Intradural extramedullary Ewing's sarcoma: A case report and review of the literature

Introduction Extra-skeletal Ewing's sarcomas are very rare lesions to the spine surgeon, with the intradural, extramedullary lesions being even rarer. Herein we present a patient with an intradural, extramedullary form of Ewing's sarcoma and review the relevant literature. The medical records, operative reports, radiographical studies and histological examinations of a single patient are retrospectively reviewed. Case report A 31-year old male presented with back-pain, right-leg progressive paraparesis, and inability to walk. Both motor and sensory disturbances were revealed on the right leg at the clinical examination. Lumbar MRI showed two lesions. The first one was an intradural, extramedullary lesion at the L2-L3 level, while the second was smaller, located at the bottom of the dural sac. The patient underwent gross total resection of the L2-L3 lesion after a bilateral laminectomy. Histological examination was compatible with Ewing's sarcoma, and was verified by molecular analysis. No other extra-skeletal or skeletal lesion was found. A chemotherapy scheme was tailored to the patients’ histological diagnosis. The patient presented with local recurrence and bone metastasis 2 years after his initial diagnosis. A second operation was performed and the follow up of the patient showed no disease progression 18 months after revision surgery. Conclusion The spine surgeon should be aware of the existence of such rare entities, in order to timely fulfill the staging process and institute the proper therapy. The management of patients with extra-skeletal Ewing's sarcomas involves professionals as members of a multidisciplinary team, all of which should co-operate for the patient's optimal outcome

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

European ST80 community-associated methicillin-resistant Staphylococcus aureus orbital cellulitis in a neonate

<p>Abstract</p> <p>Background</p> <p>Methicillin-resistant <it>Staphylococcus aureus</it> is a serious cause of morbidity and mortality in hospital environment, but also, lately, in the community. This case report is, to our knowledge, the first detailed description of a community-associated methicillin-resistant <it>S. aureus</it> ST80 orbital cellulitis in a previously healthy neonate. Possible predisposing factors of microbial acquisition and treatment selection are also discussed.</p> <p>Case presentation</p> <p>A 28-day-old Caucasian boy was referred to our hospital with the diagnosis of right orbital cellulitis. His symptoms included right eye proptosis, periocular edema and redness. Empirical therapy of intravenous daptomycin, rifampin and ceftriaxone was initiated. The culture of pus yielded a methicillin-resistant <it>S. aureus</it> isolate and the molecular analysis revealed that it was a Panton-Valentine leukocidine-positive ST80 strain. The combination antimicrobial therapy was continued for 42days and the infection was successfully controlled.</p> <p>Conclusions</p> <p>Clinicians should be aware that young infants, even without any predisposing condition, are susceptible to orbital cellulitis caused by community-associated methicillin-resistant <it>S. aureus.</it> Prompt initiation of the appropriate empirical therapy, according to the local epidemiology, should successfully address the infection, preventing ocular and systemic complications.</p

Angiographic findings and clinical implications of persistent primitive hypoglossal artery

BACKGROUND: The primitive hypoglossal artery (PHA) is a rare vascular anomaly, which belongs to the group of carotid-basilar anastomosis that may occur in adults. CASE PRESENTATION: Herein is presented a case of a patient with a PHA, who had undergone a cerebral angiography due to investigation of subarachnoid hemorrhage. Additionally, the diagnostic alternatives for detection and assessment of PHA and the spectrum of diseases related to its presence are discussed. CONCLUSIONS: The presence of a persistent PHA can be recognized as an incidental finding in a cerebral angiography without any other clinical implication or may be associated with certain clinical entities such as aneurysm formation and atherosclerotic disease

Incidental Non-Cardiac Findings of a Coronary Angiography with a 128-Slice Multi-Detector CT Scanner: Should We Only Concentrate on the Heart?

Objective: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT). Materials and Methods: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations. Results: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers. Conclusion: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice

Assessment of bone mineral density in paraplegic patients by the use of dual x-ray absorptiometry (DXA)

Paraplegia due to spinal cord injury is related with sublesional bone demineralisation with an increased incidence of pathologic fractures in lower extremities. This study was carried out in order to evaluate bone density alterations in forearm and hip in Greek paraplegic patients after spinal cord injury and to correlate the findings with the level of injury, the neurological status, the time interval from injury and the performing of physiotherapy and therapeutic standing. Fifty-seven paraplegic patients (33 men and 24 women, with injuries sustained from 6 months to 27 years) and 36 able-bodied age-matched controls (25 men, 16 women) participated in the study. Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA) in the proximal and distal forearm, the femoral neck, the greater trochanter and Ward`s triangle. The measurements revealed a significant reduction of BMD of femoral neck (p<0.001 in male, p<0.001 in female paraplegics), greater trochanter (p<0.001 and p=0.001, respectively) and Ward’s triangle (p=0.001 and p=0.005, respectively). Proximal forearm depicted non-significantly decreased BMD values and distal forearm depicted a slight increase in BMD values. The degree of demineralisation was independent of factors such as complete or incomplete spinal cord injury, level of the lesion, physiotherapy and performing of standing. In addition to that, BMD values in both hip and forearm showed no statistically significant correlation with time after injury. BMD measurements in Greek paraplegic patients reveal bone loss, which most dramatically occurs in the region of hip with a consequent increase of fracture risk. Forearm measurements depict a non-homogeneous response with limited proximal bone loss and slight distal increase of BMD, the latter being possibly attributed to daily activities.Η παραπληγία λόγω κάκωσης του νωτιαίου μυελού σχετίζεται με ελάττωση της οστικής πυκνότητας κάτω από το επίπεδο της βλάβης και με αυξημένη συχνότητα παθολογικών καταγμάτων στα κάτω άκρα. Η παρούσα μελέτη πραγματοποιήθηκε με σκοπό την εκτίμηση των μεταβολών της οστικής πυκνότητας στο αντιβράχιο και στο ισχίο ενός ελληνικού πληθυσμού παραπληγικών ασθενών καθώς και τη συσχέτιση των ευρημάτων με το ύψος της βλάβης, το ατελές ή πλήρες της βλάβης, το χρονικό διάστημα από την κάκωση καθώς και την πραγματοποίηση φυσιοθεραπείας και ορθοστασίας. Πενήντα επτά παραπληγικοί ασθενείς (33 άνδρες και 24 γυναίκες, με παραπληγία χρονικής διάρκειας από 6 μήνες έως 27 χρόνια) καθώς και 36 υγιείς εθελοντές αντίστοιχης ηλικίας με τον πληθυσμό των ασθενών (25 άνδρες, 16 γυναίκες) συμμετείχαν σε αυτή τη μελέτη. Έγιναν μετρήσεις οστικής πυκνότητας με τη μέθοδο DXA στο εγγύς και στο περιφερικό αντιβράχιο καθώς και στον αυχένα του μηριαίου, στο μείζονα τροχαντήρα και στο τρίγωνο του Ward. Οι μετρήσεις ανέδειξαν μια σημαντική ελάττωση της οστικής πυκνότητας στον αυχένα του μηριαίου (p<0.001 στους άνδρες, p<0.001 στις γυναίκες ασθενείς), στο μείζονα τροχαντήρα (p<0.001 and p=0.001, αντίστοιχα) και στο τρίγωνο του Ward (p=0.001 and p=0.005, αντίστοιχα). Στο εγγύς άκρο του αντιβραχίου καταγράφηκε μια μη στατιστικά σημαντική ελάττωση της οστικής πυκνότητας ενώ στο περιφερικό άκρο καταγράφηκε μια μικρή αύξηση της οστικής πυκνότητας. Η ελάττωση της οστικής πυκνότητας ήταν ανεξάρτητη από παράγοντες όπως πλήρης ή ατελής κάκωση του νωτιαίου μυελού, ύψος της βλάβης, πραγματοποίηση φυσιοθεραπείας και ορθοστασίας. Επίσης, οι τιμές στο ισχίο και στο αντιβράχιο δεν παρουσίασαν κάποια στατιστικά σημαντική συσχέτιση με τον χρόνο από την κάκωση. Οι μετρήσεις της οστικής πυκνότητας σε ελληνικό πληθυσμό παραπληγικών ασθενών έδειξαν σημαντική ελάττωση της οστικής πυκνότητας, η οποία εντοπίζεται ιδιαίτερα στην περιοχή του ισχίου με μία συνεπακόλουθη αύξηση του κινδύνου εμφάνισης καταγμάτων. Οι μετρήσεις στο αντιβράχιο έδειξαν μια ανομοιογενή ανταπόκριση, με περιορισμένη απώλεια οστικής πυκνότητας στο εγγύς άκρο και μικρή αύξηση στο περιφερικό άκρο. Η τελευταία θα μπορούσε πιθανώς να αποδοθεί στις καθημερινές δραστηριότητες

Body Composition in Adult Patients with Thalassemia Major

Objective. To assess body composition in adult male and female patients with thalassemia major by dual-energy X-ray absorptiometry (DXA) and to compare the findings with a group of healthy age-matched controls. Methods. Our study group included sixty-two patients (27 males, mean age 36 years, and 35 females, mean age 36.4 years) and fifteen age-matched healthy controls. All patients had an established diagnosis of thalassemia major and followed a regular blood transfusion scheme since childhood and chelation treatment. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy X-ray absorptiometry. Ferritin levels and body mass index of all patients and controls were also recorded. Student t-test and Wilcoxon test were performed and statistical significance was set at p<0.05. Results. BMD and whole body lean mass are lower in both male and female adult patients compared with controls (p<0.01 in both groups), whereas whole body fat mass was found to have no statistically significant difference compared to controls. Regional trunk fat around the abdomen was found to be lower in male patients compared to controls (p=0.02). Conclusion. Severe bone loss and diminished lean mass are expected in adult male and female patients with thalassemia major. Fat changes seem to affect mainly male patients

A M. avium complex spondylodiscitis in a middle-aged woman with diabetes

Spondylodiscitis, the inflammation of the vertebral bodies and the intervertebral disk space, is the reason for low back pain in a minority of cases. This is caused by various pathogens. Mycobacterium tuberculosis is responsible for 17–39% of all the cases of spondylodiscitis. On the contrast, spondylodiscitis from non tuberculous mycobacteria is extremely rare in literature. We describe a 68 -year old diabetic woman which is the first case of bone marrow involvement by M. intracellulare (member of M avium complex)with spondylodiscitis

Optimisation of Radiation Exposure to Gastroenterologists and Patients during Therapeutic ERCP

This study intended to optimize the radiation doses for gastroenterologists and patients during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and to compare the doses based on available data obtained by other researchers. A total of 153 patients were studied in two Gastroenterology Departments, (group A, 111; group B, 42). Thermoluminescent dosimeters (TLD) were used to measure the staff and patients entrance surface air kerma (ESAK) at different body sites. The mean ESAK and effective doses per procedure were estimated to be 68.75 mGy and 2.74 mSv, respectively. Staff was exposed to a heterogonous doses. The third examiner (trainee) was exposed to a high dose compared with other examiners because no shield was located to protect him from stray radiation. Patients and examiners doses were lower compared to the lowest values found in previous studies taking into consideration the heterogeneity of patients and equipment. Staff doses during ERCP are within the safety limit in the light of the current practice