Intramedullary cervical abscess mimicking a spinal cord tumor in a 10-year-old girl: a case-based review.

BACKGROUND: Intramedullary spinal cord abscesses (ISCA) are a rare pathological entity with very few cases reported in the world and may be confused with an intramedullary tumor. Cervical location is the least frequently affected, except for cryptogenic spread, mostly seen in adult patients. Meticulous study of contrast-enhanced MRI pictures has a key role in the diagnosis. METHOD AND RESULTS: We present a case of a spontaneous cervical ISCA, mimicking a spinal cord tumor, in a pediatric patient with good outcome. A review of the literature shows that this is a life-threatening condition with high chances of rupture and subsequent meningitis. CONCLUSIONS: We point out that if a solitary cervical spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, fever, and elevation of WBC, the possibility of a spinal cord abscess should be considered prior to surgery.

Prevalence of latex allergy in a population of patients diagnosed with myelomeningocele.

INTRODUCTION: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. OBJECTIVE: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. POPULATION AND METHODS: Descriptive, cross-sectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact with latex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. RESULTS: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ± 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. CONCLUSION: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.

INTRODUCCIÓN: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. OBJETIVO: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. PACIENTES Y MÉTODOS: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. RESULTADOS: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. CONCLUSION: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.

Prevalencia de alergia al látex en una población de pacientes con diagnóstico de mielomeningocele / Prevalence of latex allergy in a population of patients diagnosed with myelomeningocele

Introducción: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. Objetivo: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. Pacientes y métodos: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. Resultados: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. Conclusión: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.

Introduction: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. Objective: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. Population and Methods: Descriptive, crosssectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact withlatex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. Results: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ? 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. Conclusion: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.

[How I do it: spinal cord lipomas]. / Como Lo Hago Yo: Lipomas Medulares.

Based on 82 cases reviewed, in 5% we observed pelvic associated anomalies. In children less than 3 years of age the consult was triggered by the lumbar-sacral mass. In older than 3 years (42%) neurological problems triggered the consult. Only 24% at that age were concerned by the mass. The objective of the surgery is to untether the cord, and not to remove the entirety of the lipoma. Filum lipoma is the simplest to treat. Event though the French School is popular in Argentina I favor preventive surgery for lipoma even in asymptomatic patients. We had only 2.5% of added motor impairment and 6% in long term urological deficit.

[How I do it: surgical treatment of myelomeningocele]. / Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele.

In Argentina there is national program for fortifying flour with folic acid. Prenatal diagnosis is not always accurate. Closure according to standard technique. We close muscle layer. We don × t favor corpectomy for kyphosis. We suture the placode to restore cylinder shape of the cord. We close muscle layer. Hydrocephalus: V-P shunt. Third ventriculostomy is not effective. Chiari II: Cervical laminectomy. Syringomyelia: We shunt the syrinx to the peritoneum. MMCL is the most common neural tube defect. It consists of a neural placode exposed to environment. The placode is surrounded by arachnoid and by thin epithelial tissue.

Reparación de una perforación iatrogénica en el tercio cervical de un incisivo central superior: a propósito de un caso / No disponible

Se describe el caso clínico de una paciente mujer de 35 años que presenta necrosis pulpar con periodontitis apical aguda de 1.1 con una perforación iatrogénica asociada, localizada en la pared vestibular del tercio cervical de la raíz, observándose la emergencia de la lima por la encía vestibular. El sondaje es regular de 3 mm. El plan de tratamiento consiste en la limpieza y conformación del conducto y el sellado del defecto de la perforación con MTA (ProRootMTA®) a través de la cavidad de acceso. Se describe detalladamente la secuencia de tratamiento así como la evolución a los 2,6 y 9 meses (AU)

We describe the case of a 35 year old woman patient who presents pulp necrosis with acute apical periodontitis of 1.1 with an associated iatrogenic perforation, located at the buccal Wall in the cervical third of the root, showing the emergence of the file on the buccal gingiva. The probing is regular 3mm. The treatment plan consists in cleaning and the canal and sealing the perforation defect with MTA (ProRootMTA®) through the access cavity. It describes in detail the sequence of treatment as well as the evolution at 2, 6 and 9 months (AU)

The International Tethered Cord Partnership: Beginnings, process, and status.

BACKGROUND: Spina bifida presents a significant cause of childhood morbidity in lower- and middle-income nations. Unfortunately, there is a paucity of literature examining outcomes among children with spina bifida in these countries. The goal of the International Tethered Cord Parternship is twofold: (1) to establish an international surveillance database to examine the correlation between time of repair and clinical outcomes in children with spina bifida and tethered cord; and (2) to foster collaboration among international institutions around pediatric neurosurgical concerns. METHODS: Twelve institutions in 7 countries committed to participating in the International Tethered Cord Partnership. A neurosurgeon at each institution will evaluate all children presenting with spina bifida and/or tethered cord using the survey instrument after appropriate consent is obtained. The instrument was developed collaboratively and based on previous measures of motor and sensory function, ambulation, and continence. All institutions who have begun collecting data received appropriate Institutional Review Board approval. All data will be entered into a Health Insurance Portability and Accountability Act (HIPAA) compliant database. In addition, a participant restricted internet forum was created to foster communication and includes non-project-specific communications, such as case and journal article discussion. RESULTS: From October 2010 to December 2010, 82 patients were entered from the various study sites. CONCLUSION: To our knowledge this is the first international pediatric neurosurgical database focused on clinical outcomes and predictors of disease progression. The collaborative nature of the project will not only increase knowledge of spina bifida and tethered cord, but also foster discussion and further collaboration between neurosurgeons internationally.

Diferentes tecnicas neuroendoscopicas para el tratamiento de la hidrocefalia en pediatria. Estudio multicentrico en 360 pacientes / Different neuroendoscopical Techniques for the treatment of pediatric hydrocephalus Study in 360 patients

Objective: To analize our experience in the endoscopical treatment of pediatrichydrocephalus. Methods: In a retrospective study we analyzed 360 hidrocephalic patients treated endoscopically in 5 Pediatric Neurosurgical Services in Buenos Aires. 374 procedures were performed: 207 third-ventriculostomies, 70 septal fenestrations, 48 catheter implantations, 26 cyst-ventriculostomies, 11 septomies, 7 catheter removals, 4 aqueductoplasties and 1 monoplasty. Results: Third ventriculostomy was the most frequent procedure with a very low failure rate (19,8 por ciento). The overall complication rate was 4,5 por ciento. IN pineal tumor related hydrocephalus, a simultaneous biopsy procedure was always sucessful. Conclusions: Endoscopic treatment of hydrocephalus must always be consideraded as an effective method and as the first choice treatment in an important number of patients

Diferentes tecnicas neuroendoscopicas para el tratamiento de la hidrocefalia en pediatria. Estudio multicentrico en 360 pacientes / Different neuroendoscopical Techniques for the treatment of pediatric hydrocephalus Study in 360 patients

Objective: To analize our experience in the endoscopical treatment of pediatrichydrocephalus. Methods: In a retrospective study we analyzed 360 hidrocephalic patients treated endoscopically in 5 Pediatric Neurosurgical Services in Buenos Aires. 374 procedures were performed: 207 third-ventriculostomies, 70 septal fenestrations, 48 catheter implantations, 26 cyst-ventriculostomies, 11 septomies, 7 catheter removals, 4 aqueductoplasties and 1 monoplasty. Results: Third ventriculostomy was the most frequent procedure with a very low failure rate (19,8 por ciento). The overall complication rate was 4,5 por ciento. IN pineal tumor related hydrocephalus, a simultaneous biopsy procedure was always sucessful. Conclusions: Endoscopic treatment of hydrocephalus must always be consideraded as an effective method and as the first choice treatment in an important number of patients (AU)