Differential Diagnosis of Tumoral Lesions in the Spinal Canal in Patients Undergoing Hemodialysis

Study DesignA retrospective study.PurposeTo clarify the features useful for the differential diagnosis of spinal canal tumoral lesions in patients undergoing hemodialysis.Overview of LiteratureTumoral lesions in the spinal canal are rarely found in hemodialysis patients. Therefore, the differential diagnosis of tumoral lesions in the spinal canal in hemodialysis patients has been very difficult.MethodsSpinal canal tumors in 17 patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis were investigated. Histopathological analysis was conducted for all specimens obtained during surgery. The tumoral lesions were categorized into 3 groups on the basis of histopathology: spinal cord tumor, amyloidoma, and other. Patient medical history and diagnostic images of each group were reviewed.ResultsEight of 17 cases were histopathologically diagnosed as spinal cord tumors and were neurinomas, 6 were amyloidomas, and 3 were classified as other. The rate of spinal cord tumors was 47.1% (8 of 17 cases), which revealed the most frequent lesion type. The rate of amyloidomas and other types was 35.3% (6 of 17 cases) and 17.6% (3 of 17cases), respectively. In the amyloidoma group, the mean duration of hemodialysis (24.3 years) was longer than that of spinal cord tumors and other types (9.2 years and 8.6 years, respectively). All spinal cord tumors were intradural extramedullary, whereas all amyloidomas and other types were extradural.ConclusionsThe rate of each tumoral lesion, the duration of hemodialysis, and the tumoral localization are important features for the differential diagnosis of tumoral lesions in the spinal canal in hemodialysis patients

Surgical Treatment for Atlanto-Occipital Subluxation due to Destructive Spondyloarthropathy in a Patient Undergoing Long-Term Hemodialysis

Destructive spondyloarthropathy (DSA) has been reported in patients undergoing long-term hemodialysis. Cervical spinal lesions, including those of the upper cervical spine, are reported to be some of the most common. To our knowledge, we report for the first time, a case of atlanto-occipital subluxation requiring surgical treatment due to severe myelopathy and nuchal pain in a patient undergoing long-term hemodialysis. The patient was a 66-year-old woman who had undergone hemodialysis for 40 years. She visited our hospital due to an acute progression of gait disturbance and severe nuchal pain. Computed tomography showed posterior subluxation of the atlanto-occipital joints. DSA was also observed in the lower cervical spine. Magnetic resonance imaging showed spinal canal stenosis at both the upper and lower cervical levels. We performed Oc-C7 fixation, C1 laminectomy, and C3-C7 laminoplasty. We first recognized that the atlanto-occipital subluxation was caused by the extremely long-term, in this case, 40 years, hemodialysis

Surgical Outcome for Hemodialysis-Related Upper Cervical Lesions

Study DesignA retrospective study.PurposeTo investigate the surgical outcome for hemodialysis-related upper cervical lesions.Overview of LiteratureSurgical outcome of lower cervical lesions in patients undergoing hemodialysis has been reported. However, surgical outcome for upper cervical lesions in hemodialysis patients is unclear.MethodsUpper cervical lesions in nine patients undergoing hemodialysis were surgically treated. Mean age at surgery was 61.6 years (range, 52-68 years), and the mean follow-up period was 45.4 months (range, 2-98 months). Patients had undergone hemodialysis for an average of 25.3 years (range, 16-40 years) at surgery. Seven patients with destructive spondyloarthropathy (DSA) of the upper cervical spine were treated with atlantoaxial or occipitocervical fixation. Two patients with retro-odontoid pseudotumors were treated with C1 posterior arch resection alone. Japanese Orthopedic Association (JOA) scores for cervical myelopathy, postoperative complications, postoperative radiography, and preoperative and postoperative occipital pain were evaluated.ResultsMean preoperative and postoperative JOA score was 3.7 and 8.1, respectively. The seven patients with DSA had severe preoperative occipital pain that disappeared postoperatively. Postoperative radiography showed solid bone union in DSA cases and no instability in pseudotumor cases.ConclusionsSatisfactory surgical outcome was observed for hemodialysis-related upper cervical lesions

Characteristic expression of HTLV-1 basic zipper factor (HBZ) transcripts in HTLV-1 provirus-positive cells

<p>Abstract</p> <p>Background</p> <p>HTLV-1 causes adult T-cell leukemia (ATL). Although there have been many studies on the oncogenesis of the viral protein Tax, the precise oncogenic mechanism remains to be elucidated. Recently, a new viral factor, HTLV-1 basic Zip factor (HBZ), encoded from the minus strand mRNA was discovered and the current models of Tax-centered ATL cell pathogenesis are in conflict with this discovery. HBZs consisting of non-spliced and spliced isoforms (HBZ-SI) are thought to be implicated in viral replication and T-cell proliferation but there is little evidence on the HBZ expression profile on a large scale.</p> <p>Results</p> <p>To investigate the role of HBZ-SI in HTLV-1 provirus-positive cells, the HBZ-SI and Tax mRNA loads in samples with a mixture of infected and non-infected cells were measured and then adjusted by dividing by the HTLV-I proviral load. We show here that the HBZ-SI mRNA level is 4-fold higher than non-spliced HBZ and is expressed by almost all cells harboring HTLV-1 provirus with variable intensity. The proviral-adjusted HBZ-SI and Tax quantification revealed a characteristic imbalanced expression feature of high HBZ and low Tax expression levels in primary ATL cells or high HBZ and very high Tax levels in HTLV-1-related cell lines (cell lines) compared with a standard expression profile of low HBZ and low Tax in infected cells. Interestingly, according to the mutual Tax and HBZ expression status, HTLV-1-related cell lines were subcategorized into two groups, an ATL cell type with high HBZ and low Tax levels and another type with high Tax and either high or low HBZ, which was closely related to its cell origin.</p> <p>Conclusion</p> <p>This is the first comprehensive study to evaluate the mutual expression profile of HBZ and Tax in provirus-positive cells, revealing that there are quantitative and relative characteristic features among infected cells, primary ATL cells, and cell lines.</p

Pycnodysostosis with Multi-Segmental Spinal Canal Stenosis due to Ossification of the Yellow Ligament

Pycnodysostosis is an autosomal recessive disorder characterized by osteosclerosis, small stature, acro-osteolysis of the distal phalanges, loss of the mandibular angle, separated cranial sutures with open fontanels, and frequent fractures. One identified cause of the disease is reduced activity of the cysteine protease cathepsin K. A 48-year-old woman with a history of frequent fractures presented with a severe gait disturbance. Radiography, computed tomography, magnetic resonance imaging, and gene analysis were performed. Physical examination revealed open fontanels, and radiographs showed increased bone density. DNA sequence analysis revealed a deletion mutation of the cathepsin K gene. We diagnosed pycnodysostosis based on these findings. The magnetic resonance and computed tomography images demonstrated multilevel spinal canal stenosis due to ossification of the yellow ligament. We performed a laminectomy, and the patient's neurological signs and symptoms improved. To our knowledge, this is the first case of pycnodysostosis with ossification of the yellow ligament

High Field Magnetization of Itinerant Electron Metamagnetic Laves Phase Lu(Co_<1-x>Ga_x)_2 Compounds(Magnetism)

Nearly ferromagnetic pseudobinary Lu(Co_Ga_x)_2 compounds have been investigated. The lattice constant increases with increasing Ga concentration, x, especially above x=0.09. High field magnetization and magnetoresistance of Lu(Co_Ga_x)_2 compounds have been measured in static and pulsed magnetic fields. No significant difference is obtained between the static and pulsed fields. A clear itinerant electron metamagnetic transition is observed and its critical field increases with increasing temperature for x=0.09. It is suggested from the discussion based on the Clausius-Clapeyron equation that the magnetic entropy of these compounds decreases above the critical field. This is consistent with the recent result of the electronic specific heat coefficient in the magnetic fields. The magnetoresistance of the ferromagnetic state after the transition is reduced about 30% compared with that of the paramagnetic state. This means that the metamagnetic transition results in a reduction of the spin fluctuation

Imparting CO₂ reduction selectivity to ZnGa₂O₄ photocatalysts by crystallization from hetero nano assembly of amorphous-like metal hydroxides

Imparting an enhanced CO₂ reduction selectivity to ZnGa₂O₄ photocatalysts has been demonstrated by controlled crystallization from interdispersed nanoparticles of zinc and gallium hydroxides. The hydroxide precursor in which Zn(II) and Ga(III) are homogeneously interdispersed was prepared through an epoxide-driven sol–gel reaction. ZnGa₂O₄ obtained by a heat-treatment exhibits a higher surface basicity and an enhanced affinity for CO₂ molecules than previously-reported standard ZnGa₂O₄. The enhanced affinity for CO₂ molecules of the resultant ZnGa₂O₄ leads to highly-selective CO evolution in CO₂ photo-reduction with H₂O reductants. The present scheme is promising to achieve desirable surface chemistry on metal oxide photocatalysts

Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Comparative Study of 5-Year Outcomes Following Decompression with Fusion and Microendoscopic Decompression

Study DesignRetrospective review of prospectively collected outcome data.PurposeTo compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition.Overview of LiteratureThere have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS.MethodsForty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.ResultsThe degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups.ConclusionsMED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS