold standard that distinguishes tumoral from non-tumoral status. We report four cases of disc herniation mimicking a tumor, and all the pathological results were intervertebral disc tissue. CASE SUMMARY: The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year, with exacerbation over the last 2 wk. After admission, MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment, with enhancement on contrast-enhanced MRI suggesting neurilemmoma. The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years, with exacerbation over the last 3 mo. MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4-5 level, with obvious peripheral enhancement on contrast-enhanced MRI. Thus, neurilemmoma was suspected. The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk. MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4-5 level, with obvious rim enhancement on contrast-enhanced MRI. Thus, a spinal tumor was suspected. The fourth case was a 75-year-old man with right lower extremity pain for 2 wk, with exacerbation over the last week. MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion. There was no obvious enhancement on contrast-enhanced MRI, so a spinal tumor was suspected. All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5, 8, 8, and 6, respectively. All patients had an uneventful postoperative course and fully recovered within 3 mo. CONCLUSION: Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor. Examinations and tests should be improved preoperatively. Patients should undergo comprehensive preoperative evaluations, and the lesions should be removed surgically and confirmed by pathological diagnosis.

Multi-response gelation based on the molecular assembly of Sudan I dye derivatives for phase selective gelators and chemosensors.

Sudan I dye-based smart low molecular weight gelators with/without a perfluoroalkyl group have been successfully synthesized and characterized by rheological measurements, scanning electron microscopy (SEM), IR, and NMR spectroscopies. The gelation behaviors in response to temperature, pH changes, metal cations, and UV-vis light irradiation are investigated. Compounds 1 and 2 could selectively sense the Cu2+ cation in the presence of other metal cations. Moreover, compound 2 with a perfluoroalkyl group shows phase selective gelation ability. This work also provides a valuable reference for exploiting photosensitive materials as chemosensors.

Delayed diagnosis and management of necrotizing fasciitis of the left lower leg: A case report.

INTRODUCTION: Necrotizing fasciitis (NF) is a rare, severe soft tissue infection, characterized by rapid and extensive necrosis of the skin, subcutaneous tissue, and superficial and deep fascia. It is frequently misdiagnosed as other infectious diseases, leading to inappropriate treatment and potentially serious consequences. It may be complicated by septic shock and multiple organ failure with a fatal outcome. PATIENT CONCERNS: A 73-year-old woman presented with continuous itching, skin lesions, pain, and swelling of the outer side of her left leg. The patient was diagnosed with septic shock and multiorgan failure caused by left leg NF. DIAGNOSIS: Septic shock and multiorgan failure caused by left leg NF. INTERVENTIONS: Two surgeries were performed on the patient's leg, which effectively treated her septic shock and multiple organ dysfunction. OUTCOMES: The patient was followed up three times after her discharge. She had a good recovery, was generally well with no significant sequelae, and returned to her regular life. CONCLUSION: NF is an acute severe illness with high mortality. It is easily misdiagnosed, leading to delayed or erroneous treatment and serious (or potentially fatal) outcomes. Rapid and accurate diagnosis of NF is essential for patient recovery. In difficult cases, multidisciplinary consultations may be helpful. The management of NF includes early and thorough surgical debridement, antibiotics, and symptomatic treatment.

Scedosporium apiospermum infection of the lumbar vertebrae: A case report.

BACKGROUND: Scedosporium apiospermum (S. apiospermum) is a clinically rare and aggressive fungus mainly found in contaminated water, wetlands, decaying plants, stagnant water, and potted plants in hospitals. The lung, bone, joint, eye, brain, skin, and other sites are easily infected, and there is a marked risk of misdiagnosis. There have been few case reports of infection by S. apiospermum of the lumbar vertebrae; most reports have focused on infection of the lung. CASE SUMMARY: An otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain, stooping, and limited walking. The symptoms were significantly aggravated 10 d prior to hospitalization, and radiating pain in the back of his left lower leg developed, which was so severe that he could not walk. Movement of the lumbar spine was significantly limited, anterior flexion was about 30°; backward extension, right and left lateral curvature, and rotational mobility were about 10°; tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident, and the muscle strength of both lower limbs was grade IV. Imaging suggested bony destruction of the lumbar 3, 4, and 5 vertebrae and sacral 1 vertebra; in addition, the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable. Lumbar vertebral infection was also noted, and the possibility of lumbar tuberculosis was considered. We first performed surgical intervention on the lesioned lumbar vertebrae, cleared the infected lesion, and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device, which restored the stability of the lumbar vertebrae. Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S. apiospermum infection of the lumbar vertebrae; on this basis, the patient was administered voriconazole. At the 6-mo follow-up, efficacy was significant, no drug-related side effects were observed, and imaging examination showed no evidence of recurrence. CONCLUSION: S. apiospermum infection can occur in immunocompetent individuals with no history of near drowning. Voriconazole is effective for the treatment of S. apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.

[Monitoring of sentinel mice and risk assessment of schistosomiasis transmission in key regions of Yunnan Province in 2014].

OBJECTIVE: To establish and perfect the surveillance and forecast system of schistosomiasis, and timely discover the suspicious high risk environments for preventing the human and livestock from schistosomiasis. METHODS: Eight villages of three counties were selected as survey points. Then, the surveillance and forecast of sentinel mice were carried out in the key water regions. The recovered sentinel mice were dissected in laboratory. The sentinel mouse serum antibodies against schistosome were detected by ELISA, the suspicious water contacts of residents and livestock were investigated and the results were analyzed, and the epidemic risk was assessed. RESULTS: Totally 300 sentinel mice were placed, the recovery rate was 94.67%, and the mortality rate was 8.80%. There were no mice with positive serum antibodies against schistosome, and the results of the dissection of all the sentinel mice were negative. The humans who contacted with the suspicious water were mainly villagers, students, children and fishermen by washing hands and feet, washing vegetables, harvesting, fishing and swimming. The Oncomelania hupensis snail areas, human infection rates, and cattle infection rates were obviously declined in recent 3 years. However, the epidemic risks still existed. CONCLUSION: Although schistosomiasis transmission was effectively controlled in the three counties, the comprehensive control measures still should be strengthened.

Eco-social determinants of Schistosoma japonicum infection supported by multi-level modelling in Eryuan county, People's Republic of China.

Schistosomiasis remains of considerable public health concern in many tropical and subtropical regions of the world, including the People's Republic of China (P.R. China). The effectiveness of schistosomiasis control interventions are, among other factors, governed by the social-ecological context. However, eco-social determinants of schistosomiasis are poorly understood, particularly at the household or village levels. In the current study, residents in 26 villages of Eryuan county, Yunnan province, P.R. China, were screened for Schistosoma japonicum infection with a serological assay that was followed by stool examination for sero-positive individuals. Bayesian multilevel models with spatial random effects were employed to profile the S. japonicum infection risk based on known transmission sites of S. japonicum that are scattered across individual land parcels in this part of the country. The key risk factors identified with this approach were the absence of a sanitary stall house for livestock and presence of living and infected intermediate host snails in close proximity. We conclude that a spatially explicit Bayesian multilevel approach can deepen our understanding of eco-social determinants that govern schistosomiasis transmission at a small geographical scale.

[Current situation and effect of non-hazardous treatment of excrement of sanitary latrines in rural schistosomiasis endemic areas of Eryuan County, Yunnan Province].

OBJECTIVE: To understand the condition of the construction and management of sanitary latrines, and assess the effect of disposal of the excrement in rural schistosomiasis endemic areas in Yunnan Province. METHODS: Three villages with schistosomiasis endemic were selected from Eryuan County and 30 households per village were sampled randomly for the field survey. The stool samples were sampled and tested according to the national standard. RESULTS: Totally 90 latrines were surveyed. The popularity rates of sanitary latrines in Yongle, Qiandian and Xinzhuang villages were 83.19%, 83.12% and 81.63% respectively. In the 90 household latrines, only 32.22% located inside the courtyard, and 91.67% of sanitary latrines and 70.00% of non-sanitary latrines had integrated buildings. Maggots or pupae or adult flies were found in 33.33% of sanitary latrines and all of non-sanitary latrines with the average amounts of 1.05 and 3.40 per latrine respectively. The removal rate of fecal coliform, the sedimentation rate of parasitic eggs and the mortality rate of Ascaris eggs were 90.00%, 80.61% and 95.20% on average respectively. The qualified rate of the fecal coliform of the outlet of the sanitary latrines was 41.67%, and the qualified rate of the mortality rate of Ascaris eggs was 78.13%. No living schistosome eggs were found at the outlets of latrines. For the effect of non-hazardous treatment, there was a statistically significant difference between the sanitary latrines and non-sanitary latrines. CONCLUSIONS: The latrine improvement has a good effect on non-hazardous treatment of the excrement in Yunnan Province, but the construction, application and management of sanitary latrines still need to be strengthened.

[Study on spatio-temporal pattern of mountainous Oncomelania hupensis snails at village scale in Eryuan County, Yunnan Province].

OBJECTIVE: To develop a spatio-temporal model of mountainous Oncomelania hupensis snails based on the Bayesian model, and to analyze and identify the spatio-temporal pattern at a village scale. METHODS: The data including the intensity and spatial distribution of live and infected snails from 2000 to 2006 and the village boundary were collected. The independent and interactive spatio-temporal models were established, and then the best fitness model was selected to analyze the spatio-temporal pattern of live and infected snails. RESULTS: The interactive model of live snails and the independent model of infected snails were relative fitness models, and the models showed 95% CI (confidence interval) of the spatial and temporal coefficient included zero, and indicated that the spatial and temporal correlation of live and infected snails was not significant at a village scale. CONCLUSION: There is no significant spatial and temporal correlation of live and infected mountainous snails at a village scale, and the furthermore study should be carried out at a small scale.

[Effect of water- saving irrigation engineering on schistosomiasis control in Eryuan County of Yunnan Province].

OBJECTIVE: To evaluate the effect of a water-saving irrigation project on schistosomiasis control. METHODS: The Oncomelania snail situation before and after the water-saving irrigation project was investigated, and the data of snails and schistosomiasis of people in the area of the water-saving irrigation engineering were collected and analyzed statistically. RESULTS: The incidence of frames with snails declined from 10.70% to 2.27% after actualized water-saving irrigation project, and the snail density declined from 0.42 snails/0.1 m(2) to 0.10 snails/0.1 m(2). The snails were eliminated in 57% of the ditches. The snail area and schistosome infection rate of residents declined obviously. CONCLUSION: The water-saving irrigation project is effective in schistosomiasis control and has good social and economic benefits.