Giant cervicothoracic extradural arachnoid cyst: case report

The pathogenesis, etiology, and treatment of the spinal arachnoid cyst have not been well established because of its rarity. A 57-year-old male was presented with spastic quadriparesis predominantly on the left side. His radiological examination showed widening of the cervical spinal canal and left neural foramina due to a cerebrospinal fluid - filled extradural cyst that extended from C2 to T2 level. The cyst was located left anterolaterally, compressing the spinal cord. Through a C4–T2 laminotomy, the cyst was excised totally and the dural defect was repaired. Several features of the reported case, such as cyst size, location, and clinical features make it extremely unusual. The case is discussed in light of the relevant literature

Medial femoral head border is a reliable and reproducible reference for axis determination for femoral component of unicompartmental knee arthroplasty.

PURPOSE: The femoral component should be implanted parallel to the mechanical axis in unicompartmental knee arthroplasty. It was hypothesised that a line between medial femoral condyle centres and medial border of femoral head will be parallel to the mechanical axis; this study set out to examine this hypothesis. METHODS: One hundred X-rays in fifty patients were included for this study. Long-leg standing X-rays including hip and ankle with patellae facing forwards were obtained. On these films, we measured the angle, α, between mechanical axis and the line between the femoral head centre and knee centre (medial mechanical axis), and the angle, β, between the medial mechanical axis and a line between medial femoral condyle and femoral head centre. RESULTS: The average value of α was 0.1 ± 0.5° and the average value of β 3.0° ± 0.3°. These data indicate that mechanical axis and medial mechanical axis are virtually parallel to each other. CONCLUSION: As medial femoral head border is easily identified fluoroscopically, it is a reliable landmark for orientating the femoral component of medial UKA

Spontaneus bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Spontaneous fractures of the spine are a common entity. They usually occur in older people with osteoporosis. This case is presented on account of its rarity. To the best of the authors' knowledge only one case of an osteoporotic pedicle fracture after Harrington Instrumentation has been described before.</p> <p>Case presentation</p> <p>We report the case of a 46-year-old Caucasian woman who underwent surgery due to idiopathic scoliosis with a Harrington Instrumentation (T4 to L3) 30 years ago. During the operation she was infected with hepatitis C while receiving erythrocyte concentrates and has suffered from liver cirrhosis since then. She presented with a sudden pain in her lower back and paraesthesia in both her legs but no other neurological symptoms. A computed tomography scan showed a bilateral pedicle fracture of L3 and an additional compression fracture of L4. In the first session we performed a dorsal stabilization with massive intraoperative bleeding and a postoperative failure of liver synthesis. In a second session an additional ventral augmentation was done. After the second operation she developed a hepatorenal syndrome. Both operations left the patient in a very critical state which led to a prolonged stay in the intensive care and rehabilitation unit. At her 12-month follow-up visit, she was free of complaints.</p> <p>Conclusion</p> <p>The un-physiological load of the spine after Harrington Instrumentation can lead to osteoporosis due to inactivity even in younger patients. Although these implants are not used anymore one should keep this possibility in mind when dealing with patients who have received Harrington rods in surgical procedures.</p

Spontaneous and cytokine regulated c-fos gene expression in rheumatoid synovial cells: resistance to cytokine stimulation when the c-fos gene is overexpressed

OBJECTIVE—To study the effect of cytokines on the transactivation of the c-fos gene in relation to the contribution of overexpression of c-fos/AP-1 in rheumatoid joint destruction.
METHODS—The promoter region (−447 to +109) of the human c-fos gene was integrated upstream of the chloramphenicol acetyltransferase (CAT) reporter gene, and the effect of cytokines on the expression of the c-fos gene was studied in the rheumatoid synovial cells of early (3-4) or late (14-18) passages, in the presence or absence of cytokines, by the transient transfection assay.
RESULTS—Expression of c-fos gene was enhanced by tumour necrosis factor α (TNFα) and interleukin 6 (IL6) in the synovial cells of early passage, whereas it was not enhanced in the synovial cells of late passage. The c-fos gene expression was also enhanced by 13-O-tetradecanoyl phorbol-13-acetate (TPA) in early passage but was somewhat suppressed in the late passage. It was found that the c-fos gene and c-Fos protein were both increased in the synovial cells of late passage. Similarly, c-fos gene expression was also not increased by TPA or cytokine stimulation in the stable c-fos transformants (fos-pH8) or H-ras transformed NIH3T3 cells (NIH H-ras cells) that constitutively expressed c-fos genes.
CONCLUSIONS—Although TNFα and IL6 augmented c-fos gene expression of rheumatoid synovial cells, transactivation of c-fos gene became resistant against cytokine stimulation under prolonged expression of c-fos gene, which may impart a tumour-like characteristic to rheumatoid synovial cells.