Microsurgical Resection of Recurrent Cavernous Sinus Hemangioma by Superior and Lateral Approach: 2-Dimensional Operative Video.

This video shows the technical nuances of microsurgical resection of recurrent cavernous sinus (CS) hemangioma by superior and lateral approach. A 77-yr-old woman presented with headache and difficulty in vision in right eye for 6 mo. She had previously undergone attempted resection of a right CS tumor in another hospital with partial removal, and the tumor had grown significantly. Neurological examination revealed proptosis, cranial nerve 3 palsy, and loss of vision in right eye (20/200). Left side visual acuity was 20/20. Brain magnetic resonance imaging (MRI) demonstrated a large CS mass with homogeneous enhancement, measuring 3.3 × 3.3 × 2.6 cm, extending into the suprasellar cistern with mass effect on the right optic nerve. It extended anteriorly to the region of the right orbital apex and abuted the basilar artery posteriorly. She underwent right frontotemporal craniotomy, posterolateral orbitotomy and anterior clinoidectomy as well as optic nerve decompression, and the CS tumor was removed by superior and lateral approach. An incision was made into the superior wall of the CS medial to the third nerve. On lateral aspect the tumor had extended outside the CS through the Parkinson's triangle. Posteriorly it extended through the clival dura. Anteriorly tumor encased the carotid artery and it was gradually dissected away. At the end of the operation, all of the cranial nerves were intact. Postoperative MRI showed near complete tumor resection with preservation of the internal carotid artery. At 6 mo follow-up her modified Rankin Scale was 1 and vision in left eye was normal. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Larval aquatic and terrestrial mites infesting a temperate assemblage of mosquitoes.

We collected 22,769 adult female mosquitoes, representing 27 species, from light traps in Norfolk, Virginia (2006-2007) and examined them to assess infestation by larval mites. Mosquitoes were parasitized by two species of aquatic (Acari: Arrenuridae: Arrenurus) and three species of terrestrial mites (Acari: Erythraeidae). The prevalence of infestation varied from 0.55% (2006) to 0.17% (2007). The mean intensity of parasitism ranged from 3.6 mites per host (2006) to 1.8 mites per host (2007). The most common host species for aquatic mites was Culex erraticus, while the most common host for terrestrial mites was Anopheles quadrimaculatus. Relationships between biotic and abiotic factors were investigated in an attempt to provide insight into temporal, spatial, and interspecific variation in mite-mosquito interactions. Scanning electron microscopy was used to examine the mode of attachment for larval mites. While the prevalence of aquatic mite parasitism was correlated for Culex erraticus, the invasive mosquito, Aedes albopictus, was never parasitized through the duration of the study.

Comparing Cortical Trajectory Transforaminal Lumbar Interbody Fusions Against Pedicle Trajectory Transforaminal Lumbar Interbody Fusions and Posterolateral Fusions: A Retrospective Cohort Study of 90-day Outcomes.

BACKGROUND: The cortical screw (CS) trajectory for pedicle screw placement is believed to require a smaller incision and less tissue dissection resulting in lower blood loss and faster healing; however, this has not yet been confirmed in clinical studies. OBJECTIVE: To compare CS transforaminal lumbar interbody fusions (TLIF), traditional pedicle screw (TPS) trajectory TLIFs, and posterolateral fusion (PLF) without interbody for differences in operative characteristics and complications. METHODS: We performed a retrospective cohort study (CS, TPS, and PLF) looking at patients who underwent lumbar fusion with 1 or 2 levels. Extracted data included demographics, comorbidities, estimated blood loss, transfusions, operative time, length of stay, discharge disposition (home vs rehabilitation), and complications within the perioperative, 30- and 90-d periods. RESULTS: A total of 118 patients (45 CS, 35 TPS, and 38 PLF) were included with average age 62 and 90-d follow-up for 106 (90%) patients. CS had less average blood loss (231 ml) than either TPS (424, P = .0023) or PLF (400, P = .0070). CS had far fewer transfusions than either TPS or PLF (P < .0001). TPS had longer average operating room (OR) time (262 min) than either CS (214, P = .0075) or PLF (211, P = .0060). CS had the shortest length of postoperative stay (4.3 days) which was significantly shorter than PLF (6.2, P = .0138) but not different than TPS (4.8). There were no differences in discharge disposition, complications, perioperative, 30-d, 90-d, durotomy, or wound healing issues. CONCLUSION: The CS trajectory is associated with less blood loss, fewer transfusions, reduced OR time, and shorter length of stay, with no difference in complications.

Vitamin C protects low-density lipoprotein from homocysteine-mediated oxidation.

Homocysteine, an atherogenic amino acid, promotes iron-dependent oxidation of low-density lipoprotein (LDL). We investigated whether vitamin C, a physiological antioxidant, could protect LDL from homocysteine-mediated oxidation. LDL (0.2 mg of protein/ml) was incubated at 37 degrees C with homocysteine (1000 microM) and ferric iron (10-100 microM) in either the absence (control) or presence of vitamin C (5-250 microM). Under these conditions, vitamin C protected LDL from oxidation as evidenced by an increased lag time preceding lipid diene formation (> or = 5 vs. 2.5 h for control), decreased thiobarbituric acid-reactive substances accumulation (< or = 19 +/- 1 nmol/mg when vitamin C > or = 10 microM vs. 32 +/- 3 nmol/mg for control, p <.01), and decreased lipoprotein anodic electrophoretic mobility. Near-maximal protection was observed at vitamin C concentrations similar to those in human blood (50-100 microM); also, some protection was observed even at low concentrations (5-10 microM). This effect resulted neither from altered iron redox chemistry nor enhanced recycling of vitamin E in LDL. Instead, similar to previous reports for copper-dependent LDL oxidation, we found that vitamin C protected LDL from homocysteine-mediated oxidation through covalent lipoprotein modification involving dehydroascorbic acid. Protection of LDL from homocysteine-mediated oxidation by vitamin C may have implications for the prevention of cardiovascular disease.

Current approaches to the treatment of metastatic brain tumours.

Metastatic tumours involving the brain overshadow primary brain neoplasms in frequency and are an important complication in the overall management of many cancers. Importantly, advances are being made in understanding the molecular biology underlying the initial development and eventual proliferation of brain metastases. Surgery and radiation remain the cornerstones of the therapy for symptomatic lesions; however, image-based guidance is improving surgical technique to maximize the preservation of normal tissue, while more sophisticated approaches to radiation therapy are being used to minimize the long-standing concerns over the toxicity of whole-brain radiation protocols used in the past. Furthermore, the burgeoning knowledge of tumour biology has facilitated the entry of systemically administered therapies into the clinic. Responses to these targeted interventions have ranged from substantial toxicity with no control of disease to periods of useful tumour control with no decrement in performance status of the treated individual. This experience enables recognition of the limits of targeted therapy, but has also informed methods to optimize this approach. This Review focuses on the clinically relevant molecular biology of brain metastases, and summarizes the current applications of these data to imaging, surgery, radiation therapy, cytotoxic chemotherapy and targeted therapy.

Morphological changes during postembryonic development in two species of neotropical harvestmen (Opiliones, Laniatores, Cranaidae).

Morphological changes during postembryonic development in the Cranaidae are described on the basis of the examination of an incomplete series of larvae, nymphs, and adults of Phareicranaus calcariferus and Santinezia serratotibialis. The life histories of these species are hypothesized to consist of six nymphal stages, featuring the appearance of secondary male sexual characteristics in the antepenultimate nymph (N5). Color and body shape change dramatically during development. Growth rates for nymphs based upon leg measurements were similar for both species. In S. serratotibialis, the greatest increase in leg size occurred from larva to 1st nymph. The tarsomeres of legs I-IV varied by 1-2 segments per leg for each nymph stage, with the number of tarsal segments increased by 1-2 segments at each stage. Adults had nearly twice as many tarsomeres on leg II than other legs. Ontogenetic changes were observed in the armature of the proximal cheliceral segment, ocularium, pedipalp, opisthosoma, distitarsus III and IV, and leg IV. Morphological changes in postembryonic development in cranaid harvestmen are similar to those reported for other Laniatores.

New insight into the enigmatic white cord in Rembrandt's The Anatomy Lesson of Dr. Nicolaes Tulp (1632).

The anatomic accuracy of Rembrandt's The Anatomy Lesson of Dr. Nicolaes Tulp (1632) has been debated in the literature for many years. The white cord that courses along the ulnar aspect of the carpus and small finger of the cadaver in Dr. Tulp's dissection conforms to no normal anatomic structure and is believed to represent an anomalous branch of the ulnar nerve, an artistic error, or a combination of both. After the discovery of an accessory abductor digiti minimi (AADM) during a routine dissection of a late-middle-aged male cadaver, we noted that the course of its tendon over the hypothenar eminence resembled the white cord in the painting. After conducting a detailed literature search and anatomic interpretation of the painting, we established 4 criteria for identifying the white cord. Using these criteria, we evaluated the plausibility of an AADM being represented in the painting. We conclude that an AADM should be considered as a possible explanation for the white cord.