Management of intramedullary spinal cord tumors: A single-center experience of 247 patients.

Intramedullary spinal cord tumors (ISCT) are rare tumors requiring multidisciplinary care in an expert center. Here, we report a single-center experience including 247 patients with ISCT: 134 ependymomas, 54 astrocytomas and 59 hemangioblastomas. Preoperative evaluation and surgical considerations are discussed to share our principles in managing these patients. Ependymomas are largely benign lesions (95% of WHO grade II) for which total resection (91% rate of gross total resection (GTR)) without neurological impairment (79% of patients remained stable or improved) is the goal in order to ensure long-term oncological control (94.5% overall survival at 5 years, excluding anaplastic ependymomas). On the other hand, astrocytomas are more frequently high-grade tumors (30% of WHO grade III or IV) for which partial resection (60% of cases) is often necessary to preserve neurological status (48% of patients deteriorate at one year), leading to higher rates of recurrence (60% recurrence rate at 5 years for grade III astrocytomas). Lastly, spinal hemangioblastomas require a specific microsurgical resection with particular attention to the vasculature in order to ensure en bloc resection (95% GTR), allowing excellent neurological results (12% of patients improved, 86% remained stable). Altogether, these results demonstrate that ISCT can be managed surgically with good functional outcome, while oncological results will mostly depend on the histopathological grading.

NEONATAL INTENSIVE CARE OF 10 HOSPITALIZED GIRAFFE CALVES (GIRAFFA CAMELOPARDALIS) REQUIRING HAND-REARING.

This retrospective case series describes the clinicopathologic findings, diagnoses, treatment, and outcomes of 10 hand-reared newborn giraffe (Giraffa camelopardalis) calves admitted to a university teaching hospital for intensive care. Ten calves (five males, five females; nine reticulated giraffes [Giraffa camelopardalis reticulata], one Masai giraffe [G. c. tippelskirchi]), were admitted under 2 days of age. Inadequate transfer of passive immunity was suspected in 5 of 10 calves based on assessment of serum total solids and globulin values. These calves were treated with oral frozen bovine colostrum and/or intravenous hyperimmune bovine plasma. Diarrhea occurred in 6 of 10 calves and was managed with supportive care, fecal microbiota transplantation, and limiting milk intake (offering 10% body weight [BW] in milk per day, while feeding <2 L per meal at 2- to 4-hr intervals). Less common diagnoses included pneumonia (n = 3) and mycoplasma-associated septic arthritis (n = 1). Eight calves received systemic antimicrobial therapy. Hyperlactatemia (lactate > 5 mmol/L; n = 8) and hypercreatininemia (creatinine > 2.0 mg/dl, n = 7) were the most common presenting laboratory abnormalities, which resolved with intravenous fluid therapy. All neonatal giraffes survived to discharge after a median hospitalization of 9.5 days (range, 5-37 days) and were successfully hand-reared at their place of birth. In conclusion, neonatal giraffe calves can be intensively managed in a hospital environment. Diarrhea was a common clinical problem and can be related to feeding regimens. Intravenous hyperimmune bovine plasma infusion was well tolerated to manage failure of transfer of passive immunity in calves with inadequate colostrum administration. The current study supports that compromised neonatal giraffe calves may carry an excellent prognosis after early, intensive intervention.

HEALTH AND NUTRITIONAL ASSESSMENT OF FREE-RANGING EASTERN INDIGO SNAKES (DRYMARCHON COUPERI) IN GEORGIA, UNITED STATES.

Clinical pathology and nutritional parameters are useful in evaluating and monitoring threatened and endangered wildlife populations, but reference ranges for most snake species are lacking. From 2001 to 2005, health assessments were performed on 58 eastern indigo snakes (EIS) (Drymarchon couperi) captured in the wild in southeastern Georgia, United States. Health and nutritional assessments performed included hematology, serum biochemistry, fat-soluble vitamins, heavy metals, pesticide contaminants, parasitology, and surveys of other pathogens. Significant differences in total solids, packed cell volume, glucose, blood urea nitrogen, albumin : globulin ratio, amylase, triglycerides, and bile acids between males and females were observed. Additionally, there was a significant difference between liver and kidney concentrations for vitamins A and E. As previously noted in captive EIS, total Ca was elevated in comparison to concentrations reported in other snake species. Parasitism was a common finding in sampled EIS, but the overall health status of this free-ranging population appeared good. A winter-time dermatitis was found in most snakes, which resolved in the summer months. This study represents the first health and nutritional assessment of free-ranging EIS, and provides needed data to guide monitoring and conservation efforts.

Recurrent calcium phosphate urolithiasis in a black-and-white ruffed lemur (Varecia variegata).

An adult intact male black-and-white ruffed lemur (Varecia variegata) suffered recurrent bouts of urethral blockage over a 3-yr period caused by calcium phosphate (apatite form) uroliths. Surgical intervention was required in two of the three instances. Various attempts at medical management failed to control formation of the stones, and the underlying etiology remains unclear. In addition, there have been consistent, multiple, unchanging renal mineralizations over the course of the case. Medical management failed to significantly alter the urinary pH; although, to date, no further problems have been noted. To the authors' knowledge, this is the first known report of calcium phosphate stones in a prosimian species.

WIP is a negative regulator of neuronal maturation and synaptic activity.

Wiskott-Aldrich syndrome protein (WASP) -interacting protein (WIP) is an actin-binding protein involved in the regulation of actin polymerization in cells, such as fibroblasts and lymphocytes. Despite its recognized function in non-neuronal cells, the role of WIP in the central nervous system has not been examined previously. We used WIP-deficient mice to examine WIP function both in vivo and in vitro. We report here that WIP(-)(/-) hippocampal neurons exhibit enlargement of somas as well as overgrowth of neuritic and dendritic branches that are more evident in early developmental stages. Dendritic arborization and synaptogenesis, which includes generation of postsynaptic dendritic spines, are actin-dependent processes that occur in parallel at later stages. WIP deficiency also increases the amplitude and frequency of miniature excitatory postsynaptic currents, suggesting that WIP(-)(/-) neurons have more mature synapses than wild-type neurons. These findings reveal WIP as a previously unreported regulator of neuronal maturation and synaptic activity.

Citrate phosphate dextrose adenine (CPDA-1) can be sampled from blood collection bags in a multi-dose manner.

OBJECTIVE: To evaluate the sterility of citrate phosphate dextrose adenine (CPDA-1) anticoagulant when sampled from blood collection bags in a multi-dose manner. SAMPLE: 10 pre-filled CPDA-1 blood collection bags; 46 bacterial and 28 fungal culture result reports. PROCEDURES: 10 CPDA-1 blood collection bags were split into 2 equal groups and stored at either room temperature (24 °C) or refrigerator temperature (5 °C) for 30 days. Two bags in each group were designated as controls. Beginning on day 0 a 1.0 mL aliquot was withdrawn from each experimental bag and submitted for bacterial culture (aerobic and anaerobic) every 5 days, and fungal culture every 10 days. All 10 bags were sampled on day 30. Bacterial and fungal culture results were compiled and interpreted. RESULTS: 46 CPDA-1 aliquots were cultured, resulting in 2 positive microbial isolates: Bacillus was cultured from a previously unopened experimental bag on day 0, and Candida was cultured from a refrigerated experimental bag on day 30. Both positives are thought to represent post-sampling contamination, though these suspicions cannot be confirmed in the bag yielding Candida due to a lack of subsequent data. All other samples were negative for microbial growth. CLINICAL RELEVANCE: CPDA-1 blood collection bags stored at either 24 °C or 5 °C can be used in a multi-dose manner for up to 20 days when each sample is obtained aseptically. These results support the clinician's ability to utilize the contents of 1 bag multiple times rather than discarding the bag after a single use.

Long-bone fractures in llamas and alpacas: 28 cases (1998-2008).

Treatment and outcome of camelids with long-bone fractures are described. Medical records (1998-2008) of camelids (n = 28) with long-bone fractures were reviewed for signalment, time to presentation, fracture type, method of repair, duration of hospitalization, and post-operative complications. Follow-up information was obtained via telephone interviews with owners. Mean age and weight at presentation were 3.4 years and 56.3 kg, respectively. Twenty-six fractures were treated with internal fixation (n = 11), external fixation (n = 10), combination of internal and external fixation (n = 3), amputation (n = 1), and external fixation followed by amputation (n = 1). Long-term follow-up information was obtained for 19 of the 26 animals. The post-operative complication rate was 23% and owner satisfaction was high. Animals with open fractures were more likely to experience complications. Internal fixation was associated with superior alignment and outcome. Internal fixation techniques should be recommended for camelids.

Magnetic resonance imaging diagnosis of intervertebral disc disease and myelomalacia in an American black bear (Ursus americanus).

A 23-yr-old black bear (Ursus americanus) was examined because of paralysis of unknown duration. The precise onset of clinical signs was unknown as a result of seasonal torpor. The bear was immobilized and transported to a university veterinary teaching hospital for further evaluation and treatment. Radiography revealed increased mineral opacity and ventral bridging across vertebral segments T8-11. Magnetic resonance imaging demonstrated dorsal and ventral compression of the spinal cord at T8-9. Given the bear's advanced age, the unknown duration of spinal cord compression, unknown presence of deep pain perception, and thus an unknown prognosis for surgical success, euthanasia was elected. Postmortem examination revealed severe spondylosis deformans from T7 to L3 and dorsal extradural extruded disc material in the area of T8-9. Histopathology demonstrated the dorsal horns of the spinal cord at T9 were replaced by foamy macrophages extending into the dorsal and lateral funiculi of the white matter compatible with focal, severe, chronic myelomalacia. This is the first report of intervertebral disc disease and myelomalacia diagnosed using MRI in a large carnivore.

Layer-specific alterations to CA1 dendritic spines in a mouse model of Alzheimer's disease.

Why memory is a particular target for the pathological changes in Alzheimer's Disease (AD) has long been a fundamental question when considering the mechanisms underlying this disease. It has been established from numerous biochemical and morphological studies that AD is, at least initially, a consequence of synaptic malfunction provoked by Amyloid ß (Aß) peptide. APP/PS1 transgenic mice accumulate Aß throughout the brain, and they have therefore been employed to investigate the effects of Aß overproduction on brain circuitry and cognition. Previous studies show that Aß overproduction affects spine morphology in the hippocampus and amygdala, both within and outside plaques (Knafo et al., (2009) Cereb Cortex 19:586-592; Knafo et al., (in press) J Pathol). Hence, we conducted a detailed analysis of dendritic spines located in the stratum oriens and stratum radiatum of the CA1 hippocampal subfield of APP/PS1 mice. Three-dimensional analysis of 18,313 individual dendritic spines revealed a substantial layer-specific decrease in spine neck length and an increase in the frequency of spines with a small head volume. Since dendritic spines bear most of the excitatory synapses in the brain, changes in spine morphology may be one of the factors contributing to the cognitive impairments observed in this AD model.

Cardiomyopathy and right-sided congestive heart failure in a red-tailed hawk (Buteo jamaicensis).

A 15-year-old female red-tailed hawk (Buteo jamaicensis) was evaluated because of dyspnea, anorexia, and coelomic distension. Diagnostic imaging results confirmed severe coelomic effusion and revealed a markedly dilated right ventricle. The diagnosis was right-sided congestive heart failure. Results of measurements of vitamin E, selenium, lead, zinc, and cardiac troponin levels were normal or nondiagnostic. The hawk was treated with furosemide, antifungal and antimicrobial agents, and supplemental fluids and oxygen, but euthanasia was elected because of the poor prognosis and the practical difficulties associated with intensive case management. To our knowledge, this is the first described case of cardiomyopathy and congestive heart failure in a captive red-tailed hawk.

Widespread changes in dendritic spines in a model of Alzheimer's disease.

The mechanism by which dementia occurs in patients with Alzheimer's disease (AD) is not known. We assessed changes in hippocampal dendritic spines of APP/PS1 transgenic mice that accumulate amyloid beta throughout the brain. Three-dimensional analysis of 21,507 dendritic spines in the dentate gyrus, a region crucial for learning and memory, revealed a substantial decrease in the frequency of large spines in plaque-free regions of APP/PS1 mice. Plaque-related dendrites also show striking alterations in spine density and morphology. However, plaques occupy only 3.9% of the molecular layer volume. Because large spines are considered to be the physical traces of long-term memory, widespread decrease in the frequency of large spines likely contributes to the cognitive impairments observed in this AD model.

The relevance of the artery of Adamkiewicz for microsurgical resection of spinal tumors- short overview and case series: Technical note.

INTRODUCTION: There is of major interest to know the exact anatomical location of artery of Adamkiewicz (AKA) for many spinal microsurgical procedures, so as to avoid postoperative ischemia of the spinal cord, with further devastating clinical impact. METHODS AND RESULTS: We detail the interest of preoperative angiography for medullary lesions in our experience. We further report two cases where the AKA was located at the same level and side with the treated lesion. The first case underwent an intracapsular decompression. The second patient undertook radiosurgery by Cyberknife. CONCLUSION: For spinal tumor where the AKA is exactly on the same level and side, an intracapsular decompression can be safely performed, with an immediate decrease of the symptomatic mass effect, while decreasing the risk of neurological injury. A second valuable alternative in such situations can also be radiosurgery, for small to medium size tumors. In our experience, this proved safe and effective both for tumor and eventual pain control.

A rare condition: Spontaneous subarachnoid haemorrhage due to spinal hemangioblastoma: Report of 2 cases and review of the literature.

INTRODUCTION: Subarachnoid haemorrhage (SAH), secondary to spinal hemangioblastoma (HBL), is extremely rare, with only a few case reports to date. We report the experience of our reference centre for spinal tumours and Von Hippel-Lindau (VHL) disease in patients with spinal HBL presenting with SAH. We further performed a systematic review of the literature. METHODS: We report two cases. A systematic search was performed using the PubMed, Embase and Cochrane databases, with no limit for publication date. Inclusion criteria were: patients with HBL presenting with SAH, with or without VHL. The systematic review retrieved only 10 studies, including 16 patients. RESULTS: In our centre, the first case concerned radicular HBL at D12 level, presenting with spinal and brain SAH. The patient underwent uneventful microsurgical en bloc resection. Postoperative course was normal. The second case concerned HBL with SAH at the cervico-medullary junction, with rapidly fatal course. The systematic review revealed female predominance, at a median age of 40 years, with HBL predominantly located at cervical level, common preoperative symptoms being headache and signs of meningeal irritation. CONCLUSIONS: In conclusion, spinal HBL is an extremely rare cause of SAH. The systematic review found putative risk factors: female gender, age 40-50 years, cervical location, and median size 2cm. Diagnosis can be difficult when presentation mimics intracerebral SAH. We advocate early surgical removal. The risk of rapidly fatal course, in case of major haemorrhage, needs to be borne in mind.

Branchial remnant cysts of mature and juvenile horses.

This clinical report describes 8 cases of branchial remnant cysts (BRC) in the horse. The horses presented with bimodal age distribution, with 5 cases in mature horses (age 8-21 years) and 3 in foals (age 1, 6 and 10 months). Mature cases presented for dysphagia or intermittent oesophageal obstruction (2/5), and retropharyngeal swelling (3/5), whereas respiratory stridor and visible mass were presenting complaints in the foals. Presence of a right-sided (5/8) or dorsally located (2/8) palpable retropharyngeal mass of 3-35 cm diameter was noted clinically; one left-sided mass was identified as an incidental finding at necropsy. Ultrasonography typically revealed a thick-walled cyst containing hypoechoic fluid with dependent hyperechoic masses consistent with blood clots. Radiographs and upper airway endoscopy were also consistent with a retropharyngeal mass. Fluid cytology revealed chronic haemorrhage in 6/8 cases, and squamous epithelial cells in one case. Histopathology in all cases demonstrated an epithelium-lined cyst with no smooth muscle or thyroid tissue. Two cases was subjected to euthanasia; one due to concurrent laryngeal anomalies and one due to financial constraints. The remaining 5 cases were treated via surgical excision. Post operatively, right laryngeal hemiplegia was observed in 4/5 cases. All previous reports of BRC in the horse have described juvenile individuals. Brachial remnant cyst should be considered a differential diagnosis for mature horses with masses of the throatlatch area and can be definitively diagnosed by the presence of squamous epithelium in aspirated fluid or by histopathology of the excised mass. Right recurrent laryngeal nerve damage is a common complication of surgery.

Evaluation of gastrointestinal activity in healthy rabbits by means of duplex Doppler ultrasonography.

OBJECTIVE: To use duplex Doppler ultrasonography to compare gastrointestinal activity in healthy sedated versus nonsedated rabbits and to evaluate agreement between B-mode and pulsed-wave Doppler (PWD) ultrasonographic measurements. ANIMALS: 10 healthy client-owned rabbits brought for routine physical examination and 11 brought for routine ovariohysterectomy or castration. PROCEDURES: Duplex Doppler ultrasonography of the gastrointestinal tract was performed once for the 10 rabbits that underwent physical examination and twice (before and after presurgical sedation) for the 11 rabbits that underwent routine ovariohysterectomy or castration. Mean number of peristaltic contractions during a 30-second period was determined for the stomach, duodenum, jejunum, cecum, and colon from B-mode and PWD ultrasonographic images that had been video recorded. Findings for the duodenum and jejunum were compared between B-mode and PWD ultrasonography and between sedated and nonsedated rabbits. RESULTS: Duodenal and jejunal segments had measurable peristaltic waves; however, the stomach, cecum, and colon had no consistent measurable activity. B-mode and PWD ultrasonographic measurements for the duodenum and jejunum had high agreement. No significant difference was identified between nonsedated and sedated rabbits in mean number of peristaltic contractions of the duodenum or jejunum. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that both B-mode and PWD ultrasonography of the duodenum and jejunum may be suitable for noninvasive evaluation of small intestinal motility in rabbits and that the sedation protocol used in this study had no impact on measured peristaltic values.

[Predictive factors of spinal deformity following surgery for intramedullary tumors]. / Facteurs prédictifs de déformation rachidienne postopératoire des tumeurs intramedullaires.

INTRODUCTION: Spinal deformity following surgery for intramedullary tumors is a serious potential complication. The aim of the study was to identify potential predictive risk factors of spinal deformity after intramedullary tumor surgery. MATERIAL AND METHODS: Retrospective study including patients harboring intramedullary tumors who underwent surgery in a single center (Hôpital Bicêtre, AP-HP, Paris) between 1985 and 2011. The main outcome was the difference at last follow-up between post- and preoperative measure of Cobb angles formed by the superior and inferior limits of the laminectomy (Δ_Cobb). RESULTS: Sixty-three patients included. Mean sagittal deformity was 15.9° (0°-77°) for a mean follow-up of 85 months (4-240). Univariate analysis of potential predictive factors showed an increased deformity for patients undergoing a 4-or-more levels laminectomy, (19.3° versus 12.1°; P=0.04), for patients aged less or equal to 30 years of age and when it included a junction (20.8° versus 12.4°; P=0.02). A neurological deficit, either pre- or postoperatively, was not associated with a greater deformity. Multivariate analysis showed that only age (P=0.01) and the number of spinal levels involved (P=0.014) were significant and independent predictors of postoperative deformity. CONCLUSION: This study indicates predictive factors of spinal deformity in any patient undergoing surgery for intramedullary tumors, allowing improvement in the planning of surgery and patients' follow-up.

Optogenetic neuromodulation: new tools for monitoring and breaking neural circuits.

Optogenetics is the combination of optical tools to monitor (i.e. "reporters") or interfere (i.e. "actuators") with neural activity, and genetic techniques to restrain the expression of these reporters and actuators in the neuronal populations of interest. Such combination of optical and genetic tools, together with the emergence of new animal models such as the zebrafish larva, has proven extremely valuable is dissecting neural circuits. Optogenetics provide a new framework to address issues that are fundamentally dynamic processes, such as sensorimotor integration in the vertebrate spinal cord. By shifting from spatially targeted electrical stimulation to genetically targeted optical stimulation, optogenetic also opens new avenues for innovative neurorehabilitative strategies, in particular after spinal cord injury.

MR Diagnosis of Bone Metastases at 1.5 T and 3 T: Can STIR Imaging Be Omitted?

OBJECTIVE: To date, no prospective comparative study of the diagnostic value of STIR versus T1-weighted (T1w) sequences at both 1.5 T and 3 T has been performed with special focus on the detectability of bone metastases. MATERIALS AND METHODS: 212 oncological patients had a whole-body MRI at 1.5 T and/or at 3 T. The standard protocol comprised STIR and T1w sequences. All patients who showed typical signs of bone metastases were included in the study. Evaluation of the images was performed by the calculation of the number of metastases by three independent readers and by visual assessment on a 4-point scale. RESULTS: 86 patients fulfilled the inclusion criteria. The total number of metastases was significantly higher on T1w than on STIR images at both field strengths (p < 0.05). T1w revealed a sensitivity of 99.72% (3 T) and 100.00% (1.5 T) versus STIR with 70.99 % (3 T) and 79.34 % (1.5 T). In 53% (38/72) of all patients, STIR detected fewer bone metastases in comparison with T1w at 3 T. At 1.5 T, STIR showed inferior results in 37.5 % (18/48) of all patients. Qualitative analysis indicated a significantly better lesion conspicuity, lesion delineation and an improved image quality on T1w compared to STIR imaging at both field strengths (p < 0.05) with similar results for T1w at 1.5 T and 3 T, but inferior results for STIR especially at 3 T. CONCLUSION: The whole-body MRI protocol for the detection of bone metastases could safely be limited to the T1w sequence in adults, especially at 3 T. There is no need for an additional STIR sequence. These initial results will have a major impact on the department's workflow if confirmed by larger studies as they will help reduce examination time and therefore save financial resources. KEY POINTS: In a routine MR protocol, T1w imaging is sufficient for the detection of bone metastases. In case of differential diagnostic problems, other appropriate sequences can be added to the protocol. STIR is inferior to T1w in the detection of metastases, especially at 3 T.

Surgical treatment of thoracic spine fractures. Outcomes on 50 patients at 23 months follow-up.

PURPOSE: The morphological and biomechanical features of the thoracic spine, together with its close proximity to the spinal cord, set it apart from other spinal segments. Management of thoracic spine injuries consists of achieving a reduction and an immediate and long-lasting stabilization of the spine while constantly protecting the central and peripheral nervous system. The aim of this study was to determine the best treatment for surgical thoracic spine fractures. MATERIALS AND METHODS: We studied the baseline characteristics of 68 patients admitted to our neurosurgical department for one or several thoracic spine fractures between 2008 and 2010. We analysed on this group of patient the surgical management, complications and functional outcomes. We detailed the 2-years radiological outcome on 50 patients (23 months mean follow-up). RESULTS: The majority of patients underwent an extensive posterior arthrodesis bridging, on average, 5.3 vertebrae. The median time between diagnosis and surgery was 2 days and the median length of stay in hospital was 13.5 days. About 94% of hooks and 80% of pedicle screws were considered stable. Mean values of reduction and correction loss were similar (about 4.5°). We concluded to the superiority of extensive procedures and of pedicle screws fixation for the reduction and the maintenance of the correction by the end of follow-up. Functional data indicated daily discomfort and moderate pain. CONCLUSION: A prospective study comparing the different procedures and instrumentations is needed to better define guidelines for the management of thoracic spine injuries. LEVEL OF EVIDENCE: Level IV.