Cement leakage in a symptomatic vertebral hemangioma: a case report and review of the literature

We present the case of a 50-year-old male with consistent back pain, not resolving with conservative treatment. Plain radiograms demonstrated a lytic lesion at the level of the 8th thoracic vertebra. Thorough examination with computerized tomography and magnetic resonance imaging revealed a hemangioma extending to the posterior third of the vertebral body, compressing the spinal cord at the level of 8th thoracic vertebra. A percutaneous vertebroplasty was performed. The post-operative computerized tomography scan demonstrated cement leakage. After thorough cement removal combined with extensive decompression and posterior stabilization, the patient reported gradual improvement of his symptoms and was able to return successfully to his work a few months later

Assessment of Bone Mineral Density in Male Patients with Chronic Obstructive Pulmonary Disease by DXA and Quantitative Computed Tomography

The purpose of this study is to identify the prevalence of osteoporosis in male patients with chronic obstructive pulmonary disease (COPD) by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and to compare the diagnostic abilities of the above methods. Thirty-seven male patients with established COPD were examined with DXA and standard QCT in lumbar spine, including L1, L2, and L3 vertebrae. T-scores and bone mineral density values were calculated by DXA and QCT method, respectively. Comparative assessment of the findings was performed and statistical analysis was applied. QCT measurements found more COPD patients with impaired bone mineral density compared to DXA, namely, 13 (35.1%) versus 12 (32.4%) patients with osteopenia and 16 (43.2%) versus 9 (16.2%) patients with osteoporosis (p=0.04). More vertebrae were found with osteoporosis by QCT compared to DXA (p=0.03). The prevalence of osteoporosis among male patients with COPD is increased and DXA may underestimate this risk. QCT measurements have an improved discriminating ability to identify low BMD compared to DXA measurements because QCT is able to overcome diagnostic pitfalls including aortic calcifications and degenerative spinal osteophytes

Symptomatic intracranial abscess after treating lower cervical spine fracture with halo vest: a case report and review of literature

We present the case of a nineteen year old male, who sustained a fracture of anterior-superior surface of C7, combined with anterior subluxation at the level of C6–C7 vertebrae. After x-ray and CT examination, he was treated conservatively by a Halo-vest. After mobilization, the patient was discharged from the hospital with instructions to visit the outpatient's clinic at regular bases

Investor personhood: the case against paternalism and welfarism in corporate law

Equity investment is seen in both dominant and critical corporate law literature as a passive act that carries exclusively instrumental value. This conceptualisation legitimises shareholder paternalism in current UK law and provides support for stakeholder welfarism reforms. Engaging with cogent emerging evidence on the preferences, motivation, and behaviour of contemporary individual investors, we demonstrate that, for the majority of them, equity investment is increasingly experienced as a choice instantiating their personhood, identity, and moral agency, and thus carrying inherent value. Drawing on Hayek’s epistemology, we propose a novel interpretation of Rawls’s theory of justice, and argue that freedom to own productive property must be included in the list of basic liberties under Rawls’s first principle of justice. Therefore, corporate law cannot continue imposing paternalistic restrictions on the configurations of shareholder rights that investors may rationally choose from, and pleas for stakeholder welfarism within corporate law must be rejected

Investor personhood:the case against paternalism and welfarism in corporate law

Equity investment is seen in both dominant and critical corporate law literature as a passive act that carries exclusively instrumental value. This conceptualisation legitimises shareholder paternalism in current UK law and provides support for stakeholder welfarism reforms. Engaging with cogent emerging evidence on the preferences, motivation, and behaviour of contemporary individual investors, we demonstrate that, for the majority of them, equity investment is increasingly experienced as a choice instantiating their personhood, identity, and moral agency, and thus carrying inherent value. Drawing on Hayek’s epistemology, we propose a novel interpretation of Rawls’s theory of justice, and argue that freedom to own productive property must be included in the list of basic liberties under Rawls’s first principle of justice. Therefore, corporate law cannot continue imposing paternalistic restrictions on the configurations of shareholder rights that investors may rationally choose from, and pleas for stakeholder welfarism within corporate law must be rejected

The role of computed tomography angiography (CTA) in the investigation of spontaneous subarachnoid hemorrhage

Purpose: Spontaneous subarachnoid haemorrhage is a clinical condition that may be attributed to various underlying causes, such as rupture of intracranial aneurysms and arteriovenous malformations (AVMs). Suspected cerebrovascular abnormalities can be detected either with digital subtraction angiography (DSA) or with computed tomography angiography (CTA) combined with postprocessing tools, namely multiplanar reformation, maximum intensity projection, shaded surface displayvirtual endoscopy and direct volume rendering. Materials and Methods: We prospectively studied a group of 205 patients with spontaneous subarachnoid haemorrhage. One hundred ninety eight (198) patients underwent both DSA and CTA and formed our study group. Patients with intracranial aneurysms underwent surgical or endovascualr treatment. Results: DSA was negative for 35 patients, detected 178/179 aneurysms and 15 AVMs. CTA correctly detected 176/179 aneurysms and all 15 cases of AVMs whereas it was negative in 35 cases. After 3D reconstruction the size, location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs with the main feeding vessel(s), nidus and draining veins were reliably shown by CTA although DSA provided more anatomic details related to the anatomy of the adjacent vessels. The accuracy, sensitivity, positive predictive accuracy and negative predictive accuracy for CTA was 98%, 97.9%, 100% and 94.3% and for DSA was 99%, 99.3%, 100% and 98%, respectively. Conclusions: It is suggested that CSA is a reliable alternative to DSA in detecting intracranial aneurysms. The role of CTA in demonstrating AVMs can be considered complementary to that of DSA.Σκοπός αυτής της εργασίας ήταν να αξιολογήσει την χρησιμότητα της Αξονικής Αγγειογραφίας (ΑΞΑ) σε ασθενείς με αυτόματη υπαραχνοειδή αιμορραγία ( ΑΥΑ ), με έμφαση στην πρώϊμη ανάδειξη και χαρακτηρισμό κυρίως των εγκεφαλικών ανευρυσμάτων και στην επιλογή της καταλληλότερης θεραπευτικής αντιμετώπισης. Έγινε συγκριτική μελέτη με την ενδαρτηριακή Ψηφιακή Αφαιρετική Αγγειογραφία ( ΨΑΑ ) και με τα χειρουργικά ευρήματα. Κατά την διάρκεια των 5 τελευταίων ετών ( 2002 - 2006 ), προσήλθαν στο Νοσοκομείο μας 205 ασθενείς με ΑΥΑ. Όλοι οι ασθενείς εξετάστηκαν με Αξονική Τομογραφία και Αγγειογραφία ( ανασυνθέσεις MPR, MIP, SSD, VRT, Virtual Endoscopy, Τransparent VR ). Με ΨΑΑ εξετάστηκαν 198 ασθενείς αφού 2 ασθενείς κατέληξαν πριν την εκτέλεση της ΨΑΑ και 5 οδηγήθηκαν άμεσα στο χειρουργείο λόγω συνύπαρξης με την υπαραχνοειδή αιμορραγία και ενδοεγκεφαλικού αιματώματος. Από τους 198 ασθενείς που εξετάστηκαν και με τις δύο μεθόδους, σε 35 δεν παρουσιάστηκαν παθολογικά ευρήματα, σε 15 αιτία της υπαραχνοειδούς αιμορραγίας ήταν η αιμορραγία αγγειακών δυσπλασιών ( 10 αρτηριοφλεβώδεις δυσπλασίες, 4 φλεβώδη αγγειώματα στα 2 δε από αυτά συνυπήρχαν σηραγγώδη αιμαγγειώματα και 1 μικρή μηνιγγική αρτηριοφλεβώδης δυσπλασία ) και σε 148 ασθενείς διαγνώστηκαν 179 ανευρύσματα ( μεγέθους 2χιλ. - 4 εκ. ). Η ΑΞΑ ανέδειξε τα 176 από τα 179 ανευρύσματα. Οι 3 ψευδώς αρνητικές περιπτώσεις αφορούσαν μικρά ανευρύσματα μεγέθους 2 - 3 χιλ. Δεν υπήρξε κανένα ψευδώς θετικό εύρημα ( ευαισθησία της ΑΞΑ 98.32% και ειδικότητα 100% ). Ένα μικρό ανεύρυσμα στον διχασμό της μέσης εγκεφαλικής αρτηρίας και η μικρή μηνιγγική αρτηριοφλεβώδης δυσπλασία δεν διαγνώστηκαν αρχικά με την ΨΑΑ. Ακόμη η ΨΑΑ δεν ανέδειξε τα 2 σηραγγώδη αιμαγγειώματα που συνυπήρχαν με τα φλεβώδη αγγειώματα. 60 ανευρύσματα αντιμετωπίστηκαν χειρουργικά, 110 με εμβολισμό και 14 συντηρητικά. Υπήρξε καλή συσχέτιση μεταξύ της ΑΞΑ και των χειρουργικών ευρημάτων. Σε 165 από τα 179 ανευρύσματα ήταν δυνατή η επιλογή της καταλληλότερης αντιμετώπισης με την ΑΞΑ ( 92.17% ), ενώ σε 14 ανευρύσματα χρειάστηκε η συμβολή της ΨΑΑ για την επιλογή της θεραπείας. Η ΑΞΑ είναι μια ακριβής, υποσχόμενη μέθοδος στην διερεύνηση της ΑΥΑ, λιγότερο επεμβατική, γρήγορη και με χαμηλότερο οικονομικό κόστος της ΨΑΑ, παρέχοντας όλες τις απαραίτητες πληροφορίες για την ανίχνευση και τον χαρακτηρισμό ενός ανευρύσματος. Είναι ασφαλής και αποτελεσματική στην επιλογή της καταλληλότερης αντιμετώπισης του ανευρύσματος, ως μόνη μέθοδος, στις περισσότερες περιπτώσεις. Η μελέτη αυτή επιβεβαιώνει τον ρόλο της ΑΞΑ, ως πρωταρχικής μεθόδου διερεύνησης της ανευρυσματικής ΑΥΑ, με την ΨΑΑ να εφαρμόζεται σε ειδικές περιπτώσεις. Τα αποτελέσματα της ΑΞΑ στην μελέτη των άλλων αγγειοδυσπλασιών είναι λιγότερο ικανοποιητικά. Για αυτές απαιτείται η εκτέλεση της ΨΑΑ πριν τον θεραπευτικό σχεδιασμό, ενώ η ΑΞΑ έχει συμπληρωματικό ρόλο

Investor personhood:the case against paternalism and welfarism in corporate law

Equity investment is seen in both dominant and critical corporate law literature as a passive act that carries exclusively instrumental value. This conceptualisation legitimises shareholder paternalism in current UK law and provides support for stakeholder welfarism reforms. Engaging with cogent emerging evidence on the preferences, motivation, and behaviour of contemporary individual investors, we demonstrate that, for the majority of them, equity investment is increasingly experienced as a choice instantiating their personhood, identity, and moral agency, and thus carrying inherent value. Drawing on Hayek’s epistemology, we propose a novel interpretation of Rawls’s theory of justice, and argue that freedom to own productive property must be included in the list of basic liberties under Rawls’s first principle of justice. Therefore, corporate law cannot continue imposing paternalistic restrictions on the configurations of shareholder rights that investors may rationally choose from, and pleas for stakeholder welfarism within corporate law must be rejected

Pulmonary actinomycosis presenting with hemoptysis and a peripheral lung mass; a case report

SUMMARY. Pulmonary actinomycosis is a rare, chronic granulomatous disease, which is difficult to diagnose because it is commonly confused with other granulomatous infections or lung cancer. The case is reported of a 48 year-old man, a smoker, who presented with a 30 day history of productive cough with blood tinged sputum and a peripheral lung mass on the chest X-ray. He underwent full clinical and laboratory evaluation including bronchoscopy, which was unrevealing. Because of the haemoptysis the patient refused a computerized tomography (CT) guided fine needle aspiration biopsy, and proceeded directly to surgery. Following a right posterolateral thoracotomy and lysis of adhesions, a wedge resection of the right lower lobe mass in the lung was performed and sent for frozen section which was negative for malignancy. His postoperative course was unremarkable. The final pathology report established the diagnosis of pulmonary actinomycosis. Pulmonary actinomycosis should be included in the differential diagnosis of a lung mass in a patient presenting with haemoptysis, because an early and accurate diagnosis will preclude unwarranted surgery. Pneumon 2009, 22(3):254-261