Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment

Spontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one or more adjacent vertebral bodies (spondylitis), the intervertebral discs (discitis) and finally - the neighboring neural structures. In most cases the condition is due to a hematogenous infection and can affect all regions of the spinal cord, but it is usually localized in the lumbar area. The most common clinical symptom is a pronounced, constant and increasing nocturnal paravertebral pain, while consequently different degrees of residual neurological symptoms from nerve roots and/or spinal cord may appear. The disease course is chronic and the lack of specific symptoms often prolongs the time between its debut and the diagnosis. This delay in diagnosis determines its potentially high morbidity and mortality. Treatment is conservative in cases with no residual neurological symptoms and consists of antibiotic therapy and immobilization. Surgical treatment is necessary in patients with neurological deficit, spinal instability or drug resistance

Initial Experience with O-Arm Navigated Spinal Surgery - Report on Two Cases

Image-guided spinal surgery is becoming increasingly popular because it allows surgeons to achieve minimal invasiveness and maximum precision in the performed procedures

Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confirmed the diagnosis - a direct carotid-cavernous fistula (CCF), with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fistula. During the first 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were significantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classification of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fistula and maintain adequate blood fl ow through the carotid artery

Mermaid syndrome associated with VACTERL-H syndrome

Mermaid syndrome or sirenomelia is an extremely rare congenital malformation with an incidence between 1.5 and 4.2 per 1,000,000 pregnancies. Association of mermaid syndrome with VACTERL-H syndrome is extremely rare, with only two cases reported so far in the literature. We present a new case of type I sirenomelia associated with VACTERL-H syndrome and review the relevant literature. A 15-year-old female patient was admitted to the Department of Pathological Pregnancy at St George University Hospital, Plovdiv with progredient abortion during her first pregnancy. She had low socioeconomic status, negative history of concomitant diseases and addictions. The patient avoided prophylactic intake of folic acid during her pregnancy. Prenatal ultrasound found a malformative fetus. Consequently, magnetic resonance imaging was performed which established the presence of hydrocephalus and defects in the lower part of the spine. These pathological findings indicated interruption of pregnancy at 20 weeks of gestation. The fetopathological examination found sirenomelia type I associated with myelomeningocele, hydrocephalus, anal imperforation, single umbilical artery, bilateral renal and ureteric agenesis, bladder agenesis, tracheo-esophageal fistula, agenesis of external genitals, monkey fold of the left palm of the hand, also known as VACTERL-H syndrome.Our case demonstrates that mermaid syndrome and VACTERL-H syndrome represent different manifestations of a single pathological process that results in disorders of the blastogenesis at different stages during embryonic development.&nbsp

Mucocele of the Sphenoid Sinus

Mucocele of the paranasal sinuses is a rare disease with slow evolution. It is a benign, encapsulated and destructive formation filled with mucous fluid and tapistrated with respiratory epithelium. Of all the paranasal sinuses, the sphenoid sinus is affected in only 1-7% of the cases. We present two cases of mucocele of the sphenoid sinus involving the posterior ethmoidal cells. We consider here their clinical presentation, use of neuroimaging in the diagnosis, surgical care and postoperative results. Both patients presented with a history of persistent headache and in addition, one of them had a paresis of the right oculomotor and abducens nerves. A transnasal endoscopic sphenoidectomy was performed in both patients, in one - with an evacuation of the mucocele and marsupialization, and in the other - with a balloon dilatation of the natural foramen of the sinus. Postoperatively, a complete reversal of the symptoms was observed in both patients. Mucocele of the paranasal sinuses should be considered as a diagnosis in cases of persistent headache with a primarily retrobulbar location and eye symptoms. Computed tomography and magnetic resonance imaging can be used to successfully diagnose the disease. The transnasal endoscopic sphenoidectomy is the therapeutic method of choice which allows evacuation of the mucocele, while the marsupialization allows good drainage and prevents recurrence

A Comparative Study Of Lamps And Ykl-40 Tissue Expression In Glial Tumors

ВВЕДЕНИЕ: YKL-40 представляет собой гликопротеин, который считается потенциальным маркером при патологических процессах. Высокие уровни YKL-40 установлены при ряде опухолевых и хронических заболеваний. Несмотря на то, что конкретные функции гликопротеина все еще неизвестны, предполагается его участие в ангиогенезисе и в опухолевой агрессивности. Лизосомно-ассоциированные мембранные протеины (LAMPs) 1 и 2 представляют высоко консервативные белки с дискутабильными функциями. Имеются доказательства об их участии в процессах как аутофагия, ангиогенезис и тканевое ремоделирование. ЦЕЛЬ: Исследовать потенциальную связь между тканевой эспрессией YKL-40, LAMP-1 и LAMP-2 при глиальных опухолях. МАТЕРИАЛ И МЕТОДЫ: Экспрессия LAMPs и YKL-40 детектирована через иммуногистохимический анализ в 36 глиальных опухолях. Проведены морфометрическое исследование и анализ тканевой экспрессии YKL-40 с помощью компьютерной системы Quick-patho Micro 2.3. Вычислены площадь (μm2), периметр (μm) и экспрессия (%) трех гликопротеинов. РЕЗУЛЬТАТЫ: Лизосомные белки позитивируются на клеточную мембрану глиальных и эндотелиальных клеток, в то время как YKL- 40 локализован в их цитоплазме. Интенсивная иммуногистохимическая реактивность наблюдается в опухолевых клетках. При LAMP-2 отчитывается более демонстративная экспрессия по сравнению с LAMP-1. ЗАКЛЮЧЕНИЕ: Впервые представлены данные о сравнительном иммуногистохимическом исследовании YKL-40, LAMP-1 и LAMP-2 при глиальных опухолях. Сходство между экспрессией трех белков предполагает их участие в процессах ангиогенезиса и в процессах тканевого ремоделирования во время опухолевого развития

Mucocele of the Paranasal Sinuses – Retrospective Analysis of a Series of Seven Cases

Aim: The present study aimed at identifying the risk factors, typical clinical symptoms and applied treatment in seven cases with mucocele of the paranasal sinuses

Glioblastoma Multiforme Classified As Mesenchymal Subtype

ВВЕДЕНИЕ: В качестве неблагоприятных прогностических факторов при первичных глиобластомах в последнее время обсуждаются не только клинические показатели, но и различные клеточные, генетические и иммунологические маркеры. ЦЕЛЬ: Работа ставит себе целью анализировать случай с первичной мультиформенной глиобластомой и краткой выживаемостью после оперативной интер- венции, а также и определить неблагоприятные прогностические маркеры. ПРЕДСТАВЛЕНИЕ СЛУЧАЯ: Авторы представляют случай 71-оголетнего мужчины с доказанной мультиформенной глиобластомой и постоперативной выживаемостью в 48 дней. Из-за непродолжительной выживаемости пациент не подвергнут телегамматерапии и адювантной терапии Темозоломид- ом. С помощью молекулярно- биологических и иммунологических анализов определены транскрипционные и сывороточные уровни TNF-α, IL-6, YKL-40 и CD44. Устанавливаются экстремно высокие транскрипционные уровни генов CD44, IL-6 и YKL-40, увеличенная экспрессия TNF-α, сопровожденные повышенной сывороточной концентрацией IL-6, TNF-α и YKL-40 и пониженной сывороточной концентрацией CD44. ЗАКЛЮЧЕНИЕ: Молекулярно-биологически

Thoracic Meningioma In Combination With Severe Lumbar Spinal Stenosis Presenting With Atypical Neurological Deficit

We report on a case of a 47-year-old female patient with a long history of low back pain irradiating bilaterally to the legs. Twenty days before admission to our clinic, she had developed progressive weakness in the legs, more pronounced on the left side. The initial neurological examination revealed signs of damage to both the cauda equina and the spinal cord. The neuroimaging studies (computed tomography, myelography and magnetic-resonance tomography) found spinal stenosis most severe at L4-L5 level, and right lateral thoracic intradural-extramedullary tumor at T9-T10 level