Isolated Cecal Necrosis Mimicking a Colonic Mass.

Isolated cecal necrosis (ICN) is a rare form of ischemic colitis that can mimic conditions such as appendicitis, malignancy, or diverticulitis. Most cases of ICN have been identified in patients with significant comorbidities that increase risk of vascular disease. We present a case of ICN mimicking a mass lesion in an elderly patient with few comorbid conditions. Although computed tomography was concerning for colonic mass, diagnostic colonoscopy revealed ischemic colon. The patient underwent right hemicolectomy, and pathology confirmed ICN. It is important to recognize conditions ICN can mimic, understand ICN can present without acute abdomen, and consider ICN in the differential diagnosis even in relatively healthy patients without a history of vascular disease.

Primary Gastrointestinal T-cell Lymphoma Presenting as Spontaneous Perforation Peritonitis.

Primary T-cell non-Hodgkin lymphoma (NHL) of the gastrointestinal tract (GIT) is a rare, poorly-characterized clinical entity. A well-known complication of intestinal NHL is perforation due to chemotherapy, but perforation as a presenting sign of GIT lymphoma is extremely rare. Here we present a case of spontaneous intestinal perforation secondary to primary intestinal T-cell lymphoma and highlight the importance of early recognition of this uncommon cause of perforation as a crucial step to ensure expedited hematology referral and initiation of appropriate treatment.

Gastrointestinal Myeloid Sarcoma a Case Presentation and Review of the Literature.

Myeloid sarcomas can be detected in up to 30% of acute myeloid leukemia cases or occur de-novo without bone marrow involvement. The most frequent localization of myeloid sarcomas in the abdominal cavity is the small intestine, and gastric presentations are infrequent, frequently misdiagnosed, and a high level of suspicion should exist when the characteristic histomorphology features are present. The current review features a case report with gastric presentation of myeloid sarcoma in a patient with a diagnosis of acute myeloid leukemia with trisomy 8. In addition, a review of the literature of intestinal-type myeloid sarcomas shows that less than 15% of these cases have been reported in the stomach. The most common molecular aberrancy detected in intestinal myeloid sarcomas is the fusion protein CBFB-MYH11. A review of several large studies demonstrates that the presence of myeloid sarcoma does not constitute an independent prognostic factor. The therapeutic approach will be tailored to the specific genetic abnormalities present, and systemic chemotherapy with hematopoietic stem cell transplant is the most efficient strategy.

Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis.

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

Quantum Capacitance Based Amplified Graphene Phononics for Studying Neurodegenerative Diseases.

Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron disease (MND) characterized by a rapid loss of upper and lower motor neurons resulting in patient death from respiratory failure within 3-5 years of initial symptom onset. Although at least 30 genes of major effect have been reported, the pathobiology of ALS is not well understood. Compounding this is the lack of a reliable laboratory test which can accurately diagnose this rapidly deteriorating disease. Herein, we report on the phonon vibration energies of graphene as a sensitive measure of the composite dipole moment of the interfaced cerebrospinal fluid (CSF) that includes a signature-composition specific to the patients with ALS disease. The second-order overtone of in-plane phonon vibration energy (2D peak) of graphene shifts by 3.2 ± 0.5 cm-1 for all ALS patients studied in this work. Further, the amount of n-doping-induced shift in the phonon energy of graphene, interfaced with CSF, is specific to the investigated neurodegenerative disease (ALS, multiple sclerosis, and MND). By removing a severe roadblock in disease detection, this technology can be applied to study diagnostic biomarkers for researchers developing therapeutics and clinicians initiating treatments for neurodegenerative diseases.

Non-neurological outcomes of anterior and posterolateral approaches in the surgical treatment of thoracic disc disease: a retrospective study.

BACKGROUND: Symptomatic thoracic disc herniation (TDH) is rare, and for those patients that fail conservative treatment, two main categories of surgical approaches exist-anterior and posterolateral. In many cases either approach would be considered equally appropriate. Recommendations in support of either anterior or posterolateral approaches are currently based on case series and expert opinion. Here, we utilize National Surgical Quality Improvement Program (NSQIP) database to determine and compare the rates of complication associated with anterior or posterolateral approaches in the treatment of TDH. METHODS: An analysis of NSQIP data from 2005 to 2014 was conducted. Patients were included based on a combination of a postoperative diagnosis of TDH. Patients were then grouped according to anterior or posterior approaches on the basis of Current Procedural Terminology (CPT) codes. Propensity score matching was performed to account for baseline demographics [sex, race, age, obesity, diabetes, smoking, history of chronic obstructive pulmonary disease (COPD), history of CHF, and American Society of Anesthesiologists (ASA) class]. The 30-day outcome measures of these patients were analyzed. RESULTS: A total of 432 patients were identified, 80.3% underwent posterolateral and 19.7% anterior interventions. There were no significant differences in 30-day outcome measures between the anterior or posterior intervention groups. Within the matched group of 170 patients, the anterior group had significantly longer lengths of stay (5.49±3.96 vs. 4.01±4.81, P<0.0001), but there were no observed significant differences in the rate of occurrences of UTIs, pneumonias, sepsis, bleeding, intubation, or death. CONCLUSIONS: Posterolateral and anterior approaches carry an equal non-neurological perioperative complication profile. Posterolateral approaches may carry shorter hospital stays compared to anterior interventions.

Magnetic Drug Targeting: A Novel Treatment for Intramedullary Spinal Cord Tumors.

Most applications of nanotechnology in cancer have focused on systemic delivery of cytotoxic drugs. Systemic delivery relies on accumulation of nanoparticles in a target tissue through enhanced permeability of leaky vasculature and retention effect of poor lymphatic drainage to increase the therapeutic index. Systemic delivery is limited, however, by toxicity and difficulty crossing natural obstructions, like the blood spine barrier. Magnetic drug targeting (MDT) is a new technique to reach tumors of the central nervous system. Here, we describe a novel therapeutic approach for high-grade intramedullary spinal cord tumors using magnetic nanoparticles (MNP). Using biocompatible compounds to form a superparamagnetic carrier and magnetism as a physical stimulus, MNP-conjugated with doxorubicin were successfully localized to a xenografted tumor in a rat model. This study demonstrates proof-of-concept that MDT may provide a novel technique for effective, concentrated delivery of chemotherapeutic agents to intramedullary spinal cord tumors without the toxicity of systemic administration.

Magnetic kyphoplasty: A novel drug delivery system for the spinal column.

Vertebral compression fractures (VCFs) caused by metastatic malignancies or osteoporosis are devastating injuries with debilitating outcomes for patients. Minimally invasive kyphoplasty is a common procedure used for symptomatic amelioration. However, it fails in treating the underlying etiologies of VCFs. Use of systemic therapy is limited due to low perfusion to the spinal column and systemic toxicity. Localized delivery of drugs to the vertebral column can provide a promising alternative approach. A porcine kyphoplasty model was developed to study the magnetically guided drug delivery of systemically injected magnetic nanoparticles (MNPs). Jamshidi cannulated pedicle needles were placed into the thoracic vertebra and, following inflatable bone tamp expansion, magnetic bone cement was injected to the vertebral body. Histological analysis was performed after intravenous injection of MNPs. Qualitative analysis of harvested tissues revealed successful placement of magnetic cement into the vertebral body. Further quantitative analysis of histological sections of several vertebral bodies demonstrated enhanced accumulation of MNPs to regions that had magnetic cement injected during kyphoplasty compared to those that did not. By modifying the kyphoplasty bone cement to include magnets, thereby providing a guidance stimulus and a localizer, we were successfully able to guide intravenously injected magnetic nanoparticles to the thoracic vertebra. These results demonstrate an in-vivo proof of concept of a novel drug delivery strategy that has the potential to treat the underlying causes of VCFs, in addition to providing symptomatic support.

Location of Thalamic Hemorrhage Impacts Prognosis.

OBJECTIVE: Approximately 12% of intracerebral hemorrhages (ICHs) occur in the thalamus. Understanding the anatomic regions involved with thalamic hemorrhages is potentially useful, offering the physician a more accurate prognosis for patient outcomes. This study was performed to determine if thalamic hemorrhage location observed on a computed tomography (CT) scan was predictive of neurologic outcomes. METHODS: A sample of 168 thalamic hemorrhage patients admitted to a tertiary care center were analyzed. Axial CT scans of thalamic hemorrhages were classified into 1 of 6 possible categories based on thalamic nuclei anatomy: anterior, posterior, medial, lateral, central, or global. For each classification, patient clinical characteristics were collected to identify variables indicative of clinical outcome. Outcome measures used in this study included mortality, hospital length of stay, readmission within 30 days, ICH score, Glasgow Coma Scale score, neurologic deterioration (calculated as a change in modified Rankin scale score from admission to discharge), and discharge disposition. RESULTS: On multivariable analysis, patients with posterior and lateral thalamic hemorrhages demonstrated a decreased likelihood of mortality; patients with posterior hemorrhages were less likely to have neurologic deterioration relative to global thalamic hemorrhages when controlling for hemorrhage volume and ventriculomegaly. Ventriculomegaly and hemorrhage volume were also predictive of both mortality and neurologic deterioration. CONCLUSIONS: In thalamic hemorrhages, patient prognosis may be influenced by hemorrhage location, with posterior and lateral hemorrhages demonstrating better clinical outcome versus hemorrhages in other locations. This is potentially valuable because hemorrhage location affords the treating physician a readily available prognostic factor when assessing intracranial hemorrhages.

Preoperative steroids do not improve outcomes for intramedullary spinal tumors: a NSQIP analysis of 30-day reoperation and readmission rates.

BACKGROUND: Intramedullary spinal cord tumors (IMSCTs) account for 8-10% of all spinal cord tumors and affect patients of all ages. Although uncommon, IMSCTs carry risk of neurological morbidity and mortality, with 5-year survival rates ranging from 50% to 80%. In this study, we utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to determine the effect of steroid administration on 30-day outcomes following surgery for IMSCTs. METHODS: ACS-NSQIP data for patients undergoing surgery for intramedullary tumors from 2005 to 2015 was reviewed. Patients were selected based on current procedural terminology (CPT) codes 63285 (Laminectomy, intradural, intramedullary, cervical), 63286 (Laminectomy, intradural, intramedullary, thoracic), and 63287 (Laminectomy, intradural, intramedullary, thoracolumbar). ICD-9 and ICD-10 codes were chosen based on the diagnosis of a tumor. The 30-day clinical outcome data, including reoperations and readmission rates, were collected and compared. RESULTS: A total of 259 patients were reviewed. One hundred eighty-one patients had benign intramedullary tumors and 78 had malignant intramedullary tumors. The majority of IMSCTs were at the thoracic level (n=100), followed by the cervical (n=99), and thoracolumbar (n=39) levels. Thirty-one patients were on corticosteroid therapy prior to surgery. Patients with preoperative steroid administration had no significant difference in reoperation and readmission rates. No significant differences were noted between steroid vs. non-steroid therapy for discharge destination, length of hospital stay, or other postoperative complications. CONCLUSIONS: Contrary to previous reports, corticosteroid use prior to surgery for IMSCTs does not have a significant impact on 30-day risk of readmission, reoperation, and risk of postoperative complications.

Functional gait analysis in a spinal contusion rat model.

Evaluating functional performance of spinal cord injury (SCI) rat models is essential for the development of novel treatments and breakthroughs. However, due to the variety of functional analysis methods available - each with its own strengths and weaknesses - it can be challenging to choose the most appropriate functional analysis test for the animal model. Therefore, we analyzed the strengths and weaknesses of five methods in order to determine which test is not only accurate and easily reproducible, but also relatively inexpensive so that it can be adopted universally. When comparing the Basso, Beattie, and Bresnahan (BBB) test, Ladder walking test, CatWalk test, Rotating Rod test, Microsoft Kinect system and VICON, we used the criteria of sensitivity, quality of data generated, statistical analysis of data, and rate of human error. These specific tests were chosen in order to compare the advantages and disadvantages of simple yet effective methods (BBB, Ladder test, and Rotating Rod test) to more complex and computerized methods (Catwalk, Microsoft Kinect and VICON).

Hypothyroidism and Lipid Levels in a Community Based Study (TTS).

BACKGROUND: Thyroid hormones play an important role in lipid metabolism. Overt hypothyroidism is known to be associated with increased lipid profiles, but the effect of subclinical hypothyroidism (SCH) on lipid profile remains controversial. OBJECTIVES: The aim of this study was to assess the association between thyroid disorders and serum lipid levels. MATERIALS AND METHODS: The present study was conducted within the framework of Tehran lipid and glucose study (TLGS). Serum concentrations of TSH and FT4, cholesterol, triglycerides and HDL-C were measured in 5786 randomly selected subjects. Serum LDL was calculated according to the Friedwald formula. RESULTS: The study assessed 5154 subjects including 42.5% males and 57.5% females, with a mean age of 39.71 ± 14.2 years (ranged 20 - 90 years). Serum cholesterol was significantly higher in overt hypothyroidism in comparison to subclinical hypothyroidism (P = 0.003). Serum cholesterol, HDL -C, LDL-C and TG did not differ between subclinical hypothyroid and control groups. Among euthyroid men, serum FT4 levels were inversely correlated with serum cholesterol and TG. In euthyroid women, serum FT4 levels were correlated positively with serum HDL-C and negatively correlated with TG and TG/HDL-C ratio and TSH levels were associated negatively with, HDL-C. CONCLUSIONS: No differences existed in lipid profiles between subclinical hypothyroidism and euthyroid subjects. There are correlations between serum FT4 and TSH and lipid profiles.