Rhythms of serum melatonin in rats with acute spinal cord injury at the cervical and thoracic regions.

OBJECTIVE: To evaluate the serum melatonin levels in acute period of the spinal cord injury (SCI) caused by trauma in the rats. BACKGROUND: Traumatic SCI induces many types of physiological and pathological damage, including hormonal level variations. METHODS: Forty male Sprague-Dawley rats were divided randomly into four groups. In the control group, neither laminectomy nor SCI were performed; only a large laminectomy was performed without SCI in the sham group. In the cervical and thoracic spinal trauma groups, laminectomies at C5-6 and a T6-7 were performed, respectively, followed by clip compression of the spinal cord. Blood samples were drawn 2, 6, 12 and 24 h after the procedures and assayed immediately. RESULTS: The levels of melatonin in the neurotrauma groups were high in the first 2 h, but at the end of sixth hour, melatonin levels increased in sham-operated group, decreased in neurotrauma groups and did not change in control group. At the 12th hour, melatonin levels continued to decrease in thoracic group significantly. At the 24th hour, the melatonin levels decreased in the cervical, control and sham groups, whereas melatonin levels increased in the thoracic group. CONCLUSIONS: The present study revealed that (1) activation of endogen melatonin secretion of the organism starts immediately after the SCI, but it shows a great lowering trend between 2 and 6 h post-SCI, (2) the tetraplegic rats, which had complete injuries at the lower cervical spinal cord, could not produce enough melatonin secretion; on the contrary, the paraplegic rats, which had complete injury at the upper thoracic spinal cord, showed normal melatonin secretion.

Cervical anterior intradural arachnoid cyst in a child.

Intradural arachnoid cysts involving the spine are uncommon and especially rare in an anterior cervical location. In the literature, among 15 patients, 8 were in the paediatric age group and in 3 patients the cyst was localised to the full length of the cervical spinal canal. Although they occur secondary to trauma, haemorrhage, surgery or inflammation, most of them are known to be idiopathic or congenital. Although the disease shows a dramatic neurological course, early diagnosis and treatment could provide good results. We report a 2(1/2) year-old boy with progressive tetraparesis with a huge anterior intradural arachnoid cyst located from the cervico-medullary junction to the C7 level. In the paediatric age group, cervical anterior intradural arachnoid cyst is an unusual cause of quadriparesis. The rarity of this condition and the relevance of MRI in the accurate and early diagnosis is discussed here. A 2(1/2) year-old boy with a large intradural arachnoid cyst extending from the cervico-medullary junction to C7 situated anteriorly is reported here; diagnosis and treatment modalities are discussed.

An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system.

Cerebrospinal fluid (CSF) leakage may develop when a defect is formed in dural layers by traumatic or iatrogenic processes. Traumatic CSF leakage was encountered in 2% of head injuries. CSF leakage is an associated feature of 12-30% of skull base fractures. Numerous treatment modalities are proposed for the management of CSF leaks. A closed lumbar drainage system (CLDS) is recommended as an alternative method to surgery for preventing complications related to leakage. In the present study, we report the clinical details of 46 patients who suffered from rhinorrhea/otorrhea (R/O), three of whom were urgently operated due to other causes like subdural hematoma and tension pneumocephalus. Leakage spontaneously ceased in 26 (60.4%) patients whereas CLDS insertion was found to be necessary in 17 patients. A prophylactic antibiotic regimen was started in the CLDS group and these patients were followed with daily CSF cell counts. Fifteen patients (88.2%) were successfully treated by CLDS, however meningitis developed in 2 patients (11.7%). Severe complications like meningitis could be avoided by a simple daily microbiological analysis of CSF.

Sympathetic skin responses from frontal region in migraine headache: a pilot study.

Frontal sympathetic skin responses (F-SSRs) were recorded to investigate sympathetic nervous system activity in migraine headache (MH). Thirty-five patients with unilateral MH and 10 healthy volunteers were studied by evoking bilateral F-SSRs with electrical stimulation of the median nerve in attack, post-attack and interictal periods. The mean latencies were longer and the maximum amplitudes were smaller on the symptomatic side compared with the asymptomatic side (P < 0.05 for both amplitude and latency) in attack and in interictal periods. In five patients, F-SSRs were absent bilaterally, in four patients the responses were absent only on the symptomatic side during the attack period. In the post-attack period, F-SSRs on the symptomatic side had higher amplitudes and shorter latencies compared with the asymptomatic side (P < 0.01 for both amplitude and latency). There is an asymmetric sympathetic hypofunction on the symptomatic side in attack and interictal periods, whereas there is a hyperfunction in the post-attack period.

Intramedullary arachnoid cyst: 3-year follow up after bilateral dorsal root entry zone myelotomy.

Spinal arachnoid cysts are relatively uncommon an intramedullary location is believed to be extremely rare. A 35 year old woman, admitted with progressive weakness in the lower limbs, was diagnosed as having a thoracic intramedullary arachnoid cyst. After bilateral dorsal root entry zone myelotomy procedures and wide fenestration was performed, there was a dramatic and immediate recovery. This is the first intramedullary arachnoid cyst reported to be treated by this approach and the long term outcome discussed.

Sturge-Weber syndrome accompanied with multiple congenital intracranial lesions.

Sturge-Weber syndrome is one of the neurocutaneous syndromes. It is a rare, nonfamiliar disease that is characterized by facial port-wine stain, leptomeningeal angiomatosis, choroidal angioma, buphthalmos, intracranial calcification, cerebral atrophy, mental retardation, glaucoma, seizures and hemiparesis. CT and MR are complementary in the evaluation of this disease. Epilepsy is an essential feature of Sturge-Weber syndrome and it has a major significance for prognosis and treatment. We report a 2-year-old boy with Sturge-Weber syndrome who had in addition an intracranial lipoma, a temporal arachnoid cyst and a porencephalic cyst. This combination of intracranial lesions with Sturge-Weber syndrome has not been previously reported.

Rare intracranial manifestations of frontal osteomas.

Osteomas of the paranasal sinuses are usually asymptomatic. When enlarged, they could give rise to intracranial manifestations and serious complications. Osteomas most commonly affect the fronto-ethmoid sinuses. They rarely show intra-orbital extension or cause intracranial complications such as CSF rhinorrhea, pneumocephalus and intracranial infection. We report two unusual cases of frontal osteomas complicated by rare manifestations such as intracranial mucocele, CSF leak, pneumocephalus and bacterial meningitis. We demonstrate the importance of these intracranial manifestations when these lesions are accompanied by neurological symptoms and signs with special emphasis on the importance of early treatment.

The effects of osteoporosis on distraction osteogenesis: an experimental study in an ovariectomised rabbit model.

The effects of oestrogen deficiency-associated osteoporosis on callus distraction were investigated in rabbits. Twenty-four female New Zealand rabbits 5 to 6 months old were used. Ovariectomy was performed on 12 rabbits, which composed the osteoporotic model group. Six weeks later, osteotomy was carried out and Ilizarov external fixators were applied to the right proximal tibial metaphyses in both the osteoporotic model group and the control group. Beginning one week postosteotomy, the metaphyses were distracted 0.35 mm twice daily for 3 weeks, and the average length increase obtained for both groups was 17.2 mm (minimum: 16.8, maximum: 19 mm). Following a postdistraction waiting period of 6 weeks for newbone formation, the subjects were sacrified and specimens were examined histopathologically. Radiography was carried out at one-week intervals during the distraction period and at 2-week intervals during the waiting period, and scintigraphy was performed at the end of each period. On histopathologic examination, a significant difference in callus remodeling was observed between the control and osteoporotic model groups. On radiologic evaluation it was observed that, while both groups had inadequate callus tissue at the end of the waiting period, callus formation and remodeling occurred later in the model group than in the control group, and the new bone was more osteoporotic. Osteoporosis associated with estrogen deficiency adversely affects the outcome of callus distraction. Nonetheless, radiographic findings in rabbits indicate that the effects may not be so great as to preclude clinical procedures. It was concluded that these results should be supported with clinical studies.

The protective effects of captopril and nitric oxide on solitary kidney after chronic partial ureteric obstruction.

OBJECTIVE: To determine whether vasodilator agents (captopril and nitric oxide) change the morphological and functional effects of chronic partial ureteric obstruction in solitary kidney tissue in unilaterally nephrectomized rats. MATERIALS AND METHODS: Each of 50 prepubertal Wistar albino rats underwent right nephrectomy and were then assigned to one of five groups. Rats in group 1 underwent a sham operation (control) and in the other groups the ureter of the remaining kidney was partially obstructed by surgery. In group 2, no drug treatments were given; in groups 3, 4 and 5 captopril, L-arginine methyl ester (L-Arg) or NG- nitro-L-arginine-methyl ester, respectively, were given for 3 weeks. In all rats, diuretic scintigraphy was used to measure kidney perfusion, glomerular filtration rate (GFR) and concentration. Blood urea nitrogen (BUN), serum creatinine levels, kidney parenchymal weight and pelvic volume were measured and the kidneys evaluated histopathologically. RESULTS: Renal perfusion was significantly greater in both group 3 and 4 than in group 2. The GFR was 18% greater in group 3 and 22.3% greater in group 4 than in group 2. The GFR was decreased by 67% in group 5 compared with the control group. The mean parenchymal weight, mean pelvic volume, BUN and serum creatinine in the four groups with a partially obstructed ureter were significantly different from the control group. There also were significant differences between group 2 and groups 3--5, and between group 2 and group 3. Histological damage was severe in all four groups with partial ureteric obstruction, but in the drug-treated groups, medullary fibrosis was less frequent. CONCLUSION: After 3 weeks of treatment, captopril and L-Arg both improved kidney perfusion, GFR, BUN and serum creatinine levels, but were less effective in preventing parenchymal atrophy and changes in pelvic volume.

Craniocervical neurenteric cyst without associated abnormalities.

Spinal neurenteric (NE) cyst is an uncommon congenital cyst and frequently found in the cervical region. The clinical symptoms associated with this entity depend on the site of the lesion and are not typical for all such cysts. A definitive diagnosis can only be made by biopsy and histological examination. MRI can confirm these cystic masses and is the method of choice for their imaging investigation. They are often connected by a fibrous tract, fistula or cleft to structures derived from the primitive gut in the thoracic or abdominal cavities and are commonly associated with anterior spina bifida or other vertebral anomalies. We report a case of craniocervical NE cyst without associated abnormalities and discuss the implications for clinical diagnosis and management by a thorough review of the literature.

Surgical management of syringomyelia-Chiari complex.

Great variety exists in the indications and techniques recommended for the surgical treatment of syringomyelia-Chiari complex. More recently, magnetic resonance (MR) imaging has increased the frequency of diagnosis of this pathology and offered a unique opportunity to visualize cavities inside the spinal cord as well as their relationship to the cranio-cervical junction. This report presents 18 consecutive adult symptomatic syringomyelia patients with Chiari malformation who underwent foramen magnum decompression and syringosubarachnoid shunting. The principal indication for the surgery was significant progressive neurological deterioration. All patients underwent preoperative and postoperative MRI scans and were studied clinically and radiologically to assess the changes in the syrinx and their neurological picture after surgical intervention. All patients have been followed up for at least 36 months. No operative mortality was encountered; 88.9% of the patients showed improvement of neurological deficits together with radiological improvement and 11.1% of them revealed collapse of the syrinx cavity but no change in neurological status. None of the patients showed further deterioration of neurological function. The experience obtained from this study demonstrates that foramen magnum decompression to free the cerebro-spinal fluid (CSF) pathways combined with a syringosubarachnoid shunt performed at the same operation succeeds in effectively decompressing the syrinx cavity, and follow-up MR images reveal that this collapse is maintained. In view of these facts, we strongly recommend this technique, which seems to be the most rational surgical procedure in the treatment of syringomyelia-Chiari complex.

Quantitative residual cortical activity measurement: appropriate test for diagnosis of renal artery stenosis?

OBJECTIVES: To evaluate the diagnostic validity of quantitative measurement of residual cortical activity (RCA) in renal artery stenosis (RAS). METHODS: In 45 patients with a high clinical likelihood of renovascular hypertension (RVH) and unimpaired renal function, dynamic imaging was performed after an intravenous bolus injection of 148 MBq (99m)Tc MAG3 for both baseline renoscintigraphy and captopril renography following oral application of 50 mg captopril. RCA was measured according to the Sfakianakis method: RCA = cortical counts at 20 min/counts at peak x100%. An increase in RCA of >/=5% from baseline was considered indicative of RAS. After renography, all patients underwent selective transfemoral angiography with the digital subtraction technique. A luminal reduction of >/=50% was considered as proof of RAS. RESULTS: The number of kidneys that had a change of >/=5% in RCA values was 12 (27.2%) in normal kidneys, 7 (58.3%) in the patients with bilateral RAS, 14 (82.3%) in the patients with unilateral RAS, and 21 (72.4%) in overall kidneys with RAS. The positive test ratio in pathologic groups was significantly higher than normal (p < 0.05). The sensitivity and specificity of the RCA test were 72.4 and 72.7%, respectively; the positive and negative predictive values were 63.6 and 80%, respectively. CONCLUSION: Quantitative measurements of RCA can be used as a diagnostic parameter of renal artery stenosis and may contribute of the diagnostic accuracy of visual interpretation and other renographic diagnostic criteria.

Subependymal giant-cell astrocytoma associated with tuberous sclerosis: case report.

Tuberous sclerosis is a neurocutaneous syndrome with a wide variety of clinical, pathologic, and radiologic manifestations. Intracranial phakomatosis has been reported to include subependymal nodules; cortical tubers, and subependymal giant-cell astrocytomas. Subependymal giant-cell astrocytomas are rare, benign brain tumors of unknown histogenesis which cause increased intracranial pressure, seizures, and focal neurologic signs. The only treatment of these tumors is total surgical removal, because they are not sensitive to irradiation and chemotherapy. We report a patient with tuberous sclerosis who underwent surgery for a large subependymal giant-cell astrocytoma.

Lung and gastric uptake in bone scintigraphy of sarcoidosis.

We report on 99mTc-MDP uptake in lungs and stomach in a patient with hypercalcaemia and renal failure due to elevated 1,25(OH)2vitD3 because of sarcoidosis. Presently, this typical scan pattern has only been described in patients with malignancies, parathyroid adenoma and drug-induced vitamin D intoxication. We offer possible explanations for the findings in our patient.