Spontaneous spinal epidural hematoma after abrupt sneezing with prompt recovery of severe paraparesis.

Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic condition with threatening consequences when spinal cord compression is present. The diagnosis must be performed quickly using magnetic resonance imaging (MRI), which shows collection of blood in the epidural space. With spinal cord compression, there is an indication for urgent surgical decompression. Here, we present a 64-year-old woman who developed sudden thoracic and lower back pain accompanied by severe paraparesis and urinary retention after sneezing abruptly. An MRI revealed a posterior thoracic epidural hematoma extending from the T6 to T11 vertebral level with spinal cord compression. Decompression was recommended, but the patient refused surgery, while neurologically improving with time. Complete neurologic recovery was observed within 24 hours after SSEH onset. A conservative therapeutic approach with careful observation may therefore be considered as a treatment of choice in some cases where surgery is refused, (due to high risk or other reasons) and neurologic recovery is early and sustained.

[Irreversible electroporation: local, non-thermal, ablation therapy of malignant tumours]. / Ireverzibilní elektroporace: lokální, non-termální, ablacní lécba maligních nádoru

BACKGROUND: Irreversible electroporation (IRE) is a new method of local therapy of malign tumours based on bioelectric effect of electrical current. Short electric pulses with high voltage create nano size-pores in tumour cell membranes resulting in apoptosis of the exposed cells. The purpose of our study was to verify the IRE technique performed percutaneously under CT navigation and to assess effects of application of this method in early stages of primary and secondary hepatic, pancreatic, renal and pulmonary tumours. METHODS AND RESULTS: From November 2011 to October 2012 IRE was performed with NanoKnife (by AngioDynamics) in the population of 15 patients - 6 males and 9 females. IRE was performed under total anaesthesia with 2-5 needle electrodes introduced under CT navigation in the tumour base. The results of the treatment were assessed on the basis of modified RECIST criteria applied in 1-, 3- and 6-month intervals. A control CT or MRI examination 6 months post IRE was undertaken by 10 patients. One patient died one month post IRE of pulmonary embolism, two refused to visit for the control examination and another two are still to undergo the examination after 6 months. Out of the 10 examined patients success of IRE was demonstrated in 7 cases (70.0%) and IRE failure in 3 patients (30.0%). CONCLUSION: IRE is a new, mini-invasive therapeutic method applicable to local treatment of malignant tumours in cases where surgical approach is technically unfeasible or excessively risky. On the basis of first experience in a small cohort of patients IRE performed under CT navigation appears to be an effective and safe ablation method with a large therapeutic potential. Its results will however need to be assessed within a longer time horizon and in a larger cohort of population.

Biodegradable polydioxanone stents: a new option for therapy-resistant anastomotic strictures of the colon.

OBJECTIVES: To assess the outcome of self-expandable, biodegradable stent insertion for anastomotic strictures following treatment for rectosigmoid carcinoma. METHODS: Three male patients (median age 66) developed benign strictures after radiotherapy and resection of a recto-sigmoid carcinoma. These were resistant to balloon dilatation and prevented stoma reversal. Biodegradable stent insertion was performed as an experimental treatment on a named-patient basis with approval of the institutional review board. Patients had monthly follow-up with endoscopy and contrast medium enemas to monitor performance and degradation of the stents. RESULTS: All stents were placed successfully without complications after pre-dilatation to 20 mm under fluoroscopic guidance. Stent degradation occurred in all patients 4-5 months following implantation, and long-term anastomotic patency was demonstrated in all. This allowed reversal of the colostomy and physiological defecation in two patients. Reversal was not undertaken in one due to subsequent development of liver metastases. No stent migration or occlusion occurred. CONCLUSIONS: Biodegradable stents can maintain an adequate lumen across anastomotic strictures resistant to balloon dilatation. They seem to allow stricture re-modelling resulting in maintained dilatation after degradation. This potentially allows reversal of a colostomy, which might otherwise be prevented by stricture recurrence.

[Computed tomography laser mammography]. / Computed tomography laser mammography.

Computed tomography laser mammography (CTLM) is a new examination method, which is used for visualization of vascular structures, not only physiological blood vessels, but also neovascularization. Neovascularization can accompany growing malignant tumour. CTLM uses laser beam of the wavelength equal to 808 nanometres, which is absorbed in blood pigments of physiological and pathological blood-vessels and is able to display their distribution. CTLM offers new possibilities of breast disease diagnostic with demonstration of neovascularisation. CTLM is able to recognize malignant tumour from benign lesion. At present, CTLM is used only as a supplementary method of the basic examination.