Spinal cord compression secondary to brown tumour in a patient on long-term haemodialysis: a case report.

Brown tumours may occur secondary to hyperparathyroidism in patients with chronic renal failure (CRF). Diagnosing a spinal brown tumour causing cord compression requires a high index of suspicion. We report a 65-year-old woman, who had been on haemodialysis for CRF for over 10 years, who presented with leg weakness and back pain over the thoracolumbar junction. She had a brown tumour at T8 causing subacute spinal cord compression. Ambulation was regained after surgical decompression and stabilisation. Adherence to the National Kidney Foundation guidelines in the management of patients with CRF may prevent renal osteodystrophy. Treatment of spinal brown tumour depends on the severity of the neurological deficit. Remineralization is expected after correction of the parathyroid level, thus negating the need for total excision of the parathyroid glands.published_or_final_versio

Time-frequency analysis of somatosensory evoked potentials for intraoperative spinal cord monitoring

PURPOSE: To evaluate the potential use of time-frequency analysis and its reliability in intraoperative somatosensory evoked potential (SEP) monitoring. METHODS: One hundred ninety-one patients undergoing thoracic and/or lumbar spinal surgery were studied retrospectively. The SEP signals were recorded during different stages of surgery. Averaged SEP was analyzed by short-time Fourier transform. The main peak in the time-frequency interpretation of SEP was measured in peak power, peak time, and peak frequency. The variability of these parameters was compared with that of amplitude and latency during different stages of surgery. The reliability of these parameters was also compared in true-positive and false-positive cases. RESULTS: During different surgical stages for the posterior tibial nerve SEP, the intrasubject variability of peak power was found to be more stable than that of amplitude, while the intrasubject variability of peak time did not show any difference compared with that of latency. The peak frequency presented stable during surgery. Moreover, the true-positive SEP case showed that peak power may detect the potential injury earlier than amplitude does. The false-positive outcomes could be reduced by the proposed method. CONCLUSIONS: The SEP peak component was found stable and reliable during the different stages of surgery. For clinical application purpose, time-frequency analysis was suggested to be an additional monitoring method besides the conventional amplitude/latency measurement since it provided a more reproducible and prompt response to the potential injury in intraoperative SEP monitoring. Copyright © 2011 by the American Clinical Neurophysiology Society.postprin

Fear of movement/(re)injury in Chinese patients with chronic pain: Factorial validity of the Chinese version of the Tampa Scale for Kinesiophobia

Objective: To assess the factor structure of the Chinese version of the Tampa Scale for Kinesiophobia (TSK). Design: Chinese patients with chronic pain attending either orthopaedic specialist services (n = 216) or multidisciplinary specialist pain services (n = 109) participated in this study. Methods: Subjects completed the Chinese version of TSK, The Chronic Pain Grade Questionnaire, Hospital Anxiety and Depression Scale, and questions assessing socio-demographic characteristics. Confirmatory factor analyses were used to compare hierarchical and correlated models of 5 different factor solutions previously reported in patients with chronic pain in the West. Results: Confirmatory factor analyses demonstrated inequality of the TSK factor structure, in that the TSK11 for the orthopaedics sample was best represented by a two-factor correlated model (S-Bχ2 = 49.593; comparative fit index (CFI) = 0.93; normed filt index (NFI) = 0.911; root mean square error of approximation (RMSEA) = 0.025) comprising 2 first-order factors, Somatic Focus (TSK11-SF) and Activity Avoidance (TSK-AA). The pain clinic sample showed a one-factor structure as best representing the TSK4’s underlying dimensions (CFI  = 0.971; NFI = 0.912; RMSEA = 0.048). There was no evidence to support a single overarching concept of kinesiophobia. Conclusion: The TSK appears to have utility in Chinese chronic pain populations. Elucidation of the TSK’s psychometrics properties in other Chinese/Asian pain populations with different diagnoses and presentations of pain problems is warranted

Pyogenic spondylitis

Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10–20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover

The mechanisms by which polyamines accelerate tumor spread

Increased polyamine concentrations in the blood and urine of cancer patients reflect the enhanced levels of polyamine synthesis in cancer tissues arising from increased activity of enzymes responsible for polyamine synthesis. In addition to their de novo polyamine synthesis, cells can take up polyamines from extracellular sources, such as cancer tissues, food, and intestinal microbiota. Because polyamines are indispensable for cell growth, increased polyamine availability enhances cell growth. However, the malignant potential of cancer is determined by its capability to invade to surrounding tissues and metastasize to distant organs. The mechanisms by which increased polyamine levels enhance the malignant potential of cancer cells and decrease anti-tumor immunity are reviewed. Cancer cells with a greater capability to synthesize polyamines are associated with increased production of proteinases, such as serine proteinase, matrix metalloproteinases, cathepsins, and plasminogen activator, which can degrade surrounding tissues. Although cancer tissues produce vascular growth factors, their deregulated growth induces hypoxia, which in turn enhances polyamine uptake by cancer cells to further augment cell migration and suppress CD44 expression. Increased polyamine uptake by immune cells also results in reduced cytokine production needed for anti-tumor activities and decreases expression of adhesion molecules involved in anti-tumor immunity, such as CD11a and CD56. Immune cells in an environment with increased polyamine levels lose anti-tumor immune functions, such as lymphokine activated killer activities. Recent investigations revealed that increased polyamine availability enhances the capability of cancer cells to invade and metastasize to new tissues while diminishing immune cells' anti-tumor immune functions

Rapid Reversal of Chondroitin Sulfate Proteoglycan Associated Staining in Subcompartments of Mouse Neostriatum during the Emergence of Behaviour

BACKGROUND: The neostriatum, the mouse homologue of the primate caudate/putamen, is the input nucleus for the basal ganglia, receiving both cortical and dopaminergic input to each of its sub-compartments, the striosomes and matrix. The coordinated activation of corticostriatal pathways is considered vital for motor and cognitive abilities, yet the mechanisms which underlie the generation of these circuits are unknown. The early and specific targeting of striatal subcompartments by both corticostriatal and nigrostriatal terminals suggests activity-independent mechanisms, such as axon guidance cues, may play a role in this process. Candidates include the chondroitin sulfate proteoglycan (CSPG) family of glycoproteins which have roles not only in axon guidance, but also in the maturation and stability of neural circuits where they are expressed in lattice-like perineuronal nets (PNNs). METHODOLOGY/PRINCIPAL FINDINGS: The expression of CSPG-associated structures and PNNs with respect to neostriatal subcompartments has been examined qualitatively and quantitatively using double-labelling for Wisteria floribunda agglutinin (WFA), and the mu-opioid receptor (muOR), a marker for striosomes, at six postnatal ages in mice. We find that at the earliest ages (postnatal day (P)4 and P10), WFA-positive clusters overlap preferentially with the striosome compartment. By P14, these clusters disappear. In contrast, PNNs were first seen at P10 and continued to increase in density and spread throughout the caudate/putamen with maturation. Remarkably, the PNNs overlap almost exclusively with the neostriatal matrix. CONCLUSIONS/SIGNIFICANCE: This is the first description of a reversal in the distribution of CSPG associated structures, as well as the emergence and maintenance of PNNs in specific subcompartments of the neostriatum. These results suggest diverse roles for CSPGs in the formation of functional corticostriatal and nigrostriatal connectivity within the striosome and matrix compartments of the developing caudate/putamen